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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. Page 12 July 2011