MEDICINE PREPARATION INDICATIONS NURSING CONSIDERATIONS

Adenosine 6mg/2mL vial Adenosine injection should Adenosine injection is Drug Interactions:
be given as a rapid bolus by indicated for the following:
the peripheral intravenous ➢​ Methylxanthines
route. To be certain the ➢​ Conversion to sinus (aminophylline, caffeine)
solution reaches the rhythm of paroxysmal
systemic circulation, it supraventricular Reduce the effects of
should be administered tachycardia adenosine.
either directly into a vein or,
if given into an IV line, it ➢​ Associated accessory ➢​ Dipyridamole
should be given as close to bypass tracts: ➢​ Carbamazepine
the patient as possible and Wolff-Parkinson-White
followed by a rapid saline Syndrome Potentiate the effect so only
flush. 3 mg boluses of adenosine
are recommended.
Repeat administration for
adults: If the first dose does Drug Incompatibilities:
not result in elimination of
the supraventricular Use IV line with no other
tachycardia within 1 to 2 medications.
minutes, 12 mg should be
given as a rapid intravenous ➢​ Monitor blood pressure
bolus. This 12 mg dose may and apical pulse prior to
be repeated a second time if administration.
required.
➢​ Cardiac monitors should
be used on patients
receiving adenosine IV
boluses.
➢​ Flush IV port with flush
solution (e.g., normal
saline) immediately after
IV bolus.

➢​ Use only clear solutions

➢​ Discard unused
medication.

➢​ Warn patient of
possibility of transient
warmth and flushing of
skin immediately
following injection.

➢​ Warn other staff that

ECG may show transient
episodes of asystole.

➢​ Assess for
bronchospasms
following administration
of medication.
Amiodarone 150mg/3mL Amiodarone Hydrochloride Amiodarone is indicated for Drug Interactions:
ampule Injection for intravenous use. the following:
It is an antiarrhythmic agent ➢​ Fluoroquinolones
indicated for initiation of ➢​ Recurrent ➢​ Macrolide antibiotics,
treatment and prophylaxis of hemodynamically ➢​ Azoles
frequently recurring unstable ventricular
ventricular fibrillation and tachycardia Cause QTc prolongation.
hemodynamically unstable There have been reports of
ventricular tachycardia in ➢​ Recurrent ventricular QTc prolongation.
patients refractory to other fibrillation.
therapy. Drug Incompatibilities:

The recommended starting ➢​ Nitroprusside

dose is about 1000 mg over ➢​ Sodium bicarbonate
the first 24 hours of therapy, ➢​ Aminophylline
delivered by the following ➢​ Ampicillin
infusion regimen: ➢​ Cephalosporins
➢​ Digoxin
Initial Load: 150 mg per 100 ➢​ Heparin
mL (in D5W) infused over 10
minutes ➢​ Monitor blood pressure
and apical pulse prior to
Followed by: 1 mg/min for 6 administration.
hours
➢​ Cardiac monitors should
Followed by: 0.5 mg/min be used on patients
thereafter. receiving amiodarone
therapy.

➢​ Baseline chest x-ray and

pulmonary function test
is recommended before
In the event of breakthrough beginning PO therapy.
episodes of VF or ➢​ Baseline assessments
hemodynamically unstable should be checked of
VT: liver function and
thyroid function.
➢​ Repeat the Initial Load
described above as ➢​ Initial therapy should be
needed (infused over 10 implemented under
minutes) hospital precautions
with access to advanced
➢​ Increase the rate of the life support.
maintenance infusion to
achieve effective ➢​ Monitor serum level
arrhythmia suppression frequently.

➢​ Encourage patient to
wear sunglasses for
photosensitivity.

➢​ Encourage patient to
wear protective clothing
and sunscreen when
outdoors.

➢​ Caution patient/family
about using OTC herbal
products (e.g., St. John's
wart, echinacea).

➢​ Patient should obtain an

ophthalmic exam
regularly.
Anti-tetanus serum 1500 IU in 1 ml ampoule, for ATS is indicated for the Administer following
IM or SQ injection. following: Besredka's method: inject 0.1
ml by SC route and wait 15
Injected as soon as possible ➢​ Prevention of tetanus in minutes; if no local or
after tetanus prone injury, wound management, in general allergic reactions
such as wounds patients non immunized occur, inject 0.25 ml by SC
contaminated with soil, dirt or incompletely route and wait 15 minutes; if
etc. Adequate surgical immunized or in patients no reactions, administer the
treatment of wounds with whose immunization injection by IM route.
the use of suitable antibiotics status is unknown, in
should be carried out in combination with ➢​ Do not administer to
addition to the prophylactic tetanus vaccine patients with known
injection of antitoxin allergy to tetanus
➢​ Treatment of clinical antiserum.
tetanus
Not to be administered by IV ➢​ May cause:
route. hypersensitivity
reactions, anaphylactic
shock,

➢​ Quincke oedema; serum

sickness up to 10 days
after injection.
Aspirin USP grade, 325 Mobile phase: 2 g/L of Aspirin is indicated for the Drug Interactions:
mg/tablet sodium 1-heptanesulfonate in following:
Meet the a mixture of ➢​ Warfarin
acetonitrile and water (15:85).
➢​ Reduce fever ➢​ Heparin
Adjust with requirements ➢​ Relieve mild to moderate
glacial acetic acid to a pH of pain from conditions: Additive anticoagulation
3.4. muscle aches, effect which increases risk
toothaches, common for bleeding
Diluent: Acetonitrile and cold, and headaches
formic acid. ➢​ Suppression of ➢​ Glucocorticoids
inflammation associated ➢​ Alcohol
Standard solution: 0.5 with arthritis. ➢​ NSAIDs
mg/mL of USP Aspirin RS in ➢​ Dysmenorrhea
Diluent ➢​ Acute Coronary Increased risk for GI
Syndrome bleeding.

➢​ Ibuprofen

Decreased antiplatelet effect.

➢​ If an ACS patient is
hypersensitive or
contraindicated for ASA,
patient may be
considered for
clopidogrel.

➢​ Assess patient for signs

of bleeding (petechiae,
ecchymosis, bloody or
black stools, bleeding
gums).
➢​ Drink adequate fluids
while taking aspirin.

➢​ Advise patient to avoid

alcohol when prescribed
high doses of aspirin.
➢​ Baby aspirin is preferred
for acute or prophylactic
management of heart
disease.

➢​ Discontinue aspirin use

if ringing or buzzing in
ears or unrelieved GI
discomfort.

➢​ Not recommended for

children with influenza
or chicken pox

Treatment for poisoning:

1) gastric lavage, 2) activated
charcoal, 3) respiratory
support, 4) fluid hydration,
and 5) urine alkalinization
with sodium bicarbonate, 6)
hemodialysis in unresponsive
cases.
Atropine 1mg/mL capsule Injection: 0.4 or 1 mg/mL as Atropine is indicated for the Drug Interactions:
a clear, colorless solution in a following:
single-dose vial. ➢​ Amantadine
➢​ Symptomatic sinus ➢​ Antihistamines
For intravenous bradycardia ➢​ Tricyclic
administration: Titrate antidepressants
according to heart rate, PR ➢​ Asystole ➢​ Quinidine
interval, blood pressure and ➢​ Disopyramide
symptoms. ➢​ 1st degree or 2nd degree
(Mobitz type I) AV Significant potentiation of
Antisialagogue or for blocks–only if anticholinergic effects
antivagal effects: Initial symptomatic
single dose of 0.5 to 1 mg. Atropine decreases the
➢​ Organophosphate effects of levo-dopa.
Antidote for poisoning
organophosphorus or Atropine enhances
muscarinic mushroom ➢​ Ophthalmic agent to extrapyramidal effects with
poisoning: Initial single dose produce mydriasis and methotrimeprazine.
of 2 to 3 mg, repeated every paralysis of ciliary muscle
20 to 30 minutes. ➢​ Phenothiazines
➢​ Intestinal hypertonicity &
Bradyasystolic cardiac hypermotility Decreased antipsychotic
arrest: 1 mg dose, repeated effects due to decreased
every 3 to 5 minutes if ➢​ Preoperative agent to absorption.
asystole persists. decrease body secretions
and intestinal motility ➢​ Monitor apical pulse
during surgery prior to administration.

➢​ Cardiac monitor should

be used on patients
receiving atropine IV
boluses.
➢​ Doses of 0.5 mg or less
may result in
paradoxical slowing of
heart rate.

➢​ Atropine can be
administered via
endotracheal tube in
dose of 2-3 mg diluted
in 10 ml H2O, but
intraosseous route is
preferred over
endotracheal tube if IV
access cannot be
achieved.

➢​ Older adults and

debilitated patients may
be more vulnerable to
CNS disturbances from
atropine.

➢​ Monitor temperature in
infants and children for
"atropine fever".

➢​ Measures to relieve dry

mouth: adequate fluid
hydration, oral hygiene,
ice chips, sugarless
gum, or hard candies to
suck on.
➢​ Avoid driving or
operating heavy
machinery while under
the influence of
atropine.
➢​ Reduce lighting to
decrease photophobia.

➢​ Monitor GI motility and

urine output while the
patient is receiving
atropine.

➢​ Atropine is a common
pre-operative agent,
and can be given IM,
SC, PO, or IV
Salbutamol 2mg/ml For oral administration. Salbutamol is indicated for Drug Interactions:
Shake the bottle before use. the following:
An oral syringe may be used Beta-blockers: Inhibit the
to measure doses less than Symptomatic relief and bronchodilatory effects of
5mL. prevention of albuterol
bronchospasms due to
Adults: The usual adult dose bronchial asthma, Diuretics: Increased risk for
is (4mg) two 5 ml spoonfuls chronic bronchitis, reversible hypokalemia.
(10ml), 3 or 4 times per day obstructive airway disease,
which may be increased to a and other chronic Sympathomimetic Agents:
maximum of (8mg) four 5 ml bronchopulmonary Can potentially lead to an
spoonfuls (20ml), 3 or 4 times disorders. additive effect, increasing the
per day. The minimum risk of cardiovascular side
starting dose is (2mg) one 5 effects like increased heart
ml spoonful (5ml), 3 or 4 rate and blood pressure.
times per day.
➢​ Assess respiratory
Elderly: Patients who are status of patient.
unusually sensitive to this
class of medicine treatment ➢​ Auscultate patient’s
may be initiated with (2mg) breath sounds.
one 5 ml spoonful (5ml), 3 or
4 times per day. ➢​ Monitor patient’s
oxygen saturation.
Pediatric population
➢​ Assess patient’s heart
2- 6 years: the minimum rate and blood pressure.
starting dose is 1mg as 2.5 ml
of oral solution three times ➢​ Educate the patient on
daily. This may be increased proper inhaler
to 2mg as 5 ml of oral technique.
solution three or four times ➢​ Teach the patient how
 daily. to recognize and
respond to
6 – 12 years: the minimum exacerbations.
starting dose is 2 mg as 5 ml
of oral solution three times ➢​ Prohibit the ingestion of
daily. This may be increased grapefruit juice and
to four times daily. high-fat meals.

Over 12 years: the minimum

starting dose is 2mg three
times daily given as 5 ml oral
solution. This may be
increased to 4 mg as 10 ml
oral solution three or four
times daily.

Benzodiazepine Adults: The usual adult dose Benzodiazepine is indicated ➢​ Administer intravenous
is 2-10 mg I.M. or I.V. for the following: diuretics slowly to
repeated every 3-4 hours as prevent severe changes
required. In general, the ➢​ Insomnia in fluid and electrolytes.
maximum adult dose should
not exceed 30 mg over an ➢​ Acute status epilepticus ➢​ Do not mix intravenous
eight-hour period. drugs in solution with
➢​ Induction of amnesia, any other drugs to avoid
Cardioversion: To provide agitation, and anxiety. potential drug-drug
light anesthesia and interactions.
anterograde amnesia prior to ➢​ Spastic, and seizure
cardioversion, 5-15 mg disorders ➢​ Maintain patients who
diazepam may be given I.V. receive parenteral
within 5-10 minutes before benzodiazepines in bed
the procedure. for at least 3 hours to
ensure patient safety.
Endoscopic Procedures: To ➢​ Monitor patient
reduce anxiety, diazepam response to drugs
may be administered slowly through vital signs,
I.V. immediately before the weight, serum
procedure; dosage should be electrolytes
titrated to obtain the desired and hydration to
sedative response. evaluate effectiveness of
drug therapy.
Anticonvulsant: In the
convulsing patient, it is ➢​ Monitor hepatic and
preferred that diazepam be renal function and CBC
given I.V. However,I.M. for long-term therapies
injection may be used if I.V. to detect dysfunction
administration is impossible. and to arrange to taper
Initially, 5-10 mg may be and discontinue drug if
given,repeated if necessary dysfunction occurs.
at 10-15 minute intervals up
to a maximum dose of 30 mg. ➢​ Provide safety measures
If necessary, afurther dose to prevent injuries.
may be repeated in 2-4
hours, however, residual ➢​ Educate client on drug
active metabolites may therapy to promote
persist andreadministration compliance.
should be made with this
consideration.

Children: Benzodiazepines
should not be given to
children without careful
assessment of the indication;
the duration of treatment
must be kept to a minimum.
 I.V. administration should be
made slowly over a 3-minute
period in a dosage not
exceeding 0.25 mg/kg. After
an interval of 15-30 minutes,
the initial dose may be
repeated.

Calcium gluconate 10% Contains 100 mg of calcium Calcium gluconate is Drug Interactions:
solution in 10mL ampule gluconate per mL which indicated for the following:
contains 9.3 mg (0.465 mEq) ➢​ Cardiac Glycoside
of elemental calcium ( 2-2.1). ➢​ Hyperkalemia
Administer intravenously Synergistic arrhythmias may
through bolus or continuous ➢​ Cardiac arrest occur if calcium and cardiac
infusion via a secure glycosides are administered
intravenous line. ➢​ Cardiotoxicity together.

Adults: 5-20 mL ➢​ Neonates receiving ➢​ Calcium Channel

Children: 2-5 mL ceftriaxone. Blockers
Infants: not more than 2 mL
Administration of calcium
may reduce the response.

➢​ Vitamin D
➢​ Vitamin A
➢​ Thiazide diuretics
➢​ Estrogen
➢​ Calcipotriene
➢​ Teriparatide

Increased risk for

hypercalcemia.
➢​ Assess the patient's
levels of calcium in the
blood.

➢​ Assess for cutaneous

burning sensations and
peripheral vasodilation,
with moderate fall in BP,
during direct IV injection

➢​ Monitor ECG during IV

administration to detect
evidence of
hypercalcemia
➢​ Monitor for
hypocalcemia and
hypercalcemia
Clopidogrel 75 mg tablet 75 mg PO qDay without a Clopidogrel is indicated for Drug Interactions:
loading dose; recommended the following:
as alternative to aspirin or ➢​ Aspirin
concomitantly with aspirin if ➢​ Prevention of occlusion ➢​ NSAIDs
patient not at increased risk of coronary stents for ➢​ Heparin
for bleeding but at high risk patients who are having ➢​ Enoxaparin
for cardiovascular disease. cardiac catheterization
with angioplasty. Increased risk of bleeding.
<75 years: 300 mg loading
dose followed by 75 mg for 14 ➢​ Reduce thrombotic ➢​ Omeprazole and other
days up to 12 months if there events in patients with proton pump inhibitors
is no bleeding. history of MI, ACS,
ischemic stroke, or Decreases efficacy of
Concomitant therapy with peripheral vascular clopidogrel.
aspirin: Administer in disease.
combination with aspirin ➢​ Feverfew
75-325 mg qDay with or ➢​ Acute coronary ➢​ Garlic
without thrombolytics. syndrome ➢​ Ginger
➢​ Ginkgo
>75 years: No loading dose.
75 mg for 14 days up to 12 Increased risk of bleeding.
months if there is no
bleeding. ➢​ Do not administer
clopidogrel to ACS
patients if CABG is
planned within 5 – 7
days.

➢​ Platelet function and

bleeding time return to
baseline in 7 – 10 days.
➢​ Monitor patient for signs
of thrombotic
thrombocytopenic
purpura (low platelet
count, neurosymptoms,
renal dysfunction, fever).

➢​ Monitor for signs and

symptoms of bleeding
(urine, stool, hematoma,
epistaxis, petechiae).

➢​ May cause elevation of

serum liver
enzymes–establish
baseline enzymes and
bilirubin levels.
D5W 250 mL As directed by a physician. D5W is indicated for the ➢​ Suspend container
Dosage is dependent upon following: from eyelet support.
the age, weight and clinical
condition of the patient as ➢​ Hypoglycemia ➢​ Remove plastic
well as laboratory ➢​ Insulin shock protector from
determinations. ➢​ Dehydration outlet port at bottom
of container.
These are parenteral
solutions containing various ➢​ Attach administration
concentrations of dextrose in set. Refer to complete
water for injection intended directions
for intravenous accompanying set
administration.
➢​ Lactated Ringer’s and
5% Dextrose
Injection, USP should
be used with caution.
Excess administration
may result in
metabolic alkalosis.

➢​ Caution must be
exercised in the
administration of
parenteral fluids,
especially those
containing sodium
ions to patients
receiving
corticosteroids or
corticotrophin.
 ➢​ Solution containing
acetate should be
used with caution as
excess administration
may result in
metabolic alkalosis.

➢​ If an adverse reaction
does occur,
discontinue the
infusion, evaluate the
patient, institute
appropriate
therapeutic
countermeasures.

D50W 50mg/vial 50% hypertonic glucose D50W is indicated for the Drug Interactions:
solution in 50 ml vial for slow following:
IV injection for 3 to 5 ➢​ Diazoxide and other
minutes. Never done through The treatment of severe thiazide diuretics.
IM or SQ. hypoglycemia.
Increased risk of toxicity.

➢​ Glucagon and other

anticoagulants.

Increased anticoagulant
effects.

➢​ Assess orientation and

reflexes and baseline
 pulses.

➢​ Monitor blood glucose

levels as ordered to
assess the effectiveness
of the drug and patient
response to treatment.

➢​ Monitor nutritional
status and consultation
as needed.

➢​ Have insulin on standby

during emergency use
to treat severe
hyperglycemia if it
occurs as a result of
overdose.

➢​ Monitor patients
receiving diazoxide for
potential cardiovascular
effects.
Digoxin 0.5 mg/2mL ampule Digoxin dose is based on Digoxin is indicated for the Drug Interactions:
patient-specific factors. following:
Intravenous administration is ➢​ PGP Inducers/Inhibitors
preferable to intramuscular. ➢​ HF. drugs
Avoid bolus administration. ➢​ Atrial fibrillation and
atrial flutter Induce or inhibit PGP have
➢​ Paroxysmal atrial the potential to alter digoxin
tachycardia. pharmacokinetics.

History:

Allergy to digitalis
preparations, ventricular
tachycardia, ventricular
fibrillation, heart block, sick
sinus syndrome, IHSS, acute
MI, renal insufficiency,
decreased K+, decreased
Mg2+ increased Ca2+,
pregnancy, lactation

Physical:

Weight; orientation, affect,

reflexes, vision; P, BP,
baseline ECG, cardiac
auscultation, peripheral
pulses, peripheral perfusion,
edema; R, adventitious
sounds; abdominal
percussion, bowel sounds,
liver evaluation; urinary
output; electrolyte levels,
LFTs, renal function tests.

➢​ Monitor apical pulse for

1 min before
administering; hold dose
if pulse < 60 in adult or <
90 in infant; retake pulse
in 1 hr. If adult pulse
remains < 60 or infant <
90, hold drug and notify
prescriber. Note any
change from baseline
rhythm or rate.

➢​ Take care to
differentiate Lanoxicaps
from Lanoxin; dosage is
very differentCheck
dosage and preparation
carefully.

➢​ Avoid IM injections,
which may be very
painful.

➢​ Follow diluting
instructions carefully,
and use diluted solutions
promptly.

➢​ Avoid giving with meals;

 this will delay
absorption.

➢​ Have emergency
equipment ready; have
K+ salts, lidocaine,
phenytoin, atropine, and
cardiac monitor readily
available in case toxicity
develops.

➢​ WARNING: Monitor for

therapeutic drug levels:
0.5–2 ng/mL.

Diphenhydramine 50mg/mL Adults Diphenhydramine is History: Allergy to any

ampule indicated for the following: antihistamines, narrow-angle
Oral: 25–50 mg q 4–8 hr PO. glaucoma, stenosing peptic
➢​ Antihistaminic ulcer, symptomatic prostatic
Parenteral: 10–50 mg IV or hypertrophy, asthmatic
deep IM or up to 100 mg if ➢​ Motion Sickness attack, bladder neck
required. Maximum daily obstruction, pyloroduodenal
dose is 400 mg. ➢​ Antiparkinsonism obstruction, third trimester
of pregnancy, lactation
Pediatric ➢​ Relief of symptoms
associated with Physical: Skin color, lesions,
Oral: 12.5–25 mg tid–qid PO perennial and seasonal texture; orientation, reflexes,
or 5 mg/kg/day PO or 150 allergic rhinitis; affect; vision examination; P,
mg/m2 per day PO. vasomotor rhinitis; BP; R, adventitious sounds;
Maximum daily dose 300 mg. allergic conjunctivitis; bowel sounds; prostate
mild, uncomplicated palpation; CBC with
 Cough suppression: urticaria and differential.
angioedema;
➢​ 2–6 yr: 6.25 mg q 4 hr, not amelioration of allergic ➢​ Administer with food if
to exceed 25 mg in 24 hr. reactions to blood or GI upset occurs.
plasma;
➢​ 6–12 yr: 12.5 mg q 4 hr PO, dermatographism; ➢​ Administer syrup form if
not to exceed 75 mg in 24 adjunctive therapy in patient is unable to take
hr. anaphylactic reactions. tablets.

Parenteral: 5 mg/kg/day or ➢​ Syrup formulation. ➢​ Monitor patient

150 mg/m2 per day IV or by response, and arrange
deep IM injection. Maximum for adjustment of dosage
daily dose is 300 mg divided to lowest possible
into four doses. effective dose.

Dobutamine 250mg/5mL USP is a clear, practically Dobutamine is indicated for Drug Interactions:
colorless, sterile, the following:
nonpyrogenic solution of ➢​ Beta blocking agents
dobutamine hydrochloride ➢​ Inotropic support of the
for intravenous use only. myocardium Inhibit the cardiovascular
Each milliliter contains 12.5 effects of dobutamine;
mg dobutamine, as the ➢​ Treatment of acute
hydrochloride and sodium congestive heart failure ➢​ General anesthetics
metabisulfite, 0.2 mg added or cardiogenic shock.
as antioxidant. May contain Increased risk for
hydrochloric acid or sodium dysrhythmias.
hydroxide for pH adjustment.
pH is 3.3. ➢​ MAO inhibitors and
tricyclic
Must be diluted prior to antidepressants
administration.
Enhance the pressor effect of
dobutamine.

Drug Incompatibilities:

➢​ Sodium bicarbonate
➢​ Aminophylline
➢​ Bretylium
➢​ Bumetanide
➢​ Calcium chloride
➢​ Calcium gluconate
➢​ Diazepam
➢​ Doxapram
➢​ Digoxin
➢​ Epinephrine
➢​ Furosemide
➢​ Heparin
➢​ Insulin
➢​ Magnesium sulfate
➢​ Nitroprusside
➢​ Phenytoin
➢​ Potassium chloride
➢​ Potassium phosphate
➢​ Acyclovir

➢​ Monitor blood pressure

and cardiac rhythm
continuously during
therapy.

➢​ Hemodynamic
monitoring of all
 parameters is
recommended during
dobutamine therapy.

➢​ Correct hypovolemia
with fluid resuscitation
prior to dobutamine
therapy.

➢​ Tolerance has been

noted during continuous
or prolonged infusions.

➢​ Check IV drug
calculations carefully.
Double-check
calculations with
another nurse or
pharmacist.

➢​ Weigh patient daily in

order to maintain
accurate dose
calculations.
Dopamine 200 mg/5mL 200, 400 and 800 mg/5 ml Dopamine is indicated for the Drug Interactions:
ampule/vial vials must be diluted before it following:
is administered by ➢​ MAO inhibitors
intravenous methods. ➢​ Low blood pressure
Potentiate the effects of
Initial doses of Dopamine are ➢​ Low heart rate dopamine.
started as an intravenous
drip at a rate of 5 ➢​ Cardiac arrest ➢​ Tricyclic antidepressants
micrograms per Kg per
minute Then the drug can be Enhance the effects of
increased at a rate of about 5 dopamine.
– 10 mcg increments to
obtain the correct dose to ➢​ General anesthetics
treat the individual patient's
symptoms. Increased the risk of
dysrhythmias secondary to
dopamine.

➢​ Beta blockers.

Antagonize the
beta-adrenergic effects of
dopamine.

➢​ Alpha blockers

Antagonize the
alpha-adrenergic effects of
dopamine.
Drug Incompatibilities:

➢​ Sodium bicarbonate
➢​ Aminophylline
➢​ Amphotericin B
➢​ Ampicillin
➢​ Cephalothin
➢​ Penicillin G
➢​ Acyclovir

➢​ Correct hypovolemia
with fluid resuscitation
before initiating
dopamine infusion.

➢​ Monitor blood pressure,

pulse, and peripheral
pulses every 15 minutes.

➢​ Monitor hourly urine

output.

➢​ Cardiac monitor should

be used on patients
receiving dopamine
infusion.
➢​ Weigh patient daily to
determine accurate
infusion dose.

➢​ Calculate infusion drips

and doses carefully.
 Double-check
calculations with
another nurse or
pharmacist.

➢​ IV site should not be

used for any other
infusions or IV
therapies.

➢​ Extravasation of
dopamine may cause
tissue necrosis to skin.
Therefore, monitor IV
sites every hour. Have
phentolamine close to
the bedside of the
patient.

➢​ Notify physician
immediately if: 1)
oliguria develops; 2)
tachy-dysrhythmias
develop; 3) diastolic
pressure rises reducing
pulse pressure; 4)
hypotension continues
to exist at maximum
dose of 20
mcg/kg/min; 5) signs
of peripheral ischemia.
Epinephrine 1mg/mL Cardiac arrest: 0.5–1 mg Epinephrine is indicated for ➢​ 1:10,000 equals 1 mg/10
(5–10 mL of 1:10,000 solution) the following: ml for IV pushes or
IV or by intracardiac neonatal umbilicus line
injection into left ventricular ➢​ Anaphylactic shock 1:1,000 equals 1 mg/1 ml
chamber; during ➢​ Acute asthma attack for SC or IM injections
resuscitation, 0.5 mg q 5 min. ➢​ 1st or 2nd degree heart
blocks. ➢​ EpiPen® is an IM
Intraspinal: 0.2–0.4 mL of a ➢​ Cardiac arrest injectable with .3 mg
1:1,000 solution added to ➢​ Wide-angle Glaucoma dose for adults or a
anesthetic spinal fluid ➢​ Topically to control smaller .15 mg dose for
mixture. bleeding children (33-66 pounds).
Instruct patients with
Other use with local hypersensitivity risks on
anesthetic: Concentrations how to administer the
of 1:100,000–1:20,000 are EpiPen®.
usually used.
➢​ Patient should seek
Respiratory distress: 0.1–0.3 immediate help after
mL (0.5–1.5 mg) using EpiPen® due to
subcutaneously. the short life of
medication.
Aerosol: Begin treatment at
first symptoms of ➢​ Epinephrine may
bronchospasm. Individualize exacerbate chest pain,
dosage. Wait 1–5 min hypertension, and
between inhalations to avoid tachydysrhythmias.
overdose.
➢​ Contact lenses should be
Nebulization: Place 8–15 removed prior to
drops into the nebulizer instilling eye drops.
reservoir. Place nebulizer
nozzle into partially opened ➢​ Patients should be
mouth. Patient inhales deeply monitored for heart rate,
while the bulb is squeezed cardiac rhythm, and
one to three times. If no blood pressure
relief in 5 min, give 2–3 frequently if an IV drip is
additional inhalations. Use to be infused.
four to six times per day
usually maintains comfort. ➢​ Never interrupt an
intravenous infusion of
Topical nasal solution: Apply medication to administer
locally as drops or spray or an IVPB or other
with a sterile swab, as medication.
required.
➢​ Extravasation of
epinephrine may cause
Ophthalmic solution: tissue necrosis to skin.
Vasoconstriction, mydriasis: Therefore, monitor IV
Instill 1–2 drops into the eye site every hour. Have
or eyes; repeat once if phentolamine close to
necessary. the bedside of the
patient.

➢​ MAO inhibitors will

counteract the effects of
epinephrine.

➢​ β-adrenergic blocking
agents will block the
actions of epinephrine
on the heart.
Furosemide 20mg/2 mL Furosemide Injection, USP is Furosemide is indicated for ➢​ Assess blood pressure
ampule a sterile, nonpyrogenic the following: and cardiac conditions.
solution of furosemide in
Water for Injection prepared Treatment of edema ➢​ Monitor potassium
with the aid of sodium associated with: levels.
hydroxide for intramuscular
(IM) or intravenous (IV) use. ➢​ Congestive heart failure ➢​ Promote potassium-rich
diet.
Each mL contains: ➢​ Cirrhosis of the liver
Furosemide 10 mg; Water for ➢​ Assess renal function
Injection q.s.; sodium ➢​ Renal disease, including
chloride to adjust isotonicity; the nephrotic syndrome ➢​ Assess for dehydration
sodium hydroxide and if and intake and output
necessary hydrochloric acid
to adjust pH between 8.0 and ➢​ Monitor daily weight
9.3.
Haloperidol 50 mg/mL Haloperidol decanoate, USP Haloperidol is indicated for ➢​ Monitor for
is a white or almost white the following: therapeutic
powder. It is very soluble in effectiveness. Because
alcohol, in methanol and in of long half-life,
methylene chloride, therapeutic effects
practically insoluble in water. are slow to develop in
early therapy or when
Haloperidol decanoate the established dosing
injection is clear, slightly regimen is changed.
viscous, colorless to pink or
amber solution. ➢​ Monitor patient’s
mental status daily.
Each mL of haloperidol
decanoate injection for ➢​ Monitor for
intramuscular injection neuroleptic malignant
contains 50 mg haloperidol syndrome (NMS) ,
(present as haloperidol especially in those
decanoate, USP 70.52 mg) in with hypertension or
a sesame oil vehicle, with taking lithium.
1.2% (w/v) benzyl alcohol as a
preservative. ➢​ Immediately
discontinue the drug
Each mL of haloperidol if NMS is suspected.
decanoate injection for
intramuscular injection ➢​ Monitor for
contains 100 mg haloperidol parkinsonism and
(present as haloperidol tardive dyskinesia.
decanoate, USP 141.04 mg) in
a sesame oil vehicle, with ➢​ Monitor for
1.2% (w/v) benzyl alcohol as a extrapyramidal
preservative. neuromuscular
reactions that occur
 frequently during the
first few days of
treatment.

➢​ Monitor for
exacerbation of
seizure activity.

➢​ Observe patients
closely for rapid mood
shift to depression
when haloperidol is
used to control mania
or cyclic disorders.

➢​ Lab tests: Monitor

WBC count with
differential and liver
function in patients
on prolonged therapy.
Hydrocortisone 250 mg/ Adult: Individualized dosage, Hydrocortisone is indicated
2mL vial based on severity and for the following:
response.
➢​ External auditory canal History: Infections; kidney
Give daily dose before 9 AM infection. disease; liver disease,
to minimize adrenal hypothyroidism; ulcerative
suppression. If long-term ➢​ Certain endocrine, colitis with impending
therapy is needed, rheumatic, collagen, perforation; diverticulitis;
alternate-day therapy should allergic, ophthalmic, recent GI surgery; active or
be considered. After respiratory, latent peptic ulcer;
long-term therapy, withdraw hematologic, neoplastic, inflammatory bowel disease;
drug slowly to avoid adrenal edematous, hypertension, CHF;
insufficiency. gastrointestinal, and thromboembolic tendencies,
other conditions. thrombophlebitis,
For maintenance therapy, osteoporosis, seizure
reduce initial dose in small ➢​ Hydrocortisone enema disorders, metastatic
increments at intervals until is indicated for carcinoma, diabetes mellitus;
lowest clinically satisfactory ulcerative colitis. lactation. Retention enemas,
dose is reached. intrarectal foam: Systemic
➢​ Topical ointment with fungal infections; recent
100–500 mg initially and q antibiotics is indicated intestinal surgery, extensive
2–10 hr, based on condition for corticosteroid fistulas. Topical dermatologic
and response. responsive dermatoses administration: Fungal,
with infections. tubercular, herpes simplex
Acute adrenal insufficiency skin infections; vaccinia,
(hydrocortisone sodium ➢​ Topical cream with varicella; ear application
phosphate): 100 mg IV acyclovir is indicated to when eardrum is perforated.
followed by 100 mg q 8 hr in treat cold sores.
IV fluids.
➢​ Oral granules of
Pediatric: Individualize hydrocortisone are Physical: Systemic
dosage based on severity and used as a replacement administration: Weight, T;
response rather than on therapy for reflexes, affect, bilateral grip
formulae that correct adult Adrenocortical strength, ophthalmologic
doses for age or weight. Insufficiency. examination; BP, P,
Carefully observe growth and auscultation, peripheral
development in infants and perfusion, discoloration, pain
children on prolonged or prominence of superficial
therapy. vessels; R, adventitious
sounds, chest x-ray; upper GI
20–240 mg/day in single or x-ray (history or symptoms
divided doses. of peptic ulcer), liver
palpation; CBC, serum
ADULTS AND PEDIATRIC electrolytes, 2-hr
PATIENTS postprandial blood glucose,
urinalysis, thyroid function
IV, IM or subcutaneous tests, serum cholesterol.
hydrocortisone and Topical, dermatologic
hydrocortisone sodium preparations: Affected area,
phosphate integrity of skin.

20–240 mg/day usually in

divided doses q 12 hr.
➢​ Space multiple doses
evenly throughout the
day.

➢​ Do not give IM
 injections if patient
has thrombocytopenic
purpura.
➢​ Rotate sites of IM
repository injections
to avoid local atrophy.

➢​ Use minimal doses for

minimal duration to
minimize adverse
effects.
➢​ Taper doses when
discontinuing
high-dose or
long-term therapy.

➢​ Arrange for increased

dosage when patient
is subject to unusual
stress.
 ➢​ Ensure that adequate
amount of Ca2+ is
taken if prolonged
administration of
steroids.

➢​ Use alternate-day
maintenance therapy
with short-acting
corticosteroids
whenever possible.

WARNING: Give daily before

9 AM to mimic normal peak
diurnal corticosteroid levels
and minimize HPA
suppression.

WARNING: Do not give live

virus vaccines with
immunosuppressive doses of
 hydrocortisone.

Lidocaine ADULTS: Lidocaine spray is indicated Drug Interactions:

10% in 50mL spray for the following:
IM ➢​ Tocainide
➢​ Local or regional ➢​ Mexiletine
Arrhythmia: Use only the anesthesia for minor ➢​ Cimetidine
10% solution for IM injection. procedures ➢​ Beta blockers
300 mg in deltoid or thigh ➢​ Phenytoin
muscle. Switch to IV ➢​ Prevention of pain from ➢​ Quinidine
lidocaine or oral minor burns, scrapes ➢​ Procainamide
antiarrhythmic as soon as and insect bites.
possible. Enhances lidocaine effects.

IV bolus ➢​ Barbiturates

Arrhythmia: Use only Decreases the effect of

lidocaine injection labeled for lidocaine.
IV use and without .
preservatives or Incompatibilities:
catecholamines. Monitor intravenous infusion include
ECG constantly. Give 50–100 phenytoin, ampicillin,
mg at rate of 25–50 mg/min. cefazolin, amphotericin B,
One-third to one-half the and thiopental.
initial dose may be given
after 5 min if needed. Do not History: Allergy to lidocaine
exceed 200–300 mg in 1 hr. or amide-type local
anesthetics, CHF, cardiogenic
shock, second- or
IV, continuous infusion third-degree heart block,
Wolff-Parkinson-White
Arrhythmia: Give 1–4 syndrome, Stokes-Adams
mg/min (or 20–50 syndrome, hepatic or renal
mcg/kg/min). Titrate the disease, inflammation or
dose down as soon as the sepsis in region of injection,
cardiac rhythm stabilizes. lactation, pregnancy.
Use lower doses in patients
with CHF, liver disease, and Physical: T; skin color,
in patients > 70 yr. rashes, lesions; orientation,
speech, reflexes, sensation
PEDIATRICS and movement (local
anesthetic); P, BP,
IV auscultation, continuous
ECG monitoring during use
Arrhythmia: Safety and as antiarrhythmic; edema; R,
efficacy have not been adventitious sounds; bowel
established. American Heart sounds, liver evaluation;
Association recommends urine output; serum
bolus of 0.5–1 mg/kg IV, electrolytes, LFTs, renal
followed by 30 mcg/kg/min function tests
with caution. The IM
auto-injector device is not
recommended.

Topical, intratissue, epidural

Local anesthesia: See adult

dosage discussion. Use lower
concentrations.
Lidocaine 2% solution Multiple-dose vials contain Lidocaine solution vial is Drug Interactions:
vial 1g/50mL 0.1% of methylparaben added indicated for the production
as preservative. May contain of local or regional ➢​ Tocainide
sodium hydroxide and/or anesthesia by infiltration ➢​ Mexiletine
hydrochloric acid for pH techniques such as ➢​ Cimetidine
adjustment. percutaneous injection and ➢​ Beta blockers
intravenous regional ➢​ Phenytoin
anesthesia by peripheral ➢​ Quinidine
nerve block techniques such ➢​ Procainamide
as brachial plexus and
intercostal and by central Enhances lidocaine effects.
neural techniques such as
lumbar and caudal epidural ➢​ Barbiturates
blocks.
Decreases the effect of
lidocaine.
.
Incompatibilities:
intravenous infusion include
phenytoin, ampicillin,
cefazolin, amphotericin B,
and thiopental.

History: Allergy to lidocaine

or amide-type local
anesthetics, CHF, cardiogenic
shock, second- or
third-degree heart block,
Wolff-Parkinson-White
syndrome, Stokes-Adams
syndrome, hepatic or renal
disease, inflammation or
 sepsis in region of injection,
lactation, pregnancy.

Physical: T; skin color,

rashes, lesions; orientation,
speech, reflexes, sensation
and movement (local
anesthetic); P, BP,
auscultation, continuous
ECG monitoring during use
as antiarrhythmic; edema; R,
adventitious sounds; bowel
sounds, liver evaluation;
urine output; serum
electrolytes, LFTs, renal
function tests

Magnesium sulfate Magnesium Sulfate Injection, Magnesium sulfate is ➢​ Use caution with renal
1g/2mL ampule USP 50% is a sterile, indicated for the following: insufficiency.
nonpyrogenic, concentrated
solution of magnesium ➢​ Hypomagnesemia ➢​ May cause decreased
sulfate heptahydrate in respiratory rate,
Water for Injection. It is ➢​ Hypercalcemia arrhythmias,
administered by the hypotension, muscle
intravenous or intramuscular ➢​ Pediatric acute nephritis weakness.
routes as an electrolyte
replenisher or ➢​ Bronchospasms ➢​ Monitor EKG and
anticonvulsant. respiratory status
➢​ Prevent seizures in
Must be diluted before IV severe pre-eclampsia, ➢​ Monitor Mg levels
use. eclampsia, or toxemia of
pregnancy ➢​ Ensure dosage with a
 secondary practitioner.
➢​ Calcium gluconate is the
antidote.

➢​ WARNING: Magnesium
toxicity results in
respiratory depression
and loss of deep tendon
reflexes

Mannitol 20% solution The dosage, concentration Mannitol is indicated for the ➢​ Mannitol is
in 500mL/bottle and rate of administration following: administered
depend on the age, weight intravenously, and the
and condition of the patient, ➢​ To increase urinary dose and rate of
including fluid requirement, output administration should
urinary output and be carefully monitored.
concomitant therapy. ➢​ Cerebral edema
➢​ Clients receiving
Reduction of Intracranial ➢​ Glaucoma mannitol should be
Pressure: 0.25 gram/kg closely monitored for
administered every 6 to 8 ➢​ Kidney failure fluid and electrolyte
hours as an intravenous imbalances,
infusion over 30 minutes. dehydration, and kidney
function.
Reduction of Intraocular
Pressure: 1.5 to 2 grams/kg ➢​ Mannitol should be
of a 15% or 20% w/v solution used cautiously in
as a single dose administered clients with heart
intravenously over at least 30 failure or pulmonary
minutes edema.
 For intravenous infusion
preferably into a large central
vein.

Prior to administration,
evaluate renal, cardiac and
pulmonary status, and
correct fluid and electrolyte
imbalances

Methylprednisolone Available forms : Tablets—4, Methylprednisolone is History: Infections; kidney or

4mg/tablet 8, 16, 24, 32 mg; powder for indicated for the following: liver disease,
injection—40, 125, 500 hypothyroidism, ulcerative
mg/mL, 1, 2 g/vial; ➢​ Short-term colitis, diverticulitis, active or
suspension for injection—40, management of various latent peptic ulcer,
80 mg/mL inflammatory and inflammatory bowel disease,
allergic disorders, such CHF, hypertension,
ADULTS as rheumatoid arthritis, thromboembolic disorders,
collagen diseases (eg, osteoporosis, seizure
ORAL: 48 mg/day. For SLE), dermatologic disorders, diabetes mellitus;
alternate-day therapy, give diseases (eg, pregnancy; lactation
twice the usual dose every pemphigus), status
other morning asthmaticus, and Physical: Weight, T, reflexes
autoimmune disorders and grip strength, affect and
IV, IM: 10–40 mg IV orientation, P, BP, peripheral
administered over 1 min to ➢​ Hematologic disorders: perfusion prominence of
several minutes. Give Thrombocytopenia superficial veins, R and
subsequent doses IV or IM purpura, adventitious sounds, serum
erythroblastopenia electrolytes, blood glucose.
➢​ Ulcerative colitis, acute
WARNING: Rapid IV exacerbations of MS, ➢​ Use caution with the
administration of large doses and palliation in some 24-mg tablets marketed
(more than 0.5–1 g in less leukemias and as Medrol; these
than 10–120 min) has caused lymphomas. contain tartrazine,
serious cardiac which may cause
complications. ➢​ Trichinosis with allergic reactions,
neurologic or especially in people
PEDIATRICS myocardial involvement who are allergic to
➢​ Prevention of nausea aspirin.
High-dose therapy: 30 and vomiting associated
mg/kg IV infused over 10–20 with chemotherapy ➢​ Give daily dose before 9
min; may repeat q 4–6 hr, but to mimic normal peak
no longer than 72 hr. ➢​ Unlabeled use: Septic corticosteroid blood
shock, respiratory levels.
distress syndrome, ➢​ Increase dosage when
acute spinal cord injury patient is subject to
stress.

➢​ WARNING: Taper doses

when discontinuing
high-dose or long-term
therapy to allow adrenal
recovery.

➢​ WARNING: Do not give

live virus vaccines with
immunosuppressive
doses of
corticosteroids.
 Metoclopramide Available forms : Tablets—5, Metoclopramide is indicated History: Allergy to
10mg/2mL ampule 10 mg; concentrated for the following: metoclopramide, GI
solution—10 mg/mL; hemorrhage, mechanical
injection—5 mg/mL ➢​ Relief of symptoms of obstruction or perforation,
acute and recurrent pheochromocytoma,
ADULT diabetic gastroparesis epilepsy, lactation, previously
detected breast cancer.
Relief of symptoms of ➢​ Short-term therapy for
gastroparesis: 10 mg PO 30 adults with symptomatic Physical: Orientation,
min before each meal and at gastroesophageal reflux reflexes, affect; P, BP; bowel
bedtime for 2–8 wk. If who fail to respond to sounds, normal output; EEG.
symptoms are severe, initiate conventional therapy
therapy with IM or IV ➢​ Monitor BP carefully
administration for up to 10 ➢​ Parenteral: Prevention of during IV
days until symptoms subside. nausea and vomiting administration.
associated with
Symptomatic emetogenic cancer ➢​ Monitor for
gastroesophageal reflux: chemotherapy extrapyramidal
10–15 mg PO up to four reactions, and consult
times/day 30 min before ➢​ Prophylaxis of physician if they occur.
meals and at bedtime. If postoperative nausea
symptoms occur only at and vomiting when ➢​ Monitor diabetic
certain times or in relation to nasogastric suction is patients, arrange for
specific stimuli, single doses undesirable alteration in insulin
of 20 mg may be preferable; dose or timing if
guide therapy by endoscopic ➢​ Single-dose parenteral diabetic control is
results. Do not use longer use: Facilitation of compromised by
than 12 wk. small-bowel intubation alterations in timing of
when tube does not pass food absorption.
Facilitation of small bowel the pylorus with
intubation, gastric conventional maneuvers. ➢​ WARNING: Keep
emptying: 10 mg (2 mL) by diphenhydramine
direct IV injection over 1–2 ➢​ Single-dose parenteral injection readily
min. use: Stimulation of available in case
gastric emptying and extrapyramidal
PEDIATRICS intestinal transit of reactions occur.
barium when delayed
Facilitation of intubation, emptying interferes with ➢​ WARNING: Have
gastric emptying: radiologic exam of the phentolamine readily
< 6 yr: 0.1 mg/kg by direct IV stomach or small available in case of
injection over 1–2 min. intestine. hypertensive crisis
6–14 yr: 2.5–5 mg by direct IV
injection over 1–2 min. ➢​ Unlabeled uses:
Improvement of
lactation (doses of 30–45
mg/day); treatment of
nausea and vomiting of a
variety of etiologies:
Emesis during
pregnancy and labor,
gastric ulcer, anorexia
nervosa
 Morphine sulfate PO: 10-30 mg q 4 hours Morphine sulfate is indicated ➢​ Monitor blood
10mg/10mL ampule for the following: pressure prior to
IV: 2 – 10 mg slow IV push q 4 administration. Hold if
hour prn; (cardiac) 2 – 4 mg ➢​ Chest pain associated systolic BP < 100 mm
slow IV push, repeat dose at with acute coronary Hg or 30 mm Hg below
5 – 15 minute intervals syndrome baseline.

IM: (not appropriate for ➢​ Acute cardiogenic ➢​ Monitor patient's

cardiac intervention) 5 – 20 pulmonary edema respiratory rate prior
mg IM q 4 hours prn to administration.

➢​ Reassess pain after

administration of
morphine.

➢​ Monitor for respiratory

depression and
hypotension frequently
up to 24 hours after
administration of
morphine.

➢​ Place call light signal

close to patient.
Accompany patient if
need to get out of bed
to minimize risk of
falls.
 Nitroglycerin inj. Total fluid load may be a Nitroglycerin is indicated for ➢​ Monitor the vital signs
10mg/10mL ampule dominant consideration in the following: of the patient.
patients with compromised ➢​ With IV nitroglycerin
function of the heart, liver, ➢​ Congestive heart failure therapy, monitor the
and/or kidneys. pulse and blood
Nitroglycerin infusions ➢​ Acute myocardial pressure every 5 to 15
should be administered only infarction minutes. Make the
via a pump that can maintain necessary dosage
a constant infusion rate. ➢​ Angina pectoris ➢​ adjustments
accordingly.

➢​ Observe adverse drug

reactions.

➢​ Monitor the
effectiveness of the
drug.

➢​ Give the nitrate tablets

on an empty stomach,
either 30 minutes or 1
to 2 hours before a
meal.

➢​ Tell the patient to

swallow the oral tablets
and to not chew them.

➢​ When administering the

first nitrate dose, keep
the patient sitting or
lying down.
➢​ Before starting the
therapy and after the
drug shows its effects,
monitor the patient’s
blood pressure and
pulse rate.

➢​ Do not give a
concomitant beta
blocker or calcium
channel blocker with
nitrate therapy to
relieve angina.

➢​ If the patient’s heart

rate is less than 60 bpm
and systolic blood
pressure drops below
90 mm of Hg, withhold
the nitrate therapy or
follow the physician’s
order.

➢​ Dilute IV nitroglycerin
with D5W or normal
saline solution for
injection, using a glass
bottle. Avoid using IV
filters because they can
bind to the plastic. A
special nonabsorbent
polyvinyl chloride
 tubing is available to be
used. Titrate the drug
and administer it with
an infusion-controlled
device and make certain
the concentration does
not exceed 400
mcg/ml.

➢​ Administer sublingual
nitroglycerin at the first
sign of the attack. Place
the medication under
the tongue until it
dissolves completely. It
can be repeated every 5
minutes for up to three
doses.

➢​ Place the prescribed

nitrate ointment on a
piece of paper and place
it on a non-hairy area of
the body and cover it
with plastic. While
applying the next dose,
remove the previously
applied one and be
careful to not get
ointment on your
fingers while applying it
to the patient
 ➢​ Before defibrillation,
remove the transdermal
patch since its
aluminum backing can
explode with the
electric current.

➢​ Be aware that initially,

the patient may have a
headache that
subsidizes when
tolerance develops, or
the dose is reduced

Nonadrenaline IV infusion: 0.5 – 1 mcg/min Noradrenaline is indicated ➢​ Monitor blood

2mg/2mL ampule titrated to blood pressure up for the following: pressure and apical
to maximum (30 mcg/min) pulse continously
➢​ Shock secondary to during norepinephrine
peripheral vasodilation therapy.
(neurogenic shock,
septic shock) ➢​ Cardiac monitor
should be used on
➢​ Severe cardiogenic patients receiving
shock with norepinephrine IV
hemodynamically infusions.
significant hypotension
and decreased SVR. ➢​ Defibrillator and
resuscitation cart
should be close by
during infusion.
➢​ Titrate infusion rate to
maintain systolic BP at
80 – 100 mg Hg.

➢​ Assess patient
frequently for
headache, chest pain,
or other signs of
toxicity.

➢​ Do not mix other

medications in IV line
with norepinephrine
drip.

➢​ Extravasation of
norepinephrine may
cause tissue necrosis
to skin. Therefore,
monitor IV site every
hour
 Paracetamol Intramuscular route: Paracetamol is indicated for ➢​ Check that the patient
300mg/ampule the following: is not taking any other
Adults: 2 - 3 ml every 4 to 6 medication containing
hours. ➢​ Mild to moderate pain. paracetamol.

Children (2 -12 years / > 33 ➢​ Pyrexia. ➢​ For children who may

kg): Up to 2 ml every 4 to 6 refuse medicine off a
hours. ➢​ Post-vaccination fever spoon try using a
from two months of age. medicine syringe to
Below 2 years of age: Half to squirt liquid slowly into
1 ml every 4 to 6 hours. the side of the child’s
mouth or use soluble
Intravenous route: Slow I.V paracetamol mixed with
Administration. a drink.

➢​ Some children may be

happy to take one
paracetamol product
but dislike the taste of
another.

➢​ There are no known

harmful effects when
used during pregnancy.

➢​ Small amounts may pass

into breast milk.
However, there are no
known harmful effects
when used by
breastfeeding mothers.
 ➢​ Alcohol increases the
risk of liver damage that
can occur if an
overdose of
paracetamol is taken.
The hazards of
paracetamol overdose
are greater in persistent
heavy drinkers and in
people with alcoholic
liver disease.

➢​ Evaluate therapeutic
response.

Phenobarbital ADULTS Barbiturates are indicated for History: Hypersensitivity to

120 mg/mL ampule IV the following: barbiturates, manifest or
30mg tablet (in high alert) Oral latent porphyria; marked
➢​ Oral or parenteral: liver impairment; nephritis;
Sedation: 30–120 mg/day in Sedative severe respiratory distress;
two to three divided doses. ➢​ Oral or parenteral: previous addiction to
No more than 400 mg per 24 Hypnotic, treatment of sedative-hypnotic drugs;
hr. insomnia for up to 2 wk pregnancy; acute or chronic
Hypnotic: 100–200 mg at pain; seizure disorders;
bedtime. ➢​ Oral: Long-term lactation, fever;
Antiepileptic: 60–100 treatment of generalized hyperthyroidism; diabetes
mg/day. tonic-clonic and cortical mellitus; severe anemia;
focal seizures cardiac disease; shock;
uremia; impaired liver or
➢​ Oral: Emergency control renal function; debilitation
IM or IV of certain acute seizures. Physical: Weight; T; skin
color, lesions; orientation,
Sedation: 30–120 mg/day IM ➢​ Parenteral: affect, reflexes; P, BP,
or IV in two to three divided Preanesthetic orthostatic BP; R,
doses. adventitious sounds; bowel
➢​ Parenteral: Treatment of sounds, normal output, liver
Preoperative sedation: generalized tonic-clonic evaluation; LFTs, renal
100–200 mg IM, 60–90 min and cortical focal function tests, blood and
before surgery. seizures urine glucose, BUN

Hypnotic: 100–320 mg IM or ➢​ Parenteral: Emergency ➢​ Monitor patient

IV. control of acute seizures responses, blood levels if
any interacting drugs
Acute seizures: 200–320 mg listed above are given
IM or IV repeated in 6 hr if with phenobarbital;
needed. suggest alternative
means of contraception
PEDIATRIC PATIENTS to women using
hormonal
Oral contraceptives.

Sedation: 2 mg/kg/dose PO ➢​ WARNING: Do not give

tid. 8–32 mg/dose. intra-arterially; may
Hypnotic: Determine dosage produce arteriospasm,
using age and weight charts. thrombosis, gangrene.
Antiepileptic: 3–6
mg/kg/day. ➢​ Administer IV doses
slowly.
IM or IV
➢​ WARNING: Monitor
Preoperative sedation: 1–3 injection sites carefully
mg/kg IM or IV 60–90 min for irritation,
before surgery. extravasation (IV use).
Antiepileptic: 4–6 Solutions are alkaline
mg/kg/day for 7–10 days to a and very irritating to the
blood level of 10–15 mcg/mL tissues.
or 10–15 mg/kg/day IV or
IM. ➢​ Monitor P, BP,
Status epilepticus: 15–20 respiration carefully
mg/kg IV over 10–15 min. during IV administration.

➢​ Arrange for periodic lab

tests of hematopoietic,
renal, and hepatic
systems during
long-term therapy.

➢​ WARNING: Taper dosage

gradually after repeated
use, especially in
patients with epilepsy.
When changing from
one antiepileptic drug to
another, taper dosage of
the drug being
discontinued while
increasing the dosage of
the replacement drug.
 Phenytoin ADULTS Phenytoin is indicated for the History: Hypersensitivity to
100mg/capsule following: hydantoins; sinus
100 mg/2 mL ampule Status epilepticus: 10–15 bradycardia, AV heart block,
mg/kg by slow IV. For ➢​ Control of grand mal Stokes-Adams syndrome,
maintenance, 100 mg PO or (tonic-clonic) and acute intermittent porphyria,
IV q 6–8 hr. Higher doses psychomotor seizures hypotension, severe
may be required. Do not myocardial insufficiency,
exceed an infusion rate of 50 ➢​ Prevention and diabetes mellitus,
mg/min. Follow each IV treatment of seizures hyperglycemia, pregnancy,
injection with an injection of occurring during or lactation
sterile saline through the following neurosurgery
same needle or IV catheter to Physical: T; skin color,
avoid local venous irritation ➢​ Parenteral lesions; lymph node
by the alkaline solution. administration: Control palpation; orientation, affect,
Continuous IV infusion is not of status epilepticus of reflexes, vision examination;
recommended. the grand mal type P, BP; R, adventitious sounds;
➢​ Unlabeled uses: bowel sounds, normal
Neurosurgery (prophylaxis): Antiarrhythmic, output, liver evaluation;
100–200 mg IM q 4 hr during particularly in periodontal examination;
surgery and the digitalis-induced LFTs, urinalysis, CBC and
postoperative period (IM arrhythmias (IV differential, blood proteins,
route is not recommended preparations); blood and urine glucose, EEG
because of erratic treatment of trigeminal and ECG
absorption, pain and muscle neuralgia (tic
damage at the injection site). douloureux) ➢​ Use only clear parenteral
IM therapy in a patient solutions.
previously stabilized on oral
dosage: Increase dosage by ➢​ WARNING: Administer
50% over oral dosage. When IV slowly to prevent
returning to oral dosage, severe hypotension; the
decrease dose by 50% of the margin of safety
original oral dose for 1 wk to between full therapeutic
prevent excessive plasma and toxic doses is small.
levels due to continued Continually monitor
absorption from IM tissue patient’s cardiac rhythm
sites. Avoid IM route of and check BP frequently
administration if possible due and regularly during IV
to erratic absorption and infusion.
pain and muscle damage at
injection site ➢​ Suggest use of
fosphenytoin sodium if
PEDIATRICS: IV route is needed.

Status epilepticus: ➢​ Monitor injection sites

Administer phenytoin IV. carefully; drug solutions
Determine dosage according are very alkaline and
to weight in proportion to irritating.
dose for a 150-lb (70-kg)
adult ➢​ WARNING: Monitor for
therapeutic serum levels
ORAL: Individualized of 10–20 mcg/mL.
dosages.
➢​ Give oral drug with or
without food in a
consistent manner. Give
with food if patient
complains of GI upset.

➢​ WARNING: Reduce
dosage, discontinue
phenytoin, or substitute
other antiepileptic
medication gradually;
abrupt discontinuation
 may precipitate status
epilepticus.

➢​ WARNING: Discontinue
drug if rash, depression
of blood count, enlarged
lymph nodes,
hypersensitivity
reaction, signs of liver
damage, or Peyronie’s
disease occurs.

➢​ Monitor hepatic function

periodically during
long-term therapy;
monitor blood counts
and urinalysis monthly.

➢​ Monitor blood or urine

sugar of patients with
diabetes mellitus
regularly.

➢​ Monitor blood proteins

to detect early
malfunction of the
immune system
Plain LRS 1L/bottle D5LRs are supplied in Plain LRS is indicated for the ➢​ Do not administer
single-dose 500 and 1000 mL following: unless solution is clear
flexible plastic containers. and container is
➢​ Acidoss undamaged.
1000 mL @ 30 gtts/min or as
prescribed by the physician ➢​ Hypotension ➢​ Caution must be
exercised in the
➢​ Low blood volume administration of
parenteral fluids,
especially those
containing sodium ions
to patients receiving
corticosteroids or
corticotrophin.

➢​ Solution containing
acetate should be used
with caution as excess
administration may
result in metabolic
alkalosis.

➢​ Solution containing
dextrose should be
used with caution in
patients with known
subclinical or overt
diabetes mellitus.

➢​ Discard unused
portion.
➢​ In very low birth
 weight infants,
excessive or rapid
administration of
dextrose injection may
result in increased
serum osmolality and
possible intracerebral
hemorrhage.

➢​ Properly label the IV

Fluid

➢​ Observe aseptic
technique when
changing IV fluid

Plain NSS 1L/bottle As directed by a physician. Normal saline is indicated for ➢​ Document baseline
0.9% Sodium Chloride Dosage is dependent upon the following: data. Before infusion,
the age, weight and clinical assess the patient’s vital
condition of the patient as Loss of water and signs, edema status,
well as laboratory electrolytes. lung sounds, and heart
determinations. sounds. Continue
monitoring during and
Parenteral drug products after the infusion.
should be inspected visually
for particulate matter and ➢​ Observe for signs of
discoloration prior to fluid overload. Look for
administration whenever signs of hypervolemia
solution and container such as hypertension,
permit. Do not administer bounding pulse,
unless solution is clear and pulmonary crackles,
seal is intact. dyspnea, shortness of
 breath, peripheral
edema, jugular venous
distention, and extra
heart sounds.

➢​ Monitor manifestations
of continued
hypovolemia. Look for
signs that indicate
continued hypovolemia
such as, decreased
urine output, poor skin
turgor, tachycardia,
weak pulse, and
hypotension.

➢​ Prevent hypervolemia.
Patients being treated
for hypovolemia can
quickly develop fluid
overload following rapid
or over infusion of
isotonic IV fluids.

➢​ Elevate the head of the

bed at 35 to 45 degrees.
Unless contraindicated,
position the client in
semi-Fowler’s position.
➢​
➢​ Elevate the patient’s
legs. If edema is
 present, elevate the legs
of the patient to
promote venous return.

➢​ Close monitoring for

patients with heart
failure. Because isotonic
fluids expand the
intravascular space,
patients with
hypertension and heart
failure should be
carefully monitored for
signs of fluid overload.

Potassium Chloride ADULT Potassium Chloride is History: Allergy to tartrazine,

40mEq/20mL vial indicated for the following: aspirin; severe renal
(in high alert box) Parenteral: 40 to 100 mEq impairment; untreated
potassium chloride for ➢​ Prevention and Addison’s disease;
injection diluted in an correction of potassium hyperkalemia; adynamia
appropriate amount and type deficiency. episodica hereditaria; acute
of solution to be dehydration; heat cramps, GI
intravenously infused once at ➢​ IV: Treatment of cardiac disorders that cause delay in
a rate not to exceed 10 to 40 arrhythmias due to passage in the GI tract,
mEq/hour. cardiac glycosides cardiac disorders, lactation

Oral: 40 to 100 mEq orally Physical: Skin color, lesions,

once a day given in equally turgor; injection sites; P,
divided doses using baseline ECG; bowel sounds,
formulations which include abdominal examination;
normal-release tablets or urinary output; serum
capsules, extended-release electrolytes, serum
tablets or capsules, bicarbonate.
dissolvable tablets, oral
solution or powder for ➢​ Arrange for serial serum
dissolution mixed with an potassium levels before
appropriate volume of water and during therapy.
or juice.
➢​ Administer liquid form to
PEDIATRICS: any patient with delayed
GI emptying.
Parenteral: 0.5 to 1
mEq/kg/dose potassium ➢​ Administer oral drug
chloride for injection diluted after meals or with food
in an appropriate amount and a full glass of water
and type of solution to be to decrease GI upset.
intravenously infused once at
a rate not to exceed 0.3 to ➢​ Caution patient not to
0.5 mEq/kg/hour. chew or crush tablets;
have patient swallow
Oral: 2 to 5 mEq/kg/day tablet whole.
orally in equally divided
doses using age-appropriate ➢​ Mix or dissolve oral
oral dosage formulations. liquids, soluble powders,
and effervescent tablets
completely in 3–8 oz of
cold water, juice, or
other suitable beverage,
and have patient drink it
slowly.

➢​ Arrange for further

dilution or dose
reduction if GI effects
 are severe.

➢​ Agitate prepared IV
solution to prevent
“layering” of potassium;
do not add potassium to
an IV bottle in the
hanging position.

➢​ Monitor IV injection
sites regularly for
necrosis, tissue
sloughing, phlebitis.

➢​ Monitor cardiac rhythm

carefully during IV
administration.

➢​ Caution patient that

expended wax matrix
capsules will be found in
the stool.

➢​ Caution patient not to

use salt substitutes.
 Vitamin B1/B6/B12 100mg/5 mg/50 mcg OD. Vitamin B complex is ➢​ Determine reticulocyte
(1g B1, 1g B6, 0.01gB12 in indicated for the following: count, hct, Vit.B12, iron,
10mL Vial) folate levels before
Complex deficiencies; beginning therapy
neuritis, polyneuritis
,diabetic neuritis,neuralgia, ➢​ Obtain a sensitivity test
lumbalgia, sciatica, history before
intercostal & trigeminal administration.
neuralgia, peripheral nerve
paralysis,arthralgia & myalgia ➢​ Avoid I.V. administration
because faster systemic
elimination will reduce
effectiveness.

➢​ Don’t give large doses

routinely as the drug is
lost through excretion.

➢​ Protect Vit.B 12 from

light

➢​ Do not refrigerate or
freeze.
 Sodium Bicarbonate Acute metabolic acidosis: 2 Sodium bicarbonate is ➢​ Monitor vital signs and
50mEq/50mL ampule to 5 mEq/kg/dose IV for a indicated for the following: notify the physician of
single dose; subsequent abnormalities.
dosing based on patient ➢​ Heartburn
response and acid-base ➢​ Obtain patient history
status. ➢​ Acid indigestion (drug history and any
hypersensitivity).
Chronic renal failure: 1625 ➢​ Metabolic acidosis
to 2925 mg/day orally conditions: severe renal ➢​ Monitor fluid balance
divided every 4 to 6 hours; disease, circulatory (input-output ratio,
dose adjustments are based insufficiency, shock. weight, edema).
on serum HCO3 levels.
➢​ Monitor manifestations
Distal renal tubular acidosis: of hypokalemia and
48 to 168 mg/kg/day orally hyponatremia
divided every 4 to 6 hours;
dose adjustments are based ➢​ Report any symptoms
on serum HCO3 levels. such as nausea, vomiting
and anorexia
Proximal renal tubular
acidosis: 420 to 840
mg/kg/day orally divided
every 4 to 6 hours; dose
adjustments are based on
serum HCO3 levels.

Salicylate overdose: 1 to 2
mEq/kg/dose IV for a single
dose.

Cardiac arrest: Dosing is 1

mEq/kg per dose
 Verapamil Initial dose: − 5 to 10 mg Verapamil is indicated for the History: Allergy to verapamil;
5mg/2ml ampule (0.075 to 0.15 mg/kg body following: sick sinus syndrome; heart
weight) given as an block; IHSS; cardiogenic
intravenous bolus over at ➢​ Angina pectoris due to shock, severe CHF;
least 2 minutes. coronary artery spasm. hypotension; impaired
hepatic or renal function;
Repeat dose: − 10 mg (0.15 ➢​ Effort-associated pregnancy, lactation
mg/kg body weight) 30 angina.
minutes after the first dose if Physical: Skin color, edema;
the initial response is not ➢​ Chronic stable angina orientation, reflexes; P, BP,
adequate baseline ECG, peripheral
➢​ Unstable, crescendo, perfusion, auscultation; R,
preinfarction angina adventitious sounds; liver
evaluation, normal output;
➢​ Essential hypertension LFTs, renal function tests,
urinalysis
➢​ Parenteral: Treatment
of supraventricular ➢​ WARNING: Monitor
tachyarrhythmias patient carefully (BP,
cardiac rhythm, and
➢​ Parenteral: Temporary output) while drug is
control of rapid being titrated to
ventricular rate in therapeutic dose.
atrial flutter or atrial
fibrillation ➢​ Dosage may be
increased more rapidly
in hospitalized patients
under close supervision.

➢​ Ensure that the patient

swallows SR tablets
whole; the patient
 should not cut, crush, or
chew them.
➢​ Monitor BP very
carefully with
concurrent doses of
antihypertensives.

➢​ Monitor cardiac rhythm

regularly during
stabilization of dosage
and periodically during
long-term therapy.

➢​ Administer SR form in
the morning with food to
decrease GI upset.

➢​ Protect IV solution from

light.

➢​ Monitor patients with

renal or hepatic
impairment carefully for
possible drug
accumulation and
adverse reactions.