Download magnesium sulfate (IV, parenteral) - DavisPlus

Name /bks_53161_deglins_md_disk/magnesiumsulfateivparent
1
02/17/2014 07:15AM
High Alert
magnesium sulfate (IV, parenteral) (9.9% Mg; 8.1
mEq Mg/g) (mag-nee-zhum sul-fate)
Classification
Therapeutic: mineral and electrolyte replacements/supplements
Pharmacologic: minerals/electrolytes
Pregnancy Category D
Plate # 0-Composite
pg 1 # 1
and bone changes in newborn); avoid continuous use during active labor or within 2
hr of delivery due to potential for magnesium toxicity in newborn.
Use Cautiously in: Any degree of renal insufficiency; Geri: May requirepdosage
due to age-relatedpin renal function.
Adverse Reactions/Side Effects
CNS: drowsiness. Resp:prespiratory rate. CV: arrhythmias, bradycardia, hypotension. GI: diarrhea. MS: muscle weakness. Derm: flushing, sweating. Metab: hypothermia.
Indications
Interactions
Drug-Drug: May potentiate calcium channel blockers and neuromuscular
Treatment/prevention of hypomagnesemia. Treatment of hypertension. Prevention of
seizures associated with severe eclampsia, pre-eclampsia, or acute nephritis. Unlabeled Use: Preterm labor. Treatment of torsade de pointes. Adjunctive treatment
for bronchodilation in moderate to severe acute asthma.
Route/Dosage
Treatment of Deficiency (Expressed as mg of Magnesium)
Action
Essential for the activity of many enzymes. Plays an important role in neurotransmission and muscular excitability. Therapeutic Effects: Replacement in deficiency
states. Resolution of eclampsia.
Pharmacokinetics
Absorption: IV administration results in complete bioavailability; well absorbed
from IM sites.
Distribution: Widely distributed. Crosses the placenta and is present in breast
milk.
Seizures/Hypertension
IM, IV (Adults): 1 g q 6 hr for 4 doses as needed.
IM, IV (Children): 20– 100 mg/kg/dose q 4– 6 hr as needed, may use up to 200
mg/kg/dose in severe cases.
IV (Infants and Children): 25– 50 mg/kg/dose, maximum dose: 2 g.
Bronchodilation
TIME/ACTION PROFILE (anticonvulsant effect)
ROUTE
ONSET
PEAK
DURATION
IM
IV
60 min
immediate
unknown
unknown
3–4 hr
30 min
IV (Adults): 2 g single dose.
IV (Children): 25 mg/kg/dose, maximum dose: 2 g.
Eclampsia/Pre-Eclampsia
Contraindications/Precautions
Contraindicated in: Hypermagnesemia; Hypocalcemia; Anuria; Heart block; OB:
Avoid using for more than 5– 7 days for preterm labor (mayqrisk of hypocalcemia
⫽ Genetic Implication.
IM, IV (Adults): Severe deficiency— 8– 12 g/day in divided doses; mild deficiency— 1 g q 6 hr for 4 doses or 250 mg/kg over 4 hr.
IM, IV (Children ⬎ 1 mo): 25– 50 mg/kg/dose q 4– 6 hr for 3– 4 doses, maximum
single dose: 2 g.
IV (Neonates): 25– 50 mg/kg/dose q 8– 12 hr for 2– 3 doses.
Torsade de Pointes
Metabolism and Excretion: Excreted primarily by the kidneys.
Half-life: Unknown.
⫽ Canadian drug name.
blocking agents.
IV, IM (Adults): 4– 5 g by IV infusion, concurrently with up to 5 g IM in each buttock; then 4– 5 g IM q 4 hr or 4 g by IV infusion followed by 1– 2 g/hr continuous
infusion (not to exceed 40 g/day or 20 g/48 hr in the presence of severe renal insufficiency).
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.
PDF Page #1
Name /bks_53161_deglins_md_disk/magnesiumsulfateivparent
02/17/2014 07:15AM
Part of Parenteral Nutrition
IV (Adults): 4– 24 mEq/day.
IV (Children): 0.25– 0.5 mEq/kg/day.
NURSING IMPLICATIONS
Assessment
● Hypomagnesemia/Anticonvulsant: Monitor pulse, BP, respirations, and ECG
●
●
●
pg 2 # 2
● Continuous Infusion: Diluent: Dilute in D5W, 0.9% NaCl, or LR. Concentra-
2
●
Plate # 0-Composite
frequently throughout administration of parenteral magnesium sulfate. Respirations should be at least 16/min before each dose.
Monitor neurologic status before and throughout therapy. Institute seizure precautions. Patellar reflex (knee jerk) should be tested before each parenteral dose
of magnesium sulfate. If response is absent, no additional doses should be administered until positive response is obtained.
Monitor newborn for hypotension, hyporeflexia, and respiratory depression if
mother has received magnesium sulfate.
Monitor intake and output ratios. Urine output should be maintained at a level of at
least 100 mL/4 hr.
Lab Test Considerations: Monitor serum magnesium levels and renal function periodically throughout administration of parenteral magnesium sulfate.
Potential Nursing Diagnoses
Risk for injury (Indications) (Side Effects)
Implementation
● High Alert: Accidental overdosage of IV magnesium has resulted in serious pa-
tient harm and death. Have second practitioner independently double check original order, dose calculations, and infusion pump settings. Do not confuse milligram (mg), gram (g), or millequivalent (mEq) dosages.
● IM: Administer deep IM into gluteal sites. Administer subsequent injections in alternate sides. Dilute to a concentration of 200 mg/mL prior to injection.
IV Administration
● Direct IV: Diluent: 50% solution must be diluted in 0.9% NaCl or D5W to a
concentration of ⱕ20% prior to administration. Concentration: ⱕ20%. Rate:
Administer at a rate not to exceed 150 mg/min.
tion: 0.5 mEq/mL (60 mg/mL) (may use maximum concentration of 1.6 mEq/
mL (200 mg/mL) in fluid-restricted patients). Rate: Infuse over 2-4 hr. Do not
exceed a rate of 1 mEq/kg/hr (125 mg/kg/hr). When rapid infusions are needed
(severe asthma or torsade de pointes) may infuse over 10– 20 min.
● Y-Site Compatibility: acyclovir, aldesleukin, alemtuzumab, alfentanil, amifostine, amikacin, argatroban, ascorbic acid, atropine, azithromycin, aztreonam,
benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol,
calcium gluconate, carboplatin, carmustine, caspofungin, cefotaxime, cefoxitin,
ceftazidime, chloramphenicol, chlorpromazine, cisatracurium, cisplatin, clindamycin, clonidine, cyanocobalamin, cyclophosphamide, cytarabine, dactinomycin,
daptomycin, dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydramine, dobutamine, docetaxel, dolasetron, dopamine, doripenem, doxacurium,
doxorubicin liposome, doxycycline, enalaprilat, ephedrine, epinephrine, epoetin
alfa, eptifibatide, ertapenem, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl, fluconazole, fludarabine, fluorouracil, folic acid, foscarnet, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hetastarch,
hydromorphone, idarubicin, ifosfamide, imipenem/cilastatin, insulin, irinotecan,
isoproterenol, ketamine, ketorolac, labetalol, leucovorin caclium, lidocaine, linezolid, lorazepam, mannitol, mechlorethamine, methotrexate, methyldopate,
metoclopramide, metoprolol, metronidazole, micafungin, midazolam, milrinone,
mitoxantrone, morphine, moxifloxacin, multivitamins, mycophenolate, nafcillin,
nalbuphine, nesiritide, nicardipine, nitroglycerin, nitroprusside, norepinephrine,
octreotide, ondansetron, oxaliplatin, oxytocin, paclitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, papaverine, pemetrexed, penicillin G, pentazocine, pentobarbital, phenobarbital, phentolamine, phenylephrine, piperacillin/tazobactam, potassium acetate, potassium chloride, procainamide,
prochlorperazine, promethazine, propranolol, propofol, propranolol, pyridoxime, quinupristin/dalfopristin, ranitidine, remifentanil, rituximab, rocuronium,
sargramostim, sodium acetate, sodium bicarbonate, streptokinase, succinylcholine, sufentanil, tacrolimus, telavancin, teniposide, theophylline, thiamine, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, trastuzumab, trimetaphan, vancomycin, vasopressin, vecuronium, verapamil,
vinblastine, vincristine, vinorelbine, vitamin B complex with C, voriconazole, zoledronic acid.
● Y-Site Incompatibility: aminophylline, amphotericin B cholesteryl sulfate, amphotericin B lipid complex, amphotericin B liposome, anidulafungin, azathio䉷 2015 F.A. Davis Company
CONTINUED
PDF Page #2
Name /bks_53161_deglins_md_disk/magnesiumsulfateivparent
02/17/2014 07:15AM
Plate # 0-Composite
pg 3 # 3
3
PDF Page #3
CONTINUED
magnesium sulfate (IV, parenteral)
prine, calcium chloride, cefepime, ceftriaxone, cefuroxime, ciprofloxacin, dantrolene, dexamethasone sodium phosphate, diazepam, diazoxide, doxorubicin
hydrochloride, epirubicin, ganciclovir, haloperidol, indomethacin, methylprednisolone sodium succinate, pentamidine, phenytoin, phytonadione.
Patient/Family Teaching
● Explain purpose of medication to patient and family.
Evaluation/Desired Outcomes
● Normal serum magnesium concentrations.
● Control of seizures associated with toxemias of pregnancy.
Why was this drug prescribed for your patient?
⫽ Canadian drug name.
⫽ Genetic Implication.
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.