Download LPN Initial IV Push Medication List

LPN Initial IV Push
Medication List
by
Barbara Sherman, MSN, RN, RT-R
January 2010
Course Objectives:
To prepare LPNs for competent
administration of medication via the
intravenous route.
 To ensure application of evidence-based
practice in developing the individual
practitioner’s role in administration of
intravenous therapy.

IV Medication Administration
The process of giving medication directly
into a patient’s vein- includes giving the
medication using a syringe via “the IV
push method”.
 Purpose to initiate a rapid systemic
response to medication

Rights to Drug Administration
Right patient
 Right drug
 Right dose
 Right time
 Right route of administration

IV Medication Administration
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Some IV push medications must be diluted
before injection.
Drug delivery rate is critical in
administration of IV medications.
The IV line must be flushed both before and
after IV medication administration to avoid
contact of incompatible solutions or medications.
IV Medication Administration

The nurse must know the indications,
actions, and adverse effects of the
medication that is delivered.
IV Medication Administration

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Make sure IV fluids are compatible with the medication
being administered via the IV.
After IV meds are administered, observe the patient for
signs/symptoms of adverse or allergic reactions.
When using single dose ampules, use a filter needle to
withdraw medication.
Wipe stoppers of medication vials with alcohol then draw
up medication.
Check IV access site for patency, changes, and phlebitis
prior to and after administering medication.
IV Medication Administration

Possible complications include:
 Infiltration (extravasation)
 Tissue necrosis
 Thrombophlebitis
 Air embolism
 Hypotension
 Cardiac arrhythmia, cardiac arrest
 Allergic reaction/anaphylaxis
 Venous thrombosis
 Pain
at the IV site
IV Delivery Methods


Peripheral IV (or saline lock)- lie within peripheral venous
system, normally in vein in forearm or hand
Central venous access- have their tip in one of the major
veins leading to the heart (the superior &
inferior vena cava)

Non-tunneled catheters- ex.
subclavians, cut-downs

PICC
Implanted devices & tunneled
catheters

IV Medication Dosage Calculations
Order: Morphine sulfate 4 mg IV q3-4 hours prn chest pain
Available: Morphine sulfate 10 mg per 1 ml
How many mls do you administer?
dose you want
_________________ X number of mls it’s provided in
amount you have
Example:
4 mg
______ X 1 ml = 0.4 X 1 = 0.4 ml
10 mg
Administering IV Medications
Uses appropriate hand hygiene/gloves for prep & administration
Preparing Injection
Checks expiration date
Compares medication with order
Chooses appropriate supplies & equipment
Checks label
Calculates correct dose
Identifies patient (barcoding)
Explains procedure
Asks about medication allergies
Checks for compatibility of medication & IV fluid
Provides information to patient about medication
Selects appropriate site on IV port
Cleanses site appropriately
Injects at appropriate site on IV port
Injects at appropriate rate
Withdraws syringe appropriately from IV port
Proper syringe disposal
Observes patient for reaction
Documents appropriately
List of Medications:
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Benadryl
Demerol
Dilaudid
Lasix
Morphine Sulfate
Narcan
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Protonix
Stadol
Talwin
Toradol
Zofran
Benadryl –
diphenhydramine hydrochloride

Class- antihistamine, antitussive, antiemetic, antivertigo agent,
antidyskinetic

Action- interferes with histamine effects at histamine1-receptor sites,
prevents but does not reverse histamine-mediated responses, possesses
CNS depressant and anticholinergic properties

Indications- allergy symptoms caused by histamine release including
anaphylaxis, seasonal & perennial allergic rhinitis & allergic dermatoses;
nausea; vertigo; motion sickness; Parkinson’s disease; sedation;
antipsychotic-induced dystonia

Contraindications- hypersensitivity to drug, alcohol intolerance, acute
asthma attacks, MAO inhibitor use within the past 14 days, breastfeeding
Benadryl, cont.
Availability:
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Capsules: 25 mg. 50 mg
Syrup/elixir: 12.5 mg/5 ml
Injection: 10 mg/ml, 50 mg/ml
Tablets: 25 mg, 50 mg
Chewables: 12.5 mg, 25 mg
Dosage

Adults & children >12 y.o.:
 25-50 mg PO q4-6h
 10-50 mg IV or IM q2-3h (some pts may need up to 100 mg)
 Don’t exceed 400 mg/day
 Children 6-12 y.o.:
 12.5-25 mg PO q4-6h
 1.25 mg/kg IM or IV qid, don’t exceed 150 mg/day
 Children 2-5 y.o.:
 6.25 mg PO q4-6h, don’t exceed 37.5 mg/day
Benadryl, cont.

Use cautiously in severe hepatic disease, angle-closure glaucoma, seizure disorders, prostatic
hypertrophy, elderly patients, pregnancy

Administration:
 Administer 30 min. prior to activity for motion sickness
 Give oral doses with food or milk to minimize GI effects
 Check compatibility for IV use before mixing with other drugs
 Inject IM dose deep into large muscle mass, rotate sites
 Discontinue drug 4 days before allergy skin testing to avoid misleading results
 Don’t exceed 25 mg/min during IV administration
 Incompatible with allopurinol, amobarbital, amphotericin B, cefepime, dexamethasone,
foscarnet, haloperidol lactate, pentobarbital, phenobarbital, phenytoin, thiopental

Adverse reactions: drowsiness, sedation, sleepiness, incoordination, dizziness, headache,
seizures, confusion, tremor, nervousness, thickening of bronchial secretions, paradoxical
stimulation especially in children, hypotension, palpitations, blurred vision, tinnitus, diarrhea,
constipation, dry mouth, dysuria, urinary frequency or retention, photosensitivity, pain at IM
injection site
Benadryl, cont.

Interactions
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Drug to drug: ↑CNS depression with antihistamines, opioids, sedative
hypnotics; ↑anticholinergic effects with disopyramide, quinidine, tricyclic
antidepressants, MAO inhibitors

Drug to diagnostics: false negative allergy tests, ↓ Hgb & platelets

Drug to herbs: ↑ CNS depression with chamomile, hops, kava,
skullcap, valerian; ↑ anticholinergic effects with angel’s trumpet, jimson
weed, scopolia

↑ CNS depression in combination with alcohol
Demerol- meperidine hydrochloride

Class- opioid, analgesic, adjunct to anesthesia

Action- binds to & depresses opiate receptors in spinal
cord & CNS altering perception of and emotional
response to pain

Indications- moderate to severe pain, pre-op sedation,
analgesia during labor

Contraindications- hypersensitivity to drug or to
bisulfites, MAO inhibitor use in past 14 days
Demerol, cont.
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Availability:

Injection- 10 mg/ml, 25 mg/ml, 50 mg/ml,
75 mg/ml, 100 mg/ml
 Syrup- 50 mg/5 ml
 Tablets- 50 mg, 100 mg

Dosages:
Adults: 50-150 mg PO, IM, or SC q3-4h, 15-35 mg/hr as an IV cont. infusion
Children: 1.1-2.2 mg/kg PO, IM, or SC q3-4h not to exceed 100 mg/dose

Use cautiously in head trauma, increased intracranial pressure, severe
renal, hepatic, or pulmonary disease, hypothyroidism, adrenal insufficiency,
extensive burns, alcoholism, undiagnosed abdominal pain or prostatic
hyperplasia, elderly or debilitated patients, pregnant patients, labor,
breastfeeding, children
Demerol, cont.

Adverse reactions: confusion, sedation, dysphoria, euphoria, headache,
floating feeling, hallucinations, unusual dreams, seizures, hypotension,
bradycardia, cardiac arrest, shock, blurred vision, diplopia, miosis, nausea,
vomiting, constipation, ileus, biliary tract spasms, urinary retention,
respiratory depression, respiratory arrest, flushing, sweating, induration &/or
pain at injection site, physical or psychological dependence, drug tolerance

Patient monitoring: CNS/ respiratory depression, seizures, agitation,
irritability, nervousness, twitches, tremors- especially in renal or hepatic
impaired patients

Reversal agent: narcan

Give slow IV push; don’t give if respirations less than 12/minute
Demerol, cont.
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Interactions

Drug to drug: ↑ CNS depression/respiratory depression with
antihistamines, sedative hypnotics, barbiturates, cimetidine, protease
inhibitor anti-retrovirals; ↑ meperidine toxicity with chlorpromazine &
thioridazine, precipitation of opioid withdrawal in physically dependent
patients with opioid agonist-antagonists; potentially fatal with MAO
inhibitors
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Drug to diagnostics: ↑ amylase & lipase

Drug to herb: ↑ CNS depression with chamomile, hops, kava, skullcap,
valerian
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Drug to alcohol: ↑ CNS depression
Dilaudid- hydromorphone hydrochloride

Class- opioid agonist, opioid analgesic, antitussive

Action- binds to opiate receptors in spinal cord & CNS altering
perception of and emotional response to painful stimuli while
producing generalized CNS depression, also subdues cough reflex
& decreases GI motility

Indications- moderate to severe pain

Contraindications- hypersensitivity to narcotics or bisulfites, acute
or severe bronchial asthma or upper respiratory tract obstruction,
premature neonates
Dilaudid, cont.
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Availability
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Injection- 1 mg/ml, 2 mg/ml, 4 mg/ml, 10 mg/ml
Oral solution- 5 mg/5 ml
Suppository- 3 mg
Tablets- 1 mg, 2 mg, 3 mg, 4 mg, 8 mg
Doses- adults > 50 kg
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2-10 mg PO (tabs) q4-6h
2.5-10 mg PO (oral solution) q4-6h
1-2 mg SC, IM, or IV q4-6h, increase to 3-4 mg q4-6h for severe
pain
3 mg PR q6-8h
Dilaudid, cont.

Use cautiously in increased intracranial pressure, severe renal, hepatic, or
pulmonary disease, hypothyroidism, adrenal insufficiency, prostatic
hypertrophy, alcoholism, concurrent use of MAO inhibitors, elderly patients,
pregnant or breastfeeding patients

Administration- give IV injections slowly over 2-5 min. for each 2 mg dose,
give oral form with food to avoid GI upset

Patient monitoring- with IV use monitor for respiratory depression, assess
for signs of physical or psychological dependence, monitor for constipation

Adverse reactions- sedation, dizziness, bradycardia, hypotension,
nystagmus, urinary retention, respiratory depression, bronchospasm,
constipation, dry mouth
Lasix - furosemide

Class: loop diuretic

Action- unclear, thought to inhibit sodium and chloride re-absorption from
ascending loop of Henle and distal renal tubules, increases potassium
excretion and plasma volume, promoting renal excretion of water, sodium,
chloride, magnesium, hydrogen, and calcium

Indications- acute pulmonary edema, edema caused by heart failure,
hepatic cirrhosis or renal disease, hypertension

Contraindications- hypersensitivity to drug or other sulfonamides, anuria

Use cautiously in diabetics, severe hepatic disease, elderly patients,
pregnant or breastfeeding patients, neonates
Lasix, cont.
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Availability:
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Injection- 10 mg/ml
Oral solution- 10 mg/ml, 40 mg/5 ml
Tablets- 20 mg, 40 mg, 80 mg
Dosages: adults
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40 mg IV over 1-2 min, if inadequate response within 1 hr give
80 mg IV over 1-2 min.
20-80 mg PO qday, max. 600 mg/day PO for CHF, liver or renal
failure but max. 240 mg PO qday for hypertension
Lasix, cont.

Administration- if giving via IV infusion, don’t infuse more than 4 mg/min, if
giving via IV injection give over 1-2 min.

Adverse reactions- dizziness, headache, vertigo, weakness, lethargy,
paresthesia, drowsiness, restlessness, light headedness, hypotension,
orthostatic hypotension, tachycardia, volume depletion, necrotizing angiitis,
thrombophlebitis, arrhythmias, blurred vision, xanthopia, hearing loss,
tinnitus, nausea, vomiting, diarrhea, constipation, dyspepsia, oral & gastric
irritation, cramping, anorexia, dry mouth, acute pancreatitis, excessive &
frequent urination, nocturia, glucosuria, bladder spasm, oliguria, interstitial
nephritis, anemia, purpura, leukopenia, thrombocytopenia, hemolytic
anemia, jaundice, hyperglycemia, hyperuricemia, dehydration, hypokalemia,
hypomagnesemia, hypocalcemia, hypochloremic alkalosis, muscle
pain/cramps, photosensitivity, rash, diaphoresis, urticaria, pruritis, exfoliative
dermatitis, erythema multiforme, fever, transient pain at injection site
Lasix, cont.
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Interactions:
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Drug to drug- ↑ risk of ototoxicity with aminoglycosides,
ethacrynic acid, other ototoxic drugs; ↑ hypokalemia with
amphotericin B, corticosteroids, corticotropin, potassium-wasting
diuretics, stimulant laxatives; ↑ glycoside toxicity & fatal
arrhythmias with cardiac glycosides; ↑ hypotension with
antihypertensives, diuretics, nitrates; ↑ diuretic response, muscle
pain & stiffness with clofibrate; ↓ hypoglycemic effect with insulin
& oral hypoglycemics; diuresis inhibition with hydantoins,
NSAIDS, probenicid; ↓ lithium excretion & toxicity; ↓ arterial
response with norepinephrine; ↑ serum concentration of
propranolol; ↑ toxicity with salicylates; ↓ naturetic &
antihypertensive effects with succinylcholine; hyperglycemia with
sulfonylureas; altered effects with theophylline; antagonism of
effects with tubocurarine
Lasix, cont.

Drug to diagnostics- transient ↑ BUN, ↓ calcium, magnesium,
platelets, potassium, sodium; ↑ cholesterol, creatinine, glucose,
nitrogenous compounds (uric acid)
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Drug to herb- ↓ lasix efficacy with ephedra (ma huang) & ginseng;
rapid potassium loss with licorice; dandelion interferes with lasix

Drug to behavior- ↑ hypotension with alcohol, ↑ photosensitivity to
sun exposure

Patient monitoring- assess for drug toxicity- arrhythmias, renal
dysfunction, abdominal pain, sore throat, fever, increased
photosensitivity
Morphine Sulfate

Class- opioid

Action- interacts with opioid receptor sites primarily in limbic
system, thalamus, and spinal cord. This interaction alters
neurotransmitter release, altering perception of and tolerance for
pain.

Indications- moderate to severe pain

Contraindications- hypersensitivity to drug, tartrazine, bisulfites, or
alcohol, acute bronchial asthma, upper airway obstruction,
respiratory depression, GI obstruction, paralytic ileus
Morphine, cont.
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Availability:
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Capsules- 15 mg, 30 mg
ER capsules- 10, 20, 30, 50, 60, 80, 90, 100, 120, & 200 mg
SR capsules- 10, 20, 30, 50, 60, 100 mg
Oral solution- 2 mg/ml, 4 mg/ml, 20 mg/ml (concentrate), 10 mg/5 ml, 20 mg/5 ml, 100
mg/5 ml
IV, IM, or SC injection- 1 mg/ml, 2 mg/ml, 4 mg/ml, 5 mg/ml, 8 mg/ml, 10 mg/ml, 15
mg/ml, 25 mg/ml, 50 mg/ml
Tablets- 10, 15, 30, 60, 100, & 200 mg
Dosage: adults
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5-30 mg PO q4h, if sustained release give 20 mg PO qd or bid, or 200 mg PO of MS
Contin
5-20 mg/70 kg IM or SC q4h
2-20 mg/70 kg IV slowly over 4-5 min
10-30 mg PR q4h
Adjust dose if <50 kg, elderly, children
Morphine, cont.
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Administration- Give oral form with food or milk. Dilute
in at least 5 ml NSS when giving IV and give 2.5-10 mg
over 4-5 min.
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Adverse reactions- confusion, sedation, dizziness,
dysphoria, euphoria, floating feeling, hallucinations,
headache, nightmares, hypotension, bradycardia,
blurred vision, diplopia, miosis, nausea, vomiting,
constipation, dry mouth, urinary retention, apnea,
respiratory depression, respiratory arrest, flushing,
itching, sweating, physical or psychological dependence,
drug tolerance, seizures
Morphine, cont.
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Interactions:
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Drug to drug: ↑ CNS depression with antihistamines, barbiturates,
clomipramine, sedative hypnotics, tricyclic antidepressants; ↓ analgesia with
buprenorphine, butorphanol, dezocrine, nalbuphine, & pentazocine; changes in
metabolism and medication effects with cimetidine; severe unpredictable
reactions with MAO inhibitors; precipitation of withdrawal with mixed opioidantagonists; ↑ anticoagulant effect with warfarin

Drug to diagnostics: increased amylase & lipase
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Drug to herbs: increased CNS depression with chamomile, hops, kava,
skullcap, & valerian
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Drug to behaviors: increased CNS depression with alcohol
Narcan- naloxone hydrochloride

Class: opioid antagonist

Indications: opioid induced respiratory depression

Adverse reactions: seizures, tremors, v. fib.,
hyper/hypotension, tachycardia, nausea, vomiting,
pulmonary edema, withdrawal, diaphoresis

Dosage:
 Adults- 0.4 - 2 mg IV, IM, or SC q2-3 min, max dose
10 mg, titrated based on response, slow IV push
Protonix- pantoprazole sodium

Class- proton pump inhibitor

Action- reduces gastric acid secretion and increases
gastric mucous and bicarbonate production creating a
protective coating on gastric mucosa

Indications- erosive esophagitis caused by
gastroesophageal reflux disease, pathologic
hypersecretory conditions

Contraindications- hypersensitivity to drug
Protonix, cont.

Availability:
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Powder for injection (freeze dried)
– 40 mg/vial
 Tablets- 20 mg, 40 mg

Dosage: adults

40 mg IV qday for 7-10 days, may give 80 mg IV q12h to max 240
mg/day
 40 mg PO qday for 8 weeks to max 240 mg PO qday, may give for up to
2 years in some cases

Use cautiously in severe hepatic disease, pregnant or breastfeeding,
children
Protonix, cont.
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Administration- When giving IV use the in-line filter
provided, dilute with 10 ml NS, further dilute in D5W, NS,
or LR as directed. Give over 10 -15 min., no faster than
3 mg/min. Per City Hospital’s Pharmacy and their
additional research via Lexicomp, 40 mg Protonix
reconstituted in 10 ml NS can be given SIVP over 2
minutes. Don’t mix with other meds in IV.

Adverse reactions- dizziness, headache, chest pain,
rhinitis, vomiting, diarrhea, abdominal pain, dyspepsia,
hyperglycemia, rash, pruritis, injection site reaction
Protonix, cont.
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Interactions:
 Drug
to drug- delayed absorption of ampicillin,
cyanocobalamin, digoxin, iron salts, ketoconazole;
increased protonix level with clarithromycin,
diazepam, flurazepam, phenytoin, & triazolam;
delayed protonix absorption with sucralfate; increased
bleeding with warfarin
 Drug
to diagnostics- increased levels of aspartate
aminotransferase & glucose; false positive
tetrahydrocannabinol tests
Stadol- butorphanol tartrate

Class- opioid agonist-antagonist

Action- alters perception of and emotional response to pain by
binding with opioid receptors in the brain causing CNS depression.
Also exerts antagonistic activity at opioid receptors which reduces
risk of toxicity, drug dependence, and respiratory depression

Indications- moderate to severe pain, labor pain, pre-op anesthesia

Contraindications- hypersensitivity to drug
Stadol, cont.

Availability:
 Injection- 1 mg/ml, 2 mg/ml
 Nasal spray- 10 mg/ml

Dosage: adults
 1-4 mg IM q3-4h not to exceed 4 mg per
 0.5-2 mg IV q 3-4h
 One spray in one nostril = 1 mg q3-4h
 Dose
dose
adjustment for renal or hepatic impairment,
elderly patients
Stadol, cont.

Use cautiously in head injury, ventricular dysfunction, coronary insufficiency,
respiratory disease, renal or hepatic dysfunction, history of drug abuse

Adverse reactions- drowsiness, sedation, dizziness, tremor, irritability, syncope,
stimulation, hypertension, hypotension, palpitations, bradycardia, tachycardia,
arrhythmias, blurred vision, nasal congestion or dryness, dry or sore throat, nausea,
vomiting, constipation, epigastric distress, dry mouth, GI obstruction, urinary retention
or hesitancy, dysuria, early menses, decreased libido, erectile dysfunction, thickened
bronchial secretions, chest tightness, wheezing, urticaria, rash, diaphoresis, change
in appetite, weight gain, local stinging, anaphylaxis, hypersensitivity reaction

Interactions:
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Drug to drug: increased CNS depression with CNS depressants
Drug to herb: increased CNS depression with kava, St. John’s Wort, valerian
Drug to behavior: additive effects with alcohol
Talwin- pentazocine lactate

Class- opioid agonist-antagonist

Action- unknown. Thought to interact with opioid
receptors primarily in limbic system, thalamus, and
spinal cord blocking transmission of pain impulses

Indications- moderate to severe pain, pre-op, adjunct to
surgical anesthesia or labor

Contraindications- hypersensitivity to drug,
acetaminophen, or oral form of narcan
Talwin, cont.

Availability:
 Injection: 30 mg/ml
 Tablets: Talwin NX =
50 mg talwin + 0.5 mg narcan;
Talacen = 25 mg talwin + 650 mf acetaminophen

Dosages: adults
 20-30
mg SC, IV, or IM q 3-4h not to exceed 60
mg/dose SC or IM or 30 mg/dose IV. Max. daily dose
= 360 mg, IV doses given slow IV push at 5 mg/min.
SC route can cause tissue damage.
 1-2 tabs PO q3-4h, max 12 tabs/day
Talwin, cont.

Use cautiously in head trauma, ICP, respiratory conditions, adrenal
insufficiency, seizure disorder, acute CNS manifestations, hepatic
impairment, AMI, alcohol or narcotic use, sulfite sensitivity, history of drug
use, pregnant or breast feeding, children

Adverse reactions: dizziness, drowsiness, euphoria, hallucinations,
headache, sedation, dysphoria, insomnia, unusual dreams, weakness,
depression, irritability, excitement, tremor, paresthesia, hypertension,
hypotension, syncope, tachycardia, circulatory depression, shock, blurred
vision, diplopia, nystagmus, miosis, tinnitus, nausea, vomiting, constipation,
diarrhea, dry mouth, ileus, cramps, abdominal distress, anorexia, urinary
retention, thrombocytopenia purpura, dyspnea, respiratory depression,
clammy skin, diaphoresis, rash, urticaria, nodules, cutaneous depression,
sclerosis, dermatitis, pruritis, flushing, altered taste, chills, stinging at
injection site
Talwin, cont.

Interactions:
 Drug
to drug: increased CNS depression with
barbiturates, sedating antihistamines, & other
sedating drugs; decreased effect with opioids
 Drug to diagnostics: increased amylase & lipase,
decreased WBCs
 Drug to herbs: increased CNS depression with
chamomile, hops, kava, skullcap, valerian
 Drug to behavior: increased CNS depression with
alcohol
Toradol – ketoralac tromethamine

Class- NSAID

Actions- Interferes with prostaglandin biosynthesis by inhibiting
cyclooxygenase pathway of arachidonic acid metabolism; also acts as
potent inhibitor of platelet aggregation

Indications- Short term management of moderately severe acute pain

Contraindications- advanced renal impairment or patients at risk for renal
failure, suspected or confirmed cerebrovascular bleeding or bleeding for
other sources, known hypersensitivity, not for intrathecal or epidural
administration due to alcohol content, not for use during labor or during
breastfeeding, concurrent use of aspirin, other NSAIDs or probenicid, peptic
ulcer disease
Toradol, cont.

Availability:
Injection: 15 mg/ml, 30 mg/ml
Tablets: 10 mg

Dosage: Initially 30 mg IV or 60 mg IM as a
single dose; or 30 mg IM or IV q6 hrs not to
exceed 120 mg/day. Do not exceed 15 mg IV
for pediatric patients or older patients weighing
less than 50 kg
Toradol, cont.

Use cautiously in: mild to moderate renal
impairment or cardiovascular disease, elderly
patients, pregnant patients, or children

Adverse reactions: drowsiness, headache,
dizziness, hypertension, tinnitus, nausea,
vomiting, diarrhea, constipation, flatulence,
dyspepsia, epigastric pain, stomatitis,
thrombocytopenia, rash, pruritis, diaphoresis,
excessive thirst, edema, injection site pain
Toradol, cont.

Interactions:
Drug-drug: decreased antihypertensive effect with ACE inhibitors
and Beta blockers, prolonged prothrombin time with anticoagulants,
altered metabolism with aspirin, decreased absorption with
cholestyramine, additive adverse g.i. effects with corticosteroids or
other NSAIDs, decreased diuretic effect with diuretics, increased
blood levels with lithium and methotrexate
Drug-diagnostic tests: prolonged bleeding times for 24-48 hours
after therapy ends
Drug-herb: increased risk of bleeding with anise, arnica,
chamomile, clove, dong quai, feverfew, garlic, ginger, ginkgo,
ginseng
Zofran- ondansetron hydrochloride

Class- serotonin type 3 (5-HT3) antagonist, antiemetic

Action- blocks serotonin at 5-HT3 receptor sites in vagal
nerve terminals by disrupting CNS chemoreceptor trigger
zone

Indications- to prevent nausea & vomiting caused by
emetogenic chemotherapy, post-op nausea & vomiting

Contraindications- hypersensitivity to drug
Zofran, cont.

Availability:
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Injection- 2 mg/ml in 2 & 20 ml vials
Premixed injection- 32 mg/50 ml
Oral solution- 4 mg/5 ml
Tablets- 4 mg, 8 mg, 24 mg
Orally disintegrating tabs- 4 mg, 8 mg
Dosage:
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Adults & children >12 y.o.: 8 mg tab or 10 ml oral solution PO bid, first dose 30 min. before
chemo & repeat in 8h then similar dosing q12h for 1-2 days after chemo
Children 4-11 y.o.: 4 mg tab or 5 ml oral solution PO q8h then follow process as above
Adults & children > 12 y.o.: 32 mg IV infused over 15 min 30 min prior to chemo or three 0.15
mg/kg doses IV with first dose over 15 min. 30 min. before chemo then 4 & 8 hours later;
4 mg IV over 2-5 min q4 hours for pre-op use, nausea /vomiting
Dose adjustment- hepatic impairment
Zofran, cont.

Use cautiously in hepatic disease, phenylketonuria, pregnant or
breastfeeding, < 12 y.o.

Administration: give undiluted IM or direct IV over 2-5 min.

Adverse reactions: headache, dizziness, malaise, drowsiness, fatigue,
weakness, extrapyramidal reactions, chest pain, hypotension, constipation,
diarrhea, abdominal pain, dry mouth, urinary retention, bronchospasm, rash,
pain at injection site

Interactions:

Drug to drug: drugs that alter hepatic enzyme activity alter pharmokinetics of
zofran
 Drug to diagnostics: transient elevations in ALT & AST
Question
What are the patient identifiers that must be
checked before administration of any
medication?
Answer

Patient’s full name and date of birth
Question

Before injecting a medication into the
medication port on the IV administration
tubing, what must the prudent nurse do
first?
Answer

Pull IV fluids back into the syringe with the
medication to check for precipitation prior
to pushing the medication into the IV line.
Question

What is the generally accepted dose of
Zofran to administer for nausea and
vomiting?
Answer

4 mg IV push
Question

True or False

Toradol is an opiate traditionally used for
pain.
Answer

False

Toradol is a Non-steroidal antiinflammatory.
Question

Protonix is given over how many minutes?
Answer

A minimum of 2 minutes – slow IV push
Question

How is morphine given?
Answer

Dilute in at least 5 ml NSS when giving IV
and give 2.5-10 mg over 4-5 min.
Question

How is Lasix administered?
Answer
 40
mg IV over 1-2 min, if inadequate
response within 1 hr give 80 mg IV over 1-2
min.
Question

Possible complications include of IV drug
administration include:
Answer
 Infiltration
(extravasation)
 Tissue necrosis
 Thrombophlebitis
 Air embolism
 Hypotension
 Cardiac arrhythmia, cardiac arrest
 Allergic reaction/anaphylaxis
 Venous thrombosis
 Pain at the IV site