IVdl_tblDrugsZUZUZU DATAIVdl  @ @@@`@@i@@@ j@ @ @ "@ %W@5P@8@:@<@=@?@Aw@D@E@I@T@XV@[@^@`@c@d@e@ j@!l@"m@#n@$x.@%|@&&@'@("@)@*@+"@,W@-y@.@/]@0@1@2@3@4@56@6@7\@8@9@:@;@<k@=@>@?@@@A@B@C@Dş@E#@F@G@HB@I@J@K@L@M@N@O@P@Qj@R@S@T@U@V@W@X@Yx@Zd@[@\ @]#@^%\@_*+@`+*@a/@b0@c3@d4@e6%@f8@g:Z@h<@i?1@jB@kF@lJ@mP<@nQ @oS@pV@qZ@r_R@s`@tc@ud$@vd@wgW@xk+@yn@zu'@{xo@|{8@}\@~D@@@@&@@@@@@@@|@@@@W@@d@8@@§@'@@p@@@@m@@v@@;@݉@ބ@m@6@@y@i@L@,@ @@@@x@ @ @@@@'@+b@-@2@3@5@9F@>^@B_@I@N@O@P@Tw@W@X@Z@_E@e@h<@i@kI@m`@rK@sC@v@|@~@H@|@3@g@@@@@@@@ @@@,@@@@@@2@~@ɶ@@΢@R@й@@F@@@@@g@@q@;@@@m@@@@@@ O@ @@-@@"_@0@3Q@4@6@7o@8@>@E@Ff@G@ Stability / Miscellaneous: Indications: Adjunct to percutaneous transluminal coronary angioplasty or atherectomy for the prevention of acute cardiac ischemic complications in patients at high risk for abrupt closure (restenosis) after treatment. (Patients at high risk include: acute MI within 12 hours of onset of symptoms; Non q-wave MI; Early postinfarction angina or unstable angina with at least 2 episodes of angina associated with EKG changes during past 24hrs.) Use as an adjunct with heparin to prevent cardiac ischemic complications in patients with unstable angina not responding to conventional treatment when a percutaneous coronary intervention(PCI) is scheduled within 24 hours. Preparation: Bolus dose: Use 0.22 micron filter to withdraw dose into syringe. [supplied: 10mg/5 ml vial (REF) ] Continuous infusion: withdraw 9mg (4.5 ml) through a 0.22 micron filter into a syringe; inject into 250 ml NS or D5W (35 mcg/ml). Infuse at 17 ml/hr (10 mcg/min) x 12 hours. Filter all infusions."""Reopro Usual Diluents: NS, D5W Standard Dilutions: [9mg (4.5 ml)] [250 ml] [As directed] AbciximabStability/Miscellaneous EXP: 15 hours (Refrigerate). Standard concentration: 1 mg/ml Minimum dilution: 2 mg/ml Supplied: 100mg/20ml vial. Indications: treatment of aspergillosis in patients who are refractory to or intolerant of conventional ampho-B therapy. Dosing: 5 mg/kg given as a single infusion once daily.""Amphotericin B Lipid complex Diluents: D5W ---Concentration 1 mg/ml--- [300 mg] [240 ml] [2 hours] [350 mg] [280 ml] [ 2 hours] [400 mg] [320 ml] [2 hours] ---Minimum dilution: --- [300mg] [90ml] [2 hours]AbelcetStability / Miscellaneous: Stability: 24 hours room temp. Supplied: Acetadote injection is available as a 20% solution in 30 ml (200mg/ml) single glass vials. Do not use previously opened vials for IV administration.See package insert for additional comments. ""Acetylcysteine Usual Diluents: D5W Standard Dilutions: Acetaminophen overdose: Adult Loading dose: [150mg/kg] [200 ml] [15 min] Maintenance dose: [50 mg/kg] [500ml] [over 4 hrs] Followed by: [100 mg/kg] [1000ml] [over 16 hrs] Important note: in fluid restricted patients or patients <40kg: the volume of D5W used should be reduced proportionately. Acetadote EXP: 1 day (RT). Dilute 500mg vials with at least 5ml. Recommended route: IV-push (100-500 mg/min).""Diamox Usual diluents: NS or D5W Standard Dilution: [250-500 mg] [50 ml] [15-30 min]AcetazolamideStability / Miscellaneous: Stability: 24 hours room temp. Supplied: Acetadote injection is available as a 20% solution in 30 ml (200mg/ml) single glass vials. Do not use previously opened vials for IV administration.See package insert for additional comments. """Acetadote Usual Diluents: D5W Standard Dilutions: Acetaminophen overdose: Adult Loading dose: [150mg/kg] [200 ml] [15 min] Maintenance dose: [50 mg/kg] [500ml] [over 4 hrs] Followed by: [100 mg/kg] [1000ml] [over 16 hrs] Important note: in fluid restricted patients or patients <40kg: the volume of D5W used should be reduced proportionately. AcetylcysteineEXP: 1 day (RT). (Note: conflicting data regarding estimated stability. Some studies have reported much longer stability (3- 4 weeks), while other studies confirm the stability indicated by the manufacturer (24 hours). Label: Do not refrigerate. Maximum concentration = 7 mg/ml."""Zovirax Usual diluents: D5W or NS [0-350 mg] [50 ml] [60 min] [351-700 mg] [100 ml] [60 min]Acyclovir Stability/Miscellaneous Indications: In combination with heparin, treatment of acute coronary syndrome (unstable angina, non-Q wave MI), including patients undergoing PTCA or atherectomy. Dosing: 0.4 mcg/kg/min for 30 min, followed by 0.1 mcg/kg/min. Therapy should continue through angiography and for 12-24hours after angioplasty or atherectomy. (Note: Reduce dose by 50% if CRCL < 30 ml/min -- 0.2 mcg/kg/min x 30 minutes, then 0.05 mcg/kg/min.) Hemodialysis: USE WITH CAUTION. Reduce dose by 50% (0.2 mcg/kg /min x 30 minutes, then 0.05 mcg/kg/min). Supplied: 250 mcg/ml-50 ml vial (12.5 mg/50ml). Calculation of rate: Loading dose (ml/hr) = 0.48 x weight(kg). Infuse for 30 minutes. Continuous infusion (ml/hr) = 0.12 x weight(kg)""Tirofiban Usual diluents: NS, D5W Total volume = 250 ml: [12.5 mg (50ml)] [200 ml] ----- Total volume = 500 ml: [25 mg (100ml)] [400 ml] Infusion rate: see comments Aggrastat Infusion rate: 25% vials: 2-3 ml/min maximum. 5% solution: 5-10 ml/min max. Discard unused solution after 4 hours. Dilute if necessary with D5W or NS. Hypoproteinemia (Usual dose): 0.5- 1 gram/kg/dose q1-2 days as calculated to replace ongoing losses. Maximum dose/day: 250 grams/48 hours. ""Usual diluents: NS or D5W [12.5 gm] [50 ml vial] [30 min] [25 gm] [100ml][45-60 min] [12.5 gm/250ml - 5%] [30-60min] [25 gm/500 ml-5%][1-3 hours]AlbuminStability/Miscellaneous EXP: 1 DAY (RT)"Methyldopate Usual diluents: D5W [0 to 500 mg] [100 ml] [60 min] [over 500 mg] [250 ml] [60 min]Aldomet Manufacturer recommends 20 mg/ml as the maximum concentration, however, some studies have used concentrations up to 100 mg/ml. Supplied: 5 g/20ml & 24g/96ml vials. Treatment of acute bleeding syndromes: Usual dose: 4-5 grams IV during the first hour followed by a continuous infusion: 1 to 1.25 grams/hour. Maintenance doses may be given IV (Exp: 3 grams IV q3h etc). Doses above 30 grams/24 hours are not recommended."""Aminocaproic acid Usual diluents: NS or D5W [1 gram] [50 ml] [1 hour] [2 gram] [100 ml] [2 hours] [3 gram] [150 ml] [3 hours] [4-5 gm] [250 ml] [See comments] [6-10 gm] [500 ml][See comments] [11-24gm][1000ml][see comments]Amicar Stability/Miscellaneous EXP: 1 day (RT) 7 days (REF). Refrigerate. """Usual diluents: NS or D5W [0-1000 mg] [100 ml] [30 min]Amikacin Manufacturer recommends 20 mg/ml as the maximum concentration, however, some studies have used concentrations up to 100 mg/ml. Supplied: 5 g/20ml & 24g/96ml vials. Treatment of acute bleeding syndromes: Usual dose: 4-5 grams IV during the first hour followed by a continuous infusion: 1 to 1.25 grams/hour. Maintenance doses may be given IV (Exp: 3 grams IV q3h etc). Doses above 30 grams/24 hours are not recommended."""Amicar Usual diluents: NS or D5W [1 gram] [50 ml] [1 hour] [2 gram] [100 ml] [2 hours] [3 gram] [150 ml] [3 hours] [4-5 gm] [250 ml] [See comments] [6-10 gm] [500 ml][See comments] [11-24gm][1000ml][see comments]Aminocaproic acidStability/Miscellaneous EXP: 1 day (RT). Maximum rate: 25 mg/min. IV loading: 5 mg/kg TBW based on theophylline or 6 mg/kg based on aminophylline. Previous therapy: [Loading dose= 0.5 L/kg TBW x (desired level - current level)] IV maintenance dose based on IBW and theophylline. For aminophylline dosing divide result by 0.8. Adult non-smoker: 0.4 mg/kg/hr Adult (smoker): 0.7 mg/kg/hr Elderly (smoker): 0.5 mg/kg/hr Elderly (non-smoker)/ CHF/ Liver dx: 0.2 mg/kg/hr. Obtain level 24-48 hours after initiation of tx. Average half-life: 3 to 12 hours. Vd: 0.5 L/kg Therapeutic range: 5-20 mcg/ml. """Usual diluents: D5W or NS (loading dose) [0-250 mg] [50 ml] [30 min] [251-500 mg][100 ml] [30 min] (Continuous infusion) [500 mg] [500 ml] [Titrate] (Fluid restricted) [500 mg] [250 ml] [Titrate]AminophyllineStability / Miscellaneous Recommended concentration: 1-6 mg/ml. Central line is req'd for concentrations > 2 mg/ml. [Supplied: 3 ml amp (50 mg/ml)]. Infusion: whenever possible administer through a central venous catheter. Also, an in-line filter should be used during administration. Cordarone I.V. concentrations greater than 3 mg/mL in D 5 W have been associated with a high incidence of peripheral vein phlebitis; however, concentrations of 2.5 mg/mL or less appear to be less irritating. Therefore, for infusions longer than 1 hour, Cordarone I.V. concentrations should not exceed 2 mg/mL unless a central venous catheter is used. Cordarone I.V. infusions exceeding 2 hours must be administered in glass or polyolefin bottles containing D5W. Use of evacuated glass containers for admixing Cordarone I.V. is not recommended as incompatibility with a buffer in the container may cause precipitation. Amiodarone: I.V. DOSE RECOMMENDATIONS -- FIRST 24 HOURS -- Loading infusions. The recommended starting dose of Cordarone I.V. is about 1000 mg over the first 24 hours of therapy, delivered by the following infusion regimen: First Rapid: 150 mg over the FIRST - 10 minutes (15 mg/min). Add 3 mL of Cordarone I.V. (150 mg) to 100 mL D 5 W. Infuse 100 mL over 10 minutes. Followed by Slow: 360 mg over the NEXT 6 hours (1 mg/min). Add 18 mL of Cordarone I.V. (900 mg) to 500 mL D 5 W (conc = 1.8 mg/mL). Maintenance infusion: 540 mg over the REMAINING 18 hours (0.5 mg/min). After the first 24 hours, the maintenance infusion rate of 0.5 mg/min (720 mg/24 hours) should be continued utilizing a concentration of 1 to 6 mg/mL (Cordarone I.V. concentrations greater than 2 mg/mL should be administered via a central venous catheter). In the event of breakthrough episodes of VF or hemodynamically unstable VT, Give 150-mg/100 ml D5W over 10 minutes to minimize potential for hypotension. The rate of the maintenance infusion may be increased to achieve effective arrhythmia suppression. The initial infusion rate should not exceed 30 mg/min. The maintenance infusion of up to 0.5 mg/min can be cautiously continued for 2 to 3 weeks regardless of the patient's age, renal function, or Left-ventricular function. There is limited experience in patients receiving Cordarone I.V. > 3 weeks. RECOMMENDATIONS FOR ORAL DOSAGE AFTER I.V. INFUSION Duration of Cordarone I.V. Infusion*: <1 week Initial Daily Dose of Oral Cordarone : 800-1600 mg Duration of Cordarone I.V. Infusion: 1 to 3 weeks Initial Daily Dose of Oral Cordarone : 600-800 mg Duration of Cordarone I.V. Infusion: >3 weeks Initial Daily Dose of Oral Cordarone : 400 mg *Assuming a 720 mg/day infusion (0.5 mg/min). Cordarone I.V is not intended for maint therapy. Restated: Duration of IV infusion < 1 week: 800-1600mg/day po initially x 1-2 weeks or complete current week; 1-3 weeks: 600-800mg/day po initially - total therapy approximately 1 month counting IV infusion ; >3 weeks: 400mg po qd initially. Oral Loading - Half-life elimination: 40-55 days (range: 26-107 days); Administration of Cordarone in divided doses with meals is suggested for total daily doses of 1,000 mg or higher, or when gastrointestinal intolerance occurs.) If side effects become excessive, the dose should be reduced. Loading Dose (Daily): (Ventricular Arrhythmias) 800 to 1,600 mg x 1-3 weeks, then 600 to 800 mg x ~1 month, then start maintenance of 400mg/day. Recommendations for conversion to intravenous amiodarone after oral administration: During long-term amiodarone therapy (ie, 4 months), the mean plasma-elimination half-life of the active metabolite of amiodarone is 61 days. Replacement therapy may not be necessary in such patients if oral therapy is discontinued for a period <2 weeks, since any changes in serum amiodarone concentrations during this period may not be clinically significant. """Cordarone Diluents: D5W [150 mg / 100 ml] [10 minutes] (Glass bottle) [720 mg / 500 ml ] [See comments] [900 mg / 500 ml ] [See comments] (an inline 0.22 micron filter should be used). AmiodaroneStability/Miscellaneous EXP: 1 Day (RT). Label: REFRIGERATE. Precipitates in normal saline or solution with bacteriostatic agent. Test dose: 1 mg/20 ml D5W over 10-30 min. Monitor Temp, pulse, RR and BP q30min x 4 hours. Dosing: initially 0.25 to 0.3 mg/kg (possibly up to 0.5 mg/kg for life threatening infections). Increase as tolerated on the following days to 0.5 to 1.0 mg/kg/day or 1.5 mg/kg qod. If central line is used, may increase concentration up to 0.25 mg/ml. Bladder irrigation: add 10-50mg to 1000ml sterile water. Instill 200-300ml into bladder then clamp off for 60-90min, then allow bladder to drain-then repeat. Continue treatment for 2-5 days."""Diluents: D5W Dilute each 1 mg with 10ml (e.g. 20mg would require 200ml). [4- 6 hours infusion] Central line: 0.25 mg/ml (higher concentrations possible)Amphotericin BStability/Miscellaneous EXP: 15 hours (Refrigerate). Standard concentration: 1 mg/ml Minimum dilution: 2 mg/ml Supplied: 100mg/20ml vial. Indications: treatment of aspergillosis in patients who are refractory to or intolerant of conventional ampho-B therapy. Dosing: 5 mg/kg given as a single infusion once daily."""Abelcet Diluents: D5W ---Concentration 1 mg/ml--- [300 mg] [240 ml] [2 hours] [350 mg] [280 ml] [ 2 hours] [400 mg] [320 ml] [2 hours] ---Minimum dilution: --- [300mg] [90ml] [2 hours]Amphotericin B Lipid complex Stability/Miscellaneous EXP: 1 Day (RT); 3 Days (REF). Label: REFRIGERATE. Max rate: 100mg/min. IM injection: 500mg/ 1.8 ml; 1 gram/ 3.5 ml; 2 grams/ 6.8 ml (H20 or BS-H20). Injection site: Intragluteal or lateral aspect of thigh. Dosing: Mild to moderate infection: 500mg to 2g ivpb q6h. Severe infection: 2g ivpb q4h (150-200mg/kg/day). """Usual diluents: NS [0 - 1 gram] [50 ml] [30 min] [Over 1 gram] [100 ml] [30 min] Ampicillin Stability/Miscellaneous EXP: 1 DAY (RT) /3 Days (REF). Label: Refrigerate. IM injection: 1.5 gram/ 3.2 ml of SW or 0.5-2% lido. 3 gram vial/ 6.4 ml. """Unasyn Usual diluents: NS [0 - 1.5 grams] [50 ml] [30 min] [Over 1.5 grams] [100ml] [30 min]Ampicillin/SulbactamStability/Miscellaneous EXP: 2 Days (RT) / 10 Days (REF). Label: Refrigerate. Maximum dose/day=12 grams. IM injection: 500mg/ 2 ml; 1 gram/ 2.5 ml H20/BS-H20. Usual dosage: 500mg to 1g IV 8h. Severe: 1.5g IV q6h. Life threatening: 6-12g/day.""Cefazolin Usual diluents: D5W, NS [0 to 1 gram] [50 ml] [30 min] [Over 1 gram] [100 ml] [30 min]Ancef Stability/Miscellaneous Supplied: 20&50 mg/ml-10ml vial 100 mg/ml-5,10,20ml vial EXP: 1 DAY (REF). Label: Refrigerate. Depolarizing skeletal muscle blocker. Indications: procedures of short duration such as endotracheal intubation. [Onset: (IM): 2-3 minutes (IV):30-60 seconds] [Duration: (IM): 10-30min (IV): 4-6 min.] Dosing: Adults: 0.6 mg/kg (0.3 to 1.1) over 10-30 seconds, up to 150mg total dose. Maintenance: 0.04 to 0.07 mg/kg q5-10min prn. ""Succinylcholine Normally given slow IV push. Continuous infusion: 2.5 mg/min (0.5 to 10 mg/min). Dilute to 1-2 mg/ml. Diluents: D5W, NSAnectine Stability/Miscellaneous Dosing: loading dose: 15 mg/kg, followed by 10 mg/kg q12h x 4 doses, then 15 mg/kg q12h thereafter until ethylene glycol levels <20 mg/dl. Dialysis should be considered in addition to fomepizole in the case of renal failure, significant or worsening metabolic acidosis, or a measured ethylene glycol level >50 mg/dl. Fomepizole is dialyzable and should be given q4h during hemodialysis. MOA: complexes and inactivates alcohol dehydrogenase thus preventing formation of the toxic metabolites of the alcohols. Supplied: 1 g/ml-1.5 ml vial."" Fomepizole Usual diluents: NS, D5W [Prescribed dose] [100ml] [30 min]Antizol Stability/Miscellaneous Monitor BP q5min during initial infusion. Manufacturer recommends IM or IV push. Usual dosage: 10 to 40 mg IV q4-6h prn. May be given q20-30 minutes (until adequate response) for the treatment of severe hypertension. IV push (rate): 10 mg/min.""Hydralazine Diluent: NS [0 to 20 mg] [50 ml] [30 min] [21 to 40 mg] [100 ml] [30 min] [>40 mg] [250 ml] [60 min or longer]Apresoline Stability/Miscellaneous Restricted to oncology. Serum calcium levels should be corrected for serum albumin before determining dose. Corrected calcium= serum calcium + 0.8 (4 - serum albumin). Dosage: Moderate hypercalcemia (12- 13.5 mg/dl): 60 to 90 mg. Severe hypercalcemia (> 13.5 mg/dl): 90 mg. The manufacturer recommends that the repeat dose not be given sooner than 7 days after the initial dose in order to allow full response to this dose. Mechanism of action: biphosphonate compound-inhibits bone resorption (anti-osteoclast activity). Has little effect on bone remineralization. Relative potency of biphosphonate agents: Risedronate (Actonel)>> (pamidronate & alendronate (Fosamax)) >>Etidronate(Didronel) "Pamidronate Usual diluents: NS, D5W [60-90 mg] [1000 ml] [24 hours] Minimum dilution: [60-90mg] [500ml] [Usually over 4 hours] (Range: 2 to 24 hr)Aredia Stability: 24 hrs RT // 48 hrs REF (protect from light). Preparation: Argatroban should be diluted in 0.9% Sodium Chloride Injection, 5% Dextrose Injection, or Lactated Ringer's Injection to a final concentration of 1 mg/mL. The contents of each 2.5 mL vial should be diluted 100-fold by mixing with 250 mL of diluent. Use 250 mg (2.5 mL) per 250 mL of diluent or 500 mg (5 mL) per 500 mL of diluent. The constituted solution must be mixed by repeated inversion of the diluent bag for one minute. Upon preparation, the solution may show slight but brief haziness due to the formation of microprecipitates that rapidly dissolve upon mixing. Initial Dosage: Before administering Argatroban, discontinue heparin therapy and obtain a baseline aPTT. The recommended initial dose of Argatroban for adult patients without hepatic impairment is 2 g/kg/min, administered as a continuous infusion . Actions: Argatroban is a direct thrombin inhibitor that reversibly binds to the thrombin active site. It is capable of inhibiting the action of both free and clot-associated thrombin. No dosage adjustment is necessary in patients with renal dysfunction. Indications: as an anticoagulant for prophylaxis or treatment of thrombosis in patients with heparin-induced thrombocytopenia. Argatroban is indicated as an anticoagulant in patients with or at risk for heparin-induced thrombocytopenia undergoing percutaneous coronary intervention (PCI). Excessive anticoagulation, with or without bleeding, may be controlled by discontinuing Argatroban or by decreasing the infusion dosage. In clinical studies at therapeutic levels, anticoagulation parameters generally return to baseline within 2 to 4 hours after discontinuation of the drug. Reversal of anticoagulant effect may take longer in patients with hepatic impairment. Monitoring therapy: Tests of anticoagulant effects (including the aPTT) typically attain steady-state levels within 1-3 hours following initiation of Argatroban. Dose adjustment may be required to attain the target aPTT. Check the aPTT 2 hours after initiation of therapy to confirm that the patient has attained the desired therapeutic range. Dosage adjustment: After the initial dose of Argatroban, the dose can be adjusted as clinically indicated (not to exceed 10 g/kg/min), until the steady-state aPTT is 1.5 to 3 times the initial baseline value (not to exceed 100 seconds). For patients with moderate hepatic impairment, an initial dose of 0.5 g/kg/min is recommended, based on the approximate 4-fold decrease in Argatroban clearance relative to those with normal hepatic function. The aPTT should be monitored closely and the dosage should be adjusted as clinically indicated."""Usual diluents NS, D5W, LR [250mg][250ml][2 mcg/kg/min] [500mg][500ml][2 mcg/kg/min]ArgatrobanStability/Miscellaneous EXP: 1 DAY (RT) Label: Do not Refrigerate /An in-line 0.22u filter should be used / Monitor patient for acidosis. Concentrations recommended by the manufacturer: 0.1 , 0.16, or 0.2 mg/ml. May also dilute 4 mg/ml and 2 mg/ml vials 1:1 with D5W or NS. Do not send if solution is yellow or contains a precipitate. Maximum infusion rate: 2 mg/min. Maximum dose/day: 480 mg (20 mg/hr). Dosing: Status epilepticus: 4 mg IV push (range: 2 to 8 mg). May repeat q5 to 15 minutes. Monitor patient for acidosis."Lorazepam Usual Diluents: D5W, NS Standard Dilutions: Dilute 2 mg/ml (10 ml vials) or 4 mg/ml (10 ml) vials 1:1 with D5W or NS. May add to viaflex bag. Alternatively: Glass bottle: 40 mg/250 ml (250ml D5W). Infusion Rate: As directed. (See comments). Primary: Dilution for 2 mg/ml - 10 ml vials. = Final Concentration 1 mg/ml == 20 mg/20 ml (10 ml diluent + 10ml of drug) Total volume =20ml. 40 mg/ 40 ml (20 ml diluent + 20ml of drug) Total volume =40ml. 80 mg/ 80 ml (40 ml diluent + 40ml of drug) Total volume =80ml. Ativan Stability/Miscellaneous EXP: 24 hours (RT/REF). May be given undiluted by IV bolus. IMPORTANT NOTE: Use Ideal body weight in obese patients, otherwise use actual body weight. Dosing (adult): initial bolus of 0.4 to 0.5 mg/kg IV bolus, followed by 0.08 to 0.1 mg/kg q20-45 min after initial dose. Continuous infusion: initial IV bolus of 0.4 to 0.5 mg/kg, followed by an initial infusion rate of 5 to 10 mcg/kg/min initially. Maintenance infusion rates of 5 to 9 mcg/kg/min are usually adequate. (Range: 2 to 15 mcg/kg/min). Toxic metabolite (laudanosine) may accumulate in renal failure. [Supplied: 50 mg/5 ml ; 100 mg/10ml vial]"""Tracrium Usual diluents: D5W, NS --Usual conc: 0.2 to 5 mg/ml-- [100 mg] [100 ml] [Titrate] [250 mg] [100 ml] [Titrate] [1000 mg] [250 ml] [Titrate] (Usual concentration: 0.2 to 5 mg/ ml) Atracurium Stability/Miscellaneous EXP: 1 Day (RT); 7 Days (REF). Label: Refrigerate. May be given IM (preparation): 500mg/1.5 ml; 1 gram/ 3 ml; 2 grams/6 ml H20, BS-H20, NS. Greater volumes may be used. Usually restricted to one of the following: (1) Gram negative infections (primarily Pseudomonas) in penicillin allergic patients. (2) Patients at increased risk of aminoglycoside toxicity (poor renal function or rapidly changing renal function) with a gram negative infection. ***Lacks anaerobe coverage*** Dosing: Mild infection (i.e. UTI): 500mg to 1g IV q8-12h. Usual dose: 1-2g IV q8-12h. Severe or life threatening: 2g IV q6-8h. Max 8g/day. ""Aztreonam Usual diluents: D5W, NS [0 - 1 gram] [50 ml] [30 min] [Over 1 gram] [100 ml] [60 min] Azactam Stability/Miscellaneous EXP: 24hours (RT)/ 7 Days (REF). Label: refrigerate. Dosing: Community acquired pneumonia: 500 mg IV qd for 2-5 days, followed by 500mg po qd x 7 to 10 days. Renal dosing: No adjustment in renal failure""Zithromax Usual diluents: D5W, NS [500 mg] [250 ml] [1 hour] [1000mg] [500ml] [2 hours]AzithromycinStability/Miscellaneous EXP: 1 Day (RT); 7 Days (REF). Label: Refrigerate. May be given IM (preparation): 500mg/1.5 ml; 1 gram/ 3 ml; 2 grams/6 ml H20, BS-H20, NS. Greater volumes may be used. Usually restricted to one of the following: (1) Gram negative infections (primarily Pseudomonas) in penicillin allergic patients. (2) Patients at increased risk of aminoglycoside toxicity (poor renal function or rapidly changing renal function) with a gram negative infection. ***Lacks anaerobe coverage*** Dosing: Mild infection (i.e. UTI): 500mg to 1g IV q8-12h. Usual dose: 1-2g IV q8-12h. Severe or life threatening: 2g IV q6-8h. Max 8g/day. ""Azactam Usual diluents: D5W, NS [0 - 1 gram] [50 ml] [30 min] [Over 1 gram] [100 ml] [60 min] Aztreonam Stability/Miscellaneous EXP: 6 hours (RT) / 2 hours (minimum dilution) Label: Do not Refrigerate Minimum dilution: 80 mg TMP/ 75 ml. Dosing: Non-PCP: 10mg/kg/day ( based on TMP component) divided q6h or q8h or q12h PCP: 15-20mg/kg/day (based on TMP component) divided q6h ""Trimethoprim /sulfamethoxazole Usual diluents: D5W [0 to 80 mg] [100 ml] [60 min] [81-120 mg] [150-250ml] [90 min] [121-240 mg] [250 ml] [90 min] [241-450 mg] [500 ml] [2 hours]Bactrim Stability/Miscellaneous EXP: 1 DAY (RT). Maximum dose/ 24 hours= 400 mg. Dosing: 10 to 50mg IM or IV q2 to 6h. ""Diphenhydramine Diluents: D5W, NS [0 to 100 mg] [50 ml] [20-30 min] Benadryl Stability/Miscellaneous: EXP: 1 DAY (RT). Note: the listed dilutions are for the 2.5 gram ampules. If the ampules are not available, the 10 ml (10mg/ml) vials must be transferred to an empty viaflex bag. Do not dilute the contents of the "vial," they are pre-diluted. Dosing: PSVT: 500 mcg/kg over 1 min, then 50 mcg/kg/min x 4 to 5min. If heart rate not controlled, repeat load of 500 mcg/kg and increase infusion to 100 mcg/kg/min. Repeat load and increase infusion q5 to 10min as needed to max of 200 (up to 300?) mcg/kg/min. Watch blood pressure. Calculation of drip rate (ml/hr): 2.5 grams/250 ml: wt (kg) x mcg/min x 0.006 Minimum Dilution: Note: The use of esmolol with propylene glycol has been associated with a higher incidence of venous irritation at concentrations greater than 10 mg/mL on continued infusion. Mixed from the ampul at concentrations of greater than 10 mg/mL BREVIBLOC has, however, been well tolerated when administered via a central vein. A premixed bag is available from the manufacturer: 2000 mg/100 ml (solution osmolarity adjusted to 312 mOsmol/L).""Esmolol Usual diluents: D5W, NS [2.5 grams] [250 ml] [Titrate] [5 grams] [500 ml] [Titrate] Minimum dilution: see comments Brevibloc Stability/Miscellaneous EXP: 1 Day (RT). May add 0 to 25 mg/100 to 250 ml D5W / NS. Supplied: 2.5mg/ 10 ml vial. Equivalent dosages: [1 mg Bumex] =[40mg Lasix] = [10 to 20mg Demadex]. Higher doses are required in renal failure (usually > 10 mg/day). Usual infusion rates: 0.1 to 1 mg/hr. ""Bumex Usual diluents: D5W, NS [25 mg(100ml)] [empty viaflex] [Titrate]Bumetanide Stability/Miscellaneous EXP: 1 Day (RT). May add 0 to 25 mg/100 to 250 ml D5W / NS. Supplied: 2.5mg/ 10 ml vial. Equivalent dosages: [1 mg Bumex] =[40mg Lasix] = [10 to 20mg Demadex]. Higher doses are required in renal failure (usually > 10 mg/day). Usual infusion rates: 0.1 to 1 mg/hr. ""Bumetanide Usual diluents: D5W, NS [25 mg(100ml)] [empty viaflex] [Titrate]BumexStability/Miscellaneous 1 gram= 13.6 meq/10 ml. Normal range: 8.4 to 10.2 mg/dl Ionized Ca++: 1.19 to 1.29. Maximum IV rate: 100mg (1 ml)/ min. Too rapid injection may decrease BP/ cardiac syncope. ""Usual diluents: D5W, NS [0 to 1 gram] [50 ml] [30-60 min] [Over 1 gram] [100 ml] [60 min]Calcium ChlorideContinuous infusion: Initially multiply ( 0.5 x weight(kg) x 24 ) / 93 mg = number of grams of calcium gluconate needed. Add calculated amount to 500 to 1000 ml D5W or NS. A continuous infusion may be used in symptomatic patients with hypocalcemia. Usual rate: 0.3 to 2 mg/kg/hr based on elemental calcium Stability/Miscellaneous 1 gram= 4.65 meq (93 mg) 10 ml. Maximum IV rate: 1.5 ml/min or approximately 1 gram/ 7 minutes. Too rapid injection may decrease blood pressure or cause cardiac syncope. Calcium administration: Onset: rapid Duration: 30 min to 2 hours. Recommended only in cases of hyperkalemia, hypocalcemia, or calcium antagonist blockade. [Treatment of hypocalcemia]: Acute hypocalcemic tetany (unless induced by alkalosis): give 1 gram calcium gluconate IV over 5 - 15 minutes. After 1-2 hours may be necessary to repeat dose or add 2-3 grams calcium gluconate to 250-500ml and infuse over 12-24hours. Alternatively: Symptomatic patient: give 1 gram calcium gluconate over 5 - 15 minutes q1-2hours. If Tetany returns after 6 hours (3 grams calcium gluconate given) start continuous infusion (5-10g of calcium gluconate /1000 ml D5W infused at rate to prevent tetany-usually 30 to 100 ml/hr). Make sure magnesium levels are corrected first - patients with hypocalcemia and hypomagnesemia will not respond to calcium replacement. Alternative therapy: give 0.3 to 2 mg elemental calcium/kg/hour as a continuous infusion. Asymptomatic patient: 1 gram calcium gluconate IV q6-12h with careful monitoring of Ca++ levels. Monitoring: during intensive therapy, monitor calcium levels at least twice daily. (Differentiation of hypo-parathyroidism vs Vitamin D deficiency): Hypoparathyroidism: Decreased serum Ca++/serum PO4 increased/Alk phos normal. Vitamin D deficiency: decreased Ca++ & PO4/ Alk phos increased. [Calcium channel blocker blockade]: give 0.01 to 0.04 ml/kg of 10% CaCl IV over 5-10min; may repeat q10minutes. May also use calcium gluconate 0.5-0.8g IV q10min. Some recommend 1gram CaCL over 5 minutes, q10-20min x 3 to 4 doses. Some degree of hypercalcemia may be necessary. Calcium therapy is more effective in overcoming mild toxicity vs massive overdose since calcium channel blockade is noncompetitive. ""Usual diluents: D5W, NS [0 to 1 gram] [50 ml] [30 min] [Over 1 gram] [100 ml] [60 min]Calcium gluconateStability/Miscellaneous 24 hours RT / REF. Label: Refrigerate. Storage: Vials are stored in the refrigerator. Reconstitution: 50 and 70 mg vial: add 10.5 ml normal saline. Transfer 10 ml of the reconstituted solution to 250ml normal saline IV bag. If using two 50mg vials to obtain the 70mg loading dose, add 10.5 ml to each vial and then withdraw 14 ml of the reconstituted solution to 250ml normal saline IV bag. Patients who are fluid restricted: 50mg dose may be added to 100 ml normal saline. Hepatic dosing: Patients with moderate hepatic insufficiency should receive 35mg once daily. To prepare this dose, reconstitute the 50mg vial with 10.5 ml and then withdraw 7 ml from the vial and transfer this to 250ml normal saline. Dosing: 70 mg loading on day 1, followed by 50mg once daily thereafter. Patients with moderate hepatic insufficiency should receive the 70mg loading dose on day 1, and then 35mg IV once daily thereafter. Indications: treatment of invasive aspergillosis in patients who are refractory to or intolerant of other therapies (ampho B, itraconazole etc.).""Caspofungin acetate Diluents: NS [35 to 75 mg] [250 ml] [1 hour]Cancidas Stability/Miscellaneous EXP: 1 DAY (RT). Higher concentrations can be used if patient has a central line (75 mg / 50 ml). Treatment of hypertension: Start infusion at 5 mg/hr - if not effective increase dose 2.5 mg/hr q5 to 15 minutes to a maximum of 15 mg/hr. Postop hypertension: 10 to 15 mg/hr for initial control, followed by maintenance infusion of 1 to 3 mg/hr. IV to PO conversion: 20mg po q8h= 0.5 mg/hr; 30mg po q8h= 1.2 mg/hr ; 40mg po q8h= 2.2 mg/hr. Supplied: 25 mg/10 ml ampule. "Nicardipine Usual diluents: D5W, NS (Total volume: 250 ml) [25 mg] [240 ml] [Titrate]Cardene Stability/Miscellaneous EXP: 1 DAY (RT) Label: Refrigerate Concentration= 1 mg/ ml. Dosing (A-fib/flutter) initially 0.25 mg/kg over 2 minutes. If inadequate give 0.35 mg/kg over 2 min-15 min after 1st dose. Subsequent doses should be individualized. Continuous infusion: started immediately following an effective bolus dose. Initial rate= 10 mg/hr (some may respond to 5 mg/hr). If needed, may increase up to 15 mg/hr. Contraindicated: AMI, hypotension (sys<90), 2nd & 3rd degree AV block. ""Diltiazem Diluents: D5W, NS ---Final Concentration 1 mg/ml --- [125 mg (25 ml)] [100ml] [Titrate]Cardizem Stability/Miscellaneous 24 hours RT / REF. Label: Refrigerate. Storage: Vials are stored in the refrigerator. Reconstitution: 50 and 70 mg vial: add 10.5 ml normal saline. Transfer 10 ml of the reconstituted solution to 250ml normal saline IV bag. If using two 50mg vials to obtain the 70mg loading dose, add 10.5 ml to each vial and then withdraw 14 ml of the reconstituted solution to 250ml normal saline IV bag. Patients who are fluid restricted: 50mg dose may be added to 100 ml normal saline. Hepatic dosing: Patients with moderate hepatic insufficiency should receive 35mg once daily. To prepare this dose, reconstitute the 50mg vial with 10.5 ml and then withdraw 7 ml from the vial and transfer this to 250ml normal saline. Dosing: 70 mg loading on day 1, followed by 50mg once daily thereafter. Patients with moderate hepatic insufficiency should receive the 70mg loading dose on day 1, and then 35mg IV once daily thereafter. Indications: treatment of invasive aspergillosis in patients who are refractory to or intolerant of other therapies (ampho B, itraconazole etc.).""Cancidas Diluents: NS [35 to 75 mg] [250 ml] [1 hour]Caspofungin acetate Stability/Miscellaneous EXP: 2 Days (RT) / 10 Days (REF). Label: Refrigerate. Maximum dose/day=12 grams. IM injection: 500mg/ 2 ml; 1 gram/ 2.5 ml H20/BS-H20. Usual dosage: 500mg to 1g IV 8h. Severe: 1.5g IV q6h. Life threatening: 6-12g/day. ""Ancef Usual diluents: D5W, NS [0 to 1 gram] [50 ml] [30 min] [Over 1 gram] [100 ml] [30 min]Cefazolin Stability/Miscellaneous EXP: 24 hr (RT) / 7 Days (REF). Label: Refrigerate. IM Injection: 500mg vial/ 1.3 ml; 1 gram vial/ 2.4 ml (Sterile H2O; BS-SW; Lidocaine 0.5 to 1%; Normal saline). Mild to moderate infection: 500mg to 2 g IV q12h. Severe: 2 g IV q8h.""Maxipime Usual diluents: D5W, NS [0 to 2 grams] [ 50 ml] [30 min]Cefepime HCLStability/Miscellaneous EXP: 1 Day (RT)/ 5 days (REF). Label: Refrigerate Usual dose: 1-2 grams IV q12h. Maximum daily dose: 12 grams or 4 grams for patients with advanced liver cirrhosis. ""Cefoperazone Usual diluents: D5W, NS [0 to 1 gram] [50 ml] [30 min] [Over 1 gram] [100 ml] [30 min]Cefobid Stability/Miscellaneous EXP: 1 Day (RT)/ 5 days (REF). Label: Refrigerate Usual dose: 1-2 grams IV q12h. Maximum daily dose: 12 grams or 4 grams for patients with advanced liver cirrhosis. ""Cefobid Usual diluents: D5W, NS [0 to 1 gram] [50 ml] [30 min] [Over 1 gram] [100 ml] [30 min]Cefoperazone Stability/Miscellaneous EXP: 1 day (RT / 5 days (REF). Label: Refrigerate. Mild infection: 1-2g IV q12h. Moderate: 1-2g IV q8h; Severe: 2g IV q6-8h; Life threatening: 2g IV q4h (Max dose/day= 12g). ""Claforan Usual diluents: D5W, NS [0 to 2 grams] [ 50 ml] [30 min]Cefotaxime Stability/Miscellaneous EXP: 1 DAY (RT); 4 DAYS (REF). Label: Refrigerate. Usual dose: 1g IV q12h. Severe: 2-3 grams IV q12h. (Max 6g/day). Maximum dose: 3 grams IV q12h. Do not exceed q12h interval. IM injection: 1 gram/ 2 ml; 2 grams/ 3 ml SW /BS-SW /NS /0.5 to 1% lidocaine. ""Usual diluents: D5W, NS [0 to 1 gram] [50 ml] [30 min] [Over 1 gram] [100 ml] [30 min]CefotetanStability/Miscellaneous EXP: 1 Day (RT)/ 7 Days (REF). Label: Refrigerate. IM injection: 1 gram/ 2ml ; 2 grams/ 4 ml. (Sterile water or lidocaine 0.5-1%). Usual dose 1g q6-8h. Moderate-severe: 2g q6-8h. Severe: 2 grams q4h.""Mefoxin Usual diluents: D5W, NS [0 to 1 gram] [50 ml] [30 min] [Over 1 gram] [100 ml] [30 min]Cefoxitin Stability/Miscellaneous EXP: 1 DAY (RT) ; 7 DAYS (REF) Label: Refrigerate. Maximum dose: 2 grams IV q8h. IM injection: 500mg/ 1.5 ml; 1 gram/ 3 ml SW / BS-SW / 0.5-1% lidocaine. (Intragluteal or lateral aspect of thigh). Usual dose: 1g IV q8-12h. Severe: 2g IV q8-12h. (Max dose/day= 6 grams).""Fortaz Usual diluents: D5W, NS [0 to 1 gram] [50 ml] [30 min] [Over 1 gram] [100 ml] [30 min]Ceftazidime Stability/Miscellaneous EXP: 1 day (RT) /10 days (REF). Label: Refrigerate. Total daily dose should not exceed 4 grams. IM injection preparation: 250 mg/ 0.9 ml; 500mg/ 1.8 ml; 1 gram/3.6 ml; 2grams/ 4.2 or 7.2 ml H20;BS-H20; 0.5 to 1% lidocaine. Usual dose: 1-2g IV q24h. Severe: 2g IV q12h""Rocephin Usual diluents: D5W, NS [0 to 1 gram] [50 ml] [30 min] [Over 1 gram] [100 ml] [30 min]Ceftriaxone Stability/Miscellaneous EXP: 1 DAY (RT) ; 7 DAYS (REF). Label: Refrigerate. IM injection: 750 mg vial/ 3ml SW. Usual: 750mg to 1.5g IV q8h. Severe: 1.5g IV q6-8h. ""Zinacef Usual diluents: D5W, NS [0 to 750 mg] [50 ml] [30 min] [Over 750 mg] [100 ml] [30 min]Cefuroxime Stability/Miscellaneous Water soluble prodrug of phenytoin. Status epilepticus: loading: 15 to 20 mg PE/kg. Maintenance dose: 4 to 6 mg PE/kg/day. Fosphenytoin offers many advantages over phenytoin: minimum phlebitis, complete IM absorption, and the ability to administer the drug much more rapidly. Cerebyx (IM / IV) can be substituted 1:1 for oral phenytoin. IM cerebyx is not recommended for tx of status epilepticus. ""Fosphenytoin Usual diluents: D5W, NS [100 to 1250 mg PE][50 ml] [10 min or greater] Max rate: 150 mg PE / minuteCerebyx Stability/Miscellaneous EXP: 1 DAY (RT). Supplied: 1 gram vial (Powder)-dilute with 10 ml. Dosing: 12.5 to 25 mg/kg q6h IVPB. Reduce dose in hepatic disease. ""Chloromycetin Usual diluents: D5W, NS [0 to 2 grams] [50 ml] [30 min] [Over 2 grams] [100 ml] [60 min]ChloramphenicolStability/Miscellaneous EXP: 1 DAY (RT). Supplied: 1 gram vial (Powder)-dilute with 10 ml. Dosing: 12.5 to 25 mg/kg q6h IVPB. Reduce dose in hepatic disease. ""Chloramphenicol Usual diluents: D5W, NS [0 to 2 grams] [50 ml] [30 min] [Over 2 grams] [100 ml] [60 min]Chloromycetin Stability/Miscellaneous EXP: 1 DAY (RT). Label: Do not refrigerate// Monitor BP closely. The IV route is very irritating and should be reserved for severe cases only (intractable hiccups-- oral or IM dosing were not effective). Intractable hiccups: (1) 25 to 50 mg po tid -qid. (2) 25-50mg IM if hiccups persist for 2-3 days (3) Last choice: slow IV infusion: 25- 50mg/500- 1000 ml NS. If irritation at the IM injection site is a problem use the dilution listed at the beginning. IV therapy should be reserved for recumbent patients because of the potential for severe hypotension. ""Thorazine Usual diluents: NS, D5W [25 mg] [100 ml] [30 min] [50 mg] [100 ml] [50-60 min]ChlorpromazineStability/Miscellaneous EXP: 7 DAYS (RT/REF). Patients requiring > 300mg/dose may be a good candidate for continuous infusion. Tagamet may be given IM. ""Tagamet Usual diluents: NS, D5W [0 to 300mg] [50 ml] [30 min] [400 mg] [100 ml] [30 min] ----Continuous infusion---- [900 mg] [100-250 ml] [24 hours] [901-2400mg][250-1000ml][24 hr]Cimetidine Stability/Miscellaneous EXP: 14 DAYS (RT/REF). Cipro 400mg ivpb produces the same levels as 500mg tablet. Oral dosing: 250-750mg po q12h; cystic fibrosis: 750mg po q8h. IV dosing: 200-400mg ivpb q12h. Febrile neutropenic patient: 400mg ivpb q8h ""Cipro Diluents: D5W [200 mg] [100 ml] [60 min] [400 mg] [250 ml] [60 min]Ciprofloxacin Stability/Miscellaneous EXP: 1 DAY (RT/REF). [Supplied: 10mg/ 5ml and 20 mg/10 ml vials (In refrigerator)]. Usual dilution: 0.1 to 0.4 mg/ml. Dosing: Intermittent: initial dose: 0.15 to 0.2 mg/kg IV bolus followed by 0.03 mg/kg IV q40-60min. Continuous infusion: 0.1 to 0.2 mg/kg IV bolus followed by 1 to 3 mcg/kg/min. The average infusion rate for long term use in the ICU is approximately 3 mcg/kg/min (range: 0.5 to 10.2 mcg/kg/min). In some cases, re-administration of the bolus dose may be req'd while titrating. Dosage reductions are not required in renal or hepatic failure. Drug of choice in the following cases (1) hemodynamically significant increases in HR (e.g. >20%) while paralyzed with pancuronium or MAP>110. (2) Concurrent corticosteroid administration (>72hrs) (3) Significant renal dysfunction (CRCL < 30 ml/min) (4) History of asthma or bronchospasm.""Nimbex Usual diluents: NS, D5W ---Using 200mg/20 ml vial---- Total volume =200ml (1 mg/ml) [200 mg] [180 ml] [Titrate] ( Total volume=100ml (1 mg/ml): [100 mg] [90 ml] [Titrate] ----Using 2 mg/ml vials------- [40 mg] [80 ml] [Total vol=100ml] [100 mg] [200ml] [Total vol=250] [200 mg] [400ml] [Total vol=500] (Concentration= 0.4 mg/ml) (May also be given undiluted)Cisatracurium Stability/Miscellaneous EXP: 1 day (RT / 5 days (REF). Label: Refrigerate. Mild infection: 1-2g IV q12h. Moderate: 1-2g IV q8h; Severe: 2g IV q6-8h; Life threatening: 2g IV q4h (Max dose/day= 12g). ""Cefotaxime Usual diluents: D5W, NS [0 to 2 grams] [ 50 ml] [30 min]Claforan Stability/Miscellaneous EXP: 2 DAYS (RT) /10 DAYS (REF) Label: Refrigerate. Maximum dose/day: 4800 mg. May be given IM. Usual oral dose: 150-450mg po q6h (take with a full glass of water to reduce risk of esophageal irritation/erosion). Usual IV dose: 600mg IV q6-8h or 900mg ivpb q8h. Maximum daily dose= 4800mg. Maximum infusion rate: 30 mg/min. ""Usual diluents: D5W, NS [0 to 600 mg] [50 ml] [30 min] [601-1200 mg] [100 ml] [60 min]ClindamycinStability/Miscellaneous EXP: 1 DAY (RT). Label: Protect from light. Single doses normally should not exceed 10mg. Maximum rate (IV-push): 5 mg/min (usual: 2.5 mg/min). Usual rate(infusion): 1 mg/min. Maximum recommended dose/day: 40 mg. Some studies have used high dose compazine (30-40mg) over 20-30 minutes prior to chemotherapy."Prochlorperazine Edisylate Usual diluents: NS, D5W [0 to 20mg] [50 ml] [30 min]Compazine Stability/Miscellaneous An inline 0.22 micron filter should be used. Recommended concentration: 1-6 mg/ml. Central line is req'd for concentrations > 2 mg/ml. [Supplied: 3 ml amp (50 mg/ml)]. Infusion: Use D5W (glass bottle) for infusions > 2 hours. The initial infusion rate should not exceed 30 mg/min. An in-line filter should be used during administration. Ventricular arrhythmias: 1 gram over the first 24 hours as follows: infuse 150mg over 10 min, followed by 360mg over 6 hours, then 540 mg over the remaining 18 hours (add 900mg/ 500ml D5W). After the first 24hr start maintenance infusion: 0.5 mg/min (720 mg/ 24 hours)-can be cautiously continued for 2 to 3 weeks regardless of age. If breakthrough episodes of V.fib or V.tach occur, an additional infusion of 150 mg over 10 min may be given. IV amiodarone (10-20 mg/kg/day) for 4-7 days was given to patients with refractory sustained V.tach or V.fib. Amiodarone 200mg IV bolus over 30 seconds has been effective in converting V.fib to normal sinus rhythm. This was followed by a maintenance infusion of 600-800mg over 24 hours. IV/Oral loading: 5 mg/kg IV over 30min followed by 800mg po/day x7d, then 600mg/day x 3, then 200-400mg/day maintenance. Recommendations for oral dosage after IV infusion: Duration of IV infusion < 1 week: 800-1600mg/day po initially; 1-3 weeks: 600-800mg/day po initially ; >3 weeks: 400mg po qd initially."""Amiodarone Diluents: D5W [150 mg] [100 ml] [10 min] ----Infusion---- [720 mg] [500 ml (glass bottle)] [900 mg] [500 ml (glass bottle)] See comments for rateCordarone Stability/Miscellaneous EXP: 1 Day (RT). Indications: Short term treatment (up to 48hrs) of severe hypertension when rapid, but quickly reversible, emergency reduction of blood pressure is indicated. May be discontinued abruptly or tapered gradually. Dosing: Usual initial rate: 0.1 mcg/kg/min, increased by increments of 0.05 to 0.1 mcg/kg/min at 15-20min intervals until target blood pressure reached. Usual effective doses: 0.1 to 1.6 mcg/kg/min. Generally, lower initial doses (0.03 to 0.1 mcg/kg/min) titrated slowly, have been associated with less reflex tachycardia. Never given by IV bolus. MOA: Selective dopamine (D1) agonist which decreases peripheral vascular resistance; increases renal blood flow; increased diuresis and natriuresis. 6 times as potent as dopamine in producing renal vasodilation. Onset: 10 minutes. Supplied: 10mg/ml-1&2 ml ampules.""Fenoldopam Usual diluents: NS, D5W ----Final conc: 40 mcg/ml ----- [10 mg] [250 ml] [Titrate] [20 mg] [500 ml] [Titrate] Corlopam Stability/Miscellaneous EXP: 1 DAY (RT) / 2 DAYS (REF). May be administered undiluted as well. Indications: rapid conversion of A-fib/flutter of recent onset. Dosing: patient wt >60kg: 1 mg over 10min. If < 60kg: 0.01 mg/kg over 10 min. If the arrhythmia does not terminate within 10 minutes after the 1st dose, a 2nd dose may be given 10 minutes after the completion of the first infusion. Mechanism of action : prolongs action potential duration and increases both atrial & ventricular refractoriness (class III agent). ""Ibutilide Usual diluents: D5W, NS [0 to 1 mg] [50 ml] [10 min]Corvert DOSAGE AND ADMINISTRATION Complicated Skin and Skin Structure Infections: CUBICIN 4 mg/kg should be administered over a 30-minute period by IV infusion in 0.9% NACL q 24 hours x 7-14 days. Doses of CUBICIN higher than 4 mg/kg/day have not been studied in Phase 3 controlled clinical trials. In Phase 1 and 2 clinical studies, CPK elevations appeared to be more frequent when daptomycin was dosed more frequently than once daily. Therefore, CUBICIN should not be dosed more frequently than once a day. Renal Dosing: CrCl >= 30 ml/min: 4 mg/kg q24h CrCl < 30 ml/min: 4 mg/kg q48h (Including patients receiving hemodialysis or CAPD.) PREPARATION: CUBICIN 250 mg vial: reconstitute with 5 mL of 0.9% NACL injection. 500 mg vial should be reconstituted with 10 mL of 0.9% NACL injection. Reconstituted CUBICIN should be further diluted with 0.9% sodium chloride injection (50ml) and infused over a period of 30 minutes. SUPPLIED: CUBICIN is supplied in single-use vials containing either 250 or 500 mg daptomycin as a sterile, lyophilized powder. STABILITY: Stability studies have shown that the reconstituted solution is stable in the vial for 12 hours at room temperature or up to 48 hours if stored under refrigeration at 2 to 8C (36 to 46F). The diluted solution is stable in the infusion bag for 12 hours at room temperature or 48 hours if stored under refrigeration. The combined time (vial and infusion bag) at room temperature should not exceed 12 hours; the combined time (vial and infusion bag) under refrigeration should not exceed 48 hours. Compatible Intravenous Solutions: CUBICIN is compatible with 0.9% sodium chloride injection and lactated Ringer?s injection. CUBICIN is not compatible with dextrose-containing diluents. STORAGE: Store original packages at refrigerated temperatures 2 to 8C (36 to 46F); avoid excessive heat.""Daptomycin Usual diluents: NS [4 mg/kg] [50 ml] [30 min]Cubicin Stability / Miscellaneous: EXP: 1 DAY (REF). Exception: IV ganciclovir, when reconstituted with sterile water for injection, further diluted with 0.9% Sodium Chloride Injection, stored refrigerated at 5C (41F) in polyvinyl chloride (PVC) bags, remains physically and chemically stable for 14 days. Reconstitute vial with 10 ml of Sterile Water for Injection (do not use bacteriostatic water), and shake well to dissolve drug. Vial stability: stable at room temperature for 12 hours (Do not refrigerate). Remember when further diluted with NS or D5W, final solution should be refrigerated until ready for use. Label: Refrigerate. In-line 0.22m filter recommended. Maximum concentration: 10 mg/ml. Follow chemotherapy handling precautions when preparing. Must adjust dose in renal failure. ""Ganciclovir Usual diluents: NS, D5W [5 to 6 mg/kg] [100 ml] [60 min]Cytovene Stability/Miscellaneous Preparation: Remove 120 ml from 1 liter sterile water irrigation bottle. Add 100ml bleach (sodium hypochlorite) plus 20 ml sodium bicarbonate. Label appropriately.""Full strength (0.5%) Label: FOR IRRIGATION ONLYDAKINS Solution Stability/Miscellaneous Dantrium is given by direct injection and is incompatible with D5W or NS. Prepare just before use. EXP: 6hours (RT). Tx severe muscle rigidity: 1 mg/kg rapid iv push, may repeat q1-3min until muscle relaxation or total dose of 10 mg/kg. When pt can tolerate po may substitute 1-2 mg/kg po qid. If refractory (NMS) consider adding bromocriptine 5 mg tid initially -if response is inadequate, increase dose rapidly to max of 10-20 mg po q6h. D/C when pt improves or CPK (nml). Prevention of malignant hyperthermia: 2.5 mg/kg IV over 1 hr approximately 75 minutes prior.""Dantrolene [20 mg vial] [60 ml sterile water without a bacteriostatic agent] Infusion rate: as directedDantrium Stability/Miscellaneous Dantrium is given by direct injection and is incompatible with D5W or NS. Prepare just before use. EXP: 6hours (RT). Tx severe muscle rigidity: 1 mg/kg rapid iv push, may repeat q1-3min until muscle relaxation or total dose of 10 mg/kg. When pt can tolerate po may substitute 1-2 mg/kg po qid. If refractory (NMS) consider adding bromocriptine 5 mg tid initially -if response is inadequate, increase dose rapidly to max of 10-20 mg po q6h. D/C when pt improves or CPK (nml). Prevention of malignant hyperthermia: 2.5 mg/kg IV over 1 hr approximately 75 minutes prior.""Dantrium [20 mg vial] [60 ml sterile water without a bacteriostatic agent] Infusion rate: as directedDantrolene DOSAGE AND ADMINISTRATION Complicated Skin and Skin Structure Infections: CUBICIN 4 mg/kg should be administered over a 30-minute period by IV infusion in 0.9% NACL q 24 hours x 7-14 days. Doses of CUBICIN higher than 4 mg/kg/day have not been studied in Phase 3 controlled clinical trials. In Phase 1 and 2 clinical studies, CPK elevations appeared to be more frequent when daptomycin was dosed more frequently than once daily. Therefore, CUBICIN should not be dosed more frequently than once a day. Renal Dosing: CrCl >= 30 ml/min: 4 mg/kg q24h CrCl < 30 ml/min: 4 mg/kg q48h (Including patients receiving hemodialysis or CAPD.) PREPARATION: CUBICIN 250 mg vial: reconstitute with 5 mL of 0.9% NACL injection. 500 mg vial should be reconstituted with 10 mL of 0.9% NACL injection. Reconstituted CUBICIN should be further diluted with 0.9% sodium chloride injection (50ml) and infused over a period of 30 minutes. SUPPLIED: CUBICIN is supplied in single-use vials containing either 250 or 500 mg daptomycin as a sterile, lyophilized powder. STABILITY: Stability studies have shown that the reconstituted solution is stable in the vial for 12 hours at room temperature or up to 48 hours if stored under refrigeration at 2 to 8C (36 to 46F). The diluted solution is stable in the infusion bag for 12 hours at room temperature or 48 hours if stored under refrigeration. The combined time (vial and infusion bag) at room temperature should not exceed 12 hours; the combined time (vial and infusion bag) under refrigeration should not exceed 48 hours. Compatible Intravenous Solutions: CUBICIN is compatible with 0.9% sodium chloride injection and lactated Ringer?s injection. CUBICIN is not compatible with dextrose-containing diluents. STORAGE: Store original packages at refrigerated temperatures 2 to 8C (36 to 46F); avoid excessive heat.""CUBICIN Usual diluents: NS [4 mg/kg] [50 ml] [30 min] DaptomycinStability/Miscellaneous Supplied: 4 mcg/ml-1 ml vial. Indications: Hemophilia (increases factor VIII levels): 0.3 mcg/kg in 50ml normal saline over 15-30 minutes. Diabetes insipidus: 2-4 mcg/day IV push or SC. Decrease bleeding following cardiac bypass: 0.3 mcg/kg ivpb. Provide short term protection for uremic hemorrhagic tendency: 0.3 mcg/kg ivpb q8h x 2 doses (diminishing response). Greatly enhanced ADH activity. Less vasopressor activity. Longer DOA. (Synthetic analog of vasopressin-posterior pituitary hormone). ADH activity : Pressor activity [DDAVP: 2000-4000: 1 Vasopressin: 1:1]""Desmopressin Diluents: NS [0 - 35 mcg] [50 ml] [15-30 min] DDAVP Stability/Miscellaneous EXP: 1 DAY (RT). Label: Do not Refrigerate/ protect from light. Dexamethasone my be given iv push undiluted (slowly). Spinal cord compression: 10 to 100mg (usually 10 mg) iv stat; followed by 4 to 24 mg iv q6h. Use larger doses (eg up to 100mg initially) in patients with profound or rapidly progressive neurologic injury, and lower doses in patients with mild or equivocal signs. ""Dexamethasone Diluents: D5W, NS [0 to 50 mg] [50 ml] [30 min] [[51-100mg] [100 ml][As directed]Decadron Label: Do not Refrigerate. Supplied: 500 mg/ 5ml Vial Package Insert Data: DEPACON should be administered as a 60 minute infusion (but not more than 20 mg/min) with the same frequency as the oral products, although plasma concentration monitoring and dosage adjustments may be necessary. In one clinical safety study, approximately 90 patients with epilepsy and with no measurable plasma levels of valproate were given single infusions of DEPACON (up to 15 mg/kg and mean dose of 1184 mg) over 5-10 minutes (1.5-3.0 mg/kg/min). Administration: Rapid infusion of DEPACON has been associated with an increase in adverse events. There is limited experience with infusion times of less than 60 minutes or rates of infusion > 20 mg/min in patients with epilepsy. DEPACON should be administered intravenously as a 60 minute infusion, as noted above. It should be diluted with at least 50 mL of a compatible diluent. Any unused portion of the vial contents should be discarded. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit. Compatibility and Stability: DEPACON was found to be physically compatible and chemically stable in the following parenteral solutions for at least 24 hours when stored in glass or polyvinyl chloride (PVC) bags at controlled room temperature 15-30C (59-86F). - dextrose (5%) injection, USP - sodium chloride (0.9%) injection, USP - lactated ringer's injection, USP""Valproate Sodium Usual diluents: D5W / NS / LR [Prescribed dose] [50-100 ml] [60 minutes] [(Maximum rate: 20 mg/min)]Depacon Stability/Miscellaneous Supplied: 4 mcg/ml-1 ml vial. Indications: Hemophilia (increases factor VIII levels): 0.3 mcg/kg in 50ml normal saline over 15-30 minutes. Diabetes insipidus: 2-4 mcg/day IV push or SC. Decrease bleeding following cardiac bypass: 0.3 mcg/kg ivpb. Provide short term protection for uremic hemorrhagic tendency: 0.3 mcg/kg ivpb q8h x 2 doses (diminishing response). Greatly enhanced ADH activity. Less vasopressor activity. Longer DOA. (Synthetic analog of vasopressin-posterior pituitary hormone). ADH activity : Pressor activity [DDAVP: 2000-4000: 1 Vasopressin: 1:1] ""DDAVP Diluents: NS [0 - 35 mcg] [50 ml] [15-30 min] Desmopressin Stability/Miscellaneous EXP: 1 DAY (RT). Label: Do not Refrigerate/ protect from light. Dexamethasone my be given iv push undiluted (slowly). Spinal cord compression: 10 to 100mg (usually 10 mg) iv stat; followed by 4 to 24 mg iv q6h. Use larger doses (eg up to 100mg initially) in patients with profound or rapidly progressive neurologic injury, and lower doses in patients with mild or equivocal signs. ""Decadron Diluents: D5W, NS [0 to 50 mg] [50 ml] [30 min] [[51-100mg] [100 ml][As directed]Dexamethasone Stability / Miscellaneous: EXP: 1 day (RT). Dilute 500mg vials with at least 5ml. Recommended route: IV-push (100-500 mg/min)."""Acetazolamide Usual Diluents: NS, D5W Standard Dilution: [250-500 mg] [50 ml] [15-30 min] Diamox Stability/Miscellaneous EXP: 7 DAYS (RT) if solution is transferred. Label: Do not Refrigerate. Maximum IV rate: 200 mg/hr. Since oral absorption is rapid and essentially complete--IV dose=oral dose. ""Fluconazole Usual diluents: NS [200 mg] [100 ml] [1 hour] [400 mg] [200 ml] [2 hours]Diflucan Stability/Miscellaneous Use promptly after mixing (may refrigerate up to 4 hours). Reconstitution: Dissolve each vial with 4 ml sterile water (do not shake). May be further diluted with normal saline. Infuse over 30 minutes-- must use 0.22 micron filter. If cardiac arrest is imminent, may give as a bolus. Number of vials needed =[(steady state serum digoxin level (ng/ml) x weight (kg)] / 100. Each vial contains 38 mg which will bind approximately 0.5 mg of digoxin. Dosage for acute ingestion of unknown amount: 20 vials (760mg) of Digibind is adequate to treat most life-threatening ingestions. May consider giving 10 vials, observing the patient's response, and following with an additional 10 vials. Dosage for toxicity during chronic therapy: for adults, 6 vials (228mg) usually is adequate to reverse most cases of toxicity. This dose can be used in patients in acute distress or when a serum concentration is not available. Improvement in signs and symptoms usually begins in 30 minutes or less.""Digoxin Immune Fab Diluents: NS [Prescribed dose] [ 50ml] [30 min] (Must use 0.22 micron filter)Digibind Stability/Miscellaneous Immediate use is recommended. Minimum of a 4-fold dilution. Loading dose: CHF: 8-12 mcg/kg in divided doses (q4-8h) over 12 to 24 hours. [Normally, give 50% of the total digitalizing dose in the initial dose, then give 25% of the total dose in each of the two subsequent doses at 8 to 12 hr intervals--Obtain EKG 6 hours after each dose to assess potential toxicity (AV block, sinus bradycardia, atrial or nodal ectopic beats, ventricular arrhythmias); Other: vision changes, confusion.] If patent has renal insufficiency give 6 to 10 mcg/kg IBW. A-fib: 10 to 15 mcg/kg IBW given as above. (If given IVPush - administer over at least 5 minutes). Avoid IM injections-can lead to severe pain (If it must be given by this route, give deep IM followed by massage). Monitoring: Obtain blood samples at least 4 hours after IV dose and 6-8hours after oral dose. Serum levels: 0.5 to 2.5 ng/ml Onset/peak: IV: 5-30min/ 1-4hours Oral: 1-2hours/ 2-8 hours. Time to steady state: 5-7 days (average) ESRD: 15-20 days. Half-life: 38-48 hours. (anephric: 4-6 days). Conversion from oral to IV: Decrease IV dose by 20 to 25%. When the maintenance dose is given IV, the onset and peak will occur earlier, however the duration of action is the same. Patients' on the floors may receive once daily IV maintenance doses, however, IV loading regimens (multiple doses) are restricted to patients on a monitor- ICU's. [Oral bioavailability (tablets): 70 to 80%]. ""Lanoxin Diluents: NS, D5W [All doses] [50 ml] [15 min]Digoxin Stability/Miscellaneous Use promptly after mixing (may refrigerate up to 4 hours). Reconstitution: Dissolve each vial with 4 ml sterile water (do not shake). May be further diluted with normal saline. Infuse over 30 minutes-- must use 0.22 micron filter. If cardiac arrest is imminent, may give as a bolus. Number of vials needed =[(steady state serum digoxin level (ng/ml) x weight (kg)] / 100. Each vial contains 38 mg which will bind approximately 0.5 mg of digoxin. Dosage for acute ingestion of unknown amount: 20 vials (760mg) of Digibind is adequate to treat most life-threatening ingestions. May consider giving 10 vials, observing the patient's response, and following with an additional 10 vials. Dosage for toxicity during chronic therapy: for adults, 6 vials (228mg) usually is adequate to reverse most cases of toxicity. This dose can be used in patients in acute distress or when a serum concentration is not available. Improvement in signs and symptoms usually begins in 30 minutes or less.""Digibind Diluents: NS [Prescribed dose] [ 50ml] [30 min] (Must use 0.22 micron filter)Digoxin Immune FabStability/Miscellaneous Label: Do not Refrigerate / Use an inline 0.22u filter. EXP: 2 HOURS (RT) Another source: Concentrations up to 6.7 mg/ml are stable up to 24 hours (insignificant loss). Ideally, the solution should be infused within 1 hour of mixing. Constantly monitor for precipitate formation. Infusion rates: Maximum: 50 mg/min Recommended rate for most adults: 40 mg/min. Elderly (rate): 20 mg/min. Usual IV loading dose: 15 mg/kg TBW Maintenance dose (started 18-24h after load): 6 mg/kg ibw IV/PO in divided doses q8 to 12h. (The IV maintenance dose should never be given qd in a single dose). Oral loading: 16 mg/kg TBW (use adjBW if obese) given in 3 to 4 divided doses at q2h intervals (divided doses increase bio-availability as well as decrease potential for gastrointestinal side effects such as N&V). The maximum single oral dose should not exceed 400mg in order to minimize gastrointestinal side effects and increase absorption. Sampling: 18 to 24h after loading dose, then q5 to 7 days to assess trend. Average time to steady state: 10 to 14days. Half-life: 7-42hrs (average=24h). Capsules/injection= 92% phenytoin. Elixir/tabs=100% pht. Equation used to estimate the dose req'd to increase current level to normal range if subtherapeutic: = [0.7 x IBW x (15 - current level) ] / 0.92* * (if capsules/injection used) Adjusted phenytoin concentration if low serum albumin= measured total concentration / [ (0.2 x albumin) + 0.1] "Phenytoin Usual diluents: NS Give IV push- max 50mg/min or [100 mg] [50 ml] [5-15 min] [200-500 mg] [100ml] [15-30 min] [501-1500 mg] [250 ml] [See comments]Dilantin Stability/Miscellaneous EXP: 24 hours RT/REF. Some studies indicate stability up to 42 days. Usual rate: 0.2 to 2 mg/hr. ""Hydromorphone Usual diluents: D5W, NS [0 - 100 mg] [100 ml] [Titrate]Dilaudid Stability/Miscellaneous EXP: 1 DAY (RT) Label: Refrigerate Concentration= 1 mg/ ml. Dosing (A-fib/flutter) initially 0.25 mg/kg over 2 minutes. If inadequate give 0.35 mg/kg over 2 min-15 min after 1st dose. Subsequent doses should be individualized. Continuous infusion: started immediately following an effective bolus dose. Initial rate= 10 mg/hr (some may respond to 5 mg/hr). If needed, may increase up to 15 mg/hr. Contraindicated: AMI, hypotension (sys<90), 2nd & 3rd degree AV block. ""Cardizem Diluents: D5W, NS ---Final Concentration 1 mg/ml --- [125 mg (25 ml)] [100ml] [Titrate]DiltiazemStability/Miscellaneous EXP: 1 DAY (RT). Maximum dose/ 24 hours= 400 mg. Dosing: 10 to 50mg IM or IV q2 to 6h.""Benadryl Diluents: D5W, NS [0 to 100 mg] [50 ml] [20-30 min]DiphenhydramineStability/Miscellaneous Label: Do not Refrigerate / Shake well before use/ Replace IV tubing q6-12h. Dosing: (ICU sedation in intubated/mechanical vent patients): initially 0.3 mg/kg/hr for at least 5 minutes. Then increase by 0.3 to 0.6 mg/kg/hr q5-10min until desired level of sedation. Alternative (initial dosing): 1-3 mg/kg/hr-titrate to effect. Usual dose req'd for maintenance: 1.5 to 4.5 mg/kg/hr. Calculation of rate (ml/hr) = (mg/kg/hr) x 0.1 (Note: changes in the rate of administration should be made slowly (>5 min) in order to minimize hypotension and avoid acute overdosage. Monitoring: Patients should be monitored for early signs of significant hypotension and/or cardiovascular depression, which may be profound. "Propofol Vials: [1000 mg] [100 ml] [Titrate] [500 mg] [50 ml] [Titrate] [Concentration: 10 mg/ml]Diprivan Stability/Miscellaneous EXP: 1 DAY (RT). Drip rate (500mg/250 ml) ml/hr= wt(kg) x (mcg/min) x 0.03. Direct beta agonist that increases cardiac output with little direct effect on BP. Uses: refractory CHF or hypotensive patients in whom vasodilators cannot be used because of effects on blood pressure.""Diluents: D5W, NS [500 mg] [250 ml] [Titrate] [0-1000 mg] [250 ml] [Titrate]DobutamineStability/Miscellaneous EXP: 1 DAY (RT). The ICU's prefer 400 to 800mg/250 ml. Calculation of drip rate (ml/hr) 400mg/250 ml: wt(kg) x mcg/min x 0.0375. Refractory CHF: initial dose: 0.5 to 2 mcg/kg/min. Renal: 1 to 5 mcg/kg/min. Severely ill patient: initially 5 mcg/kg/min, increase by 5 to 10 mcg/kg/min (q10 to 30 min) up to max of 50 mcg/kg/min. [0.5 to 2 mcg/kg/min-dopa; 2-10-dopa/beta; >10-primarily alpha.] Used to support BP, CO and renal perfusion in shock. ""Diluents: D5W, NS [400-800mg] [250 ml] [Titrate] [200-800 mg] [250-500 ml]Dopamine Stability/Miscellaneous EXP: 12 hours (RT) /3 DAYS(REF) Label: Refrigerate/protect from light. Concentrations < 0.1 mg/ml or > 1 mg/ml are not recommended. Cannot be given IM. No dosage adjustments required for renal failure""Vibramycin Diluents: D5W, NS [0 to 100 mg] [100 ml] [1 hour] [Up to 200 mg] [250ml] [2 hours]DoxycyclineStability/Miscellaneous Label: Do not Refrigerate. Actions: Marked sedation/ anti-emetic. Premedication: 2.5 to 10mg IV / IM. Usually 1.25 to 2.5 mg q3-6h prn. [Continuous infusion:] 25 mg/500 ml D5W at 1 mg/hr initially for tx of hyperemesis gravidarum (give 1 to 2.5 mg loading initially). May increase by 0.25 mg at 4hr intervals if patient not responding (usual range: 1 to 1.25 mg/hr). Also add benadryl 50mg q6h until infusion is stopped. When patient is ready to take oral meds switch to reglan 10mg qid + hydroxyzine 50mg.""Inapsine Diluents: D5W, NS [1 to 3 mg] [50 ml] [30 min] [4-10 mg] [100 ml] [As directed] ------Continuous infusion------ [25 mg] [500 ml] [As directed] DroperidolStability/Miscellaneous: Label: Refrigerate. Do not shake. Dosage & administration: Xigris should be administered intravenously at aninfusion rate of 24 mcg/kg/hr x 96 hours. If the infusion is interrupted, Xigris should be restarted at the initial infusion rate and continued to complete the recommended duration of infusion. Dose escalation or bolus doses of Xigris are not recommended. In the event of clinically important bleeding, immediately stop the infusion. No dosage adjustment is required regardless of age, hepatic impairment, or renal impairment. Preparation: 12 hour infusion bags: Actual Patient Weight (kg) x Dose (24 mcg/kg/hr) = Amount of Xigris needed per hour.Amount of Xigris needed/hr (g/hr) x 12 hours ????? 1000 = mg of Xigris needed per 12 hours ? round to the nearest 5-mg increment. The solution of reconstituted Xigris is typically diluted into an infusion bag (0.9% Sodium Chloride) to a final concentration of between 100 mcg/mL - 200 mcg/mL. Vial dilution: Prior to administration, 5 mg vials must be reconstituted with 2.5 mL of Sterile Water for Injection, USP, and 20 mg vials of Xigris must be reconstituted with 10 mL of Sterile Water for Injection, USP. The resulting concentration of the solution isapproximately 2 mg/mL of Xigris. Slowly add the Sterile Water for Injection, USP tothe vial and avoid inverting or shaking the vial. Gently swirl each vial until the powder is completely dissolved. Because Xigris contains no antibacterial preservatives, the intravenous solution should be prepared immediately upon reconstitution of the Xigris in the vial(s). If the vial of reconstituted Xigris is not used immediately, it may be held at controlled room temperature 20 to 25C (68 to 77F), but must be used within 3 hours. Before further dilution or administration, the product should be inspectedvisually for particulate matter and discoloration. Do not use vials if particulate matter is visible or solution is discolored. Stability: After preparation, the intravenous solution should be used at controlled roomtemperature 20 to 25C within 14 hours. If the intravenous solution isnot administered immediately, the solution may be stored refrigerated 2 to 8Cfor up to 12 hours. If the prepared solution is refrigerated prior to administration, the maximum time limit for use of the intravenous solution, including preparation, refrigeration, and administration, is 24 hours. Instructions for a Syringe Pump: See package insert (The solution of reconstituted Xigris must be further diluted with 0.9% Sodium Chloride Injection, USP to a final concentration of between 100 g/mL and 1000 g/mL.)Actions: Recombinant form of human Activated Protein C. Activated Protein C exerts an antithrombotic effect by inhibiting Factors Va and VIIIa. Indications: reduction of mortality in adult patients with severe sepsis (sepsis associated with acute organ dysfunction) who have a high risk of death. Efficacy has not been established in adult patients with severe sepsis and lower risk of death. Contraindications: Xigris increases the risk of bleeding. Xigris is contraindicated in patients with the following clinical situations in which bleeding could be associated with a high risk of death or significant morbidity: Active internal bleeding, Recent (within 3 months) hemorrhagic stroke, Recent (within 2 months) intracranial or intraspinal surgery, or severe head trauma; Trauma with an increased risk of life-threatening bleeding; Presence of an epidural catheter; Intracranial neoplasm or mass lesion or evidence of cerebral herniation; known hypersensitivity.""Xigris Usual diluents: NS See comments for dilution. Infusion rate: 24 mcg/kg/hour Drotrecogin alfaStability/Miscellaneous EXP: 1 DAY (RT). The dose for pt's being converted from oral to IV is the same. May also be given IV push over 5 minutes. ""Vasotec Usual diluents: D5W, NS [0 - 2.5 mg] [50 ml] [15-20 min]EnalaprilatStability/Miscellaneous EXP: 1 DAY (RT). Dosing: Continuous infusion: 1 to 4 mcg/min. Anaphylaxis (adult): 0.1 to 0.5 SC / IM (1:1000) repeat q10 to 15 minutes prn or give 0.1 to 0.25 mg IV (1:10,000) over 5-10min repeat q5 to 15 minutes as needed or start continuous infusion: 1 to 4 mcg/min. Cardiac arrest: 0.5 to 1 mg bolus (1:10,000) q5min prn. May give 0.3 mg SC or start continuous infusion (range: 1 to 10 mcg/min). Calculation of drip rate (ml/hr) 1 mg/250 ml: mcg/min x 15. ""[1 to 5 mg] [250 ml] [Titrate] Central line required for administration. EpinephrineStability/Miscellaneous Indications: Treatment of patients with acute coronary syndrome (unstable angina or Non-Q wave MI). Administration: Bolus: withdraw dose from 10ml vial and give by ivpush over 1-2 minutes. Continuous infusion: administer calculated rate directly from 100ml vial. [Supplied: 0.75 mg/ml (100ml) vial; 20 mg/10 ml vial. (REF) ] Properties: Onset: within 1 hr T1/2: 2.5 hours Platelet function restored in @ 4hours after discontinuation. Acute Coronary Syndrome Patients with serum creatinine < 2.0 mg/dL: IV bolus of 180 g/kg as soon as possible following diagnosis, followed by a continuous infusion of 2.0 g/kg/min until hospital discharge or initiation of CABG surgery, up to 72 hours. If a patient is to undergo a percutaneous coronary intervention (PCI) while receiving eptifibatide, the infusion should be continued up to hospital discharge, or for up to 18-24 hours after the procedure, whichever comes first, allowing for up to 96 hours of therapy. Patients weighing more than 121 kg should receive a maximum bolus of 22.6 mg followed by a maximum infusion of 15 mg per hour. If the serum creatinine is between 2.0 and 4.0 mg/dL: Give an IV bolus of 180 g/kg as soon as possible following diagnosis, immediately followed by a continuous infusion of 1.0 g/kg/min. Patients with serum creatinine between 2.0 and 4.0 mg/dL and weighing more than 121 kg should receive a maximum bolus of 22.6 mg followed by a maximum infusion rate of 7.5 mg per hour. Percutaneous Coronary Intervention (PCI) The recommended adult dosage of eptifibatide in patients with a serum creatinine <2.0 mg/dL initiated at the time of PCI is an intravenous bolus of 180 g/kg administered immediately before the initiation of PCI followed by a continuous infusion of 2.0 g/kg/min and a second 180 g/kg bolus 10 minutes after the first bolus. Infusion should be continued until hospital discharge, or for up to 18 to 24 hours, whichever comes first. A minimum of 12 hours of infusion is recommended. Patients weighing more than 121 kg should receive a maximum of 22.6 mg per bolus followed by a maximum infusion rate of 15 mg per hour. Patients with a serum creatinine between 2.0 and 4.0 mg/dL initiated at the time of PCI is an intravenous bolus of 180 g/kg administered immediately before the initiation of the procedure, immediately followed by a continuous infusion of 1.0 g/kg/min and a second 180 g/kg bolus administered 10 minutes after the first. Patients with a serum creatinine between 2.0 and 4.0 mg/dL and weighing more than 121 kg should receive a maximum of 22.6 mg per bolus followed by a maximum infusion rate of 7.5 mg per hour.""Integrilin [100 ml vial (0.75 mg/ml)] [100 ml vial (2.0 mg/ml)] Administer directly from vial. (No dilution required) Infusion rate: as directedEptifibatideStability / Miscellaneous: Stability: 6 hours RT / 24 hours REF. Label: Refrigerate. Preparation: (IV): Reconstitute 1 gram vial with 10 mL of Water for Injection, 0.9% Sodium Chloride Injection, or Bacteriostatic Water for Injection and then add contents to 50 ml normal saline. Complete the infusion within 6 hours of reconstitution. (IM): Reconstitute 1 gram vial with 3.2 mL of lidocaine 1% injection without epinephrine. Give deep IM into a large muscle mass (gluteal or lateral aspect of thigh). Administer solution within 1 hour of preparation. DO NOT give this solution Intravenously Dosing: 1 gram IV or IM q24h. Renal dosing: CRCL: >/= 30 ml/min: no changes. < 20-30 ml/min: 0.5 grams IM or IV q24h. ""Invanz Usual diluents: NS [1 gram] [50 ml] [30 min]Ertapenem Sodium Stability/Miscellaneous EXP: 1 DAY (RT/REF). Label: Refrigerate. If D5W is used must neutralize solution with sodium bicarbonate (0.5 meq/ 100ml). Usual oral dose: 500mg to 1g po q12h or 250mg to 1g po q6h. Usual IV dose: 250mg to 1g q6h. Max 4 g/day. ""Diluents: NS [0 to 500 mg] [100 ml] [1 hour] [Up to 1000mg] [250ml] [2 hours] Erythromycin Stability/Miscellaneous: EXP: 1 DAY (RT). Note: the listed dilutions are for the 2.5 gram ampules. If the ampules are not available, the 10 ml (10mg/ml) vials must be transferred to an empty viaflex bag. Do not dilute the contents of the "vial," they are pre-diluted. Dosing: PSVT: 500 mcg/kg over 1 min, then 50 mcg/kg/min x 4 to 5min. If heart rate not controlled, repeat load of 500 mcg/kg and increase infusion to 100 mcg/kg/min. Repeat load and increase infusion q5 to 10min as needed to max of 200 (up to 300?) mcg/kg/min. Watch blood pressure. Calculation of drip rate (ml/hr): 2.5 grams/250 ml: wt (kg) x mcg/min x 0.006 Minimum Dilution: Note: The use of esmolol with propylene glycol has been associated with a higher incidence of venous irritation at concentrations greater than 10 mg/mL on continued infusion. Mixed from the ampul at concentrations of greater than 10 mg/mL BREVIBLOC has, however, been well tolerated when administered via a central vein. A premixed bag is available from the manufacturer: 2000 mg/100 ml (solution osmolarity adjusted to 312 mOsmol/L).""Brevibloc Usual diluents: D5W, NS [2.5 grams] [250 ml] [Titrate] [5 grams] [500 ml] [Titrate] Minimum dilution: see commentsEsmololStability/Miscellaneous EXP: 14 DAYS (REF). Renal Dosing: >10: no change <10: 1/2 usual dose ""Pepcid Usual diluents: D5W, NS [20 mg] [100 ml] [30 min] [40 mg] [250 ml] [30 min] Recommended concentration for infusion: 0.2 mg/mlFamotidineStability/Miscellaneous EXP: 1 Day (RT). Indications: Short term treatment (up to 48hrs) of severe hypertension when rapid, but quickly reversible, emergency reduction of blood pressure is indicated. May be discontinued abruptly or tapered gradually. Dosing: Usual initial rate: 0.1 mcg/kg/min, increased by increments of 0.05 to 0.1 mcg/kg/min at 15-20min intervals until target blood pressure reached. Usual effective doses: 0.1 to 1.6 mcg/kg/min. Generally, lower initial doses (0.03 to 0.1 mcg/kg/min) titrated slowly, have been associated with less reflex tachycardia. Never given by IV bolus. MOA: Selective dopamine (D1) agonist which decreases peripheral vascular resistance; increases renal blood flow; increased diuresis and natriuresis. 6 times as potent as dopamine in producing renal vasodilation. Onset: 10 minutes. Supplied: 10mg/ml-1&2 ml ampules. ""Corlopam Usual diluents: NS, D5W ----Final conc: 40 mcg/ml ----- [10 mg] [250 ml] [Titrate] [20 mg] [500 ml] [Titrate] FenoldopamStability/Miscellaneous EXP: 2 Days (RT / REF). Some studies indicate stability up to 30 days. Continuous infusion: 1 to 3 mcg/kg/hr. Minimum dilution: 2500 to 5000 mcg/ 50 ml. ""Usual diluents: NS, D5W [0 - 5000 mcg] [50-250ml][Titrate] [2500 mcg] [250 ml] [Titrate] [5000 mcg] [250 ml] [Titrate] (May concentrate further) [2500 mcg] [ 50 ml] (50 mcg/ml) Fentanyl Stability / Miscellaneous: EXP: If diluted in saline, use immediately after dilution. Supplied: [62.5 mg/ 5 ml ampule] Recommended dosage: repletion treatment of iron deficiency in hemodialysis: 10 mL of Ferrlecit (125 mg of elemental iron). Most patients will require a minimum cumulative dose of 1.0 gram of elemental iron, administered over eight sessions (125mg per session) at sequential dialysis treatments, to achieve a favorable hemoglobin or hematocrit response. Ferrlecit has been administered by infusion or by slow IV injection during the dialysis session itself. ""Sodium Ferric Gluconate Complex Ferrlecit Usual Diluents: NS Standard Dilutions: --Intravenous dilution: -- [125 mg ] [100 ml] [60 minutes] --Undiluted-- Ferrlecit may be administered undiluted as a SLOW IV injection (at a rate of up to 12.5 mg/min). Ferrlecit Stability/Miscellaneous Label: Do not Refrigerate. Reconstituted vials must be neutralized with 5 meq sodium bicarbonate for each 500 mg used."Metronidazole Usual diluents: NS [500 mg] [100 ml] [60 min] [Over 500 mg] [250 ml] [60 min]Flagyl Stability/Miscellaneous EXP: 7 DAYS (RT) if solution is transferred. Label: Do not Refrigerate. Maximum IV rate: 200 mg/hr. Since oral absorption is rapid and essentially complete--IV dose=oral dose. ""Diflucan Usual diluents: NS [200 mg] [100 ml] [1 hour] [400 mg] [200 ml] [2 hours]Fluconazole Stability/Miscellaneous Dosing: loading dose: 15 mg/kg, followed by 10 mg/kg q12h x 4 doses, then 15 mg/kg q12h thereafter until ethylene glycol levels <20 mg/dl. Dialysis should be considered in addition to fomepizole in the case of renal failure, significant or worsening metabolic acidosis, or a measured ethylene glycol level >50 mg/dl. Fomepizole is dialyzable and should be given q4h during hemodialysis. MOA: complexes and inactivates alcohol dehydrogenase thus preventing formation of the toxic metabolites of the alcohols. Supplied: 1 g/ml-1.5 ml vial.""Antizol Usual diluents: NS, D5W [Prescribed dose] [100ml] [30 min] Fomepizole Stability/Miscellaneous EXP: 1 DAY (RT) ; 7 DAYS (REF) Label: Refrigerate. Maximum dose: 2 grams IV q8h. IM injection: 500mg/ 1.5 ml; 1 gram/ 3 ml SW / BS-SW / 0.5-1% lidocaine. (Intragluteal or lateral aspect of thigh). Usual dose: 1g IV q8-12h. Severe: 2g IV q8-12h. (Max dose/day= 6 grams). ""Ceftazidime Usual diluents: D5W, NS [0 to 1 gram] [50 ml] [30 min] [Over 1 gram] [100 ml] [30 min]Fortaz Stability/Miscellaneous Water soluble prodrug of phenytoin. Status epilepticus: loading: 15 to 20 mg PE/kg. Maintenance dose: 4 to 6 mg PE/kg/day. Fosphenytoin offers many advantages over phenytoin: minimum phlebitis, complete IM absorption, and the ability to administer the drug much more rapidly. Cerebyx (IM / IV) can be substituted 1:1 for oral phenytoin. IM cerebyx is not recommended for tx of status epilepticus. ""Cerebyx Usual diluents: D5W, NS [100 to 1250 mg PE][50 ml] [10 min or greater] Max rate: 150 mg PE / minuteFosphenytoin Stability/Miscellaneous EXP: 1 DAY (RT). Label: Do not Refrigerate. Recommended routes: IM, IV-push, Continuous infusion. Doses up to 6 grams/day have been used in patients with renal failure. Dosing: 20 to 40 mg initially. Increase by 20 mg increments q1 to 2 hours until response. Continuous infusion: 20 to 160 mg/hr. IV bolus: Usual doses (eg <80 mg) can be given slowly over 1-2 minutes. If higher doses are needed, a continuous infusion is recommended-usually greater efficacy as well as decreased risk of side effects.""Lasix Usual diluents: D5W, NS [All doses] [50 ml] [As directed] May administer undiluted. Maximum rate = 4mg/ min IV.Furosemide Stability / Miscellaneous EXP: 1 DAY (REF). Exception: IV ganciclovir, when reconstituted with sterile water for injection, further diluted with 0.9% Sodium Chloride Injection, stored refrigerated at 5C (41F) in polyvinyl chloride (PVC) bags, remains physically and chemically stable for 14 days. Reconstitute vial with 10 ml of Sterile Water for Injection (do not use bacteriostatic water), and shake well to dissolve drug. Vial stability: stable at room temperature for 12 hours (Do not refrigerate). Remember when further diluted with NS or D5W, final solution should be refrigerated until ready for use. Label: Refrigerate. In-line 0.22m filter recommended. Maximum concentration: 10 mg/ml. Follow chemotherapy handling precautions when preparing. Must adjust dose in renal failure. ""Cytovene Usual diluents: NS, D5W [5 to 6 mg/kg] [100 ml] [60 min]GanciclovirStability / Miscellaneous EXP: 14 days RT or REF. Usual dose: 400 mg po/IV qd Cannot be given IM. [CRCL >40]: No changes. [<40 ]: 400mg x1, then 200mg qd Stability of TEQUIN Injection Following Dilution: TEQUIN Injection, when diluted in a compatible intravenous fluid to a concentration of 2 mg/mL, is stable for 14 days when stored between 20C to 25C or when stored under refrigeration between 2C to 8C. TEQUIN Injection, when diluted to a concentration of 2 mg/mL in a compatible intravenous fluid EXCEPT FOR 5% SODIUM BICARBONATE INJECTION, USP, may be stored for up to 6 months at -25C to -10C (-13F to 14F). Frozen solutions may be thawed at controlled room temperature. Solutions that have been thawed are stable for 14 days after removal from the freezer when stored between 20C to 25C or when stored under refrigeration between 2C to 8C. Solutions should not be refrozen. ""Tequin Usual Diluents D5W, NS, D5NS, D5LR Standard Dilutions: [400 mg] [200 ml] [60 min] [200 mg] [100 ml] [60 min] Also available in premixed bags - same concentration as above. GatifloxacinEXP: 1 DAY (RT) / 4 DAYS (REF) Increased Vd: CHF, peritonitis, ascites, acute burn, hypo-albuminemia, immediate post partum. Kel (for gent/tobra/amikacin): (crcl) (0.003) + 0.01 Vd (for gent/tobra/amikacin): 0.3 L/kg ibw or adjusted body if >30% ibw. Adjusted body wt: (Actual body wt - ibw) (0.4) + ibw. Dose by levels (target trough): Gent/tobra: < 2 mcg/ml (<3 HD). Amikacin: < 8 mcg/ml (<10 HD). Estimation of dosing interval: Gent/Tobra/Amik: 3 x T1/2 Vanco: 2 x T1/2 (Note: may also solve for (T=dosing interval) using the Cmin equation). T= [ln (Cmax/Cmin) / Kel] + ti Usual target trough (conventional dosing): Gent/Tobra: 0.5 to 1 mcg/ml // Amikacin: 4-8 mcg/ml. Monitoring: Scr qod or qd if unstable. Follow clinical response: monitor WBC, Tmax, C&S, I&O's. Obtain levels 30 minutes before and after a 30 min infusion.""Usual diluents: NS or D5W [0 to 40 mg] [50 ml] [30 min] [>40mg] [100 ml] [30 min]Gentamicin Stability/Miscellaneous Stability: Reconstituted solutions should be used immediately; any unused portion should be discarded. Use diluent provided only if dose is < 2 mg otherwise dilute vials with sterile water or D5W to prevent phenol toxicity. After all of the vials have been reconstituted, follow the dilutions listed above: eg 10mg/100 ml D5W or NS. Beta-blocker overdose: Separate glucagon receptors stimulate adenylcyclase improving heart rate, blood pressure and conduction defects. Adults: 3 - 5 mg (up to 10 mg) rapid IV push followed by an IV drip of 0.07 mg/kg/hr (usually 1 to 5 mg/hour) (The dose used to increase glucose in hypoglycemic patients is only 0.5 - 1 mg IM, IV, or SC). Note: bolus dose may be repeated in 10 minutes. Usually causes nausea and vomiting. May give Reglan IV, Compazine or Tigan. Monitor blood glucose levels in hypoglycemic patients until they are asymptomatic; effective in treating hypoglycemia only if sufficient liver glycogen is present; since liver glycogen availability is necessary to treat hypoglycemic patients, glucagon has virtually no effects on patients in states of starvation, adrenal insufficiency, or chronic hypoglycemia. Recommended routes: IM, IV, or SC. Half-life: 8 to 18 minutes.""Usual diluents: D5W, NS [Recommended conc: 0.1 mg/ml] [5 mg] [50 ml] [10 mg] [100 ml] [20 mg] [200 ml] May be given as a bolus or continuous infusion (See Comments)Glucagon Stability/Miscellaneous EXP: 1 DAY (RT). Supplied: 1 mg/ml vial. Dosage: 10 mcg/kg IV over 5 minutes, 30 minutes prior. ""Kytril Usual diluents: D5W, NS [0 to 1 mg] [50 ml] [5 min]GranisetronStability/Miscellaneous EXP: 7 DAYS (RT) Label: Do not Refrigerate. Haldol may be given IV push. Max IV rate (usual): 5 mg/min. Oral to IV conversion (approximate): oral dose x 0.625 = daily IV dose. Continuous infusion: Doses of 3 to 25 mg/hr (72 to 600mg/day) have been studied in critically ill patients requiring mechanical ventilation. Continuous infusions have also been used to treat severely agitated critically ill patients: Start 10 mg/hr, adjust as necessary to provide relief from agitation in increments of 5 mg/hr. ""Haloperidol Lactate Usual diluents: D5W May dilute all doses to 1 mg/ml [0 to 50 mg] [50 ml] [As directed] [51-100 mg] [100 ml] [As directed] [200 mg] [160 ml] (1 mg/ml)Haldol Stability/Miscellaneous EXP: 7 DAYS (RT) Label: Do not Refrigerate. Haldol may be given IV push. Max IV rate (usual): 5 mg/min. Oral to IV conversion (approximate): oral dose x 0.625 = daily IV dose. Continuous infusion: Doses of 3 to 25 mg/hr (72 to 600mg/day) have been studied in critically ill patients requiring mechanical ventilation. Continuous infusions have also been used to treat severely agitated critically ill patients: Start 10 mg/hr, adjust as necessary to provide relief from agitation in increments of 5 mg/hr. ""Haldol Usual diluents: D5W May dilute all doses to 1 mg/ml [0 to 50 mg] [50 ml] [As directed] [51-100 mg] [100 ml] [As directed] [200 mg] [160 ml] (1 mg/ml)Haloperidol LactateStability/Miscellaneous Mix just before use / Must use 0.22 micron filter. Final concentration: 7 mg/ml or @ 301 mg/ 43 ml per manufacturer. Remove entire volume with a syringe and add the amount ordered back into the vial. Mix just before use (undergoes rapid decomposition). Usual dose: 1 to 4 mg/kg/day. Maximum dose: 6 mg/kg. Mechanism of action: Heme acts to limit the hepatic and/or marrow synthesis of porphyrin (likely due to inhibition of aminolevulonic acid synthetase-the enzyme which limits the rate of porphyrin synthesis.) Nursing instruction: (1) flush the line with normal saline (2) Add a 0.22 micron filter to the line-must be used because the solution is not transparent and any undissolved particulate matter is difficult to see. (3) Infuse Hematin over 10 to 15 minutes. (4) Use normal saline as a backflush to complete the infusion. Note: the filter will be stained dark brown.""Panhematin Diluent: Sterile water 313 mg vial/ 43 ml [Prescribed dose] [10-15 min] (See comments)HematinStability/Miscellaneous EXP: 1 DAY (RT). Cautions: active hemorrhage, acute CVA, History of thrombocytopenia, baseline labs: PT > 15 ; PTT >48; or Platelets < 100,000 Monitoring: PTT q6 to 8 hours following heparin therapy initiation or change in infusion until 2 consecutive therapeutic PTT levels are achieved at a consistent rate of infusion. Once the patient is stabilized, a PTT level should be checked qam. If a patient's PTT does not change significantly from baseline after 2 legitimate attempts to increase dose, consider heparin resistance (antithrombin III deficiency). Baseline labs: PT, PTT, CBC (Hgb, Hct, platelet count). QOD labs: Hgb, Hct, Platelets. Labwork requiring physician attention: (1) PTT > 100 sec (2) Platelet count < 100,000 or 40% decrease (3) INR > 3.5 (4) Hemoglobin decrease > 2 gm/dl. Remember: The most significant factor in reducing recurrent thrombo-embolism is reaching a therapeutic PTT in < 24 hours. Heparin induced thrombocytopenia: Consider changing to a direct thrombin inhibitor such as Lepirudin.""Usual diluents: D5W, NS [25,000 units] [250 ml] [Titrate] Loading dose: Give IV-push or add to 50 ml D5W. Heparin sodiumStability/Miscellaneous Monitor BP q5min during initial infusion. Manufacturer recommends IM or IV push. Usual dosage: 10 to 40 mg IV q4-6h prn. May be given q20-30 minutes (until adequate response) for the treatment of severe hypertension. IV push (rate): 10 mg/min. ""Apresoline Diluent: NS [0 to 20 mg] [50 ml] [30 min] [21 to 40 mg] [100 ml] [30 min] [>40 mg] [250 ml] [60 min or longer]Hydralazine Stability/Miscellaneous EXP: 24 hr (RT) Administer through central line. Usual daily dose: 100 to 400 meq/day of HCL by continuous infusion. Concentrations above 0.2N are not recommended (hemolysis). ""Usual diluents: D5W, NS Preparation of 0.1 N solution [100 ml (100 meq ) of 1.0N HCL] [1000 ml]. Filter HCL with 0.22 micron filter before adding it to the IV bag . (Prepare in glass bottle) Preparation of 0.15 N solution [150 ml (150 meq) of 1.0 N HCL] [1000 ml] Infusion rate: As directed - (4 - 6 hours for 0.1N soln)Hydrochloric acid Stability/Miscellaneous EXP: 1 DAY (RT) for concentration of 1 mg/ml. ""Solu Cortef Usual diluents: D5W, NS [0 -100mg] [100 ml] [30 min] [101-150 mg] [150 ml] [30 min] [151 - 250 mg [250 ml] [60 min] Minimum dilution: [0-3000 mg] [50 ml] (4hr stability) Hydrocortisone Stability/Miscellaneous EXP: 24 hours RT/REF. Some studies indicate stability up to 42 days. Usual rate: 0.2 to 2 mg/hr.""Dilaudid Usual diluents: D5W, NS [0 - 100 mg] [100 ml] [Titrate]Hydromorphone Stability/Miscellaneous EXP: 1 DAY (RT) / 2 DAYS (REF). May be administered undiluted as well. Indications: rapid conversion of A-fib/flutter of recent onset. Dosing: patient wt >60kg: 1 mg over 10min. If < 60kg: 0.01 mg/kg over 10 min. If the arrhythmia does not terminate within 10 minutes after the 1st dose, a 2nd dose may be given 10 minutes after the completion of the first infusion. Mechanism of action : prolongs action potential duration and increases both atrial & ventricular refractoriness (class III agent). ""Corvert Usual diluents: D5W, NS [0 to 1 mg] [50 ml] [10 min]IbutilideStability/Miscellaneous Parenteral iron treatment should be administered only when iron deficiency is not correctable with oral treatment. A test dose of 25 mg infused over 5 minutes should be given. Infusion should then be stopped for 1 hour. If there is no reaction after 1 hour continue. Fatal anaphylactic reactions are possible. May also be given IM or slow IVP (1 ml/min x 2 min = 100 mg). Epinephrine should be immediately available. Total amount of iron dextran required in ml (Total dose infusion) = 0.0442 (14.8 - observed Hgb) x IBW + (0.26 x IBW). Parenterally administered iron does not give a faster response compared to oral administration, therefore, the rate of recovery from anemia should be the same. Reticulocyte count will increase in 3-4 days and peak in 7-10 days. ""Iron Dextran Usual diluents: NS (Test dose) [25 mg] [100 ml] [5 min] [Prescribed dose] [250 to 1000ml] (Usually 500 ml NS) Total dose infusion: infuse over 2 to 6 hours.Imferon Stability/Miscellaneous EXP: 4 HRS (RT) / 24 HRS (REF). Label: Refrigerate. Usually restricted to one of the following: (1) Serious nosocomial infections, especially those involving resistant organisms; polymicrobial infections (mixed gram pos/negative + anaerobes). (2) As an alternative to combination therapy for serious intra-abdominal infections. It is used alone, thus avoiding the ototoxic & nephrotoxic effects of amino-glycosides. (3) Pseudomonas infections caused by organisms resistant to both piperacillin & Fortaz. IM injection: 500 mg/ 2ml (1% lidocaine) forms a suspension-shake well. Dosing: Mild to moderate infection: 250-500mg ivpb q6-8h. Severe infection: 500mg to 1g ivpb q6-8h. Max dose/day= 50mg/kg/day or 4g/day. ""Primaxin Usual diluents: NS [0 to 500 mg] [100 ml] [30 min] [up to 1 gram] [250 ml] [60 min]Imipenem/cilistatinStability/Miscellaneous EXP: 1 DAY (REF) Label: Do not shake/Refrigerate. Immune globulins with high concentrations of IgA: (1) Venoglobulin-S (2) Gamimune-N (3) Gammar-P IV (4) Sandoglobulin (5) Panglobulin Immune globulins with low concentrations of IgA: (1) Polygam S/D (2) Gammagard S/D Before dispensing, determine if the patient has an IgA deficiency: In patients with IgA deficiency, IgA can be antigenic and anti-IgA antibodies can develop rapidly leading to anaphylaxis when a product containing significant concentrations of IgA is administered. Therefore, use Polygam S/D or Gammagard S/D for IgA deficient patients. Overview: IgG is comprised of 4 subclasses with a distribution similar to normal serum (IgG1 thru IgG4). IgG1 is the major component in IGIV preparations. IgG1 is involved in tissue protection, complement activation and virus inactivation. Bacterial cells are opsonized by IgG1, making them more prone to phagocytosis. Treatment of immune deficient states probably depends on straightforward replacement of missing antibodies. Immunomodulatory doses of IVIG for autoimmune conditions are considerably larger & are thought to promote blockade of Fc receptors in macrophages (preventing phagocytosis of circulating opsonized platelets or cells tagged c autoantibodies). IVIG may also neutralize pathogenic auto-antibodies, and possibly down regulate IgG production. According to the National Institutes of Health, the commercially available products are equally effective and they may be used interchangeably. (Exception: IgA deficient patients). ""Dilute with diluent provided Initial rate: 0.5 ml/kg/hr. Maximum: 4ml/kg/hrImmune GlobulinStability / Miscellaneous: EXP: 1 Day (RT). Label: Do not refrigerate/ Protect from light. Supplied: [100mg/20 ml ampule] Dosing: initially 0.75 mg/kg IV bolus over 2-3 min, then start maintenance infusion 5 - 10 mcg/kg/min. Additional bolus of 0.75 mg/kg may be given 30 minutes after treatment starts. Max dose/day: 10 mg/kg. Mechanism of Action: Phosphodiesterase inhibitor with positive inotropic and vasodilator activity. ADMINISTRATION ????? May be administered undiluted for I.V. bolus doses. For continuous infusion: Dilute with 0.45% or 0.9% sodium chloride to final concentration of 1-3 mg/mL. ""Inocor Usual Diluents: NS Standard Dilutions: --Continuous infusion-- (Titrate) 300 mg/ 240 ml (total volume = 300ml) Minimum dilution: 300mg/60 ml Concentration = 2.5 mg/ml Total volume=120ml InamrinoneStability/Miscellaneous Label: Do not Refrigerate. Actions: Marked sedation/ anti-emetic. Premedication: 2.5 to 10mg IV / IM. Usually 1.25 to 2.5 mg q3-6h prn. [Continuous infusion:] 25 mg/500 ml D5W at 1 mg/hr initially for tx of hyperemesis gravidarum (give 1 to 2.5 mg loading initially). May increase by 0.25 mg at 4hr intervals if patient not responding (usual range: 1 to 1.25 mg/hr). Also add benadryl 50mg q6h until infusion is stopped. When patient is ready to take oral meds switch to reglan 10mg qid + hydroxyzine 50mg.""Droperidol Diluents: D5W, NS [1 to 3 mg] [50 ml] [30 min] [4-10 mg] [100 ml] [As directed] ------Continuous infusion------ [25 mg] [500 ml] [As directed] Inapsine Stability/Miscellaneous EXP: 1 DAY (RT) [Supplied: 1 mg/ml amp] Dosing: Life-threatening arrhythmia: usually 1- 3 mg (maximum rate: 1 mg/min)-may dilute in D5W-50ml. After 3 mg infused, may repeat in 2 minutes. Subsequent doses no sooner than 4 hours. May start IV infusion: usual rate: 2 to 3 mg/hr. Titrate to HR/BP. Oral to IV conversion: An equivalent IV dose cannot be predicted with any precision because of the highly variable metabolic and bioavailability characteristics of oral propranolol, as well as significant variability in patient response. Therefore, careful titration of an IV dose is necessary (start continuous infusion: 2 to 3 mg/hr-titrate to HR/BP). Average bioavailability of oral propranolol: (30-40%) ( range: 16-60%). Propranolol is well absorbed, however, there is an extensive first pass metabolism. Variations in metabolism result from differences in hepatic blood flow, intrinsic clearance, genetic makeup, etc."Propranolol Usual diluents: NS, D5W [1 mg] [50 ml] [10-15 min] [15 mg] [250ml] [Titrate] Inderal Stability/Miscellaneous Stability: Use immediately. Infusion should begin within 3 hours of preparation. Label: Do not shake. Must use Filter Reconstitute each vial with 10 ml of sterile water for injection using a syringe with a 21-gauge needle or smaller. Direct stream to sides of vial. Do not use if vacuum not present in vial. Gently swirl solution by rotating vial to dilute; do not shake. May foam upon reconstitution; allow to stand for 5 minutes. Solution is colorless to light yellow and opalescent; a few translucent particles may develop as infliximab is a protein. Do not use if opaque particles, discoloration, or other particles occur. Do not reuse or store any portion of infusion. Use an in-line, sterile, non-pyrogenic, low protein-binding filter with 1.2 micron pore size or less. Supplied: 100mg vial (refrigerate) ""Usual diluents: NS [Prescribed dose [250 ml] [2 hours] Recommended conc: 0.4 to 4 mg/ml Infusions less than 2 hours are not recommended. Infliximab EXP: 1 Day (RT). Label: Do not refrigerate/ Protect from light. Supplied: [100mg/20 ml ampule] Dosing: ini 0.75 mg/kg IV bolus over 2-3 minutes, then start maintenance infusion of 5 - 10 mcg/kg/min. Additional bolus of 0.75 mg/kg may be given 30min after therapy starts. Max dose/day: 10 mg/kg.""Inamrinone Usual diluents: NS Total Volume = 300 ml [300 mg][240 ml][Titrate] Minimum dilution (Total Vol: 120 ml): [300 mg][60 ml][Titrate]Inocor Stability/Miscellaneous EXP: 1 DAY (RT/REF) ""Usual diluents: NS Usual final concentrations: 0.5 unit/ml or 1 unit/ml (ICU's only) [120 units/ 240 ml] [Titrate] [100 units] [100 ml] [Titrate] Insulin Stability/Miscellaneous Indications: Treatment of patients with acute coronary syndrome (unstable angina or Non-Q wave MI). Administration: Bolus: withdraw dose from 10ml vial and give by ivpush over 1-2 minutes. Continuous infusion: administer calculated rate directly from 100ml vial. [Supplied: 0.75 mg/ml (100ml) vial; 20 mg/10 ml vial. (REF) ] Properties: Onset: within 1 hr T1/2: 2.5 hours Platelet function restored in @ 4hours after discontinuation. Acute Coronary Syndrome Patients with serum creatinine < 2.0 mg/dL: IV bolus of 180 g/kg as soon as possible following diagnosis, followed by a continuous infusion of 2.0 g/kg/min until hospital discharge or initiation of CABG surgery, up to 72 hours. If a patient is to undergo a percutaneous coronary intervention (PCI) while receiving eptifibatide, the infusion should be continued up to hospital discharge, or for up to 18-24 hours after the procedure, whichever comes first, allowing for up to 96 hours of therapy. Patients weighing more than 121 kg should receive a maximum bolus of 22.6 mg followed by a maximum infusion of 15 mg per hour. If the serum creatinine is between 2.0 and 4.0 mg/dL: Give an IV bolus of 180 g/kg as soon as possible following diagnosis, immediately followed by a continuous infusion of 1.0 g/kg/min. Patients with serum creatinine between 2.0 and 4.0 mg/dL and weighing more than 121 kg should receive a maximum bolus of 22.6 mg followed by a maximum infusion rate of 7.5 mg per hour. Percutaneous Coronary Intervention (PCI) The recommended adult dosage of eptifibatide in patients with a serum creatinine <2.0 mg/dL initiated at the time of PCI is an intravenous bolus of 180 g/kg administered immediately before the initiation of PCI followed by a continuous infusion of 2.0 g/kg/min and a second 180 g/kg bolus 10 minutes after the first bolus. Infusion should be continued until hospital discharge, or for up to 18 to 24 hours, whichever comes first. A minimum of 12 hours of infusion is recommended. Patients weighing more than 121 kg should receive a maximum of 22.6 mg per bolus followed by a maximum infusion rate of 15 mg per hour. Patients with a serum creatinine between 2.0 and 4.0 mg/dL initiated at the time of PCI is an intravenous bolus of 180 g/kg administered immediately before the initiation of the procedure, immediately followed by a continuous infusion of 1.0 g/kg/min and a second 180 g/kg bolus administered 10 minutes after the first. Patients with a serum creatinine between 2.0 and 4.0 mg/dL and weighing more than 121 kg should receive a maximum of 22.6 mg per bolus followed by a maximum infusion rate of 7.5 mg per hour.""Eptifibatide [100 ml vial (0.75 mg/ml)] [100 ml vial (2.0 mg/ml)] Administer directly from vial. (No dilution required) Infusion rate: as directedIntegrilin Stability / Miscellaneous: Stability: 6 hours RT / 24 hours REF. Label: Refrigerate. Preparation: (IV): Reconstitute 1 gram vial with 10 mL of Water for Injection, 0.9% Sodium Chloride Injection, or Bacteriostatic Water for Injection and then add contents to 50 ml normal saline. Complete the infusion within 6 hours of reconstitution. (IM): Reconstitute 1 gram vial with 3.2 mL of lidocaine 1% injection without epinephrine. Give deep IM into a large muscle mass (gluteal or lateral aspect of thigh). Administer solution within 1 hour of preparation. DO NOT give this solution Intravenously Dosing: 1 gram IV or IM q24h. Renal dosing: CRCL: >/= 30 ml/min: no changes. < 20-30 ml/min: 0.5 grams IM or IV q24h. ""Ertapenem Sodium Usual diluents: NS [1 gram] [50 ml] [30 min] Invanz Stability/Miscellaneous Parenteral iron treatment should be administered only when iron deficiency is not correctable with oral treatment. A test dose of 25 mg infused over 5 minutes should be given. Infusion should then be stopped for 1 hour. If there is no reaction after 1 hour continue. Fatal anaphylactic reactions are possible. May also be given IM or slow IVP (1 ml/min x 2 min = 100 mg). Epinephrine should be immediately available. Total amount of iron dextran required in ml (Total dose infusion) = 0.0442 (14.8 - observed Hgb) x IBW + (0.26 x IBW). Parenterally administered iron does not give a faster response compared to oral administration, therefore, the rate of recovery from anemia should be the same. Reticulocyte count will increase in 3-4 days and peak in 7-10 days. ""Imferon Usual diluents: NS (Test dose) [25 mg] [100 ml] [5 min] [Prescribed dose] [250 to 1000ml] (Usually 500 ml NS) Total dose infusion: infuse over 2 to 6 hours. Iron DextranStability/Miscellaneous EXP: 1 DAY (RT). (B1/B2) agonist. IV infusion: 2 to 20 mcg/ min. Usual initial rate: 5 mcg/min. Titrate to HR/BP. May give IV-push (must use 1:50,000 dilution). Calculation of drip rate: 1 mg/250 ml (ml/hr) = 15 x mcg/min. eg: 5 mcg/min = 75 ml/hr ""Isuprel Usual diluents: D5W, NS [1 mg] [250 ml] [Titrate] [1 - 2 mg] [250-500 ml] [Titrate]IsoproterenolStability/Miscellaneous EXP: 1 DAY (RT). (B1/B2) agonist. IV infusion: 2 to 20 mcg/ min. Usual initial rate: 5 mcg/min. Titrate to HR/BP. May give IV-push (must use 1:50,000 dilution). Calculation of drip rate: 1 mg/250 ml (ml/hr) = 15 x mcg/min. eg: 5 mcg/min = 75 ml/hr ""Isoproterenol Usual diluents: D5W, NS [1 mg] [250 ml] [Titrate] [1 - 2 mg] [250-500 ml] [Titrate]Isuprel Stability/Miscellaneous EXP: 1 DAY (RT). Supplied: 1 mg/ml vial. Dosage: 10 mcg/kg IV over 5 minutes, 30 minutes prior. ""Granisetron Usual diluents: D5W, NS [0 to 1 mg] [50 ml] [5 min]Kytril Stability/Miscellaneous EXP: 1 DAY (RT) Label: Concentration=1 mg/ ml Supplied: 100 mg/20 ml vial. Dosing: initially 20 mg IV push over 2 minutes. May repeat 20 to 80 mg q10 minutes (up to 300 mg total dose) until desired BP is reached or start continuous infusion: 2 mg/min (range: 1 to 3 mg/min)--titrate to blood pressure. "Usual diluents: D5W, NS Final concentrations: 1 mg/ml Total volume= 200ml: [200 mg] [160 ml] [Titrate] Total volume= 300ml [300 mg] [240 ml] [Titrate] Total volume= 600ml: [600 mg] [480 ml] [Titrate]LabetalolStability/Miscellaneous Immediate use is recommended. Minimum of a 4-fold dilution. Loading dose: CHF: 8-12 mcg/kg in divided doses (q4-8h) over 12 to 24 hours. [Normally, give 50% of the total digitalizing dose in the initial dose, then give 25% of the total dose in each of the two subsequent doses at 8 to 12 hr intervals--Obtain EKG 6 hours after each dose to assess potential toxicity (AV block, sinus bradycardia, atrial or nodal ectopic beats, ventricular arrhythmias); Other: vision changes, confusion.] If patent has renal insufficiency give 6 to 10 mcg/kg IBW. A-fib: 10 to 15 mcg/kg IBW given as above. (If given IVPush - administer over at least 5 minutes). Avoid IM injections-can lead to severe pain (If it must be given by this route, give deep IM followed by massage). Monitoring: Obtain blood samples at least 4 hours after IV dose and 6-8hours after oral dose. Serum levels: 0.5 to 2.5 ng/ml Onset/peak: IV: 5-30min/ 1-4hours Oral: 1-2hours/ 2-8 hours. Time to steady state: 5-7 days (average) ESRD: 15-20 days. Half-life: 38-48 hours. (anephric: 4-6 days). Conversion from oral to IV: Decrease IV dose by 20 to 25%. When the maintenance dose is given IV, the onset and peak will occur earlier, however the duration of action is the same. Patients' on the floors may receive once daily IV maintenance doses, however, IV loading regimens (multiple doses) are restricted to patients on a monitor- ICU's. [Oral bioavailability (tablets): 70 to 80%].""Digoxin Diluents: NS, D5W [All doses] [50 ml] [15 min]Lanoxin Stability / Miscellaneous IMPORTANT: See Package insert for instructions for Priming the finished admiture and using the provided filter. Stability: 24 hours (room temperature): if diluted with NS or LR. 12 hour stability if diluted with D5W. Label: Do not refrigerate. // IN-LINE FILTER MUST BE USED. Reconstitution in Vial and Preparation of Admixture: There are two steps for preparing Prevacid I.V. for Injection. STEP ONE - Reconstitution in Vial - First Prevacid I.V. MUST be reconstituted with Sterile Water for Injection, USP. - Inject 5 mL of ONLY Sterile Water for Injection, USP into a 30 mg vial of PREVACID I.V. for Injection. The resulting solution will contain lansoprazole 6 mg/mL (30 mg/5 mL). - Failure to reconstitute with Sterile Water may result in formation of precipitation/particulates. - Mix gently until the powder is dissolved. The pH of this reconstituted solution is approximately 11. The reconstituted solution can be held for 1 hour when stored at room temperature prior to further dilution. STEP TWO - Preparation of Admixture - Dilute the reconstituted solution in either 50 mL of 0.9% Sodium Chloride, Lactated Ringers Injection, USP, or 5% Dextrose Injection, USP. Prevacid IV Usual Diluents NS, LR, D5W Standard Dilutions: [30 mg] [50 ml] [30 min] ------------------------------ Unlabeled Use: GI Bleed Bolus dose: [60 mg] [100 ml] [60 min] Continuous infusion: [60 mg] [100 ml] [10ml/hr] = 6 mg/hr. LansoprazoleStability/Miscellaneous EXP: 1 DAY (RT). Label: Do not Refrigerate. Recommended routes: IM, IV-push, Continuous infusion. Doses up to 6 grams/day have been used in patients with renal failure. Dosing: 20 to 40 mg initially. Increase by 20 mg increments q1 to 2 hours until response. Continuous infusion: 20 to 160 mg/hr. IV bolus: Usual doses (eg <80 mg) can be given slowly over 1-2 minutes. If higher doses are needed, a continuous infusion is recommended-usually greater efficacy as well as decreased risk of side effects.""Furosemide Usual diluents: D5W, NS [All doses] [50 ml] [As directed] May administer undiluted. Maximum rate = 4mg/ min IV.Lasix Stability/Miscellaneous EXP: 1 DAY (RT). Recombinant hirudin derived from yeast cells. Used for treatment of disseminated intravascular coagulation, in particular heparin-induced thrombocytopenia type II. Mechanism of action: reacts with thrombin in a 1:1 molar ratio to form a noncovalent complex; directly inhibits all actions of thrombin. There is no physiologic inhibitor of lepirudin. Lepirudin provides more stable level of anticoagulation than heparin. Lepirudin does not require endogenous cofactors and acts independently of antithrombin-III. Preparation: Bolus dose: use concentration of 5 mg/ml. Dilute 50mg vial with 1 ml NS or sterile water, then transfer to at least 10 ml syringe and qs to 10ml with sterile water, NS or D5W. Continuous infusion: Dilute two 50mg vials, each with 1 ml sterile water or NS and add to 250 or 500ml bag of D5W or NS. (Concentration: 0.2 or 0.4 mg/ml)"Refludan Usual diluents: D5W, NS [100 mg] [250 ml] [As directed] (Concentration: 0.4 mg/ml) [100 mg] [500 ml] [Titrate] (Concentration: 0.2 mg/ml) UD D5W / NS Lepirudin Stability/Miscellaneous EXP: 3 DAYS (RT) /14 DAYS (REF) Label: Refrigerate. Usual dose: 500mg orally or ivpb q24h. UTI or pyelonephritis: 250mg orally/ivpb q24h."Levofloxacin Usual diluents: D5W, NS [250 mg] [40 ml] [60 min] [500 mg] [80 ml] [60 min]Levaquin Stability/Miscellaneous EXP: 3 DAYS (RT) /14 DAYS (REF) Label: Refrigerate. Usual dose: 500mg orally or ivpb q24h. UTI or pyelonephritis: 250mg orally/ivpb q24h. "Levaquin Usual diluents: D5W, NS [250 mg] [40 ml] [60 min] [500 mg] [80 ml] [60 min]LevofloxacinStability/Miscellaneous EXP: 1 DAY (RT). Used to maintain BP in hypotensive states. Most potent vasoconstrictor (Norepi >>> phenylephrine). Dosage (initial): 8 to 12 mcg/min -titrate to BP(Usual target: SB:80-100 or MAP=80). Usual maintenance: 2 to 4 mcg/min. Note: doses as high as 0.5 to 1.5 mcg/kg/min for 1-10days have been used in septic shock. Calculation of drip rate 8 mg/ 250 ml (ml/hr) = mcg/min x 1.875. Administer through a central line (large vein). "Norepinephrine Usual diluents: D5W Standard: [8 mg] [250 ml] [Titrate] Range: [4 to 32 mg] [250 ml] [Titrate] Central line required for administration. Levophed Stability/Miscellaneous Mix on floor just prior to administration. Normally given IV-push. "Synthroid Usual diluents: NS [Prescribed dose][50ml] [10-15 min]Levothyroxine Stability/Miscellaneous Maximum concentration: 8 mg/ml Dosing: Treat Vtach / V fib: 50 to 100mg (1 to 1.5 mg/kg) IV bolus (25 to 50 mg/min) Decrease by 50% in elderly /CHF /Hepatic disease. Repeat bolus q3 to 5min until arrhythmia subsides or side effects (convulsions /hypo-tension /bradycardia). Do not exceed 3 mg/ kg bolus in a 1 hour period. IV infusion: 1 to 4 mg/ min. Calculation of drip rate: 1 gram/250 ml (ml/hr) = mg/min x 15. Decrease rate by 50% after 24 hours."Xylocaine Usual diluents: D5W, NS [2 grams] [250 ml] [As directed] [1-2 grams] [250-500 ml][As directed]Lidocaine Stability/Miscellaneous Usual dose: 600 mg q12 hours for 10 to 28 days. Store at room temperature / Protect from light / Do not freeze. Dosage adjustment not required in renal failure. ZYVOX has been shown to be clinically active against key Gram-positive pathogens, including vancomycin-resistant strains of Enterococcus species (VRE). "Zyvox (Pre-made) Isotonic D5W [600 mg] [300 ml] [60 min] [400 mg] [200 ml] [60 min] (Infusion range: 30-120 min)LinezolidStability/Miscellaneous EXP: 1 DAY (RT). The dilutions listed are conservative guidelines that can be used in non-acute conditions. The infusion times were formulated to mimic the onset of an oral formulation. (@ onset-oral= 45-60min). Oral to IV conversion (2.5 to 1) : eg 50mg oral=20mg IV (equivalent beta-blockade). Lopressor may be given by IV bolus (HR, BP, and EKG should be carefully monitored). IV therapy permits rapid control of HR and contractility. Post MI (early tx): 5 mg IV bolus x 3 doses q2 minutes. In patients who tolerate full 15 mg dose, oral lopressor 50mg po q6h should be started 15 min after last IV dose x 48 hours. Unstable angina: 5 mg IV bolus x3 q2min f/b 2 to 5 mg hourly titrated to min HR of 55 to 60 BPM or min systolic BP of 80 . May switch to oral dosing (50 to 100mg po q6h) after IV bolus therapy. Supraventricular tachycardias(PAT, A-fib/flutter): 5 to 15 mg (usually 5 mg) over 2.5 min at 7.5min intervals-usually a high response rate."Metoprolol Usual diluents: D5W, NS [0 to 20 mg] [50 ml] [30 min] [21 to 40 mg] [100 ml] [60 min]Lopressor Stability/Miscellaneous EXP: 1 DAY (RT) Label: Do not Refrigerate /An in-line 0.22u filter should be used. Concentrations recommended by the manufacturer: 0.1 , 0.16, or 0.2 mg/ml. May also dilute 4 mg/ml and 2 mg/ml vials 1:1 with D5W or NS. Do not send if solution is yellow or contains a precipitate. Maximum infusion rate: 2 mg/min. Maximum dose/day: 480 mg (20 mg/hr). Dosing: Status epilepticus: 4 mg IV push (range: 2 to 8 mg). May repeat q5 to 15 minutes. Monitor patient for acidosis."Ativan Usual Diluents D5W, NS Standard Dilutions: Dilute 2 mg/ml (10 ml vials) or 4 mg/ml (10 ml) vials 1:1 with D5W or NS. May add to viaflex bag. Alternatively: Glass bottle: 40 mg/250 ml (250ml D5W). Infusion Rate: As directed. (See comments). Primary: Dilution for 2 mg/ml - 10 ml vials. = Final Concentration 1 mg/ml == 20 mg/20 ml (10 ml diluent + 10ml of drug) Total volume =20ml. 40 mg/ 40 ml (20 ml diluent + 20ml of drug) Total volume =40ml. 80 mg/ 80 ml (40 ml diluent + 40ml of drug) Total volume =80ml. Lorazepam Stability/Miscellaneous 1 gram = 8.12 meq. Maximum rate: 1 gram/ 7 minutes. Normal range:1.5 to 2.5 meq/L or 1.7 to 2.6 mg/dl. Magnesium content: Mag Oxide: 49.6 meq/gram Mag Gluconate: 4.5 meq/gram MOM: @ 13.4 meq/5 ml"Usual diluents: D5W, NS [1 gram] [ 50 ml] [30 min] [2 grams] [100 ml] [60 min] [3 grams] [100 ml] [2 hours] [4 grams] [250 ml] [3 hours]Magnesium SulfateStability/Miscellaneous Label: Do not Refrigerate. Note: Diluted soln's of mannitol are less likely to crystallize, especially if the final concentration is less than 15%. An administration set with a filter should be used for infusions containing 20% or more of mannitol. At concentrations of 15% or greater, mannitol may crystallize at low temperatures. Dosing: Oliguria: 50 to 100 grams (15 to 25% soln) over 90 minutes to several hours. Test dose may be given: 12.5 g over 3 to 5 min. May repeat. Usual adult dosage ranges (50 to 200 g/ 24hrs)."Usual diluents: D5W Using 12.5 gram(50 ml vials) [12.5 grams] [33 ml] (15%) [25 grams] [67 ml] (15%) [50 grams] [133 ml] (15%) [12.5 -100 grams][empty viaflex] See commentsMannitol Stability/Miscellaneous EXP: 24 hr (RT) / 7 Days (REF). Label: Refrigerate. IM Injection: 500mg vial/ 1.3 ml; 1 gram vial/ 2.4 ml (Sterile H2O; BS-SW; Lidocaine 0.5 to 1%; Normal saline). Mild to moderate infection: 500mg to 2 g IV q12h. Severe: 2 g IV q8h.""Cefepime HCL Usual diluents: D5W, NS [0 to 2 grams] [ 50 ml] [30 min]Maxipime Stability/Miscellaneous EXP: 1 Day (RT)/ 7 Days (REF). Label: Refrigerate. IM injection: 1 gram/ 2ml ; 2 grams/ 4 ml. (Sterile water or lidocaine 0.5-1%). Usual dose 1g q6-8h. Moderate-severe: 2g q6-8h. Severe: 2 grams q4h.""Cefoxitin Usual diluents: D5W, NS [0 to 1 gram] [50 ml] [30 min] [Over 1 gram] [100 ml] [30 min]Mefoxin Stability/Miscellaneous EXP: 2 hr (RT)/18 hours (REF) in saline. vs 8 hr stability in D5W. Label: Refrigerate. Reconstitute 500mg vial with 10 ml; 1 gram vial with 20ml."Merrem Usual diluents: NS, D5W [0.5 - 1 gram] [100 ml] [30 min] (Minimum volume= 50 ml) MeropenemStability/Miscellaneous EXP: 2 hr (RT)/18 hours (REF) in saline. vs 8 hr stability in D5W. Label: Refrigerate. Reconstitute 500mg vial with 10 ml; 1 gram vial with 20ml. "Meropenem Usual diluents: NS, D5W [0.5 - 1 gram] [100 ml] [30 min] (Minimum volume= 50 ml) Merrem Stability/Miscellaneous Dosing: usual dose=20% of ifosfamide dose given just before and 4 and 8 hours after ifosfamide (total=60%). May also be given as a continuous IV infusion concurrently with ifosfamide. Total daily dose= 60% to 160% of ifosfamide dose or 60% to 200% of cyclophosphamide dose. May give 20% W/W 15min prior, and then q3hrs x 3-6 doses. Administration: IVPB in 50 ml or more of D5W or normal saline over 5 minutes or longer. Also by continuous IV infusion. Storage/stability: Vials stored at RT. Diluted solutions (1-20 mg/ml)-24 hrs (REF). 20 mg/ml (D5W)-48hrs RT; 1-mg/ml (D5W)-24 hours RT. Preparation: May be further diluted in D5W, NS, D5/.45NS, or LR to a final concentration of 1-20 mg/ml. Availability: 2-,4-,10-ml ampules (100mg/ml)"Mesnex Usual diluents: D5W, NS [Usual dose] [100 ml] [15-30min] (Concentration range: 1-20 mg/ml)MesnaStability/Miscellaneous Dosing: usual dose=20% of ifosfamide dose given just before and 4 and 8 hours after ifosfamide (total=60%). May also be given as a continuous IV infusion concurrently with ifosfamide. Total daily dose= 60% to 160% of ifosfamide dose or 60% to 200% of cyclophosphamide dose. May give 20% W/W 15min prior, and then q3hrs x 3-6 doses. Administration: IVPB in 50 ml or more of D5W or normal saline over 5 minutes or longer. Also by continuous IV infusion. Storage/stability: Vials stored at RT. Diluted solutions (1-20 mg/ml)-24 hrs (REF). 20 mg/ml (D5W)-48hrs RT; 1-mg/ml (D5W)-24 hours RT. Preparation: May be further diluted in D5W, NS, D5/.45NS, or LR to a final concentration of 1-20 mg/ml. Availability: 2-,4-,10-ml ampules (100mg/ml)"Mesna Usual diluents: D5W, NS [Usual dose] [100 ml] [15-30min] (Concentration range: 1-20 mg/ml)Mesnex Stability/Miscellaneous EXP: 1 DAY (RT)"Aldomet Usual diluents: D5W [0 to 500 mg] [100 ml] [60 min] [over 500 mg] [250 ml] [60 min]MethyldopateStability/Misc Methylpred dose/ 0.8 =prednisone dose EXP: 1 DAY (RT) Label: Do not Refrigerate. May be given IM, IVpush, or IVPB. High dose: 30 mg/kg over 30 minutes (may rpt q4-6h) in a 48hr period. Asthma: 2 mg/ kg q4 -6h until severe symptoms controlled, then reduce dose. MS acute exacerbation: 500 mg once daily x 5 days. PCP: 40 to 60 mg every 6 hours or pulse dosing: 250 to 1000mg once daily x 3 to 5 days. Spinal cord injury: 30 mg/kg (over 15 to 30 minutes) then 5.4 mg/ kg/ hr x 23 hours. (higher doses possible). Medrol dose pack: (4mg tab # 21): Day#1: 2 tabs before breakfast, 1 tab after lunch & dinner, and 2 tabs at bedtime. (Total=6 tabs) If received later in the day, may take all 6 tablets at once or in divided doses. Day#2: 1 tab before breakfast, 1 tab after lunch & dinner, and 2 tablets at bedtime. Day#3: Same as day#2 except 1 tab at bedtime. Day#4: 1 tab before breakfast, after lunch and at bedtime. Day#5: 1 tab after breakfast and at bedtime. Day#6: 1 tab after breakfast."Solu Medrol Usual diluents: D5W, NS [60 -100 mg] [50 ml] [30 min] [101-500mg] [100ml][As directed] [501-1250mg][250ml][As directed]MethylprednisoloneStability/Miscellaneous EXP: 1 DAY (RT). Dosing: GI hypomotility: 10mg (PO/IM/IV) 30min AC & hs. Antiemetic: 1-2 mg/kg IV 30min prior to chemo, then q2-4hr. Crcl [10-40]- decrease dose by 50%. [<10]--75% decrease."Reglan Usual diluents: D5W [All doses] [50 ml] [30 min]Metoclopramide Stability/Miscellaneous EXP: 1 DAY (RT). The dilutions listed are conservative guidelines that can be used in non-acute conditions. The infusion times were formulated to mimic the onset of an oral formulation. (@ onset-oral= 45-60min). Oral to IV conversion (2.5 to 1) : eg 50mg oral=20mg IV (equivalent beta-blockade). Lopressor may be given by IV bolus (HR, BP, and EKG should be carefully monitored). IV therapy permits rapid control of HR and contractility. Post MI (early tx): 5 mg IV bolus x 3 doses q2 minutes. In patients who tolerate full 15 mg dose, oral lopressor 50mg po q6h should be started 15 min after last IV dose x 48 hours. Unstable angina: 5 mg IV bolus x3 q2min f/b 2 to 5 mg hourly titrated to min HR of 55 to 60 BPM or min systolic BP of 80 . May switch to oral dosing (50 to 100mg po q6h) after IV bolus therapy. Supraventricular tachycardias(PAT, A-fib/flutter): 5 to 15 mg (usually 5 mg) over 2.5 min at 7.5min intervals-usually a high response rate."Lopressor Usual diluents: D5W, NS [0 to 20 mg] [50 ml] [30 min] [21 to 40 mg] [100 ml] [60 min]Metoprolol Stability/Miscellaneous Label: Do not Refrigerate. Reconstituted vials must be neutralized with 5 meq sodium bicarbonate for each 500 mg used. "Flagyl Usual diluents: NS [500 mg] [100 ml] [60 min] [Over 500 mg] [250 ml] [60 min]Metronidazole Stability / Miscellaneous Stability: 24 hours room temperature. Label: Protect from light. Indications: Treatment of patients with esophageal candidiasis: 150mg qd. Prophylaxis of Candida infections in patients undergoing hematopoietic stem cell transplantation: 50 mg qd. The diluent to be used for reconstitution and dilution is 0.9% Sodium Chloride Injection, USP (without a bacteriostatic agent). Alternatively, 5% Dextrose Injection, USP, may be used for reconstitution and dilution of MYCAMINE. Do not mix or co-infuse MYCAMINE with other medications. Reconstitution: MYCAMINE 50 mg vial: Aseptically add 5 mL of 0.9% Sodium Chloride Injection, USP (without a bacteriostatic agent) to each 50 mg vial to yield a preparation containing approximately 10 mg micafungin/mL. Dissolution: To minimize excessive foaming, GENTLY dissolve the MYCAMINE powder by swirling the vial. DO NOT VIGOROUSLY SHAKE THE VIAL.Visually inspect the vial for particulate matter. MYCAMINE is preservative-free. Discard partially used vials. HOW SUPPLIED: MYCAMINE is available in cartons of 10 individually packaged 50 mg single -use vials, coated with a light protective film and sealed with a blue flip-off cap. MYCAMINE is a trademark of Astellas Pharma, Inc., Tokyo , Japan."Mycamine Usual Diluents NS or D5W Standard Dilutions: [ 50 mg ] [ 100 ml] [ 1 hour] [ 150 mg ] [100 ml] [1 hour] Reconstitute each 50mg vial with 5 ml 0.9% Sodium Chloride Injection, USP (without a bacteriostatic agent).Micafungin SodiumStability/Miscellaneous EXP: 1 DAY (RT). Usual dose requested: 1 to 5 mg/hr Status epilepticus: 0.1 to 0.35 mg/kg load, followed by continuous infusion: 0.05 to 1.08 mg/kg/hr (possibly up to 2? Based on EEG). Mechanical ventilator patient: usually 0.05 to 0.2 mg/kg/hr for sedation. Maximum dose: In isolated reports, midazolam has been given in doses ranging from 0.3 to 0.85 mg/kg/hr (20 to 55 mg/hr) without respiratory depression or decreased BP. Decrease dose by 50% for patients with renal failure. [Little support for doses > 0.35 mg/kg/hr-disregarding limited case studies.] "Versed Usual diluents: D5W, NS ICU only [100 mg] [100 ml] [Titrate] [0 to 100 mg] [100 ml] [Titrate] Midazolam Stability/Miscellaneous EXP: 3 DAYS (RT). Dosing: initially give loading dose: 50 mcg/kg IV over 10 minutes, followed by continuous infusion: 0.375 to 0.75 mcg/kg/min (usually 0.5 mcg/kg/min). Lower doses are required in renal failure (0.2 to 0.23 mcg/kg/min for crcl <10 ml/min, crcl 10-30 ml/min-0.23 to 0.33 mcg/kg/min). Venodilator: 0 Arterial dilator: ++ Inotropic effect: +++ Calculation of drip rate: 50 mg/250ml (ml/hr) = wt (kg) x 0.3 x mcg/kg/min "Primacor Usual Diluents: D5W, NS Remove 50 ml from 250ml bag. (Final volume =250 ml) [50 mg] [200 ml] [Titrate]Milrinone Stability/Miscellaneous Exp: 7 days (RT / REF). Some studies indicate stability up to 30 days. Usual rate: 1 to 10 mg/hr. "Usual diluents: D5W, NS [50 mg] [50 ml] [As directed] [100 mg] [100 ml] [As directed]Morphine Sulfate Stability / Miscellaneous Stability: 24 hours room temperature. Label: Protect from light. Indications: Treatment of patients with esophageal candidiasis: 150mg qd. Prophylaxis of Candida infections in patients undergoing hematopoietic stem cell transplantation: 50 mg qd. The diluent to be used for reconstitution and dilution is 0.9% Sodium Chloride Injection, USP (without a bacteriostatic agent). Alternatively, 5% Dextrose Injection, USP, may be used for reconstitution and dilution of MYCAMINE. Do not mix or co-infuse MYCAMINE with other medications. Reconstitution: MYCAMINE 50 mg vial: Aseptically add 5 mL of 0.9% Sodium Chloride Injection, USP (without a bacteriostatic agent) to each 50 mg vial to yield a preparation containing approximately 10 mg micafungin/mL. Dissolution: To minimize excessive foaming, GENTLY dissolve the MYCAMINE powder by swirling the vial. DO NOT VIGOROUSLY SHAKE THE VIAL.Visually inspect the vial for particulate matter. MYCAMINE is preservative-free. Discard partially used vials. HOW SUPPLIED: MYCAMINE is available in cartons of 10 individually packaged 50 mg single ??use vials, coated with a light protective film and sealed with a blue flip-off cap. MYCAMINE is a trademark of Astellas Pharma, Inc., Tokyo , Japan. "Micafungin Sodium Usual Diluents NS or D5W Standard Dilutions: [ 50 mg ] [ 100 ml] [ 1 hour] [ 150 mg ] [100 ml] [1 hour] Reconstitute each 50mg vial with 5 ml 0.9% Sodium Chloride Injection, USP (without a bacteriostatic agent). Mycamine Stability/Miscellaneous EXP: 1 DAY (RT) ;7 DAYS (REF) Label: Refrigerate. IM injection: 500 mg vial/ 1.8 ml SW or BS-SW or NS. 1 gram/ 3.4 ml. 2 gram vial/ 6.6 ml. Mild to moderate infection: 500mg to 1 gram ivpb q4h or 1-2g ivpb q6h. Severe: 1-2g ivpb q4h. Renal dosing: No dosage changes required for renal failure. || Renal + Hepatic dysfcn: decrease dose by 50%. "Usual diluents: D5W, NS [0 to 1 gram] [50 ml] [30 min] [Over 1 gram] [100 ml] [60 min]NafcillinStability/Miscellaneous Dosing: Treatment of narcotic-induced respiratory depression: 0.4 to 2 mg IV / SC/ IM repeat q2 to 3 minutes prn (if no response after 10 mg --- questionable narcotic ingestion). IV infusion: ( 2 mg/500 ml per manufacturer) Usual infusion rate: @ 0.4 mg/hr (100 ml/hr)-titrate to respiratory rate/ level of consciousness."Narcan Usual diluents: D5W, NS [2 mg] [500 ml] Fluid restricted: [4 mg] [250 ml] [Titrate] Usual rate: 0.4 mg/hrNaloxone Stability/Miscellaneous Dosing: Treatment of narcotic-induced respiratory depression: 0.4 to 2 mg IV / SC/ IM repeat q2 to 3 minutes prn (if no response after 10 mg --- questionable narcotic ingestion). IV infusion: ( 2 mg/500 ml per manufacturer) Usual infusion rate: @ 0.4 mg/hr (100 ml/hr)-titrate to respiratory rate/ level of consciousness."Naloxone Usual diluents: D5W, NS [2 mg] [500 ml] Fluid restricted: [4 mg] [250 ml] [Titrate] Usual rate: 0.4 mg/hrNarcan Stability/Miscellaneous Restrictions: Restricted to Cardiology Consult Preparation: Reconstitute one 1.5-mg vial of Natrecor by adding 5 mL of diluent removed from a pre-filled 250-mL plastic IV bag containing the diluent of choice. The following preservative-free diluents are recommended for reconstitution: 5% Dextrose Injection (D5W), USP; 0.9% Sodium Chloride Injection, USP; 5% Dextrose and 0.45% Sodium Chloride Injection, USP, or 5% Dextrose and 0.2% Sodium Chloride Injection, USP. Do not shake the vial. Rock the vial gently so that all surfaces, including the stopper, are in contact with the diluent to ensure complete reconstitution. Use only a clear, essentially colorless solution. The IV bag should be inverted several times to ensure complete mixing of the solution. Label: Monitor BP closely. Stability: (reconstituted vials / solutions): 24 hours RT or REF. Dosing: IV bolus of 2 g/kg (over 1 minute) followed by a continuous infusion of 0.01 mcg/kg/min. Withdraw bolus dose from the infusion bag. Higher initial dosages are not recommended. Calculation: Bolus Volume (mL) = 0.33 ?????? Patient Wt (kg). Infusion Rate (mL/hr) = 0.1 ?????? Patient wt (kg). There is limited experience with administering Natrecor for longer than 48 hours. Indications: IV treatment of patients with acutely decompensated CHF who have dyspnea at rest or with minimal activity. Actions: venous and arterial vasodilation (decreased PCWP etc), plus mild diuretic effect."Nesiritide Usual diluents: D5W, NS, D5-1/2NS [1.5 mg] [250 ml] [As directed]Natrecor Stability/Miscellaneous EXP: 12 to 24 hrs (RT). Label: Do not refrigerate. Onset: 15-60 min Duration: (Oral): 1-4 hrs (IV): 15 min May be given deep IM (max 250mg per site) or by slow IV injection. Note: can be given IV undiluted. Dosing: Hypnotic (Adult): Oral: 100-200mg qhs. IM: 150-200mg. IV: Initially 100mg, may repeat q1-3min up to 200-500mg total dose. Rectal: 120-200mg at bedtime. Preoperative sedation: IM: 150-200 mg. Barbiturate coma in head injury patients: IV loading dose of 5-10 mg/kg over 1 to 2 hours. Maintenance: Initial: 1 mg/kg/hr; may increase to 2-3 mg/kg/hr. Monitor for dose-dependent cardiovascular and respiratory depression. Maintain ser