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STUDENT NURSE VI. MEDICATIONS Non IV Medication Template Directions: List all routine meds scheduled to given on your shift including prn medications that the pt has received in the last 24hrs and complete each column. Patient Allergies: Lanolin, PCN, Silicone, Sulfa, Vicodin – Response: UNK IV Solution: LR 75 mL/hr Agents: Medication Names Generic (Trade) Time Reference General things to know before giving meds in this category: Dose, Route, Reason your patient is on this medication Frequency, & Dosage Range Administration Considerations enoxaparin (Lovenox) 40 mg/0.4 mL Time: 2100 D: 40 mg R: SubQ F: q24hr DR: 40 mg q24h in acute ill pts. Contraindicated/Caution: Hypersensitivity to pork products, bleeding, Hx. of heparin-induced thrombocytopenia, severe hepatic or renal disease, retinopathy, untreated HTN. (Vallerand et al, 2013, p. 647) DVT Prophylaxis Adverse effects: BLEEDING, Anemia Lab Test Considerations: Monitor CBC and Platelets, Sudden decrease of H&H check for bleeding, May cause increase AST and ALT levels. ANTIDOTE: 1mg of PROTAMINE SULFATE for each mg of enoxaparin by slow IV. lansoprazole (Prevacid Solutab) (Vallerand et al, 2013, p. 763) D: 15 mg R: PEG F: Before Breakfast DR: 15 mg GERD Prophylaxis Contraindicated/Caution: Severe hepatic impairment. Pt. was NPO Adverse effects: dizziness, HA, diarrhea, Lab Test Considerations: Increase AST, ALT, Alk Phos, LDH, Bili, Cr, May alter RBC, WBC and platelets. May cause hypomagnesemia. Oral Care: chlorhexidine (Peridex, Periogard) 0.12% 10mL q12h Home Medds – all suspended Fluticasone (Flonase) 50 mcg/actuation Nasal SpSn – 1 spray by both nares route daily. Menthol-zinc oxide (Calmoseptine) 0.44-20.6% Topical Oint – q6h PRN Miscellaneous medication: 1 each once. Medical marijuana for spasms. Ferrous sulfate ER (SLOW FE) 140 mg (45 mg iron) Oral TbSR – 65 mg BID Methadone (Dolophine) 10 mg PO q4hr PRN Pregabalin (Lyrica) 75 mg PO 1 cap TID Mirtazapine (Remeron) 7.5 mg Oral Tab – 1 TAB HOS Hydromorphone (Dilaudid) 2 mg Oral Tab – 1 Tab by mouth q4h PRN Baclofen Intrathecal VI. Medications 1 STUDENT NURSE Intravenous Medications and Medicated Infusions Directions: List all IV medications and medicated infusions to be given on your shift including prn medications that the pt has received in the last 24hrs and complete each column. Patient Allergies: Lanolin, PCN, Silicone, Sulfa, Vicodin – Response: UNK IV Solution: LR 75 mL/hr Agents: Medication Names Generic (Trade) Time Reference General things to know before giving meds in this category: Dose, Route, Reason your patient is on this Frequency, & medication Dosage Range Administration Considerations Dilution: Rate of Administration: Compatibility with current Meds/IVs: Other: hydrocortisone PF (SoluCORTEF) 100 mg/2mL Time: 0900 (Vallerand et al, 2013, p. 363) D: 100 mg R: IV F: q8h DR: 100-500 mg q2-6 hr (Range 100-8000 mg/day) Dilution: Reconstitute with provided solution or 2 mL of bacteriostatic water or saline for injection. Concentration: 50 mg/mL Tx. of Inflamatory Process r/t aspiration Rate of Administration: 100 mg/30 sec. Doses >500 mg should be infused over at least 10 min. Compatibility with current Meds/IVs: CHECK COMPATIBILITY CHART Contraindicated/Caution: Active untreated infections, hypothyroidism, cirrhosis Adverse Effects: CNS depression, CNS euphoria, HTN, PEPTIC ULCERATION, anorexia, n/v, acne, decreased wound healing, ecchymosis, fragility, hirsutism, petichiae, adrenal suppression, THROMBOEMBOLISM, muscle wasting, osteoporosis, cushingoid appearance. levofloxacin (Levaquin) Time: 1300 (Vallerand et al, 2013, p. 580) D: 750 mg at 100 mL/hr R: IV F: q24h DR: 250-750 mg q24h Tx. of Respiratory Infection Lab Test Considerations: Monitor electrolytes and glucose (hyperglycemia), hypokalemia, monitor CBC, may decrease WBC, hypernatremia, Dilution: Dilute with NS, D5W, or D5NS. Also available in premised bottles and flexible containers with D5W which need no further dilution. Concentration: 5 mg/mL Rate of Administration: Adm. AT LEAST over 60 min for doses of 250-500 mg and AT LEAST over 90 min for doses of 750 mg Compatibility with current Meds/IVs: CHECK COMPATIBILITY CHART Contraindicated/Caution: Hypersensitivity, Hx. of myasthenia gravis, concurrent use of Class IA or Class III antiarrhythmics, Known QT interval prolongation or use of agents that lead to prolongation, known or suspected CNS disorder, renal impairment, Cirrhosis, concurrent use of erythromycin, antipsychotics, and tricyclic antidepressants, acute myochardial ischemia, concurrent use of corticosteroids (increase risk of tendinitis/tendon rupture), transplant pts., Adverse Effects: ELEVATED ICP, SEIZURES, dizziness, HA, insomnia, TORSADE DEPOINTS, HEPATOTOXICITY, PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea, ANAPHYLAXIS, STEVENS-JOHNSON SYNDROME Lab Test Considerations: Increase AST, ALT, LDH, Bili, and Alk. Phos, alter glucose levels. VI. Medications 2 STUDENT NURSE Potassium chloride 40 mEq in 100 mL Time: Once (Vallerand et al, 2013, p. 1036 and Lexicom Online) fentanyl (Sublimaze) 50 mcg/mL (Vallerand et al, 2013, p. 552) D: 40 mEq R: IV F: Once DR: IV intermittent infusion (must be diluted prior to administration): 5-10 mEq/dose (maximum: 40 mEq/dose) to infuse over 2-3 hours (maximum: 40 mEq over 1 hour) D: 25 mcg R: IVP F: PRN DR: 0.51mcg/kg/dose Tx. of Hyperkalemia Dilution: maximum concentration for peripheral infusion is 10 mEq/100 mL and 20-40 mEq/100 mL for central infusions Rate of Administration: Over 2-3 hours Compatibility with current Meds/IVs: CHECK COMPATIBILITY CHART Contraindicated/Caution: Hyperkalemia, severe renal impairment, addison’s disease, severe tissue trauma, known hypersensitivity. Vesicant – ensure proper catheter or needle position. People taking potassium sparing drugs. Cardiac disease, renal impairment, DM as some medications include sugar, Hypomagnesemia may make correction of hypokalemia more difficult.Close monitoring to avoid hyperkalemia Adverse Effects: Confusion, restlessness weakness, ARYTHMIAS, ECG changes. Irritation at IV site. GI ulcerations, stenotic lesions. Paralysis, paresthesia. Tx. of Severe Pain Assess for S/S of hypokalemia – weakness, fatigue U wave in ECG, arrhythmias, polyuria, polydipsia. Monitor hyperkalemia (toxicity) slow, irregular heartbeat, fatigue, muscle weakness, paresthesia, confusion peaked T wave, depressed ST segments, prolonged QT segments widened QRS, loss of P waves, and cardiac arrhythmias. Dilution: Administered undiluted. Concentration: 50 mcg/mL Rate of Administration: over 1-3 minutes. Com patibility with current Meds/IVs: Look at compatibility chart Contraindicated/Caution: Hypersensitivity, intolerance, debilitated or critically ill pts Adverse Effects: APNEA, LARYNGOSPASM fentanyl (Sublimaze) 25 mcg/mL Lumen 2 (Vallerand et al, 2013, p. 552) D: 25 mcg/hr 1mL/hr R: IV F: Continous DR: 0.5-1 mcg/kg/dose may repeat q30-60min Sedation/Analgesia NALOXONE (NARCAN) is the antidote Dilution: May be diluted in D5W or NS. Concentration: up to 50 mcg/mL Rate of Administration: Slow – drip. Slow adm. may reduce the incidence and severity of muscle rigidity, bradycardia, and hypotension. Compatibility with current Meds/IVs: CHECK COMPATIBILITY CHART Contraindicated/Caution: Hypersensitivity, intolerance, debilitated or critically ill pts Adverse Effects: APNEA, LARYNGOSPASM Midazolam – NS (Versed) 100 mg in 100 mL drip (conc: 1mg/mL) Lumen 1 (Vallerand et al, 2013, p. 552) D: 1 mg/hr R: IV F: Continous DR: 0.01-0.05 mg/kg (0.5-4 mg in most adults) loading dose may be repeated q1015 min until desired effect is obtained. 0.02-0.1 mg/kg/hr (1-7 mg/hr) Sedative for Mechanical Ventilation NALOXONE (NARCAN) is the antidote Dilution: Dilute with NS or D5W. Concentration 0.5-1 mg/mL. Rate of Administration: Based on pt.’s weight. Compatibility with current Meds/IVs: CHECK COMPATIBILITY CHART Contraindicated/Caution: Comatose/CNS Depression, Acute angle-closure glaucoma, pulmonary disease, HF, Renal and Liver impairment. Adverse Effects: APNEA, LARYNGOSPASM, RESPIRATORY DEPRESSION, CARDIAC ARREST, phlebitis. FLUMEZENIL (ROMAZICON) is the antidote. VI. Medications 3 STUDENT NURSE norepinephrine (Levophed) 8000 mcg in D5W mL drip (conc: 32 mcg/ml) Lumen 1 (Vallerand et al, 2013, p. 933) Propofol (Diprivan) 10 mg/ml drip (Vallerand et al, 2013, p. 606 and Lexicom Online) Haloperidol (Haldol) 5 mg/mL injection 1 mg (Vallerand et al, 2013, p. 641) D: 5 mcg/min 9.38 mL/hr R: IV F: Continous DR: 0.5-1 mcg/min initially. Maintnance dose 2-12 mcg/min titrated by BP response (avg. 2-4 mcg/min up to 30 mcg/min) D: 5 mcg/kg/min x 53.6 kg 268 mcg/min 1.61 mL/hr R: IV F: Continous DR: IV: (Geriatric Patients, Cardiac patients, Debilitated Patients, or Hypovolemic Patients): Induction– 20 mg q 10 sec until induction achieved (1– 1.5 mg/kg total). Maintenance– 50–100 mcg/kg/min (dose in cardiac anesthesia ranges from 50–150 mcg/kg/min depending on concurrent use of opioid). D: 1 mg R: IV F: PRN q2hr DR: 0.5-5 mg, may be repeated q30 min Tx. of hypotension/shock (?) – Dilution: 4 mg in 1000 mL of D5W or D5NS. DO NOT DILUTE IN NS WITHOUT DEXTROSE! Concentration: 4 mcg/mL Rate of Administration: Titrate according to Pt.’s response. Compatibility with current Meds/IVs: CHECK COMPATIBILITY CHART Contraindicated/Caution: Vascular, mesenteric or peripheral thrombosis, HTN, concurrent use of MAO inhibitors, tricyclic antidepressants, cyclopropane or halothane anesthetics, hyperthyroidism, cardiovascular disease. Sedation of intubated, mechanically ventilated patients in ICU”s Adverse Effects: anxiety, dizziness Dilution: Usually undiluted but if needed with D5W only. Rate of Administration: Weight dependent. Compatibility with current Meds/IVs: CHECK COMPATIBILITY CHART Contraindicated/Caution: Contraindications: Hypersensitivity to propofol, soybean oil, egg lecithin or glycerol. Cardiovascular disease, lipid disorders, increased intracranial pressure; cerebrovascular disorders; hypovolemic patients. Geri: lower induction and maintenance dose reduction recommended Adverse Effects: dizziness, headache, APNEA, bradycardia, hypotension, Hypertension, N/V, Hiccups, cramping, local burning, pain, stinging, coldness numbness, tingling at IV site, involuntary muscle movements, urine discoloration (green). PROPOFOL INFUSION SYNDROME Abrupt discontinuation may cause rapid awakening with anxiety, agitation, and resistance to mechanical ventilation. Monitor for propofol infusion syndrome –severe metabolic acidosis, hyperkalemia, lipemia, rhabdomyolysis, hepatomegaly, cardiac and renal failure. If overdose occurs, monitor pulse, RR and BP contiuously Agitation Dilution: May be administered undiluted or diluted in 30-50 m of D5W. Concentration 5mg/mL. Rate of Administration: Rate of 5mg/min or over 30 min. Compatibility with current Meds/IVs: CHECK COMPATIBILITY CHART Contraindicated/Caution: Hypersensitivity, angle-closure glaucoma, bone marrow depression, CNS depression, Parkinsonism, severe liver or cardiovawscular disease, debilitated pt., diabetes, respiratory insufficiency, prostatic hyperplasia, CNS tumors, intestinal obstruction, seizures. Adverse Effects: SEIZURES, extrapyramidal reactions, blurred vision, dry eyes, constipation, dry mouth, AGRANULOCYTOSIS, NEUROLEPTOC MALIGNANT SYNDROME (fever, respiratory distress, tachy, seizures, diaphoresis, HTN or hypoTN, pallor, tiredness, severe muscle stiffness, loss of bladder control. Monitor CBC with differential and liver functions test. May increase prolactin levels. VI. Medications 4 STUDENT NURSE NEW MEDS Agents: Medication Names Generic (Trade) Time Reference General things to know before giving meds in this category: Dose, Route, Reason your patient is on this medication Frequency, & Dosage Range Administration Considerations QUEtiapine (Seroquel) Time: 1500 D: 50 mg R: PO F: BID DR: not to exceed 800 mg/day Contraindicated/Caution: Hypersensitivity, Hx. of arrhythmias, Hypokalemia or hypomagnesemia, CD, CVD, dehydration or hypovolemia, Hx. of seizures, alzheimers, diabetes, Pt. at risk for aspiration PNA, hepatic impairement, hypothyroidism, Hx. of suicide attempt. (Vallerand et al, 2013, p. 1079) Adjunctive treatment of pain (Calandre and Rico-Villademoros, 2012) Adverse effects: NEUROLEPTIC MALIGNANT SYNDROME, SEIZURES, dizziness, weight gain. Methadone (Dolophine) (Vallerand et al, 2013, p. 833) D: 10 mg R: TID F: Before Breakfast DR: 15 mg Severe pain Lab Test Considerations: May increase AST, ALT, cholesterol, triglycerides, and prolactin. Anemia, thrombocytopenia, leukocytosis, leukopenia, Contraindicated/Caution: Hypersensitivity, structural heart disease, hypokalemia, hypomagnesemia, Hx. of arrhythmias/syncope, head trauma, increased ICP, severe renal, hepatic, or pulmonary disease, hypothyroidism, adrenal insufficiency. . Adverse effects: confusion, sedation, TORSADES DE POINTES, hypotension, constipation Lab Test Considerations: Increase amylase and lipase. ANTIDOTE IS NALOXONE (NARCAN) VI. Medications 5 STUDENT NURSE VI. Medications 6