Download Drug admin guide July 11 (AMU) 181KB Jul 08 2011 03:11:39 AM

Guidelines for Drug Administration (adults)
Acute Medical Unit, SGH.
These guidelines are intended to aid medical/nursing staff in the reconstitution and administration of drugs.
It is the responsibility of the person administering the drug to ensure the correct diluent, volume admixture and rate are used.
Continuous ECG monitoring is recommended for those entries marked with a ‘ ♥’ symbol.
Drug
Acetylcysteine
2g in 10mL (20%)
Aciclovir
250mg vial
500mg vial
Adenosine
6mg in 2mL
Guidelines for preparation and administration
Comments
Paracetamol overdose:
- initially 150mg/kg (maximum 16.5g) in 200mL glucose 5% over 15 minutes
- followed by 50mg/kg (maximum 5.5g) in 500mL glucose 5% over 4 hours
- followed by 100mg/kg (maximum 11g) in 1L glucose 5% over 16 hours
Reconstitution:
- 250mg vial with 10mL water for injections or sodium chloride 0.9%.
- 500mg vial with 20mL water for injections or sodium chloride 0.9%.
Dilution:
- for doses between 250mg and up to and including 500mg add to 100mL
sodium chloride 0.9%.
- for doses over 500mg add to 250mL sodium chloride 0.9%.
Administer as an infusion over a minimum of 1 hour.
Irritant. Phlebitis common. Extravasation
can produce severe inflammation and
ulceration.
Rapid iv bolus over 2 seconds, followed by a rapid flush of 10mL sodium
chloride 0.9%.
Wait 1-2 minutes between incremental doses.
Give centrally if possible, as adenosine is
painful and rapidly metabolised in the
peripheral circulation (half-life <10
seconds).
May cause facial flushing, dyspnoea,
tightness of the chest. Monitor ECG.
Anaphylaxis:
500mcg (=0.5mL of the 1:1,000 solution) by intramuscular injection.
Adrenaline (epinephrine)
1 in 1,000 (1mg/mL)
1 in 10,000 (1mg/10mL)
For infusion, dilute with sodium chloride 0.9% or glucose 5%, typically 10mg
would be added to 100mL glucose 5% (giving a 100micgrogram/mL solution).
Monitor ECG, arterial BP.
Central line administration only.
Nebulised for treatment of localised angioedema:
Use 1-5mL of the 1:1,000 solution (which contains 1mg/mL) made up to 5mL
(the opitmum volume for nebulisation) with sodium chlioride 0.9% if needed.
Acute Medical Unit drug administration guide.
Page 1
July 2011
Alteplase
50mg vial
20mg vial
Aminophylline ♥
250mg in 10mL
Amiodarone ♥
150mg in 3mL
Amoxicillin
500mg vial
1g vial
For the treatment of pulmonary embolism:
Reconstitute with the vials of water for injection provided to produce a
1mg/mL solution. Administer 10mg as an iv injection over 1-2 minutes and
then the remainder as an iv infusion over 2 hours.
Loading dose:
5mg/kg in 100mL sodium chloride 0.9% or glucose 5% over 30 minutes.
Maintenance dose (continuous infusion):
Dilute 500mg to 500mL sodium chloride 0.9% or glucose 5%. Infusion
started at 0.5mL/kg/hr and adjusted according to level.
Loading dose:
5mg/kg in 250mL glucose 5% over 20 minutes to 2 hours.
Continuous infusion:
15mg/kg (max. 1.2g) in 500mL glucose 5% over 24 hours.
Reconstitution:
- 500mg vial with 10mL water for injections
- 1g vial with 20mL water for injections
Administer as a slow iv injection over 3-5 minutes, or as an infusion in 100mL
sodium chloride 0.9% or glucose 5% over 30 minutes.
For the 1mg test dose:
Reconstitute a 50mg vial with 12mL water for injections.
Withdraw 0.25mL (1mg) using the filter provided and administer in 5mL
glucose 5% over 10mins.
Ambisome®
50mg vial
For all other doses:
Reconstitute each 50mg vial with 12mL water for injections and shake
vigorously.
Withdraw the required volume (reconstituted solution contains 4mg/mL) with
using the filter provided.
Doses 20-200mg: Administer in 100mL glucose 5% over 60 minutes.
Doses 200-500mg: Administer in 250mL glucose 5% over 60 minutes.
Acute Medical Unit drug administration guide.
Page 2
Do not give loading dose if already taking
an oral theophylline or aminophylline
preparation (e.g. Nuelin, Slo-Phyllin).
Take blood for the initial (theophylline) level:
- 4 to 6 hours after starting the infusion if
patients received a loading dose or were
previously taking an oral preparation
- 24 hours after starting the infusion
otherwise
Incompatible with sodium chloride 0.9%.
Irritant.
Central venous administration recommended
for repeated or continuous infusion.
Incompatible with sodium chloride 0.9%.
Ambisome® is a liposomal formulation of
amphotericin.
Final concentration must be between 0.2
and
2mg/mL.
July 2011
Atropine
Benzylpenicillin
(penicillin G)
600mg vial
1.2g vial
Beriplex®
250 units vial
500 units vial
C1-esterase inhibitor
500 units vial
Calcium gluconate
1g in 10mL (10%)
Cefotaxime
500mg vial
1g vial
2g vial
Ceftazidime
1g vial
2g vial
Ceftriaxone
1g vial
2g vial
Cefuroxime
750mg vial
1.5g vial
Direct rapid iv injection.
Not recommended by infusion.
Reconstitute with 10mL water for injections.
Administer as a slow iv injection at a maximum rate of 300mg per minute or
as an infusion in 100mL sodium chloride 0.9% or glucose 5% over 30-60
minutes.
Reconstitute with the device and diluent provided and then give by iv
infusion at a rate determined by patient’s weight:
- 34-41kg: 4mL/min, - 42-49kg: 5mL/min, - 50-58kg: 6mL/min
- 59-66kg: 7mL/min, ≥ 67kg: 8mL/min
Monitor ECG.
Slow administration may cause paradoxical
slowing of the heart.
600mg = 1 mega unit = 1 million units.
Skin sensitisation can occur – avoid contact
when handling the antibiotic.
Rapid injection causes CNS irritation.
Contains vitamin K dependant coagulation
factors and coagulation inhibitors.
Reconstitute with the 10mL water for injections provided (using the device
provided) and administer over 5 minutes.
Administer 10mL over a minimum of 5 minutes.
Can be diluted with sodium chloride 0.9%
or glucose 5% to a convenient volume.
Reconstitution:
- 500mg vial 2mL water for injections
- 1g vial with 4mL water for injections
- 2g vial with 10mL water for injections
Administer as a slow iv injection over 3-5 minutes or as an infusion in 100mL
sodium chloride 0.9% or glucose 5% over 20-60 minutes.
Reconstitute with 10mL of sodium chloride 0.9% and administer as an iv
injection over 3 minutes or as an iv infusion in 100mL sodium chloride 0.9%
or glucose 5% over 30 minutes.
For a 1g dose: Reconstitute a 1g vial with 10ml water for injections and
administer as an iv injection over 2-4 minutes.
For a 2g dose: Reconstitute a 2g vial with 40mL sodium chloride 0.9% or
glucose 5% and administer as an intravenous infusion over 30 minutes.
Reconstitution:
- 750mg vial with 6mL water for injections
- 1.5g vial with 15mL water for injections
Administer as a slow iv injection over 3-5 minutes or as an infusion in 100mL
sodium chloride 0.9% or glucose 5% over 15-30 minutes.
Acute Medical Unit drug administration guide.
Page 3
Can be added to a ready diluted bag of
metronidazole.
July 2011
Chloramphenicol
1g vial
Chlorphenamine
10mg in 1mL
Reconstitute with 10mL water for injections or sodium chloride 0.9%.
Administer as an iv injection over 1 minute or as an iv infusion in 100mL
sodium chloride 0.9% or glucose 5% over a minimum of 15 minutes.
Dilute 10mg with 5-10mL water for injections or sodium chloride 0.9% and
give slowly over at least 1 minute.
Ciprofloxacin
100mg in 50mL
200mg in 100mL
400mg in 200mL
Clarithromycin
500mg vial
Administer doses 100 or 200mg undiluted over 30 minutes.
Administer doses of 400mg undiluted over 60 minutes.
Reconstitute with 10mL water for injections. Further dilute to 250mL
(2mg/mL) with glucose 5% or sodium chloride 0.9%. Administer over 60
minutes via large vein.
Clindamycin
300mg in 2mL
600mg in 4mL
Administer as an iv infusion in 100mL sodium chloride 0.9% over 1 hour.
Clonazepam
Dilute with the 1mL water for injections provided and administer the required
dose as a slow iv injection over 3 minutes.
1mg in 1mL
Co-amoxiclav
600mg vial
1.2g vial
Colistimethate
(Colomycin®)
1 million unit vial
2 million unit vial
Reconstitution:
- 600mg vial with 10mL water for injections
- 1.2g vial with 20mL water for injections
Slow iv injection over 3-4 minutes, or iv infusion in 50-100mL sodium chloride
0.9% over 30-40 minutes.
Reconstitution:
- 1 million unit vial with 5mL sodium chloride 0.9%
- 2 million unit vial with 10mL sodium chloride 0.9%
Administer as an iv infusion in 50mL sodium chloride 0.9% over 30 minutes.
Contains a penicillin.
To prepare for nebulisation reconstitute with 4mL of sodium chloride 0.9%.
®
Colomycin
Cyclizine
50mg in 1mL
Daptomycin
350mg vial
500mg vial
See entry for colistimethate.
Slow iv injection over 3-5 minutes. May be diluted with 10mL water for
injections.
Reconstitution (to give a 50mg/mL solution):
- 350mg vial with 7mL sodium chloride 0.9%
- 500mg vial with 10mL sodium chloride 0.9%
Administer as an iv infusion in 50-100mL sodium chloride 0.9% over 30
minutes.
Acute Medical Unit drug administration guide.
Page 4
To reconstitute – add the diluent & allow to
stand for 10 minutes. Rotate or swirl for
several minutes until fully dissolved. Do
NOT shake because of foaming.
July 2011
Dexamethasone
4mg in 1mL
8mg in 2mL
Slow iv injection over 5-10 minutes or as an infusion diluted in 100mL sodium
chloride 0.9% or glucose 5% over 15 minutes.
Rapid administration may cause
cardiovascular collapse.
Can be given as an iv injection undiluted at a rate of 5mg per minute.
Monitor respiratory rate, BP and HR.
Dilute the required dose in 100mL sodium chloride 0.9% or glucose 5% and
administer over 2 hours.
Rapid administration increases risk of
arrhythmias and nausea.
For central administration dilute 500mg in 100mL glucose 5%.
For peripheral administration dilute 250mg in 250mL glucose 5%.
May turn pink due to oxidation – harmless.
Monitor HR, ECG, arterial BP.
Produces local vasoconstriction and
ischaemia may occur if extravagates.
Monitor ECG.
Unlicensed in the UK.
Stored in the fridge.
Diazepam emulsion
(“Diazemuls”)
10mg in 2mL
Digoxin ♥
500mcg in 2mL
Dobutamine
250mg in 20mL
Dopamine
200mg in 5mL
Doxycycline
100mg in 5mL
Ertapenem
1g vial
Etomidate
20mg in 10mL
Flecainide ♥
150mg in 15mL
Flucloxacillin
250mg vial
500mg vial
1g vial
For central administration dilute 400mg in 100mL glucose 5%.
For peripheral administration dilute 200mg in 500mL glucose 5%.
Administer as an infusion in 100mL sodium chloride 0.9% over 30 minutes.
Reconstitute a 1g vial with 10mL water for injection or sodium chloride 0.9%.
Administer in 50mL sodium chloride 0.9% as an iv infusion over 30 minutes.
Incompatible with glucose 5%.
Slow iv bolus into a large vein over at least 2 minutes.
For the initial 2mg/kg dose:
- Give as an iv bolus undiluted over a minimum of 10 minutes or as an iv
infusion diluted in 100mL glucose 5% over 30 minutes.
When a prolonged infusion is required this should be followed by an infusion
of 1.5mg/kg administered in 100mL glucose 5% over 1 hour. Following this
prepare a solution containing 1mg per mL in glucose 5% and administer at
the prescribed rate – usually 0.1-0.25mg/kg/hr.
Reconstitution:
- 500mg vial with 5-10mL water for injections
- 1g vial with 15-20mL water for injections
Slow iv injection over 3-5 minutes (doses ≤ 1g) or as an infusion over 30-60
minutes in 100mL glucose 5% or sodium chloride 0.9%.
Acute Medical Unit drug administration guide.
Page 5
Administration of the initial dose as an iv
infusion is preferred for patients with
ventricular tachycardia or a history of cardiac
failure.
July 2011
Fluconazole
50mg in 25mL
200mg in 100mL
Flumazenil
500mcg in 5mL
Furosemide
20mg in 2mL
50mg in 5mL
250mg in 25mL
Fusidic acid
Gentamicin
80mg in 2mL
Glucagon
1mg vials
Glucose 50%
25g in 50mL
Glyceryl trinitrate
50mg in 50mL
Heparin
5000 units in 1mL
20000 units in 20mL
Infuse the ready diluted solution over 20 minutes.
IV injection over a minimum of 15 seconds.
For a continuous iv infusion dilute to a convenient volume with sodium
chloride 0.9% or glucose 5% and infuse at 100-400mcg/hr, titrating to clinical
response.
Half-life of flumazenil is 50-60 minutes.
Doses ≤ 50mg can be given as a slow iv injection over 3 minutes.
Doses > 50mg must be administered as an infusion (diluted in sodium
chloride 0.9% if required) at a maximum rate of 4mg/minute.
Incompatible with glucose 5%.
Rapid administration is associated with an
increased incidence of hearing disorders.
See the entry for sodium fusidate.
Doses ≤ 120mg can be given as a slow iv injection over 3 minutes.
Doses > 120mg must be administered as an iv infusion diluted in 100mL
sodium chloride 0.9% over 30 minutes.
Hypoglycaemia – reconstitute with the diluent provided and administer as
slow bolus intravenous, intramuscular or subcutaneous injection.
Treatment of β-blocker or calcium channel blocker overdose:
A bolus of 5-10mg should be administered over 10 minutes, followed by an
infusion of 1-5mg/hour (50micrograms/kg/hour), titrated to clinical
response. Reconstitute with the diluent provided and then make a solution
of a convenient volume (e.g. 20mg in 50mL glucose 5%).
Treatment of hypoglycaemia:
Iv bolus peripherally into a large vein over 1-2 minutes.
Continuous iv infusion using the undiluted solution.
Can be diluted with sodium chloride 0.9% or glucose 5% to a convenient
volume if required.
A loading dose of 5000 units is given as an iv bolus over 3-5 minutes followed
by an intravenous infusion using the 20000 units in 20mL (undiluted) usually
started at 1.4mL per hour and adjusted according to APTR.
Acute Medical Unit drug administration guide.
Page 6
Highly irritant – use large vein, large gauge
needle and follow by a sodium chloride
0.9% flush.
Not compatible with PVC infusion bags.
Some loss of activity can also occur
through the infusion sets, but drug dosage
should be determined by clinical response.
Monitor BP and HR.
Please see trust heparin prescription for
continued monitoring and prescribing.
July 2011
Hydrocortisone
100mg vial
Hyoscine butylbromide
20mg in 1mL
Imipenem/ cilastatin
(Primaxin®)
500mg vials
Immunoglobulin (various
brands – e.g. Kiovig® &
Vigam®)
Insulin (soluble – e.g.
Actrapid®)
100 units per mL
Isoprenaline
2.25mg in 2mL
Labetolol ♥
100mg in 20mL
Levetiracetam
500mg in 5mL
Lorazepam
4mg in 1mL
Reconstitute with 2mL water for injections and give as iv injection over 2
minutes.
May be given as intermittent iv infusion in 100mL sodium chloride 0.9% or
glucose 5% over 20-30mins.
May be diluted with sodium chloride 0.9%
or glucose 5%.
IV bolus over 1 minute.
Reconstitute each vial with 10mL sodium chloride 0.9%.
Administration:
- For 250-500mg doses administer in 100mL sodium chloride 0.9% over 30
minutes.
- For 1000mg doses administer in 100mL sodium chloride 0.9% over 60
minutes.
Administer undiluted as an iv infusion at an initial rate of 0.3mL/kg/hr (e.g.
21mL per hour for a 70kg person) for the first 60 minutes and if tolerated
increase the rate gradually (e.g. 0.1mL/kg/hr every 30 minutes) to a
maximum of 1mL/kg/hr.
Doses are based on the imipenem content
(500mg per vial).
Can be given more rapidly - discuss with
ward or on-call pharmacist if required.
IV bolus over 3-5 minutes.
IV infusion via syringe driver:
- Dilute 0.5mL (50 units) to 50mL with sodium chloride 0.9%.
Change giving set every 24 hours.
See separate guideline.
Continuous central intravenous infusion
under ECG control. If heart rate > 100
beats/min, or if premature heart beats or
changes in ECG – consider slowing or
stopping infusion.
To administer as an iv bolus give undiluted at a maximum of 50mg per
minute.
To give as an iv infusion administer undiluted (contains 5mg/mL). The usual
maximum rate is 2mg per minute (i.e. 24mL/hr).
Administer as an iv infusion in 100mL sodium chloride 0.9% or glucose 5%
over 15 minutes.
Dilute with equal volume of sodium chloride 0.9% or water for injection and
administer as an iv bolus (avoid small veins) at a maximum rate of 2mg per
minute.
Acute Medical Unit drug administration guide.
Page 7
July 2011
Asthma:
- 2g in 100mL sodium chloride 0.9% or glucose 5% infused over 20 minutes.
Magnesium sulphate
1g in 2mL
5g in 10mL
Meropenem
500mg vial
1g vial
Methylprednisolone
♥
Hypomagnesaemia:
- Administer in a convenient volume (at least 50mL) of sodium chloride 0.9%
or glucose 5% at a rate of 1-2g per hour.
CPR (shock refractory VF):
- 8mmol (4mL) may be given over 1-2 minutes.
Reconstitution:
- 500mg vials with 10mL water for injections
- 1g vials with 20mL water for injections
Administer as a slow iv bolus over at least 5 minutes or as an infusion in
100mL sodium chloride 0.9% over 30 minutes.
40mg vial
125mg vial
500mg vial
1g vial
2g vial
Reconstitute with diluent provided.
Doses ≤ 250mg can be given as an iv bolus over at least 5mins.
Doses > 250mg should be administered in 100mL sodium chloride 0.9% or
glucose 5% over at least 30 minutes.
Metoclopramide
IV bolus over 1-2 minutes.
May be diluted in 10-20mL sodium chloride 0.9%.
10mg in 2mL
Metronidazole
500mg in 100mL
Midazolam
5mg in 5mL
Morphine
10mg in 1mL
Naloxone
400mcg in 1mL
1g magnesium sulphate provides 4mmol
magnesium.
Magnesium sulphate can be added to a
solution of potassium chloride.
Infuse over 20 minutes.
IV bolus over minimum of 30 seconds. Usually given over 2 minutes and
repeated at intervals of at least 2 minutes.
IV infusion via syringe pump, following initial loading. Dilute 50mg to 50mL
with sodium chloride 0.9% or glucose 5%.
IV bolus over 3-5 minutes. May be diluted with sodium chloride 0.9% or
glucose 5%.
For an iv infusion dilute to a convenient volume with sodium chloride 0.9% or
glucose 5%.
Inject undiluted as an iv bolus over 1 minute.
For a continuous iv infusion:
- Draw 12.5mL of injection (5mg) into a syringe and dilute to 50mL with
sodium chloride 0.9% or glucose 5% (giving a 100micgrogram/mL solution).
Acute Medical Unit drug administration guide.
Page 8
The sodium succinate salt (Solu-Medrone®)
is the correct preparation for intravenous
injection.
Dystonic reactions are a known side
effect, particularly affecting children and
young women.
Cefuroxime or cefotaxime may be added to
an infusion of metronidazole.
Rapid administration can cause
respiratory depression.
Use infusion within 12 hours.
The infusion is started with an initial rate
of ⅔rds of the dose required to see a
clinical effect per hour.
July 2011
Noradrenaline
(norepinephrine)
Prepare a solution containing 8mg in 100mL glucose 5% and administer
centrally as a continuous iv infusion.
Discard if a brown colour develops.
Monitor ECG, arterial BP.
4mg in 2mL
8mg in 4mL
Administer as an iv injection over 3 minutes.
May be diluted with sodium chloride 0.9% or
glucose 5% to a convenient volume.
Pabrinex® (various B & C
group vitamins)
One or two pairs of ampoules should be mixed and administered as an iv
infusion in 100mL of sodium chloride 0.9% or glucose 5% over 15-30
minutes.
For 30-60mg doses: Administer as an iv infusion in 250mL sodium chloride
0.9% over 1 hour* (longer in renal impairment – see comment).
For 90mg doses: Administer as an iv infusion in 500mL sodium chloride 0.9%
over 2 hours* (longer in renal impairment – see comment).
Reconstitute with 10mL of sodium chloride 0.9% and administer as an iv
injection over 3 minutes or as an iv infusion in 100mL sodium chloride 0.9%
or glucose 5% over 15 minutes.
* In renal impairment the infusion time
should be increased to a maximum or 20mg
per hour.
4mg in 4mL
Ondansetron
Pamidronate
15mg in 5mL
Pantoprazole
40mg vial
Pethidine
50mg in 1mL
100mg in 2mL
Phenobarbital ♥
60mg in 1mL
200mg in 1mL
Phenylephrine
10mg in 1mL
Phenytoin ♥
250mg in 5mL
Administer as an iv injection over 2 minutes.
Administer undiluted by im or sc injection.
MUST be diluted before iv administration.
Dilute to 10 times its own volume with water for injection immediately before
use.
Maximum rate is 100mg per minute.
Dilute 1mL (10mg) of solution to 10mL with water for injections and give the
required dose as an iv injection over 5 minutes.
Peripheral iv infusion: dilute 1mL (10mg) in 500mL sodium chloride 0.9% or
glucose 5%.
Can be administered as an iv injection into a large vein through a large gauge
needle or iv catheter at a maximum rate of 50mg per minute. Flush line with
sodium chloride 0.9% before and after infusion.
Alternatively, administer as an iv infusion:
- for doses ≤ 1g dilute in 100mL sodium chloride 0.9%
- for doses > 1g dilute in 250mL sodium chloride 0.9%
Give over 30 minutes through an in-line filter (0.22-0.5 micron) and use within
1 hour of preparation.
Acute Medical Unit drug administration guide.
Page 9
A separate guideline and prescription sheet
is used when administered as a continuous
infusion.
May be diluted with water for injections,
sodium chloride 0.9% or glucose 5% to a
convenient volume.
Take blood sample 2 hours after loading
dose for later interpretation.
Incompatible with glucose 5%.
Take blood level 2-4 hours after loading
dose for later interpretation.
July 2011
Phytomenadione
10mg in 1mL
Piperacillin/ tazobactam
(previously Tazocin®)
2.25g vials
4.5g vials
Potassium chloride
Potassium phosphate
1.742g in 10mL (17.42%)
Procyclidine
10mg in 2mL
Protamine
50mg in 5mL
Ranitidine
50mg in 2mL
Rifampicin
600mg vial
Salbutamol sulphate ♥
500mcg in 1mL
250mcg in 5mL
5mg in 5mL for dilution
Sodium fusidate
500mg vial
Administer as an iv injection over 2-3 minutes or dilute in 100mL glucose 5%
and administer as an iv infusion over 30 minutes.
The injection can be given orally.
Reconstitution:
- 2.25g vials with 10mL water for injections
- 4.5g vials with 20mL water for injections
Administer as a slow iv bolus over at least 3 minutes or as an infusion in
100mL sodium chloride 0.9% over 30 minutes.
Use ready prepared bags where possible.
Resuscitation Room Only - Concentrated potassium ampoules to be used
only if essential – extreme caution required. Dilute with sodium chloride 0.9%
or glucose 5%. Mix thoroughly to avoid layering.
Maximum rate 20mmol/hr.
Maximum concentration for peripheral administration is 40mmol/litre
= 0.3%.
Administer in 500mL sodium chloride 0.9% over 12 hours.
Risk of anaphylaxis reduced by giving as
infusion.
Contains a penicillin.
Maximum concentration 40mmol/litre without
ECG monitor
0.3% = 3g per litre.
1g = 13.5mmol potassium.
10mL contains 10mmol of phosphate and
20mmol of potassium.
Ensure that the bag is mixed thoroughly.
Rapid iv injection of the undiluted solution.
Flush with sodium chloride 0.9%.
Administer as a slow iv injection at a maximum rate of 5mg per minute, i.e.
the usual maximum single dose of 50mg is given over 10 minutes.
Dilute (each 50mg) to 20mL with glucose 5% or sodium chloride 0.9%.
Administer over a minimum of 2 minutes.
Rapid administration may produce
bradycardia.
Reconstitute with the diluent provided.
Administer a 300mg dose as an iv infusion in 250mL sodium chloride 0.9% or
dextrose 5% over 2-3 hours.
Administer a 600mg dose as an iv infusion in 500mL sodium chloride 0.9% or
dextrose 5% over 2-3 hours.
Slow iv bolus 250mcg in 5mL over 5 minutes.
Continuous infusion (for bronchospasm): dilute 5mg in 500mL sodium
chloride 0.9% or glucose 5%.
Incompatible with aminophylline.
Monitor ECG, BP and HR.
Reconstitute with the 10mL of buffer solution provided.
Administer in 500mL sodium chloride 0.9% or glucose 5% over a minimum of
6 hours.
Acute Medical Unit drug administration guide.
Page 10
July 2011
Sodium
glycerophosphate
Administer 10mL in 500mL sodium chloride 0.9% over 12 hours.
Each 10mL contains 10mmol of phosphate
and 20mmol of sodium.
Administer undiluted as an iv injection over 5 minutes.
May be diluted to a convenient volume with
sodium chloride 0.9% or glucose 5%.
2.16g in 10mL (21.6%)
Sodium valporate
300mg in 3mL
Synacthen®
Tazocin®
See the entry for tetracosactide.
Tenecteplase
40mg (8000 units) vials
50mg (10000 units) vials
See MI protocol, heparin should be given first.
Reconstitute with diluent provided.
Bolus over 10 seconds, dose based on weight.
Tenecteplase should be given via a
dedicated line (if a second cannula cannot
be sited flush with 20mLs sodium chloride
0.9% between each drug).
Tenecteplase is incompatible with glucose.
Terlipressin
(Glypressin®)
Slow iv injection over 3 minutes.
Kept in the fridge.
See the entry for piperacillin/ tazobactam.
1mg in 8.5mL
Tetracosactide
(Synacthen®)
Slow iv injection over 1 minute.
250mcg in 1mL
Thiopental (Thiopentone)
500mg in 20mL
Tobramycin
80mg in 2mL
Tranexamic acid
500mg in 5mL
Reconstitute with water for injections to give a 2.5% solution.
Induction of anaesthesia - bolus over 10-15 seconds.
Doses ≤ 160mg can be given as a slow iv injection over 3 minutes.
Doses > 160mg must be administered as an iv infusion diluted in 100mL
sodium chloride 0.9% over 30 minutes.
Administer as an iv bolus at a maximum rate of 100mg per minute.
Acute Medical Unit drug administration guide.
Page 11
Kept in the fridge.
For a short Synacthen test:
- Take blood for measurement of serum
cortisol concentration immediately before
and exactly 30 minutes after administering
the Synacthen.
Solution must be discarded 7 hours after
preparation.
May be diluted to a convenient volume with
sodium chloride 0.9% or glucose 5%.
July 2011
Vancomycin
500mg vials
Vecuronium
10mg vial
Venofer
100mg (of iron) in 5mL
Vitamin K
For administration as an iv infusion:
- Reconstitute a 500mg vial with 10mL water for injections.
- Administer as per separate guideline:
● 500mg in 100mL sodium chloride 0.9% or glucose 5% over 1 hour.
● 750mg in 250mL sodium chloride 0.9% or glucose 5% over 1 hour.
● 1g in 250mL sodium chloride 0.9% or glucose 5% over 1½ hours.
● 1.5g in 500mL sodium chloride 0.9% or glucose 5% over 2½ hours.
● 2g in 500mL sodium chloride 0.9% or glucose 5% over 3 hours.
For oral administration (for treatment of Clostridium difficile infections ONLY):
- Reconstitute a 500mg vial with 10mL water for injections.
IV bolus: dilute to 1mg/mL with water for injection and inject rapidly.
IV infusion: dilute 50mg in 50mL sodium chloride 0.9% or glucose 5%.
Administer as an iv infusion:
- For a 100mg dose: Add 1 ampoule (5mL) to 100mL sodium chloride 0.9%
and administer over 1 hour.
- For a 200mg dose: Add 2 ampoules (10mL) to 100mL sodium chloride
0.9% and administer over 2 hours.
Rapid administration is associated with
infusion-related reactions.
For fluid restricted patients the maximum
concentration is 10mg/mL.
Blood should be taken within an hour of the
time the dose is due and give that dose as
prescribed.
Reconstituted solution for oral
administration can be stored in a fridge for
up to 24 hours.
Can be given more rapidly - discuss with
ward or on-call pharmacist if required.
See the entry for phytomenadione.
References:
Summaries of Product Characteristics available from the electronic Medicines Compendium accessed via http://emc.medicines.org.uk.
UCL Hospitals Injectable Drug Administration Guide 2nd edition 2007.
Acute Medical Unit drug administration guide.
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July 2011