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r*PHYSORDE*r + + HALIFAX HEALTH 303 N. Clyde Morris Blvd., Daytona Beach, FL 32114 1041 Dunlawton Ave., Port Orange, FL 32127 "X" IN BOX FOR STAT MED PHYSICIAN’S ORDERS Patient Name Adm. Date Date of Birth MR # Dr. Age Visit # AMIODARONE (CORDARONE) (CORDARONE) ALLERGIES: Page 1 of 1 HIGH RISK / DO NOT USE ABBREVIATIONS: U, IU, MS, MSO4, MgSO4, QD, QOD. ALWAYS WRITE OUT INTENDED MEANING AND USE METRIC. DO NOT USE A ZERO AFTER A DECIMAL; ALWAYS USE A ZERO BEFORE A DECIMAL. DATE TIME CK’D (✔) ❑ X CHECK BOX TO INITIATE ORDER 1. Do not start Amiodarone in complete heart block or type II second degree heart block unless functional pacemaker in place Note: Check box if bolus needed ❑ Bolus 150 mg Amiodarone IV in 100 ml D5W (1.5 mg/ml) over the first 10 minutes Set IV pump to run at 600 ml/hour and volume to be infused = 100 ml Bolus must be hung within 2 hours of preparation Discard if not used 2. ❑ X Call Pharmacy to mix Amiodarone infusion of 900 mg diluted in 500 ml of D5W (polyolefin bag) (1.8 mg/ml) for continuous infusion over 24 hours with an inline filter as follows: • Infuse 1 mg/min. over 6 hours (set infusion pump rate at 33 ml/hour and volume to be infused = 200 ml) • Then reduce to 0.5 mg/min. over the remaining 18 hours (set infusion pump rate at 17 ml/hour and volume to be infused = 300 ml) Cordarone Guidelines: 1.) IV Cordarone is indicated for initiation of treatment and prophylaxis for recurring ventricular fibrillation and hemodynamically unstable ventricular tachycardia in patients refractory to other therapy 2.) Do not use in patient with known hypersensitivity to any component of IV Cordarone, or in patients with cardiogenic shock, marked sinus bradycardia, and second or third degree AV block unless a functioning pacemaker is available 3.) Complete assessment, baseline vital signs and rhythm strip documentation before medication is administered 4.) It is preferred that IV Cordarone be administered through a central venous catheter dedicated line 5.) Mix in D5W only 6.) An inline filter should be used during administration 7.) Cordarone infusion will be mixed by Pharmacy in polyolefin bags 8.) Monitoring Therapy: • Vital Signs: blood pressure, pulse, and respirations will be documented a minimum of every 15 minutes x 4 when intravenous push/continuous infusion is initiated or dosage is changed, then every 4 hours during continuous infusion 9.) Most Common Drug Incompatibilities (do not give through the same IV line): Heparin Quinidine Sodium Bicarbonate Aminophylline Furosemide Cefazolin Sodium (Ancef) 10.) Common Drug Interactions: Digoxin = increased digoxin levels Beta Blockers = increased effects on both drugs Warfarin = increased warfarin effect Calcium Channel Blockers = increased effect on both drugs 11.) Side Effects: hypotension, headache, dizziness, bradycardia, AV conduction abnormalities, and flushing 12.) If significant adverse effects, particular conduction disturbances and/or exacerbation of arrhythmias occur, STOP the infusion and notify physician 13.) If amiodarone oral therapy is ordered, it is generally initiated with the first dose given immediately following discontinuation of the infusion 14.) Oral amiodarone therapy yields lower serum drug levels than with IV therapy Physician Signature:__________________________________________ Dictation #:__________________ PHYSICIANS: PLEASE REMEMBER TO USE YOUR DICTATION NUMBER WITH YOUR SIGNATURE. PHYS ORDER ALL ORDERS TO PHARMACY HMC − 1565 − 2/10