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HAD12may2014 รพ.ศิริราช
HAD12may2014 รพ.ศิริราช
3
2557
Alteplase
Adrenaline
Calcium injection
Digoxin
Dobutamine
Dopamine
Heparin (Unfractionated)
Heparin, Low Molecular Weight (Innohep/Tinzaparin)
Heparin, Low Molecular Weight (Clexane/Enoxaparin)
Heparin, Low Molecular Weight (Arixtra/Fondaparinux)
Insulin
K+ (Potassium) Injection
Magnesium Sulphate injection
Morphine
Nicardipine
Nitroglycerine
Norepinephrine
Warfarin
2
3
8
20
24
28
32
38
43
49
52
55
61
69
72
76
83
87
90
94
( 2 2557)
Page 1
Onset
Peak
Peak
Duration
.. 2550
1.
2. High Alert Drug Cards
3. Guidelines Heparin Low Molecular Weight Heparin
Concurrent Trigger Tool
4.
( 2 2557)
Page 2
1.
2.
3.
3.1
3.2
3.3
3.4
3.5
3.6
4.
(High Alert Drugs)
High Alert Drugs ..
1. Adrenergic agonist Adrenaline, Dopamine, Dobutamine, Norepinephrine
2. Alteplase injection, Nicardepine injection,
Nitroglycerine injection
( 2 2557)
Page 3
5.
Cohen MR, Kilo CM. High-alert medication: safeguarding against errors. In Cohen
MR,ed. Medication Errors. WashingtonDC: American Pharmaceutical Association, 1999,
5.1-5.40.
Patient Safety Alert : High-alert medications and patient safety ; International Journal
for Quality in Health Care 2001 ,Volume 13, No.4 :pp 339-340.
Hayes ER., Kee JL. Pharmacology Pocket Companion for nurses. Pensylvania: W.B.
Saunders Company,1996.
6.
6.1
6.1.1
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Page 4
6.1.2
6.2
6.2.1
( )
6.2.2
13
MAR
6.2.3
6.3
6.3.1
6.3.2
6.3.3
6.3.4
6.3.5
6.3.6
6.3.7
6.3.8 (protocol)
6.4
6.4.1
(drug interaction)
( 2 2557)
Page 5
6.4.2
6.4.3
6.4.4
(contraindication)
****
6.5
6.5.1
(
6.5.2
6.5.3
6.6
6.6.1
6.6.2
6.6.3
6.6.4
( 2 2557)
Page 6
6.7
6.7.1
6.7.2
6.7.3
6.8
6.8.1 6
6.8.2 (Root
Cause Analysis/ RCA)
7.
( 2 2557)
Page 7
Actiilyse (alteplase)
1. AAlteplase inj 2 mg
2. Alteplase
A
inj 50
5 mg
alteplase1-3
onset
Altepplase inj. 2 mg
m
IV: coronaary
thrombolysis
30
Altepplase inj.
50 m
mg
4-8
IV: coronaary
thrombolysis
30
peak
IVV: 60
duration
IVV: 60
Screeningg
acute isschemic cerebrovascula r accident, acute
a
myocardial infarcttion, pulmonaary embolismm venouss
catheeter occlusionn
ACEIs enalapril, ccaptopril,
lisinoppril, quinapril, perindopril, imidapril ramipril
orolingual anngioedema (
antihistamines, stteroids
epineephrine)
nitroglycerin alteplase
reocclusionn
nitroglyycerin
(
2 2557)
Page 8
gentamycin
1.
1.1
6
1.2
warfarin (INR >1.3)
1.3
(aneurysm)
1.4
(subarachnoid)
1.5
1.6 10
(
)
1.7
(cardiopulmonary resuscitation)
( 2 ) 10
( subclavian jugular
vein)
1.8
( )
1.9 bacterial endocarditis pericarditis
1.10
1.11 3
1.12
1.13
( 2 2557)
Page 9
2.
2.1
2.2
transient ischaemic attack (TIA) 6
4.5
3.
3.1 4.5
3.2
3.3 /
imaging technique
( NIHSS > 25)
3.4
3.5 (stroke)
3
3.6
3.7 heparin 48
aPTT
3.8 100,000/mm3
3.9 (systolic) >
185mmHg (
diastolic) > 110mmHg
3.10 < 50 > 400mg/dL
4. alteplase
18
( 2 2557)
Page 10
1.
1.1 alteplase
alteplase
(resuscitation)
1.2 alteplase 100 mg
90 mg
alteplase
1.3
-
(biopsies)
-
-
alteplase
2.
:
2.1 (systolic) > 160mmHg
( 2 2557)
Page 11
2.2
(intracerebral haemorrhage)
alteplase
3.
:
3.1 (arrhythmias)
(coronary)
(reperfusion)
(reperfusion arrhythmias)
(conventional antiarrhythmic therapies)
3.2 Glyco-Protein II b / III a antagonists
GPIIb / IIIa
3.3 (thrombo-embolism)
mitral stenosis artrial fibrillation
4.
:
4.1
4.2
-
( 2 2557)
Page 12
-
- (late time-totreatment onset)
- acetylsalicylic acid (ASA)
(intracerebral
haemorrhage)
alteplase alteplase 0.9mg/kg
( 90 mg)
- 80
4.3 4.5
-
- ASA
-
4.4 24
systolic>180mmHg
diastolic > 105mmHg
4.5
(stroke)
4.6 (mild stroke)
alteplase
4.7 (severe
stroke) alteplase
(intracerebral haemorrhage)
4.8
( 2 2557)
Page 13
alteplase
4.9
(intracranial bleeding)
alteplase
( / imaging techniques
)
< 50mg/dL > 400mg/dL
4.10
24
alteplase
Double check
Page 14
Page 15
/4
4-5
alteplase heparin
heparin aPTT 2
aPTT 50-70
(1.5-2.5 )
acute myocardial infarction, pulmonary embolism
ischemic stroke systemic thromboses
Chest, 2008 alteplase 0.1-0.6 mg/kg/hr
6 plasminogen
deficiency
plasminogen thrombolysis therapy
Double check
Double check
sterile water NSS
SWI dextrose
(
heparin)
0.2 mg/mL
24
30 C
8
24
2- 8 C
( 2 2557)
Page 16
3,5-6
monitor
acute ischemic stroke: neurological status
acute myocardial infarction: evidence cardiac
reperfusion
catheter occlusion: catheter
pulmonary embolism:
monitor pulse, BP, hemodynamic respiratory status
acute ischemic stroke:
vital sign anaphylaxis
Adverse reaction
cholesterol embolization,
reperfusion arrhythmia
signs and symptoms of bleeding, arterial
puncture sites : bleeding 15 1
15 30 8
4 internal bleeding
neurologic,
, ,
Lab test: hematocrit, hemoglobin, platelet count,
fibrin/fibrin degradation product titer, fibrinogen
concentration, prothrombin time, thrombin time
activated partial thromboplastin
- monitor vital signs, CBC, renal function
hepatic enzymes
- monitor urine stool occult blood.
- monitor hematocrit, hemoglobin, partial
thromboplastin time, prothrombin time/INR, platelet
( 2 2557)
Page 17
( 2 2557)
Page 18
1. Klasco RK (Ed): DRUGDEX System. Truven Health Analytics, Greenwood Village,
Colorado (Vol. 159 expires [6/2014]).
2. , , . Siriraj
Drug List 2013 [online]. Version 26. Feb 2014.
3. Deglin JH, Vallerand AH, editors.Daviss drug guide for Nurses. 11th ed. PA: F. A. Davis
Company; 2009. p. 1164-1168.
4. . High Alert
Drugs. 2. : 25 2550.
5. Product information: Actilyse, Alteplase, BoehringerIngelheim, Thailand.
6. Smith KM, Riche DM, Henyan NN, editors. Clinical Drug Data. 11th ed. NY:McGraw-Hill,
Medical; 2010. p. 731-732.
7. American Pharmacists Association. Drug Information Handbook with International Trade
name index. 22nd ed. OH: Lexicomp; 2013-2014. p.86.
8. American Pharmacists Association.Pediatric and Neonatal Dosage Handbook. 19th ed. OH:
Lexicomp; 2012-2013. p.91.
( 2 2557)
Page 19
Adrenaaline (Epineephrine)
Adreenaline injectioon 1 mg/mL (1
( mL)
Adreenaline
injecction
1 mgg/mL (1 mL)
Onset1
SCC: 5-10
IM
M: 6-12
IVV: rapid
Peak1
SC: 20
IM:
IV: 20
Duratioon1
SC: < 1- 4
IM: < 1-4
IV: 20 - 30
Sccreening
(caardiac
arrest) (coaagulation disoorders)2
dihydroergotaminne linezolid
(
BP )2
halogenated hydrrocarbon anaaesthetic
( halothhane)
sympatthomimetic2
(vasoconsttriction and gangrene)
g
seecond
stage
, (closed-angle
glaucoma) ) , organic brainn damage
shock (non-anaphylactic)2
(
2 2557)
Page 20
Double check
For Anaphylaxis;
o IVinfusion 1 mg (1 mL of
1:1000(1 mg/mL)solution) D5W 250
mL ( 4 mcg/mL)
1 mcg/min (15 mL/hr)
10 mcg/min
1 mg (1 mL of
1:1000 solution 100 mL of NSS (10 mcg/mL))
5 -15 mcg/min
(30 -90 mL/hr)
/
2
o IM/SC 0.2-0.5 mg 5-10 2
o IV , IM SC 0.01 mg/kg maximum dose
0.3 mg IV infusion
10 mcg/min2
For Cardiac arrest;2
1 mg IV 3- 5
0.01 mg/kg (0.1 mL/kg of a 1:10,000 (0.1
mg/mL)solution) IV/Intraosseously ; 3 to 5 minutes
maximum dose 1 mg
For Post-cardiac arrest hypotension;2
0.1 -0.5 mcg/kg/min IV
0.1 -1 mcg/kg/min IV/INTRAOSSEOUS
Double check
1 mg/mL
( 2 2557)
Page 21
Double check
IV infusion Infusion pump
4 mcg/mL
1 - 10 mcg/min
10 mcg/mL 5 - 15 mcg/min
(30 - 90 mL/hr)
D5W, NSS
24 3
3,4
IV
Vital signs (BP, pulse rate) 3-5
tachycardia, palpitation, BP
ventricular fibrillation, pulmonary
edema
vital signs , BP 5
BP 160/90 .
BP 1 120/80 .
BP 1 100/70 .
HR 120 /
HR 1 180 /
HR 1 220 /
IV site 1
(extravasation)
(blanching)
(graying) 2
( 2 2557)
Page 22
:
1. DDeglin JH, Vaallerand AH, editors.Davisss drug guidde for Nursess. 11th ed. PAA: F. A. Davvis
Com
mpany; 2009.. p. 480-3.
2. KKlasco RK (Edd): DRUGDEEX System.. Truven Heaalth Analyticss, Greenwoodd Village,
Coloorado (Vol. 160 expires [66/2014]).
3. PProduct inform
mation: Adrennaline injectioon, Adrenalinne, Atlantic Pharmaceutic
P
cal Co., Ltd,
Thaiiland.
4. PProduct inform
mation: Adrennaline injectioon, Adrenalinne, GPO, Thailand.
5. .
High Aleert
Druggs. 2. : 25 2550. 8.
(
2 2557)
Page 23
Calccium injecction
Calcium gluconate Injectioon
Calcium chloride injection
Calccium
glucoonate
Injecction
Calccium Chloride
Injecction
onset
IVV 1
peak
p
IV1
duratiion
IV 0.5 2
1
IVV 1
IV 1
IV 0.5 2
1
SScreening
serum calcium
m (Ca2+ ) = 4 .2 - 5.1 mEq//L
digoxin Ca2+ digoxin
d
digoxin
digoxin
intoxication
ceftriaxone
ventricular fibrillaation
ccardiac glycooside
K+
Ca2+
IV push 5 (
emergency case)
Ca2+ IV drip
(
2 2557)
Page 24
( 2 2557)
Page 25
(
2 2557)
Page 26
:
1. Deglin JH, Vallerand AH, editors.Daviss drug guide for Nurses. 11th ed. PA: F. A. Davis
Company; 2009.p.256-9.
2. Klasco RK (Ed): DRUGDEX System. Truven Health Analytics, Greenwood Village,
Colorado (Vol. 160 expires [6/2014]).
3. American Pharmacists Association. Drug Information Handbook with International Trade
name index. 22nd ed. OH: Lexicomp; 2013-2014.p.317-9.
4. . High Alert
Drugs. 2. : 25 2550. 9-10.
5. Trissel LA. Handbook on injectable drugs. 15th ed. Bethesda (MD): American Society of
Health-System Pharmacists;2009.p.176-81.
6. . Electrolyte Emergencies.: ().
First hour in Emergency Room: The practical approach 2008. 1. . .
., 2551. 148-53.
( 2 2557)
Page 27
Digooxin (Lanooxin)
1. Lanoxinn 0.25 mg taablet
2. Lanoxinn PG 0.06255 mg tablet
3. Lanoxinn elixir 0.05 mg/mL (60 mL)
4. Lanoxinn injection 0.25
0 mg/mL (2 mL)
Lanoxin 0.25
mg ttablet
onseet
0.5 - 2
peak
2 8
duration
2-4 1
Lanoxin PG
0.06625 mg tableet
0.5 - 2
2 - 8
2-4 1
Lanoxin elixir
0.055mg/mL
(60 m
mL)
0.5 - 2
2- 8
2-4 1
Lanoxin
injecction 0.25
mg/mL (2 mL)
5-30
1- 4
2-4 1
Screening
ventricuular fibrillatioon
(
2 2557)
Page 28
( )
electrolyte imbalance (hypokalemia, hypo hypercalcemia, hypomagnesemia (
)
Calcium parenteral
( )
erythromycin
clarithromycin
digoxin
Double check
1 10
2 12 3
monitor heart rate
IM: 500 mcg single injection site
200 mcg single injection site
oral IM IV 20
25%3
70 impaired renal function,
lean body mass 0.125 mg
3
Double check
0.25 mg D025
0.0625 mg D06
( 2 2557)
Page 29
( 2 2557)
Page 30
:
1. Deglin JH, Vallerand AH, editors.Daviss drug guide for Nurses. 11th ed. PA: F. A. Davis
Company; 2009.p.412-5.
2. Klasco RK (Ed): DRUGDEX System. Truven Health Analytics, Greenwood Village,
Colorado (Vol. 160 expires [6/2014]).
3. American Pharmacists Association. Drug Information Handbook with International Trade
name index. 22nd ed. OH: Lexicomp; 2013-2014.p.594-6.
4. . High Alert
Drugs. 2. : 25 2550. 11-3.
5. Product information: Lanoxin injection, GlaxoSmithKline Manufacturing SpA, Italy.
( 2 2557)
Page 31
DDoBUtaminne
1.
2.
3.
4.
5.
Dobuutamine
injecction
250 mg/20 mL
(12.55 mg/mL)
Dobuutamine
(U-sqquare)
injecction 250
mg/220 mL (12.5
mg/m
mL)
Dobuutamine Siriraaj
(PFSS) Injection
1,2 6 mg/mL
20 mL
30 mL
Dobutam
mine injection 250 mg/20 mL
m (12.5 mg/m
mL)
Dobutam
mine (U-squaree) injection 2550 mg/20 mL (12.5 mg/mLL)
Dobutam
mine Siriraj (P FS) Injection 1 mg/mL 20 mL 30 mL
Dobutam
mine Siriraj (P FS) Injection 2 mg/mL 20 mL 30 mL
Dobutam
mine Siriraj (P FS) Injection 6 mg/mL 20 mL 30 mL
onset
o
1--2
peak
10
duraation
Single Dose
: 10
Multiplee Dose
: 1
1--2
10
Single Dose
: 10
Multiplee Dose
: 1
1--2
10
Single Dose
: 10
Multiplee Dose
: 1
Screeening
DDouble check
DoPAmine
hypovolemia
hypovolemmia
(
2 2557)
Page 32
myocardial infarction infarction
linezolid
hypersensitivity to dobutamine
idiopathic hypertrophic subaortic stenosis
infusion pump
doBUtamine Sodium bicarbonate
( 2 2557)
Page 33
:
50 mL ( premixed)
: D5W , D5S/2 , D5S, D10W, NSS , LRS
1(Maximum concentration) : 5 mg/mL
: 24
oxidation
(EKG),
BP, HR 1
BP 160/90 mmHg
BP 1 120/80 mmHg
BP 1 100/70 mmHg
HR 120 /
HR 1 180 /
HR 1 220 /
:
15
electrolytes ( potassium 3.55.5mEq/L) hypokalemia1
100 mL/4 hr
30 mL/hr 0.5-1 mL/ Kg/hr
( 2 2557)
Page 34
( 2 2557)
Pagge 35
(
2 2557)
Page 36
:
1. Deglin JH, Vallerand AH, editors.Daviss drug guide for Nurses. 11th ed. PA: F. A. Davis
Company; 2009.p.437-8.
2. Klasco RK (Ed): DRUGDEX System. Truven Health Analytics, Greenwood Village,
Colorado (Vol. 160 expires [6/2014]).
3. . High Alert
Drugs. 2. : 25 2550. 14-5.
( 2 2557)
Page 37
DoPAmine
1.
2.
3.
4.
mL (25 mg/mLL)
Inoppin (Dopaminne) injection 250 mg/ 10m
Dopaamine Siriraj (PFS) Injectioon 1 mg/mL 20 mL
30 mL
Dopaamine Siriraj (PFS) Injectioon 2 mg/mL 20 mL
30 mL
Dopaamine Siriraj (PFS) Injectioon 6 mg/mL
20 mL 30 mL
Inoopin (Dopamine)
injection 250 mg/
100mL (25 mg/m
mL)
Doopamine Siriraaj
(PPFS) Injection
1 mg/ml
2 mg/ml
6 mg/ml
onset
5
peak
10 1
10 1
durattion
10
10
Screeening
DDouble check
DoBUtamine
Dilantin (Pheenytoin)
ccardiac arresst
tachyyarrhythmias ventricuular
ffibrillation
MAOI dopaamine metabbolized
MAO
M
(
2 2557)
Page 38
monitor BP, HR
rate of infusion 1
( )
Initial : IV 2 - 5 mcg/kg/min 5
10 mckg/min 50 mcg/kg/min
50 mcg/kg/min renal
shutdown monitor urine flow
infusion rate
( )
Initial : IV 2 - 5 mcg/kg/min 50
mcg/kg/min
Double check
DoBUtamine
Double check
D5W,D5S, NSS, D5S/2
IV bolus
DoBUtamine
Sodium bicarbonate
Dopamine
(central vein) infusion pump/
( 2 2557)
Page 39
BP 160/90 mmHg
BP 1 120/80 mmHg
BP 1 100/70 mmHg
HR 120 /
HR 1 180/
HR 1 220 /
infusion pump 1
24
( 2 2557)
Page 40
( 2 2557)
Pagge 41
:
1. DDeglin JH, Vaallerand AH, editors.Davisss drug guidde for Nursess. 11th ed. PAA: F. A. Davvis
Com
mpany; 2009..p.448-50.
2. KKlasco RK (Ed): DRUGDEEX System.. Truven Heaalth Analyticss, Greenwoodd Village,
Coloorado (Vol. 160 expires [66/2014]).
3. .
High Alert
A
Drugs. 2. : 25 25500. 16-8.
( 2 2557)
Pagge 42
Heparinn (Unfractiionated)
1. Heparin 50000 Units/mL (5 mL)
2. Heparin PFFS 100units/m
mL (5mL)
3. Heparin PFFS 50 units/m
mL (5 mL)
Onset1-2
SC:20-30
IV:
peak
durattion
SC: 2
SC: 8 - 12
1
IV: 5 - 10 IV: 2-6 1
Hepaarin
100 units/mL
(5 m
mL)
IV:
Hepparin PFS
50 uunits/mL
(5 m
mL)
SC: 20-330
IV:
SC:: 2
IV: 5-10
Hepaarin
50000 units/mL
(5 m
mL)
SC: 8-12
IV: 2-6
Screeninng
(platelet) 1100,000/mm3
benzyl alcohol
neonnates innfants 100 kg;
100 unitss/mL
systtemic anticoaagulation
60
enoxapaarin
enoxaparrin 12
heparin10 11
enooxaparin dose
( 2 2557)
Pagge 43
enoxaparin 24 heparin 22 23
enoxaparin dose 5
Contraindication
Double check
U unit
indication
Double check
2-8
insulin
Double check
insulin
D5W, NSS NSS/24
IM hematoma
infusion pump
infusion pump 2
aPTT
Heparin
aPTT
6
CBC 7
neuro sign
Protamine sulphate
Page 44
( 2 2557)
Pagge 45
:
1. American Pharmacists Association. Drug Information Handbook with International Trade
name index. 22nd ed. OH: Lexicomp; 2013-2014. p. 958-62.
2. Deglin JH, Vallerand AH, editors.Daviss drug guide for Nurses. 11th ed. PA: F. A. Davis
Company; 2009. p. 616-9.
3. . High Alert
Drugs. 2. : 25 2550. 21-3.
4. Klasco RK (Ed): DRUGDEX System. Truven Health Analytics, Greenwood Village,
Colorado (Edition expires [6/2014]).
5. DIS revisit: the next step in patient safety 2556
14-16 2556.
( 2 2557)
Page 46
sticker
Siriraj guideline for adult patients with Heparin administration
(1) heparin
Indication : Acute coronary syndrome (ACS)
Atrial fibrillation (AF)
Intracardiac thrombosis
Pulmonary embolism (PE)
Deep vein thrombosis (DVT)
Acute ischemic stroke
Arterial occlusion
Bridging therapy
Baseline : CBC, Coagulogram
Dose calculation : Adjusted by weight
Stability : at room temperature :
in NSS 24 hour, in D5W 8 hour
Heparin
Modified early warning sign
Heparin IV (1)
Yes
No
Monitoring
Clinical
Record V/S (BP, HR, RR)
Observe neurological sign
Observe bleeding
Lab
PTT ( keep < 70 sec)
aPTT ratio (keep < 2.5) q 4-6 hr
(as indicated)
Platelet, Hematocrit q 2 day
(as indicated)
Heparin infusion
Initial dose of
Heparin (3)
No
Yes
Continue heparin
(4)
No
Bleeding (5)
Yes
(5) Bleeding
1. Internal
Intracerebral hemorrhage
Hemothorax
Hemoperitoneum, Retroperitonial hematoma
Hematoma, Ecchymosis, Petechiae
2. External
Hematemesis, Melena, Bleeding per rectum
Hematuria
Hemoptysis
Bleeding per gum
Puncture site bleeding
Bleeding per vagina
infusion pump
Notify
/ ..........................................................................................
Version 2 : 24/03/2014
Bolus dose
(units/kg)
Maximum bolus
(units)
Initial infusion
(units/kg/hr)
Maximum initial
infusion rate
(units/hr)
1,000
a. Risk factor: Garcia DA, Baglin TP, Weitz JI, et al. Antithrombotic therapy and prevention of thrombosis,
9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST
2012; 141(2) (Suppl): e24Se43S.
b. Salzman EW, et al. Management of heparin therapy; a controlled prospective trial. N Engl J Med 1975;
292;1046-50. http://www.rxkinetics.com/heparin.html
c. http://www.ugapharmd.com/ebook/pages/heparin.pdf
Guidelines for antithrombotic therapy last updated December 2003
d. aPTT ratio (Therapeutic
range)
Siriraj guideline for adult patients with Heparin administration
Version 2 : 24/03/2014
H
Heparin,
Loow Molecuular Weightt (Innohep//Tinzaparinn)
1. Tinzapparin inj 10,0000 anti-Xa IU//mL 2 mL (Innnohep)
2. Tinzapparin inj PFS 20,000 anti-XXa IU/mL 0.5 mL (Innohep)
3. Tinzapparin inj PFS 20,000 anti-XXa IU/mL 0.7 mL (Innohep)
Tinzaaparin inj
10,000
anti-Xa IU/mL
2 mL
(Innoohep)
Tinzaaparin inj
PFS
20,000 anti-Xa
IU/m
mL
0.5 mL
(Innoohep)
Tinzaaparin inj
PFS
20,000 anti-Xa
IU/m
mL
0.7 mL
(Innoohep)
onset
SC: 2- 3
peaak
SC: 4 5
duuration
SC: 161 24
SC: 2- 3
SC: 4-55
SC: 16-24
1
SC: 2- 3
SC: 4-55
SC: 16-24
1
SScreening
70
( 2 2557)
Pagge 49
Double check
U
unit
indication ( Guideline
)
Double check
heparin insulin
Double check
heparin insulin
subcutaneous
anti-factor Xa (anti-Xa) level (
recurrent
thrombosis renal
impairment
)
CBC 7
( 2 2557)
Page 50
2 <
100,000/mm3 1,3
renal liver function
neuro sign
Protamine sulphate
30
:
1. Klasco RK (Ed): DRUGDEX System. Truven Health Analytics, Greenwood Village,
Colorado (Edition expires [6/2014]).
2. American Pharmacists Association. Drug Information Handbook with International Trade
name index. 22nd ed. OH: Lexicomp; 2013-2014. p. 1968-71.
3. Product information: Innohep, tinzaparin, Leo, Ballerup, Denmark.
( 2 2557)
Page 51
H
Heparin,
Loow Molecullar Weight (Clexane/Enoxaparinn)
- Enoxaparin (PFS) inj 40 mg/0.4 mL (CClexane)
- Enoxaparin (PFS) inj 60 mg/0.6 mL (CClexane)
- Enoxaparin (PFS) inj 80 mg/0.8 mL (CClexane)
Enoxxaparin
(PFSS) inj
40 m
mg/0.4 mL
(Clexxane)
Enoxxaparin
(PFSS) inj
60 m
mg/0.6 mL
(Clexxane)
Enoxxaparin
(PFSS) inj
80 m
mg/0.8 mL
(Clexxane)
onsset
1
peak
SC
C: 3 5
duration
SC: 12
SC
C: 3 5
SC: 12
SC
C: 3 5
SC: 12
SScreening
NSAIDss, platelet inhhibitors,
anticcoagulant ,
neuraxial
anessthesia, spinaal puncture,
indwwelling epidurral catheters
spinaal surgery
( 2 2557)
Pagge 52
45
57
renal impairment (
Crcl 30 mL/minute)
renal
dysfunction 45
heparin enoxaparin
heparin enoxaparin
1 4
Contraindication
Heparin Induced Thrombocytopenia (HIT)
Double check
indication
Double check
heparin insulin
Double check
heparin insulin
IM
D5W NSS
SC
2
spinal column bleeding
enoxaparin (
deep vein thrombosis)
spinal catheter 12
(1 mg/kg
1.5 mg/kg )
( 2 2557)
Page 53
spinal catheter 24 5
post-procedure dose
enoxaparin catheter 4 5
risk benefit
thrombosis bleeding5
anti-factor Xa (anti-Xa) level (
recurrent
thrombosis renal
impairment
)
CBC 7
serum creatinine1
neuro sign
Protamine sulphate
25
:
1. Deglin JH, Vallerand AH, editors.Daviss drug guide for Nurses. 11th ed. PA: F. A. Davis
Company; 2009. p. 619-23.
2. Klasco RK (Ed): DRUGDEX System. Truven Health Analytics, Greenwood Village,
Colorado (Edition expires [6/2014]).
3. Product information: Clexane, enoxaparin, sanofi-aventis, Bangkok, Thailand.
4. DIS revisit: the next step in patient safety 2556
14-16 2556
5. FDA Drug Safety Communication: Updated recommendations to decrease risk of spinal
column bleeding and paralysis in patients on low molecular weight heparins. [Homepage on
Internet]. USFDA; [Accessed 04/04/2014]; Available from:
http://www.fda.gov/Drugs/DrugSafety/ucm373595.htm
( 2 2557)
Page 54
H
Heparin,
Low Molecular Weight (Arixtra/Foondaparinuux)
Fondaparinux
(PFSS) inj
2.5 mg/0.5 mL
(Arixxtra)
onset
1
peak
p
3 1
Duration
24 1
SScreening
NSAAIDs, platelet inhibitors, aanticoagulant
neuraxial aneesthesia
50
CContraindicaation
-
- Acute baacterial endoocarditis
( 2 2557)
Pagge 55
Double check
indication
SC : 2.5 mg
Double check
Double check
IM
100,000 /mm3
2
CBC
plasma anti-factor Xa significant renal
impairment bleeding coagulation
parameters
blood pressure
hepatic function
renal function, stool occult blood tests
neuraxial anesthesia
spinal puncture neurological
impairment spinal epidural
hematoma
( 2 2557)
Page 56
:
1. Deglin JH, Vallerand AH, editors.Daviss drug guide for Nurses. 11th ed. PA: F. A. Davis
Company; 2009. P. 575-7.
2. Micromedex Healthcare Series, Truven Health Analytics, Greenwood Village, Colorado
(Edition expires [6/2014]).
3. Product information: Arixtra, fondaparinux, GlaxoSmithKline, Bangkok, Thailand.
4. American Pharmacists Association. Drug Information Handbook with International Trade
name index. 22nd ed. OH: Lexicomp; 2013-2014. p. 881-3.
( 2 2557)
Page 57
sticker
LMWH
(1)
Yes LMWH
Indication:Acutecoronarysyndrome(ACS)
Atrialfibrillation(AF)
Pulmonaryembolism(PE)
Deepveinthrombosis(DVT)
Acuteischemicstroke
Arterialocclusion
Bridgingtherapy
Baseline:CBC,Coagulogram,BUN,Cr,BW
Dosecalculation: Adjustedbyweightand
Creatinineclearance
(2)Riskfactor
sign
Pepticulcerdisease:HxGIbleeding
Drugs:antiplatelets,NSAIDs,Fibrinolytic
Presenceofanypotentialbleedingsite
Severehypertension
Congenitaloracquiredhemostaticdefect
Severerenalfailure
Severehepaticfailure
Anemia
Recentsurgery
Trauma(orriskoftrauma)
Recentintracerebralhemorrhage
Largecerebralinfarction
Ageover60years
3
Platelet<100,000/mm
LMWH (1)
No
Yes
Monitoring
Clinical
RecordV/S(BP,HR,RR)
Observeneurologicalsign
Observebleeding
Lab
ConsidermonitoringantiXa
forweight>120kgor<60kg,4hr
( request)
Platelet,Hematocritq3day
(asindicated)
LMWHadministration
Doseof
LMWH(3)
1. Individualizeddosing
2. Dailyassessmentfor
signs/symptomsofbleeding,
essentiallabasindicated
(4)
No
V/S,neurologicalsignchange..
Yes
3
Platelet<100,000/mm ...
Hematocritdrop>3%frombaseline.
LMWHerror..
Other....
Notify
No
ContinueLMWH
(3)
Bleeding(5)
Yes
(5)Bleeding
1.Internal
Intracerebralhemorrhage
Hemothorax
Hemoperitoneum,Retroperitonialhematoma
Ecchymosis,Petechiae
2.External
Hematemesis,Melena,Bleedingperrectum
Hematuria
Hemoptysis
Bleedingpergum
Puncturesitebleeding
Bleedingpervagina
HoldLMWH / ..........................................................................
RepeatantiXa / .....................................................................
Notify /consulthematologist/ ...............................
Bleedingmanagement/ ...................................................
Bloodcomponenttransfusionasindicated
/ ...................................................................................................
Version 2 : 24/03/2014
Version 2 : 24/03/2014
References
a. Risk factor: Garcia DA, Baglin TP, Weitz JI, et al. Antithrombotic therapy and prevention of
thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice
Guidelines. CHEST 2012; 141(2) (Suppl): e24Se43S.
b. Salzman EW, et al. Management of heparin therapy; a controlled prospective trial. N Engl J Med
1975; 292;1046-50. http://www.rxkinetics.com/heparin.html
c. Uspharmacist Low Molecular Weight Heparins for Deep Vein Thrombosis Vol. 26:05 , 2001
(www.uspharmacist.com)
d. (Work Instruction) NS-00-3-162-01 Low Molecular Weight
Heparin (LMWH)
Version 2 : 24/03/2014
Insulin
1. Humulin R 10 mL
2. Gensulin R 10 mL
3. Actrapid HM 10 mL
4. Humulin N 10 mL
5. Gensulin N 10 mL
6. Insulatard HM 10 mL
7. Humulin 70:30 10 mL
8. Gensulin M30 10 mL
9. Mixtard 30 HM 10 mL
10. Lantus 10 mL
11. Insulin aspart penfill 3 mL (Novorapid)
12. Insulin aspart , biphasic penfill 3 mL (Novomix)
13. Insulin aspart, biphasic Flexpen 3 mL (Novomix 30)
14. Insulin detemir flexpen 3 mL (Levemir)
15. Insulin glulisine Prefilled pen 3 mL (Apidra solostar)
16. Insulin glargine PFS 3 mL + needle (Lantus Solostar)
17. Insulin isophane (NPH) Penfill 3 mL (Gensulin N)
18. Insulin isophane (NPH) Penfill 3 mL (Humulin N)
19. Insulin isophane (NPH) Penfill 3 mL (Insulatard HM)
20. Insulin Isophane+regular Penfill 3 mL (Gensulin M30)
21. Insulin Isophane+regular Penfill 3 mL (Humulin 70/30)
22. Insulin Isophane+regular Penfill 3 mL (Mixtard 30 HM)
23. Insulin lispro Penfil 3 mL (Humalog)
24. Insulin lispro, biphasic Penfil 3 mL (Humalog Mix 25)
25. Insulin regular Penfill 3 mL (Actrapid HM)
26. Insulin regular Penfill 3 mL (Gensulin R)
: (tradename)
( 2 2557)
Page 61
insuulin1,2
Onset1,2
Peak1,2
Duration1,2
30-600
2-3
5-8
Genssulin R 10 mLL
30-600
2-3
5-8
Actraapid HM 10 mL
m
30-600
2-3
5-8
Hum
mulin N 10 mLL
2-4
4-10
4
10 16
Genssulin N 10 mLL
2-4
4-10
4
Insulatard HM
mL
10 m
2-4
4-10
4
10-16
Hum
mulin 70:30
10 m
mL
30-600
4-8
4
10 16
Genssulin M30
10 m
mL
30-600
4-8
4
10 16
Mixtaard 30 HM
10 m
mL
30-600
4-8
4
10-16
Lanttus 10 mL
2-4
Peakless
(
20 - 244
Hum
mulin R 10 mLL
10-16
( 2 2557)
Pagge 62
Onset1,2
Peak1,2
Duration1,2
Insuulin aspart
penffill 3 mL
(Novvorapid)
5 155
30-90
3
3 5
Insuulin aspart ,
biphhasic penfill 3
mL ((Novomix)
5 155
1 4
24
Insuulin aspart,
biphhasic Flexpenn
3 mL
(Novvomix 30)
5 155
1 4
24
Insuulin detemir
flexppen 3 mL
(Levvemir)
2 -4
6-14
6
16-20
Insuulin glulisine
Preffilled pen 3 mL
m
(Apidra solostar))
Insuulin glargine
PFSS 3 mL +
needdle (Lantus
Soloostar)
5-15
30-90
3
3-5
2-4
20 - 24
Insuulin isophane
(NPH) Penfill 3
mL ((Gensulin N))
Insuulin isophane
(NPH) Penfill 3
mL (Humulin N))
2-4
Peakless
(
)
4-10
4
2-4
4-10
4
10 16
Insuulin isophane
(NPH) Penfill 3
mL
(Insuulatard HM)
2-4
4-10
4
10-16
10 16
( 2 2557)
Pagge 63
Onset1,2
Peak1,2
Duration1,2
Insuulin
Isopphane+regulaar
Penffill 3 mL
(Gennsulin M30)
Insuulin
Isopphane+regulaar
Penffill 3 mL
(Hum
mulin 70/30)
Insuulin
Isopphane+regulaar
Penffill 3 mL
(Mixxtard 30 HM)
Insuulin lispro
Penffil 3 mL
(Hum
malog)
30-600
4-8
4
10 16
30-600
4-8
4
10-16
30-600
4-8
4
10-16
5-15
30-90
3
3-5
Insuulin lispro,
biphhasic Penfil
3 mL
malog Mix 255)
(Hum
Insuulin regular
Penffill 3 mL
(Actrapid HM)
5-15
10-16
30-600
2-3
5-8
30-600
2-3
5-8
Insuulin regular
Penffill 3 mL
(Gennsulin R)
Screening
Inssulin ,
ACE inhibitors enalapril, octreotide
o
(saandostatin)
salicyylates aspirin2
Insulin
corticcosteroids, thhyroid supplements, estrrogens, INH, niacin,
( 2 2557)
Pagge 64
Double check
U unit
Regular insulin, NPH, glargine : Type 1 DM
//
Insulin penfilled
( 2 2557)
Page 65
Insulin
( 2 2557)
Page 66
( 2 2557)
Pagge 67
:
1. . . :
(). . 1. : ,
2555. . 1-11.
2. Deglin JH, Vallerand AH, editors.Daviss drug guide for Nurses. 11th ed. PA: F. A. Davis
Company; 2009.
3. Klasco RK (Ed): DRUGDEX System. Truven Health Analytics, Greenwood Village,
Colorado (Vol. 160 expires [6/2014]).
4. American Pharmacists Association. Drug Information Handbook with International Trade
name index. 22nd ed. OH: Lexicomp; 2013-2014. p. 1050-62.
5. . High Alert
Drugs. 2. : 25 2550. 26.
( 2 2557)
Page 68
K+ (Pottassium) Innjection
m ( K+ 2 mEEq/mL)
1. KCl inj. [Potassium chloride] 200 mEq/10 mL
2. K2HPO4 Inj. [Dipotaassium phossphate] 20 mL
m ( K+ 1 mEEq/mL)
Onset1
Peak1
Duraation1
KCl inj. 10 mL
( K+ 2 mEq/m
mL)
(end oof
infusion)
K2HPO4 Inj. 20 mL
( K+ 1 mEq/m
mL)
(end oof
infusion)
Sccreening
Lab K+ 3.5-5.0 mEEq/L2
( 2 2557)
Pagge 69
( 2 2557)
Page 70
40 mEq/L HR , BP
2
20-40 mEq/L HR 4
BP
BP 160/110 90/60 mmHg
HR 60-100 /
Lab K+ 3.5-5 mEq/L
K+ sparing diuretics spironolactone
K+
K+ arrhythmia
:
1. Deglin JH, Vallerand AH, editors.Daviss drug guide for Nurses. 11th ed. PA: F. A. Davis
Company; 2009. p. 997.
2. Klasco RK (Ed): DRUGDEX System. Truven Health Analytics, Greenwood Village,
Colorado (Vol. 160 expires [6/2014]).
3. American Pharmacists Association. Drug Information Handbook with International Trade
name index. 22nd ed. OH: Lexicomp; 2013-2014. p. 1619-20.
4. Phelps SJ, Hagemann TM, LEE KR, Thompson AJ, editors. Pediatric injectable drugs (The
teddy bear book). 10th ed. Bethesda, MD: American Society of Health-System Pharmacists;
20 p. 536.
5. . High Alert
Drugs. 2. : 25 2550. 29.
( 2 2557)
Page 71
Peak1
Duratioon1
50%
%
MgSSO4 inj.
2 mL
IV:
unknown
u
IM: 1
IV: 30
IM : 3 -44 hr
20%
%
MgSSO4 inj.
20 m
mL
IV:
unknown
u
IV: 30
50%
%
MgSSO4 inj.
20 m
mL
IV:
unknown
u
IV: 30
MgSSO4 in
D5W
W
40 m
mg/mL
1000 mL
IV:
unknown
u
IV: 30
Onset
O 1
( 2 2557)
Pagge 72
1.5 mg/dL
25 mL/hr
Magnesium (Hypomagnesemia)3,4
Adult
mild hypomagnesemia; 1 g (magnesium sulfate
50% solution 2 mL) IM 6 4
doses serum magnesium
severe hypomagnesemia; 250 mg/kg (
magnesium sulfate 50% solution undiluted)
IM 4 magnesium sulfate inj 5 g
D5W NSS 1000 mL IV infusion
3
TPN, maintenance; 8-24 mEq/day
Pediatric
TPN, maintenance (prophylaxis); infants; 2-10
mEq/day
Neonates children magnesium sulfate 25 50 mg/kg IV 30 60 ; MAX 2 g/ dose
( 2 2557)
Page 73
( 2 2557)
Page 74
(neuromuscular
blockade)
heart block 6
RR, HR 4 6
RR 14 /
HR 60-100 /
Urine output 100 mL/ 4 hr6
Deep tendon reflex knee jerk reflex
4 negative bicep jerk reflex
negative 6
:
1. Deglin JH, Vallerand AH, editors.Daviss drug guide for Nurses. 11th ed. PA: F. A. Davis
Company; 2009.
2. , - .
.. 2553. ... 2553. . 18.
3. American Pharmacists Association. Drug Information Handbook with International Trade
name index. 22nd ed. OH: Lexicomp; 2013-2014. p. 1221-3.
4. Klasco RK (Ed): DRUGDEX System. Truven Health Analytics, Greenwood Village,
Colorado (Vol. 160 expires [6/2014]).
5. Phelps SJ, Hagemann TM, LEE KR, Thompson AJ, editors. Pediatric injectable drugs (The
teddy bear book). 10th ed. Bethesda, MD: American Society of Health-System Pharmacists;
20 p. 429.
6. . High Alert
Drugs. 2. : 25 2550. 33.
( 2 2557)
Page 75
Morphine
:
1.
Morphine innj. 10 mg/mLL
Morphine inn NSS PFS 1 mg/mL (11, 2 mL)
2.
3.
Morphine inn NSS Inj 1 mg/mL (10 mL)
4.
Morphine inn NSS Inf 0..5 mg/mL (1100 , 200 mL)
:
5.
: Moorphine syrup GPO 2 mg/mL (60 mL)
6.
: Moorphine GPOO Tab. 10 mg(Immediat
m
teRelease)
7.
: MST continnus tablet 110, 30, 60 mg
m
8.
: Kapanool capsule 220, 50, 100 mg
1-6
Morphine
M
Morpphine inj. 10
mg/m
mL
Morpphine in NSSS
PFSS 1 mg/mL (11, 2
mL)
Morpphine in NSSS Inj
1m
mg/mL (10 mL)
Morpphine in NSSS Inf
0.5 m
mg/mL
(1000 , 200 mL)
Onset
Peeak
SC:
S 20
SC: 500-90
IM:
I 10-30
IV:
I rapid
IM: 30--60
IV: 20
IV:
I rapid
IV: 20
Duration
4 - 5
4 - 5
IV:
I rapid
IV: 20
4 - 5
IV:
I rapid
IV: 20
4 - 5
( 2 2557)
Pagge 76
Onset
Duration
Peeak
30
3
1 -2
4--5
Morpphine GPO 10
1
mg
mediateReleaase)
(Imm
30
3
1 2
4 5
MSTT tablet 10 mg
m
30
3 45
4 -5
122
m
MSTT tablet 30 mg
30
3 45
4 -5
122
MSTT tablet 60 mg
m
30
3 45
4 -5
122
Kapanol cap 20 mg
30
3 - 60
8.5
244
Kapanol cap 50 mg
30
3 - 60
8.5
244
30
3 - 60
8.5
244
( 2 2557)
Pagge 77
Screening
Double check
:
(bronchial asthma)
/
(paralytic ileus)
(delirium tremens)
MAOIs MAOIs 14
anticholinergic
diuretics zidovudine lidocaine
enzyme inducers phenytoin rifampicin
5 (.5) (
)
:
-IM , SC : 5 - 15 mg 4
- IV : opioid-nave 2.5 - 5 mg 34 opioid
- Oral :
immediate release tablet : 10 30 mg 4
( 2 2557)
Page 78
solution : 10 20 mg 4
Kapanol : opioid-naive 20 40 mg 24
40 mg 20 mg
2 ( 12 )
MST continus :
20 mg 12 70
30 mg 12 70
mL mg
Double check
syrup
Double check
NSS D5W
IV push 5-10
Usual infusion concentrations : IV infusion : 1
mg / mL
24
MST Kapanol
Kapanol6
French gastrostomy tube 16
gastrostomy tube
10
gastrostomy tube
10
Kapanol
30 ( 30
)
( 2 2557)
Page 79
600
(monitoring) : heart rate,
respiratory rate, pain score, sedation score
IV push 5 4
30 2
IV continuous drip 1
4 4
SC IM 15 4
30 2
respiratory rate (RR) 10
heart rate (HR) 60
overdose
10
( 1 30 / 1 20
/ )
continuous drip
Naloxone
Opioid intoxication :
Naloxone 0.4 2 mg
2-3 ( 10 mg)
( 2 2557)
Page 80
5 20
Naloxone 0.1 mg/kg/dose (maximum
dose : 2 mg)
5 20
2 mg 2-3 (
10 mg)
10
Naloxone
(Duration 45 ) Morphine
Morphine
( 2 2557)
Page 81
:
1.
, , .
Siriraj Drug List 2014 [online]. Version 5.0 March 2014.
2.
Deglin JH, Vallerand AH, editors.Daviss drug guide for Nurses. 11th ed. PA: F. A.
Davis Company; 2009. p.843-7.
3.
Product information: Morphine sulfate oral solution GPO, morphine sulfate, GPO,
Bangkok, Thailand.
4.
Product information: Morphine sulfate IR tablet GPO, morphine sulfate, GPO,
Bangkok, Thailand.
5.
Prodruct information, MST CONTINUS, Morphine sulfate, BARD
PHARMACEUTICALS, Cambridge, United Kingdom.
6.
Product information, Kapanol, morphine sulfate, GlaxoSmithKline, Boronia,
Australia.
7.
. High
Alert Drugs. 2. : 25 2550. 34-7.
8.
Klasco RK (Ed): DRUGDEX System. Truven Health Analytics, Greenwood Village,
Colorado (Vol.160 expires [6/2014]).
9.
American Pharmacists Association. Drug Information Handbook with International
Trade name index. 22nd ed. OH: Lexicomp; 2013-2014. p 1344-9, p 1368-70.
10. . . : Printing Place; 2552. 145-67.
.
( 2 2557)
Page 82
Nicardipine (Carddepine)
onset
ppeak
duratioon
Nicaardipine inj
2mg/2mL
IVV : 1
intracoronnary: 2
IV : 3
Nicaardipine inj
10mg/10mL
IVV : 1
intracoronnary: 2
IV : 3
2-5
Sccreening
Hypertension, Postoperaative Hyperteension
chronic staable angina
advanced aortic stennosis
myocardial oxygen balaance afterload
vecurronium neuromuscula
e
ar
block vecuroniumm (500%)
amioddarone
bradycardiia, atrioventricular block / sinuus arrest
fentannyl severe
s
hypotensioon
( 2 2557)
Pagge 83
/2-5
Double check
IV : Acute hypertension
- 5 mg/hr 2.5
mg/hr 5 ( rapid titration) 15 (
gradual titration) 15 mg/hr
3 mg/hr
:
cardepine 1
Double check
( 2 2557)
Page 84
2-5
2-5
Double check
sodium bicarbonate
lactated ringer solution ( Cardepine)
0.1 0.2 mg/mL
infusion pump
D5W, D5S/2, D5S, Sodium Chloride
0.45%, NSS.
24
venous thrombosis, phlebitis,
vascular impairment small veins dorsum
peripheral vein infusion site
12
24
(angina)
,
hypotension tachycardia
serum potassium ( hypokalemia
arrhythmias)
: IV calcium infusions (
7007)
Hypotensive episode:
refractory hypotension IV calcium, vasopressors, high
dose insulin/dextrose, glucagon
( 2 2557)
Page 85
1. , , .
Siriraj Drug List 2014 [online]. Version 5.0 March2014.
2. Klasco RK (Ed): DRUGDEX System. Truven Health Analytics, Greenwood Village,
Colorado (Vol.160 expires [6/2014]).
3. American Pharmacists Association.Drug Information Handbook with International
Trade name index.22nd ed. OH: Lexicomp; 2013-2014. p1394-6.
4. Product information, Cardepine, nicardipine hydrochloride, Westmont
Pharmaceuticals, San Juan, Philippines.
5. Deglin JH, Vallerand AH, editors.Daviss drug guide for Nurses.11th ed. PA: F. A.
Davis Company; 2009. p.879-81. Deglin JH, Vallerand AH, editors. Daviss drug guide for
Nurses. 11th ed. PA: F. A. Davis Company; 2009. p.879-81.
( 2 2557)
Page 86
NNitroglyceriin
1. Nitroglyccerin inj. 50 mg/10mL
m
Nitrooglycerin inj.
50 m
mg/10mL
onsset
peak
duration
5-10
5
anggina (
organic nittrates betta
blockers)4
anngina
acutte angina pectoris
commplications
induuction maintenance
Screenning
Doouble check
phospphodiesterasse type 5 (PDDE-5)
inhibitoors sildennafil, ,
( 2 2557)
Pagge 87
mL mg mcg
Double check
Double check
D5W , NSS
continuous I.V. infusion : 0.25-0.5
mcg/kg/min; 0.5-1 mcg/kg/min
3-5 minutes ; usual dose 1 - 3
mcg/kg/min; usual maximum dose 5 mcg/kg/min.
continuous I.V. infusion : 5
mcg/min 5 mcg/min 3-5
20 mcg/min 10-20
mcg/min 3-5 (
400 mcg/min)
24
set infusion PVC Viaflex
Steriflex
80%
400 mcg/mL
infusion pump rate
blood pressure pulse
IV heart rate , blood pressure ECG
,
( 2 2557)
Page 88
1. Klasco RK (Ed): DRUGDEX System. Truven Health Analytics, Greenwood Village,
Colorado (Vol. 160 expires [6/2014]).
2. , , . Siriraj
Drug List 2013 [online]. Version 26. Feb 2014.
3. . High Alert
Drugs. 2. : 25 2550.
4.Product information: Nitroject, Nitroglycerin, Unimed Technologies Ltd., India
5. American Pharmacists Association. Drug Information Handbook with International Trade
name index. 22nd ed. OH: Lexicomp; 2013-2014. p.1412.
6. American Pharmacists Association. Pediatric and Neonatal Dosage Handbook. 19th ed.
OH: Lexicomp; 2012-2013. p. 1125.
( 2 2557)
Page 89
Noorepinephrine
Noreepinephrine inj.
i
4 mgg/4mL
Noreepinephrine
40 m
mcg/mL in NSSS
2 mll
onset
1-2
duration
1-22
1-2
1-22
peaak
4
Adjuunct
Prrofound
Hypoteension
Acutte Hypotensiion
Screenning
Doouble check
blood volume
linezolid ( BP
)
MAOIs ( rasagilline, selegilinne
moclobem
mide )
tricyclic antidepressaants
( amitriptylinne, nortriptyline imiprramine )
metabissulfite
( 2 2557)
Pagge 90
mL mg mcg
Double check
Double check
dextrose
D5W , D5S
,
veins
occlusive vascular diseases
extravasation
:
Acute hypotension :
Continuous I.V. infusion : 0.1
mcg/kg/min
. recommended dose 0.05 - 0.3
mcg/kg/min
: 6 mcg/min
continuous I.V. infusion : 8-12
mcg/min; ;
: 2-4 mcg/min
Cardiac arrest:
continuous I.V. infusion :
( 2 2557)
Page 91
0.1 2 mcg/kg/min
continuous I.V. infusion : 8-12
mcg/min ; ;
: 2-4 mcg/min
24
blood pressure 2 target
blood pressure 5 infusion
heart rate, electrolytes, plasma volume, urine output
signs extravasation vasoconstriction (
, )
1. Klasco RK (Ed): DRUGDEX System. Truven Health Analytics, Greenwood Village,
Colorado (Vol. 159 expires [6/2014]).
2. , , . Siriraj
Drug List 2013 [online]. Version 26. Feb 2014.
3. Karen CC editors. Nursing 2011 Drug Handbook.Lippincott Williams & Wilkins.Drug
Handbook.Wolters Kluwer Health; 2011.p. 461.
4. Product information: Levophed, Norepinephrine,Indochina Healthcare, Thailand.
5. . High Alert
Drugs. 2. : 25 2550.
( 2 2557)
Page 92
( 2 2557)
Page 93
Warfarin
1. Warffarin (Maforan) 2 mg tabblet
2. Warffarin (Orfarin) 3 mg tableet
3. Warffarin (Orfarin) 5 mg tabllet
Warfaarin 1-2
Onset
Peak
duration
Warfarrin
(Maforran) 2 mg
tablet
2-5
Warfarrin
(Orfarin)3 mg
tableet
2-5
Warfarrin
(Orfarin)5 mg
tablet
2-5
2-5
Screening
basseline INR (Innternational NNormalized RRatio)
INR 2-3
( 2 2557)
Page 94
(bleeding)
(clotting)
65
Vitamin K INR response vitamin K INR
Contraindication
warfarin ,
(hemorrhagic tendencies),
, lumbar block anesthesia ,
, malignant hypertension , blood dyscrasias ,
pericarditis pericardial effusion , bacterial endocarditis,
( mechanical heart valve
thromboembolism) , , eclamsia pre-eclamsia
/
2-5
Double check
O2, O3, O5
compliance
20 (
/ total weekly dose)
NSAIDs bleeding
INR indication
:Initial dose : 2 - 5 mg once daily
usual maintenance : 2 - 10 mg once daily
Double check
( 2 2557)
Page 95
2-5
2-5
2 mg 3 mg 5 mg
OPD
// Warfarin
warfarin card
5-10
bleeding, clotting
NSAIDs
bleeding
clotting:
bleeding/clotting
warfarin
INR
Warfarin
Vitamin K Fresh Frozen Plasma (FFP) INR
bleeding
Page 96
( 2 2557)
Page 97
( 2 2557)
Page 98
( 2 2557)
Page 99
( 2 2557)
Page 100
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Page 101
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Page 102
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Page 103
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Page 104
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Page 105
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Page 106
1. , , . Siriraj Drug List 2014
[online]. Version 5.0 March 2014.
2. American Pharmacists Association. Drug Information Handbook with International Trade name index.
22nd ed. OH: Lexicomp; 2013-2014. p 2100-4.
3. . High Alert Drugs.
2. : 25 2550. 38-46.
4. . . : Printing Place; 2552. 193-213.
5. Klasco RK (Ed): DRUGDEX System. Truven Health Analytics, Greenwood Village, Colorado (Vol.160
expires [6/2014]).
( 2 2557)
Page 107
7007 (24 )
9555
Medication Reconciliation (MR) 6964