IV meds

PHENYLEPHRINE - ICU Neosynephrine ® (mcg/min) Need to change to mcg/min in VISICU

ACTION: Stimulated smooth muscle alpha-adrenergic receptors which results in increased peripheral resistance and increased blood pressure. Vasopressor, used for hypotension. CONCENTRATION: 40 mg in 250 cc NS FORMULA EXAMPLE: FOR 70 KG PT INFUSE 10 MCG/MIN Formula: (1 MCG/MIN =(0.37 ) X DOSE NEEDED = CC/HR 0.37 X 10 = 3.75 CC/HR DOSE: Begin infusion at 100-180 mcg/min until B/P stable. Or start at 10 mcg /min and rapidly Q5 min titrate to desired effect. Usual maintenance infusion range of 40-60 mcg/min. MAX DOSE: 200 mcg/min CONTRAINDICATIONS: • Narrow angle glaucoma • Severe Hypertension • Tachycardia COMPATIBLE: Fentanyl, Heparin, Versed, Levophed, Bicarb, Vasopressin INCOMPATIBLE: Insulin 

Dopamine (mcg/kg/min)

ACTION: Stimulates alpha, beta1- adrenergic, and dopaminergic receptors. An inotrope that enhances cardiac contractility, and therefore cardiac output. Used for cardiogenic and hypovolemic shock, hypotension and decreased CO. CONCENTRATION: 400mg in 250 ml D5W or NS EXAMPLE: FOR 70 KG PT INFUSE 5 MCG/KG/MIN Formula: (1 MCG/MIN = 0.0375 CC)) X (PT WEIGHT IN KG) x DOSE NEEDED = CC/HR (0.0375) X (70) X 5 = 13.1 CC/HR Low doses (dopaminergic): 2.5-5mcg/kg/min increases myocardial contractility, output without increasing heart rate or PVR. Moderate doses (beta 1 agonist): 5-10mcg/kg/min increases CO, peripheral and pulmonary vascular resistance and BP. High doses (alpha agonist): 10-50mcg/kg/min produces potent vasoconstriction and diminished renal and mesenteric perfusion. DOSE: Start at 2.5-5mcg/kg/min by continuous IV, increase by 5-10mcg up to 20- 50mcg/kg/min. Max Dose: Usual 20 mcg may go to 50 (If dosages >20-30 mcg/kg/minute are needed, a more direct-acting pressor may be more beneficial (i.e., epinephrine, norepinephrine) COMPATIBLE: Amiodarone, Cardizem, Dobutamine, Haldol, Heparin, Versed, Morphine, Ntg, Levophed, Diprivan INCOMPATIBLE: Insulin, Lasix 

antiarrhythmics amiodarone (Cordarone, Pacerone) sotalol (Betapace) propafenone (Rhythmol) *amiodarone

Antiarrhythmic drugs are medications that change the electrical properties of cardiac tissue, and by doing so, change the way the heart's electrical signal spreads across the heart. Since tachycardias are usually related to abnormalities in the electrical signal, drugs that alter the heart's electrical signal can often improve those arrhythmias. *This drug is the most effective one, and is less likely to cause arrhythmias than other drugs.

diuretics midamor bumex diuril lasix hydrochlorothiazide lozol spironolactone

Causes the body to rid itself of excess fluids and sodium through urination. Helps to relieve the heart's workload. Also decreases the buildup of fluid in the lungs and other parts of the body, such as the ankles and legs. Different diuretics remove fluid at varied rates and through different methods. Used to help lower blood pressure. Used to help reduce swelling (edema) from excess buildup of fluid in the body.

Nimbex® Cisatracurium Mg/kg BOLUS MCG/KG/MIN DRIP

USE: Adjunct to general anesthesia to facilitate endotracheal intubation and to relax skeletal muscles during surgery; to facilitate mechanical ventilation in ICU patients; does not relieve pain or produce sedation Onset of action: I.V.: 2-3 minutes Peak effect: 3-5 minutes DOSAGE: Intubating doses BOLUSES Initial dose after succinylcholine for intubation: 0.1 mg/kg; maintenance dose: 0.03 mg/kg 40-60 minutes after initial dose, then at ~20-minute intervals based on clinical criteria. Infusion : At initial signs of recovery from bolus dose, begin the infusion at a dose of 3 mcg/kg/minute and adjust rates accordingly; dosage ranges of 0.5-10 mcg/kg/minute have been reported. If patient is allowed to recover from neuromuscular blockade, readministration of a bolus dose may be necessary to quickly re-establish neuromuscular block prior to reinstituting the infusion. EXAMPLE: FOR 70 KG PT INFUSE 5 MCG/KG/MIN Formula: (0.6= 1mcg/min/cc) X (PT WEIGHT IN KG) x DOSE NEEDED = CC/HR (0.6) X ( 70 ) X 5 = 210 CC/HR CONCENTRATION: 10mg 100 cc D5W ADVERSE EFFECTS: • Bradycardia: May be more common with cisatracurium than with other neuromuscular-blocking agents since it has no clinically-significant effects on heart rate to counteract the bradycardia produced by anesthetics Compatible: amikacin, aztreonam, bumetanide, calcium gluconate, ceftriaxone, chlorpromazine, cimetidine, ciprofloxacin, clindamycin, dexamethasone sodium phosphate, digoxin, diphenhydramine, dobutamine, dopamine, , epinephrine, esmolol, fentanyl, fluconazole, gentamicin, haloperidol, hydrocortisone sodium succinate, hydromorphone, hydroxyzine, isoproterenol, ketorolac, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, meperidine, metoclopramide, metronidazole, midazolam, morphine, nitroglycerin, norepinephrine, ondansetron, phenylephrine, potassium chloride, procainamide, tobramycin, vancomycin Incompatible: Amphotericin B cholesteryl sulfate complex

CORVERT® IBUTILIDE

ACTION: Acute termination of atrial fibrillation or flutter of recent onset; the effectiveness of ibutilide has not been determined in patients with arrhythmias >90 days in duration. DOSAGE: <60 kg: 0.01 mg/kg over 10 minutes >60 kg: 1 mg over 10 minutes If the arrhythmia does not terminate within 10 minutes after the end of the initial infusion, a second infusion of equal strength may be infused over a 10-minute period. CONCENTRATION: 1 mg / 10 cc premixed ADMINISTRATION: give over 10 min IV ADVERSE EFFECTS: Potentially fatal arrhythmias (e.g., polymorphic ventricular tachycardia) can occur with ibutilide, usually in association with torsade de pointes (QT prolongation). SPECIAL CONSIDERATIONS: Observe patient with continuous ECG monitoring for at least 4 hours following infusion or until QTc has returned to baseline. Skilled personnel and proper equipment should be available during administration of ibutilide and subsequent monitoring of the patient. CONTRAINDICATIONS: QTc >440 msec Allergy to corvert Compatible: no information available Incompatible: no information available

Heparin (Units/hour)

ACTION: Anticoagulant. Inhibits conversion of prothrombin in thrombin. Prevents clot formation and stops growth of well established clots. May dissolve newer clots. Used to treat DVT and PE embolization associated with a-fib, DIC and adjunct in tx of coronary occlusion with acute MI after thrombolytic therapy. DOSE: Bolus given over 1 minute. Continuous infusion based on cardiac or lung protocol with therapeutic dosage usually 1.5-3 times control. STANDARD CONCENTRATION: 50 units/ml ADVERSE EFFECTS: Thrombocytopenia, white clot syndrome, skin necrosis, gangrene, MI, PE and CVA. CONTRAINDICATIONS: • Hypersensitivity to Heparin. • Blood dyscrasias (e.g. severe thrombocytopenia) • Uncontrolled bleeding SPECIAL CONSIDERATIONS: • Monitor H&H and occult blood in stool. • Monitor platelet count as early or late thrombocytopenia can occur and be dose related. COMPATIBILITIES: Acyclovir, aminophylline, ampicillin, ampicillin/sulbactam, atropine, aztreonam digoxin, dopamine, epinephrine, esmolol, fentanyl, , furosemide, insulin (regular), isoproterenol, lidocaine lorazepam, midazolam, milrinone, morphine, nitroglycerin, norepinephrine, ondansetron, potassium chloride, procainamide, propofol, propranolol, sodium bicarbonate, sodium nitroprusside, succinylcholine, vasopressin, vecuronium, INCOMPATIBILITIES: Gentamycin, Ciprofloxacin, Amiodarone, Haloperidol, Levofloxacin, Phenytoin and Doxycycline.

Vasopressin (units/min)

ACTION: Antidiuretic hormone for the treatment of DI and as a Vasopressor DOSAGE: IV Bolus 40 units IV push x 1 for V-FIB or PULSELESS V-TACH IM or SC in adults 5-10 units 2-3 x per day MIX: IV Standard drip 100 units in 100cc NS or D5W. EXAMPLE GIVE 0.04 UNITS/MIN FORMULA (100CC= 1 UNIT/MIN ) X (DOSE NEEDED) = CC/HOUR 100 X 0.0 4 = 4 CC/HR USUAL INFUSION RATE: For shock (ml/hr) = 0.04 units/min Max dose: 0.8 units/min x 24 hours CONTRAINDICATIONS: Hypersensitivity to vasopressin, severe vascular disease and especial CAD. Small doses may precipitate angina, large doses may cause an MI. SPECIAL CONSIDERATIONS: May cause extravasation. Check IV site closely and frequently. May cause water intoxication. Watch for S & S's. If using high doses for GI bleed consider ntg drip to prevent ischemia COMPATIBILITY: Amiodarone Cardizem Dobutamine, Dopamine, Epinephrine, Heparin, Insulin, Ntg, Levophed, Neosynephrine, Bicarb INCOMPATIBILITY: Phenytoin

Diltiazem Cardizem® (mg/hr)

ACTION: Calcium channel blocker, effective in SVT, slows conduction through the AV node, prevents reentry, decreases HR, SBP, DBP and SVR. Used for temporary control of rapid a-fib or flutter and narrow complex PSVT. Not responsive to adenosine, converts PSVT to NSR. STANDARD DRIP: 125mg/125ml (1 MG/ML) To prepare: Add 125mg (25ml) to 100ml of NS or D5W DOSE: 0.25mg/kg initially (20mg for average patient) over 2 minutes. May repeat in 15 minutes at 0.35mg/kg if needed (25mg for the average pt). Continuous infusion starts at 5mg/hr, increase by 5mg/hr to a max of 15mg/hr. Max Dose: 15 mg /hr CONTRAINDICATIONS: Sick sinus syndrome, second or third degree AV block, hypotension. ADVERSE EFFECTS: Arrhythmias, flushing, hypotension, 1st or 2nd degree AV block, bradycardia, CP, n/v, burning and itching at injection (IV) site. SPECIAL CONSIDERATIONS: • Use with caution in patients with preexisting impaired ventricular function. Example CHF, acute MI or pulmonary congestion, as it may exacerbate disease. • Do not give within a few hours of beta blockers, as it may result in bradycardia, AV block, and/or depression of contractility. • Monitor closely if given with any other drug that affects contractility (i.e. Digoxin, Procainamide, beta blockers and Quinidine.) • May cause severe hypotension with Fentanyl and may potentiate theophyllines. Any drug metabolized by the liver (i.e. Insulin) may cause competitive inhibition of metabolism. COMPATIBLE: Dobutamine, Dopamine, Epinephrine, Fentanyl, Versed, Morphine, Levophed, Vasopressin INCOMPATIBLE: Valium, Lasix, Heparin

Lidocaine (mg/min)

ACTION: Class 1B antiarrhythmic. Reduces automaticity and suppresses ventricular depolarization. Used for acute ventricular arrhythmias. DOSE: Loading dose in ventricular fibrillation or ventricular tachycardia 1-1.5mg/kg IV over 2-3 minutes. May repeat 0.5-0.75mg/kg in 5-10 minutes up to a total of 3mg/kg. Endotracheal: 2-2.5 times the IV dose. Endotracheal doses should be diluted to 10ml with normal saline prior to ET administration. Maintenance infusion: 1-4mg/min EXAMPLE: FOR 70 KG PT INFUSE 10 MG/MIN Formula: (1 MG/MIN = (15CC)) X ( DOSE NEEDED = CC/HR 15 X 4= 60 CC/HR STANDARD CONCENTRATION: 2000 mg / 500 cc premixed CONTRAINDICATIONS: Hypersensitivity to amide type of local anesthetics ADVERSE EFFECTS: Bradycardia, hypotension, headache, dizziness, confusion, seizures, cardiac arrest. SPECIAL CONSIDERATIONS: • Monitor EKG continuously • Monitor blood levels, concomitant administration of the following medications may result in increased serum concentrations of Lidocaine, Ciprofloxacin, Diltiazem, Digoxin, Fluconazole, Fluoxetine, Labetolol, Metoprolol, Phenytoin and Verapamil. COMPATIBILITIES: Alteplase, amiodarone, cefazolin, ciprofloxacin, cisatracurium, clarithromycin, diltiazem, dobutamine, dobutamine with dopamine, dobutamine with nitroglycerin, dobutamine with sodium nitroprusside, dopamine, dopamine with nitroglycerin, dopamine with sodium nitroprusside, enalaprilat, etomidate, famotidine, gatifloxacin, haloperidol, heparin, heparin with hydrocortisone sodium succinate, inamrinone, labetalol, levofloxacin, linezolid, meperidine, morphine, nitroglycerin, nitroglycerin with sodium nitroprusside, potassium chloride, propofol, remifentanil, sodium nitroprusside, streptokinase, theophylline, tirofiban, vitamin B complex with C, warfarin. INCOMPATIBILITIES: Amphotericin B cholesteryl sulfate complex, thiopental, Phenytoin, Cefazolin, Sodium Bicarbonate

cordorone amiodaroneHCL mg/min

ACTION: Class III antiarrhythmic, used in extreme cases of ventricular and supraventricular arrhythmias. DOSAGE: Follow specific guidelines outlined below. CONCENTRATION: Loading dose: 150mg/100ml D5W for a concentration of 1.5mg/ml. Maintenance infusion: 900mg/500ml of D5W in a non PVC bag or bottle for a concentration of 1.8mg/ml. ADMINISTRATION: For loading dose, draw up one ampule (150mg) through a filter needle and add to 100ml D5W. Infuse this bolus over 10 minutes for a rate of 15mg/min. For maintenance infusion, draw up six ampules and add to 500ml of D5W. For the first 6 hours only infuse at 1mg/minute or 33.3ml/hr. For the next eighteen hours infuse at 0.5mg/min or 16.6ml/hr. The initial 500ml should last 24 hours. ADVERSE EFFECTS: Hypotension, bradycardia, AV block. SPECIAL CONSIDERATIONS: • Monitor liver enzymes as the drug is metabolized by the liver. Dosage needs to be adjusted for patients with liver dysfunction. • Can be proarrhythmic • Can cause increased levels of other antiarrhythmic drugs and digoxin. Compatible: Dobutamine, Dopamine, Insulin, Versed, Morphine, Ntg, Levophed, Neosynephrine Incompatible: Heparin, Bicarb

Methylprednisolone Solumedrol® (high dose) (mg/kg/hr)

ACTION: In high doses it decreases the inflammation in acute spinal cord injury. If started within 8 hours of injury, Solumedrol improves neurological recovery and motor function. DOSE: Bolus dose over 15 minutes followed by a 45 minute pause, then begin the continuous infusion. Bolus: 30mg/kg over 15 minutes (30mg/kg) x (pt. weight in kg) = total bolus in mls -concentration (mg/ml) of reconstituted Methylprednisolone *follow infusion chart COMPATIBILITIES: Amiodarone, Dopamine, Heparin, Versed, Morphine INCOMPATIBILITIES: Propofol, Cardizem

NitroPRUSSIDE (sodium Nitroprusside) Nipride® (mcg/kg/min)

ACTION: Increases CO by decreasing preload and after load. Hypotensive agent. Potent vasodilator. Dilates peripheral vasculature. Used in hypertensive crisis. DOSE: 0.3-10mcg/kg/mmin by continuous infusion. Initial dose is 0.3-0.5mcg/kg/min. Increase at increments of 1mcg/kg/min. Average dose is 3mcg/kg/min. Maximum dose: 10mcg/kg/min STANDARD INFUSION: Nitroprusside 50mg/250ml + 1000mg Na thiosulfate EXAMPLE: FOR 70 KG PT INFUSE 2 MCG/KG/MIN Formula: (1 MCG/MIN =0.3CC) X (PT WEIGHT IN KG) x DOSE NEEDED = CC/HR (0.3) X (70) X 2 = 42 CC/HR CONTRAINDICATIONS: • Compensatory hypertension (i.e. AV shunt or coarctation of the aorta) • Poor cerebral perfusion ADVERSE EFFECTS: Reflex tachycardia, bradycardia, flushing and rash. Psychosis, headache, nausea, vomiting, muscle spasms and hypoxia. SPECIAL CONSIDERATIONS: • Monitor BP and pulse continuously, especially after dosage changes. Severe hypotension can occur from flushing the line • Cover container with aluminum foil or opaque bag to protect from light, Nitroprusside degrades when exposed to light. Change solution every 24 hours or more often if solution becomes discolored. • Assess for signs of toxicity, profound hypotension, metabolic acidosis, dyspnea, headache, loss of consciousness and vomiting. • Sodium Thiosulfate is added to each infusion to eliminate thiocyanate toxicity. • Reduce dose in renal or hepatic failure. COMPATIBILITIES: Cardizem, Dobutamine, Dopamine, Ntg, Morphine, Heparin, Insulin, Versed, Propofol INCOMPATIBILITIES: recommended not to mix with other medications if possible

Fentanyl® (Sublimaze) (mcg/hr)

ACTION: Narcotic analgesic DOSE: 2-20mcg/hr CONCENTRATION: 1 mg in 100 cc. FORMULA (0.1MCG/CC) X DOSE NEEDED EXAMPLE: FOR 70 KG PT INFUSE 25MCG/KG/MIN Formula: (1 MCG = (0.1 CC)) x DOSE NEEDED = CC/HR 0.1 X 25 = 2.5CC/HR ADVERSE EFFECTS: Bradycardia, hypotension, hypertension and respiratory depression. SPECIAL CONSIDERATIONS: • If giving IV bolus, give slowly to prevent rigidity. • Monitor patient drug history, kidney and liver function. • Monitor for allergic reactions: rash or urticaria. • Monitor for respiratory dysfunction. • Use Narcan to reverse effects. Compatible: Cardizem, Dobutamine, Dopamine, Epinephrine, Heparin, Ativan, Versed, Levophed, Propofol Incompatible: ??

LEVOPHED® (norepinephrine) (mcg/min)

ACTION: Peripheral vasoconstrictor, increase PVR, coronary blood flow, and systemic blood pressure. Used for hypotensive states such as sepsis, MI, etc. CONCENTRATION: 4mg/250ml D5W or NS for concentration of 16mcg/ml EXAMPLE: FOR 70 KG PT INFUSE 10 MCG/MIN Formula: (1 MCG/MIN = (3.75CC)) X ( DOSE NEEDED = CC/HR (3.75) X 10= 37.5CC/HR DOSAGE: Initial: 0.5-1 mcg/minute and titrate to desired response; 8-30 mcg/minute is usual range MAX DOSE: 30 mcg/min ADVERSE REACTIONS: Bradycardia, CP, Decreased CO, Ischemia, Severe HTN, V-Tach, Necrosis from extravasation. NURSING IMPLICATIONS: • Check infusion site frequently for extravagation. If Extravagation occurs, treat with 5-10mg Regitine diluted in 10-15ml NS injected liberally onto infusion site. • Correct fluid if pt is hypovolemic. CONTRAINDICATIONS: • Hypotension due to blood loss (hypovolemia) • Mesenteric or peripheral vascular thrombosis • Profound hypoxia COMPATIBLE: Fentanyl, Heparin, Versed, Neosynephrine, Amiodarone, Cardizem, Dobutamine, Dopamine, Epinephrine, Pepcid, Haldol INCOMPATIBLE: Insulin, Lasix, Bicarb 

Milrinone Primacor® (mcg/kg/min)

ACTION: Phosphodiesterase inhibitor. Inotrope with vasodilator activity. Reduces preload and after load by direct relaxation of vascular smooth muscle, improves CO. DOSE: Loading dose: 50mcg/kg over 10 minutes Maintenance infusion: 0.5mcg/kg/min. Range of 0.375-0.750mcg/kg/min. Reduce dose in renal insufficiency. STANDARD CONCENTRATION: 200 mcg/ml STANDARD INFUSION: 20mg/100ml D5W or NS FORMULA EXAMPLE: FOR 70 KG PT INFUSE 0.5 MCG/KG/MIN Formula: (1 MCG/ MIN =0.3) X (PT WEIGHT IN KG) x DOSE NEEDED = CC/HR (.03) X (70) X .5 = 10.5 CC/HR CONTRAINDICATIONS: • Severe aortic or pulmonic valve disease. • Use caution in A-fib and A-flutter COMPATIBILITIES: Digoxin, Cardizem, Dopamine, Dobutamine Epinephrine, Fentanyl, Heparin, Morphine, Ativan, Ntg, Levophed, Versed, Propofol, Bicarb INCOMPATIBILITIES: Lasix

Diprivan® (Propofol) (mcg/kg/min)

ACTION: Sedation of adults. DOES NOT PROVIDE PAIN RELIEF. DOSAGE: 10mg-20mg usual initial bolus for intubation. Usual dose 5-50mcg/kg/min as continuous infusion may titrate as high as 100mcg/kg/min. Concentration: 1000mg /100 cc premixed (10 mg/cc) EXAMPLE: FOR 70 KG PT INFUSE 5 MCG/KG/MIN Formula: (0.006 = 1mcg/min/cc) X (PT WEIGHT IN KG) x DOSE NEEDED = CC/HR (0.006) X (70) X 5 = 2.1 CC/HR ADVERSE EFFECTS: Hypotension, apnea, bradycardia, hyperlipidemia, decreased CO. SPECIAL CONSIDERATIONS: • Can cause green urine • Strict aseptic technique. Can support rapid growth of organisms. • Change vial and tubing Q12 hours. • Glass container with vented tubing. • Correct fluid volume deficiencies before administration. • Check for egg allergies and monitor triglyceride levels with long term use. • If patient is on TPN, consider total fat intake. • Cardio suppressive effects at 80 mcg and above COMPATIBLE: atropine, , calcium gluconate, dexamethasone sodium phosphate, dexmedetomidine, diphenhydramine, dobutamine, dopamine, enalaprilat, ephedrine, epinephrine, esmolol, fentanyl, furosemide, haloperidol, heparin, hydrocortisone sodium succinate, hydromorphone, hydroxyzine, inamrinone, insulin (regular), isoproterenol labetalol, lorazepam, magnesium sulfate, mannitol, meperidine, midazolam, milrinone naloxone, nitroglycerin, norepinephrine, phenylephrine, potassium chloride, propranolol, sodium bicarbonate, sodium nitroprusside, succinylcholine, vancomycin, vecuronium. INCOMPATIBLE: calcium chloride, diazepam, digoxin, doripenem, doxacurium, doxorubicin, gentamicin, levofloxacin, methotrexate, methylprednisolone sodium succinate, metoclopramide, minocycline, mitoxantrone, pantoprazole, phenytoin, tobramycin, verapamil. Variable (consult detailed reference): Ascorbic acid, ceftazidime, cisatracurium, doxacurium, lidocaine, morphine.

Midazolam Versed® (mg/hr)

ACTION: Short acting benzodiazepine and hypnotic used for sedation and control of seizures in status epilepticus. DOSE: Adult <60: 1 to 2.5mg over 2 minutes, a maximum dose 5mg may be given. Adult >60: 0.5 to 1.5mg over 2 minutes with a maximum of 3.5mg. CONTINUOUS INFUSION: 2-10mg/hr MAX DOSE: No max dose if greater than 10 mg/hr consider alternative medications STANDARD CONCENTRATION: 2mg/ml STANDARD INFUSION: 100mg in 50ml D5W or NS ADVERSE EFFECTS: Respiratory depression, apnea, laryngospasm, bronchospasm, dyspnea, airway obstruction, amnesia and respiratory arrest. SPECIAL CONSIDERATIONS: • Rapid IV injection may cause life threatening cardio respiratory reactions. • If patient becomes agitated, hyperactive or combative after initial dose, give additional does with caution. • Monitor patient response during injection as response to drug varies with age. COMPATIBILITIES: Amiodarone, Cardizem, Dopamine, Epinephrine, Fentanyl, Heparin, Insulin, Morphine, Ativan, Ntg, Levophed INCOMPATIBILITIES: Albumin, Bicarb

Isoproterenol Isuprel® (mcg/min)

ACTION: Stimulated Beta-adrenergic receptors. Increases CO, myocardial O2 consumption, HR, force of contractility, venous return and reduces peripheral resistance results in overall decrease in mean arterial pressure. Used in patients with heart block, asystole and bradycardia unresponsive to atropine. Mix: 1 mg/250 cc DOSE: 2-10mcg/min. Gradually increase dose until HR >60 FORMULA EXAMPLE: FOR 70 KG PT INFUSE 5 MCG /MIN Formula: (1 MCG/MIN =15CC) X DOSE NEEDED = CC/HR (15) X 5 = 75 CC/HR CONTRAINDICATIONS: • Sulfite allergy • Angina • Pre-existing ventricular arrhythmias • Tachycardia or AV block caused by digoxin toxicity ADVERSE EFFECTS: Tachycardia, ventricular ectopy, HA, flushing, anxiety, tremors, angina and extension of MI. SPECIAL CONSIDERATION: • Administer through a central line • Correct fluid volume deficit first • Monitor HR, rhythm and BP frequently • May cause arrhythmias if used with epinephrine • Doses the increase HR >130 may induce ventricular arrhythmias COMPATIBILITIES: Amiodarone, Heparin, Propofol INCOMPATIBILITIES: Sodium Bicarbonate, Furosemide, Aminophylline

DoBUTamine Dobutrex® (mcg/kg/min)

ACTION: Stimulates beta-1 adrenergic receptors. Strong inotrope, increase heart rate, produces mild vasodilation to increase SVR and PVR thereby reducing left ventricular filling pressures. Used for pulmonary congestion, refractory heart failure and cardiogenic shock. DOSE: 2.5-20 mcg/kg/min titrate to desired effect. MAX DOSE: Up to 40mcg/kg/min. STANDARD INFUSION: premixed 500mg in 250mls of D5W or NS EXAMPLE: FOR 70 KG PT INFUSE 5 MCG/KG/MIN Formula: (1 MCG = 0.03 CC)) X (PT WEIGHT IN KG) x DOSE NEEDED = CC/HR (0.03) X (70) X 5 = 10.5 CC/HR CONTRAINDICATIONS: Idiopathic hypertrophic subaortic stenosis ADVERSE EFFECTS: • Tachycardia, arrhythmias in higher doses, headache, nausea, vomiting, tremors, increased myocardial O2 demand. SPECIAL CONSIDERATIONS: • Assure normovolemia • Not for IV push. Use a large vein or central line. May cause tissue necrosis if extravasation occurs. COMPATIBILITIES: Cardizem , Dopamine , Epinephrine, Fentanyl, NTG, Levophed INCOMPATIBILITIES: Heparin Calcium Chloride, Calcium Gluconate, Sodium Bicarb, Piperacillin/Tazobactam, Cefepime Potassium Phosphate, Vitamin K, Phenytoin

Esmolol Brevibloc® (mcg/kg/min)

ACTION: beta- adrenergic blocker, Class II antiarrhythmic. Indicated for treatment of supraventricular tachycardia and hypertension (especially post-operative). DOSE: Loading dose (optional) 0.5mg/kg IV over 1 minute, may repeat before each increase in infusion rate. To prepare: Draw up loading dose in a syringe from Esmolol 10mg/ml pre-diluted vials. 0.5mg x (weight in kg) = loading dose in mg Loading dose in mg divided by 10mg/ml = loading dose in ml Maintenance infusion: Start at 50mcg/kg/min and increase by 50mcg/kg/min every 5 minutes until therapeutic response. Usual dose in 50-200mcg/kg/min. Max dose: Do not exceed 300mg/kg/min. STANDARD INFUSION: 2500mg in 250ml NS -premixed solution STANDARD CONCENTRATION: 10mg/ml EXAMPLE: FOR 70 KG PT INFUSE 50 MCG/KG/MIN Formula: (1 MCG /MIN = (.006036)) X (PT WEIGHT IN KG) x DOSE NEEDED = CC/HR ((.006036) X (70) X 50 = 21.1CC/HR CONTRAINDICATIONS: Sinus bradycardia, hypotension, second or third degree AV block and cardiogenic shock. ADVERSE EFFECTS: Hypotension, Diaphoresis, Confusion, Headache, Nausea SPECIAL CONSIDERATIONS: • Use caution in bronchospastic disease • Caution in heart failure • Use a large vein or central line • Extravasations can lead to skin necrosis COMPATIBILITIES: Amiodarone, Cardizem, Dopamine, Heparin, Insulin, Versed, Morphine, Ntg, Levophed, INCOMPATIBILITIES: Furosemide, Procainamide, Sodium Bicarbonate

Anticoagulants heparin lovenox warfarin dalteparin/fragmin danaparoid/orgaran

Decreases the clotting (coagulating) ability of the blood. Sometimes, they are called blood thinners, although they do not actually thin the blood. They do NOT dissolve existing blood clots. They are used to treat certain blood vessel, heart and lung conditions. Helps to prevent harmful clots from forming in the blood vessels. May prevent the clots from becoming larger and causing more serious problems. Often

beta blockers "lol"

Decreases the heart rate and cardiac output, which lowers blood pressure and makes the heart beat more slowly and with less force. Used to lower blood pressure, with therapies for cardiac arrhythmias, and in treating chest pain (angina). Used to prevent future heart attacks in patients with MI.

OCTREOTIDE Sandostatin Mcg/hr

Esophageal varices bleeding (unlabeled use): I.V. bolus: 25-50 mcg followed by continuous I.V. infusion of 25-50 mcg/hour Mix 0.5 mg in 100 cc Nursing considerations : QTc-prolonging agents: Octreotide may enhance the adverse/toxic effects of other QTc-prolonging agents. Renal impairment: Use with caution in patients with renal impairment; dosage adjustment required in patients receiving dialysis. Somatostatin analogs may affect glucose regulation. In type I diabetes, severe hypoglycemia may occur; in type II diabetes or patients without diabetes, hyperglycemia may occur. Insulin and other hypoglycemic medication requirements may change. Compatible: Heparin Incompatible: Pantoprazole , fat emulsion 10%

Angiotensin Converting Enzyme (ACE) Inhibitors- "Pril"

Expands blood vessels and decreases resistance by lowering levels of angiotensin II. Allows blood to flow more easily and makes the heart's work easier or more efficient. Used to treat or improve symptoms of cardiovascular conditions including high blood pressure and heart failure.

digitalis digoxin/digitoxin lanoxin

Increases the force of the heart's contractions, which can be beneficial in heart failure and for irregular heart beats. Used to relieve heart failure symptoms, especially when the patient isn't responding to ACE inhibitors and diuretics. Also slows certain types of irregular heartbeat (arrhythmias), particularly atrial fibrillation.

Eptifibatide (Integrillin™)

Information Sheet Indications: Eptifibatide is a reversible inhibitor of platelet aggregation. It specifically inhibits the glycoprotein (GP) II b III a receptor on the surface of the platelets. The onset of action is within 5 minutes and platelet function returns towards baseline (<50% inhibition) 4 hours after the infusion has been discontinued. Eptifibatide is indicated for acute coronary syndrome (UA/NQWMI), including patients who are managed medically and those undergoing percutaneous coronary intervention (PCI). Important Points: • Refrigerate vials. Vials are stable for 2 months at room temperature. • Protect vials from light during storage. Light protection is not necessary during administration. • All bolus doses should be drawn directly from the 75mg/100ml vial and given undiluted over 1-2 minutes. Compatibilities: • Eptifibatide may be administered in the same IV line as: Atropine Dobutamine Heparin Lidocaine Meperidine Metoprolol Midazolam Morphine Nitroglycerin Verapamil • Eptifibatide SHOULD NOT be administered through the same IV line as Furosimide.[ • Eptifibatide may be administered in the same IV line with 0.9% NS or D5NS combinations. Either solution may contain up to 60mEq/L of KCL. Contraindications: • Known hypersensitivity to any component of the product • History of bleeding diathesis or evidence of active abnormal bleed within previous 30 days. • Sever hypertension (SBP >200 OR DBP >110) not adequately controlled by antihypertensive therapy. • Major surgery within previous 6 weeks. • History of stoke within 30 days or any history of hemorrhagic stoke. • Current or planned administration of another GP II b III a (tirofiban, abciximab) inhibitor. • Serum creatinine >4mg/dL. (Adjust dose in patients with SCR 2-4mg/dL). • Dependency on renal dialysis. Precautions: • Use caution if platelet count is <100,000/mm, there is no clinical experience with Eptifibatide initiated in patients with thrombocytopenia. • Use caution if Eptifibatide is used with other drugs that affect hemostasis including: thrombolytics, oral anticoagulants, NSAID and dipyridamole. Monitoring/Labs: • Monitor renal function, reduce dose for serum creatinine >2 • Monitor for signs of bleeding • Notify physician if bleeding occurs • Report all bleeding episodes to the pharmacy by filling out and adverse drug reaction report.

calcium channel blockers "pine" & cardizem verapamil

Interrupts the movement of calcium into the cells of the heart and blood vessels. May decrease the heart's pumping strength and relax blood vessels. Used to treat high blood pressure, chest pain (angina) caused by reduced blood supply to the heart muscle and some arrhythmias (abnormal heart rhythms).

antiplatelets aspirin plavix tickled/ticlopidine aggrenox/dipyridamole persantine/dipyidamole

Keeps blood clots from forming by preventing blood platelets from sticking together. Helps prevent clotting in patients who have had a heart attack, unstable angina, ischemic strokes, TIA (transient ischemic attacks, or "little strokes") and other forms of cardiovascular disease. Usually prescribed preventively.

Sodium Bicarb

Mechanism of Action Dissociates to provide bicarbonate ion which neutralizes hydrogen ion concentration and raises blood and urinary pH Use: Labeled Indications Management of metabolic acidosis; gastric hyperacidity; as an alkalinization agent for the urine; treatment of hyperkalemia; management of overdose of certain drugs, including tricyclic antidepressants and aspirin Metabolic acidosis: I.V.: Dosage should be based on the following formula if blood gases and pH measurements are available: HCO3-(mEq) = 0.2 x weight (kg) x base deficit (mEq/L) Administer 1/2 dose initially, then remaining 1/2 dose over the next 24 hours; monitor pH, serum HCO3-, and clinical status Note: If acid-base status is not available: 2-5 mEq/kg I.V. infusion over 4-8 hours; subsequent doses should be based on patient's acid-base status Hyperkalemia: I.V.: 50 mEq over 5 minutes (as appropriate, consider methods of enhancing potassium removal/excretion) Y-site administration: Compatible: dexamethasone sodium phosphate, dexchlorpheniramine, heparin, insulin (regular), levofloxacin, linezolid, melphalan, mesna, methylprednisolone sodium succinate, milrinone, morphine, piperacillin/tazobactam, potassium chloride, propofol, vancomycin, Incompatible: amiodarone, amphotericin B calcium chloride, doxorubicin liposome, idarubicin, imipenem/cilastatin inamrinone, midazolam, nalbuphine, ondansetron, oxacillin, sargramostim, verapamil, vincristine, vindesine, vinorelbine. Variable (consult detailed reference): Ciprofloxacin, cisatracurium, diltiazem, TPN. Contraindications Alkalosis, hypernatremia, severe pulmonary edema, hypocalcemia, unknown abdominal pain

Narcan® Naloxone

Mechanism of Action Pure opioid antagonist that competes and displaces narcotics at opioid receptor sites Use: Labeled Indications Complete or partial reversal of opioid drug effects, including respiratory depression; management of known or suspected opioid overdose; diagnosis of suspected opioid dependence or acute opioid overdose Dose I.V.: 0.4-2 mg; may need to repeat doses every 2-3 minutes; after reversal, may need to readminister dose(s) at a later interval (ie, 20-60 minutes) depending on type/duration of opioid. If no response is observed after 10 mg, consider other causes of respiratory depression. Note: Opioid-dependent patients may require lower doses (0.1 mg) titrated incrementally to avoid precipitating acute withdrawal. Continuous infusion: I.V.: Calculate dosage/hour based on effective intermittent dose used and duration of adequate response seen or use 2/3 of the initial effective naloxone bolus on an hourly basis (typically 0.25-6.25 mg/hour); 1/2 of the initial bolus dose should be readministered 15 minutes after initiation of the continuous infusion to prevent a drop in naloxone levels; adjust infusion rate as needed to assure adequate ventilation and prevent withdrawal symptoms I.V. push: Administer over 30 seconds as undiluted preparation or (unlabeled) administer as diluted preparation slow I.V. push by diluting 0.4 mg (1 mL) ampul with 9 mL of normal saline for a total volume of 10 mL to achieve a concentration of 0.04 mg/mL I.V. continuous infusion: Dilute to 4 mcg/mL in D5W or normal saline Compatible: linezolid, propofol. Heparin, ondansetron Incompatible: Amphotericin B cholesteryl sulfate complex. Concerns related to adverse effects• Acute opioid withdrawal: May precipitate symptoms of acute withdrawal in opioid-dependent patients, including pain, hypertension, sweating, agitation, irritability; in neonates: shrill cry, failure to feed. Carefully titrate dose to reverse hypoventilation; do not fully awaken patient or reverse analgesic effect (postoperative patient). 

vasodilators isordil natrecor hydralazine nitrates & minoxidil

Relaxes blood vessels and increases the supply of blood and oxygen to the heart while reducing its workload. Prescribed to patients who cannot tolerate ACE inhibitors (another type of medicine that relaxes the blood vessels.) Can come in pills to be swallowed, chewable tablets and as a topical application (cream). Used to ease chest pain (angina).

Angiotensin Receptor Blockers (ARB's) "sartan"

This keeps blood pressure from rising. Used to treat or improve symptoms of cardiovascular conditions including high blood pressure

stroke TPA (100mg/100ml vial)

To administer TPA- STROKE Protocol Patient's weight in kilograms needed Patient's weight in kilograms x 0.09mg = total TPA dose Bolus _______ TPA dose x 0.10 bolus dose Administer remainder over the next 60 minutes.

cardene/NiCARdipine mg/hr

Use : Chronic stable angina (immediate-release product only); management of hypertension (immediate and sustained release products); parenteral only for short-term use when oral treatment is not feasible Unlabeled/Investigational Congestive heart failure, control of blood pressure in acute ischemic stroke and spontaneous intracranial hemorrhage, postoperative hypertension associated with carotid endarterectomy, perioperative hypertension, prevention of migraine headaches, subarachnoid hemorrhage associated cerebral vasospasm Acute hypertension: I.V.: Initial: 5 mg/hour increased by 2.5 mg/hour every 15 minutes to a maximum of 15 mg/hour; consider reduction to 3 mg/hour after response is achieved. Monitor and titrate to lowest dose necessary to maintain stable blood pressure. EXAMPLE: give 5 mg /hr Formula: (10cc= 1 mg) X DOSE NEEDED = CC/HR 10 X 5 mg = 50 cc/hour Concentration: Dilute 25 mg ampul with 240 mL of compatible solution (D5, NS,) to provide a 250 mL total volume solution and a final concentration of 0.1 mg/mL. (10 cc=1 mg) Side effects: Angina/MI: Increased angina and/or MI has occurred with initiation or dosage titration of dihydropyridine calcium channel blockers. Reflex tachycardia may occur resulting in angina and/or MI in patients with obstructive coronary disease, especially in the absence of concurrent beta blockade. • Hypotension/syncope • Infusion sites: To minimize infusion site reactions, peripheral infusion sites (for I.V. therapy) should be changed every 12 hours; use of small peripheral veins should be avoided. • Withdrawal: Abrupt withdrawal may cause rebound angina in patients with CAD. Compatible: calcium gluconate, cefazolin, ceftizoxime, , diltiazem, dobutamine, dopamine, enalaprilat, epinephrine, esmolol, famotidine, fentanyl, hydrocortisone sodium succinate, hydromorphone, labetalol, lidocaine, lorazepam, methylprednisolone sodium succinate, metronidazole, midazolam, milrinone, morphine, nitroglycerin, nitroprusside, norepinephrine, potassium chloride, potassium phosphate, sulfamethoxazole and trimethoprim, tobramycin, vancomycin, vecuronium. Incompatible: Ampicillin, ampicillin/sulbactam, cefepime, furosemide, lansoprazole, thiopental. sodium bicarbonate 5%, LR, D5LR. 

aggrastat/ticrofiban mcg/kg/min

Use : Treatment of acute coronary syndrome (i.e., unstable angina/non-ST-elevation myocardial infarction [UA/NSTEMI]) in combination with heparin Concentration: Infusion [premixed in sodium chloride]:Aggrastat®: 50 mcg/mL (100 mL, 250 mL) IV loading dose of 0.4 mcg/kg per minute for 30 minutes given as soon as possible after diagnosis, then continuous IV infusion of 0.1 mcg/kg per minute for at least 24-48 hours. Side effects Bleeding Nursing considerations: Monitor platelets Compatible: Atropine, dobutamine, dopamine, epinephrine, famotidine, heparin, lidocaine, midazolam, morphine, nitroglycerin, potassium chloride, propranolol. Incompatible: Diazepam

Metoprolol Lopressor®

Use : Treatment of angina pectoris, hypertension, or hemodynamically-stable acute myocardial infarction Treatment of ventricular arrhythmias, atrial ectopy; migraine prophylaxis, essential tremor, Concentration: 5 mg/5cc Atrial fibrillation (ventricular rate control), supraventricular tachycardia (SVT) I.V.: 2.5-5 mg every 2-5 minutes (maximum total dose: 15 mg over a 10-15 minute period). Note: Initiate cautiously in patients with concomitant heart failure Hypertension Initial: 1.25-5 mg every 6-12 hours; titrate initial dose to response. Initially, low doses may be appropriate to establish response; however, although not routine, up to 15 mg administered as frequently as every 3 hours has been employed in patients with refractory tachycardia. Nursing Considerations: monitor ECG and blood pressure; may administer by rapid infusion (I.V. push) over 1 minute. May also be administered by slow infusion (ie, 5-10 mg of metoprolol in 50 mL of fluid) over ~30-60 minutes during less urgent situations (eg, substitution for oral metoprolol). Side effects Hypotension (1% to 27%), bradycardia (2% to 16%), first-degree heart block (P-R interval ≥0.26 sec; 5%), Dizziness (2% to 10%), fatigue (1% to 10%), depression (5%), confusion, hallucinations, Compatible: Alteplase, meperidine, morphine. Incompatible: Amphotericin B cholesteryl sulfate complex 

Succinylcholine Anectine®; Quelicin

Use To facilitate both rapid sequence and routine endotracheal intubation and to relax skeletal muscles during surgery; to reduce the intensity of muscle contractions of pharmacologically- or electrically-induced convulsions; does not relieve pain or produce sedation Pharmacodynamics/Kinetics Onset of action: I.M.: 2-3 minutes; I.V.: Complete muscular relaxation: 30-60 seconds Duration: I.M.: 10-30 minutes; I.V.: 4-6 minutes with single administration Metabolism: Rapidly hydrolyzed by plasma pseudocholinesterase Excretion: Urine Dosing: Adults Neuromuscular blockade: I.M., I.V.: Dose to effect; doses will vary due to interpatient variability; use ideal body weight for obese patients I.M.: Up to 3-4 mg/kg, total dose should not exceed 150 mg I.V.: Initial: Short surgical procedures: 0.6 mg/kg (range 0.3-1.1 mg/kg) Long surgical procedures: Continuous infusion: 2.5-4.3 mg/minute; adjust dose based on response Intermittent: Initial: 0.3-1.1 mg/kg; maintenance: 0.04-0.07 mg/kg/dose as required Note: Initial dose of succinylcholine must be increased when nondepolarizing agent pretreatment used because of the antagonism between succinylcholine and nondepolarizing neuromuscular-blocking agents. Dose adjustment with reduced plasma cholinesterase activity: Administer a test dose of 5-10 mg to evaluate sensitivity, or cautiously administer 1 mg/mL by slow I.V. infusion to produce neuromuscular blockade Compatible: Etomidate, heparin, hydrocortisone sodium succinate, potassium chloride, propofol, vitamin B complex with C. Incompatible: Thiopental.

Romazicon Flumazenil®

Use: Benzodiazepine antagonist; reverses sedative effects of benzodiazepines used in conscious sedation and general anesthesia; treatment of benzodiazepine overdose Adult dosage for suspected benzodiazepine overdose: Initial dose 0.2 mg intravenously over 30 seconds; if the desired level of consciousness is not obtained, 0.3 mg can be given over 30 seconds Repeat doses 0.5 mg over 30 seconds repeated at 1-minute intervals Maximum total cumulative dose 3 mg (usual dose: 1-3 mg) Patients with a partial response at 3 mg may require additional titration up to a total dose of 5 mg. If a patient has not responded 5 minutes after cumulative dose of 5 mg, the major cause of sedation is not likely due to benzodiazepines. In the event of resedation: May repeat doses at 20-minute intervals with maximum of 1 mg/dose and 3 mg/hour. Nursing considerations: Assess level of consciousness frequently. Monitor vital signs and airway closely. ECG monitoring and oxygenation via pulse oximetry is highly recommended. Observe continually for resedation, respiratory depression, preseizure activity, or other residual benzodiazepine effects. May require pain medication sooner after reversal. Assess for nausea and vomiting. Benzodiazepine reversal may result in seizures in some patients. Patients who may develop seizures include patients on benzodiazepines for long-term sedation, tricyclic antidepressant overdose patients, concurrent major sedative-hypnotic drug withdrawal, recent therapy with repeated doses of parenteral benzodiazepines, myoclonic jerking or seizure activity prior to flumazenil administration. Use with caution in patients relying on a benzodiazepine for seizure control. Compatible: Aminophylline, cimetidine, dobutamine, dopamine, famotidine, heparin, lidocaine, procainamide, ranitidine

Etomidate Amidate®

Use: Induction and maintenance of general anesthesia Dosing: Anesthesia: I.V.: Initial: 0.2-0.6 mg/kg over 30-60 seconds for induction of anesthesia; maintenance: 5-20 mcg/kg/minute Administration: Administer I.V. push over 30-60 seconds. Solution is highly irritating; avoid administration into small vessels; in some cases, preadministration of lidocaine may be considered. Compatible: Alfentanil, atracurium, atropine, doxacurium, ephedrine, fentanyl, lidocaine, lorazepam, midazolam, mivacurium, morphine, pancuronium, phenylephrine, succinylcholine, sufentanil. Incompatible: Ascorbic acid, vecuronium. Concerns related to adverse effects: • Adrenal steroid production: Etomidate inhibits 11-B-hydroxylase, an enzyme important in adrenal steroid production. A single induction dose blocks the normal stress-induced increase in adrenal cortisol production for 4-8 hours, up to 24 hours in elderly and debilitated patients. Continuous infusion of etomidate for sedation in the ICU may increase mortality because patients may not be able to respond to stress. No increase in mortality has been identified with a single dose for induction of anesthesia. Consider exogenous corticosteroid replacement in patients undergoing severe stress Pharmacodynamics/Kinetics Onset of action: 30-60 seconds Peak effect: 1 minute Duration: 3-5 minutes; terminated by redistribution Metabolism: Hepatic and plasma esterases Half-life elimination: Terminal: 2.6 hours

Dilantin ® Phenytoin

Use: Labeled Indications Management of generalized tonic-clonic (grand mal), complex partial seizures; prevention of seizures following head trauma/neurosurgery DOSE: I.V.: Loading dose: Manufacturer recommends 10-15 mg/kg, however, 15-20 mg/kg is generally recommended; maximum rate: 50 mg/minute Administration: I.V. Vesicant. Fosphenytoin may be considered for loading in patients who are in status epilepticus, hemodynamically unstable or develop hypotension/bradycardia with I.V. administration of phenytoin. Phenytoin may be administered by IVP or IVPB administration. The maximum rate of I.V. administration is 50 mg/minute. Highly sensitive patients (eg, elderly, patients with pre-existing cardiovascular conditions) should receive phenytoin more slowly (eg, 20 mg/minute). An in-line 0.22-5 micron filter is recommended for IVPB solutions due to the high potential for precipitation of the solution. Avoid extravasation. Following I.V. administration, NS should be injected through the same needle or I.V. catheter to prevent irritation. Adverse Reactions : Hypotension, bradycardia, cardiac arrhythmia, cardiovascular collapse (especially with rapid I.V. use), venous irritation and pain, thrombophlebitis Compatible: Esmolol, famotidine, Incompatible: heparin potassium chloride, propofol

Mannitol

Use: Reduction of increased intracranial pressure associated with cerebral edema; promotion of diuresis in the prevention and/or treatment of oliguria or anuria due to acute renal failure; Dose: Intracranial pressure/Cerebral edema: I.V.: 0.25-1.5 g/kg/dose I.V. as a 15% to 20% solution over ≥30 minutes; maintain serum osmolality 310 to <320 mOsm/kg Administration: I.V. Vesicant. Do not administer with blood. Inspect for crystals prior to administration. If crystals present redissolve by warming solution. Use filter-type administration set; in-line 5-micron filter set should always be used for mannitol infusion with concentrations ≥20%; avoid extravasation; for cerebral edema or elevated ICP, administer over 20-30 minutes. do not use solutions that contain crystals. Heating in a hot water bath and vigorous shaking may be utilized for resolubilization. Cool solutions to body temperature before using. Side effects Chest pain, CHF, hyper-/hypotension, tachycardia Chills, convulsions, dizziness, headache,Rash, urticaria Fluid and electrolyte imbalance, dehydration and hypovolemia secondary to rapid diuresis, hyperglycemia, hypernatremia, hyponatremia (dilutional), hyperosmolality-induced hyperkalemia, metabolic acidosis (dilutional), osmolar gap increased, water intoxication Nausea, vomiting, Dysuria, polyuriathrombophlebitis, tissue necrosis Blurred vision Compatible: propofol, Incompatible: Cefepime,

Precedex® Dexmedetomidine Mcg/kg/hour

Use: Sedation of initially intubated and mechanically ventilated patients during treatment in an intensive care setting; sedation prior to and/or during surgical or other procedures of nonintubated patients EXAMPLE: FOR 70 KG PT INFUSE 0.2 MCG/KG/HOUR Formula: (0.25) x PT WEIGHT IN KG X DOSE NEEDED = CC/HR 0.25 x 70 X 0.2 = 3.5 CC/HR Standard Infusion: 0.2 mg in 50 cc (0.25cc = 1 mcg/hour) Administration: ICU sedation: I.V.: Initial: Loading infusion of 1 mcg/kg over 10 minutes, followed by a maintenance infusion of 0.2-0.7 mcg/kg/hour; adjust rate to desired level of sedation; titration no more frequently than every 30 minutes may reduce the incidence of hypotension Side effects: Cardiovascular effects: Episodes of bradycardia, hypotension, and sinus arrest have been associated with rapid I.V. administration (eg, bolus administration) or when given to patients with high vagal tone Withdrawal: When withdrawn abruptly in patients who have received >24 hours, withdrawal symptoms similar to clonidine withdrawal may result (eg, hypertension, nervousness, agitation, headaches). Use for >24 hours is not recommended by the manufacturer Compatible: amiodarone, , atropine, dexamethasone, digoxin, diltiazem, dobutamine, dopamine, enalaprilat, ephedrine, epinephrine, , esmolol fentanyl, furosemide, heparin, hydrocortisone sodium succinate, hydromorphone, isoproterenol, labetalol, lidocaine, lorazepam, magnesium sulfate, meperidine, methylprednisolone, metronidazole, midazolam, milrinone, morphine, nalbuphine, nitroglycerin, nitroprusside, norepinephrine, ondansetron, pancuronium, phenylephrine, potassium chloride, procainamide, promethazine, propofol, rocuronium, sodium bicarbonate, succinylcholine Incompatible: Amphotericin B, diazepam

Magnesium Sulfate

Use: Treatment and prevention of hypomagnesemia; prevention and treatment of seizures in severe pre-eclampsia or eclampsia, pediatric acute nephritis; torsade de pointes; treatment of cardiac arrhythmias (VT/VF) caused by hypomagnesemia Administration: I.V. PREMIXED Symptomatic deficiency: I.V.: 1-2 g over 5-60 minutes; maintenance infusion may be required to correct deficiency (0.5-1 g/hour). Arrhythmia (ACLS guidelines, 2005), hypomagnesemia-induced (life-threatening): 1-2 g over 5-20 minutes (torsades with cardiac arrest) or over 5-60 minutes (symptomatic arrhythmias without cardiac arrest) maximum single dose: 2000 mg Nursing considerations: Magnesium should be diluted to a ≤20% solution for I.V. infusion and may be administered IVP, IVPB or I.V.; when giving I.V. push, must dilute first and should not be given any faster than 150 mg/minute. Hypotension and asystole may occur with rapid administration •Electrolyte abnormalities: Concurrent hypokalemia or hypocalcemia can accompany a magnesium deficit. Hypomagnesemia is frequently associated with hypokalemia and requires correction in order to normalize potassium. • Parenteral administration: Monitor serum magnesium level, respiratory rate, blood pressure, deep tendon reflex, and renal function when administered parenterally, particularly with repeated dosing; magnesium toxicity can lead to fatal cardiovascular arrest and/or respiratory paralysis. SE: Cardiovascular: Flushing (I.V.; dose related), hypotension (I.V.; rate related), vasodilation (I.V.; rate related) Gastrointestinal: Diarrhea Compatible: dobutamine, esmolol, heparin, insulin (regular), morphine, ondansetron, potassium chloride, propofol, Incompatible: Alatrofloxacin, amphotericin B cholesteryl sulfate complex, cefepime. Variable (consult detailed reference): Ciprofloxacin.

Labetolol Mg/min

Use: Treatment of mild-to-severe hypertension; I.V. for severe hypertension (eg,hypertensive emergencies) DOSAGE: Acute hypertension (hypertensive urgency/emergency): Standard concentration: (for continous infusion) 500 mg/250 mL D5W (2 mg /cc) I.V. bolus: 20 mg I.V. push over 2 minutes, may give 40-80 mg at 10-minute intervals, up to 300 mg total dose I.V. infusion (acute loading): Initial: 2 mg/minute; titrate to response up to 300 mg total dose. Administration requires the use of an infusion pump. Bolus dose may be administered I.V. push at a rate of 10 mg/minute; may follow with continuous I.V. infusion EXAMPLE: FOR 70 KG PT INFUSE 2 MG/MIN Formula: (30cc = 1mg/min) x DOSE NEEDED = CC/HR 30 X 2 = 60 CC/HR Abrupt withdrawal: Beta-blocker therapy should not be withdrawn abruptly (particularly in patients with CAD), but gradually tapered to avoid acute tachycardia, hypertension, and/or ischemia. Due to the prolonged duration of action, careful monitoring should be extended for the duration of the infusion and for several hours after the infusion. Excessive administration may result in prolonged hypotension and/or bradycardia. Compatible: Amikacin, amiodarone, ampicillin, , cefazolin, ceftazidime, ceftizoxime, cimetidine, clindamycin, diltiazem, dobutamine, dopamine, enalaprilat, epinephrine, esmolol, famotidine, fentanyl, gentamicin, hydromorphone, lidocaine, linezolid, lorazepam, magnesium sulfate, meperidine, metronidazole, midazolam, milrinone, morphine, nicardipine, nitroglycerin, norepinephrine, potassium chloride, potassium phosphates, propofol, sodium nitroprusside, trimethoprim/sulfamethoxazole, vancomycin, vecuronium. Incompatible: Amphotericin B cholesteryl sulfate complex, cefoperazone, ceftriaxone, nafcillin, thiopental, warfarin. Variable (consult detailed reference): Furosemide, heparin, insulin (regular).

cholesterol lowering "statins" zocor lipitor mevacor crestor questran

Various medications can lower blood cholesterol levels. They may be prescribed individually or in combination with other drugs. They work in the body in different ways. Some affect the liver, some work in the intestines and some interrupt the formation of cholesterol from circulating in the blood. Used to lower LDL ("bad") cholesterol, raise HDL ("good") cholesterol and lower triglyceride levels.