ICU -DRUG

CALCULATIONS
NAMPALLY

DEPT OF NURSING NAMPALLY 1

S.no Name of the Drug Page no

1 Measurement conversion 4

2 Basic formula for calculation 5

3 Inj.Nitroglycerine 7

4 Inj.Heparin sodium 8

5 Inj.Dopamine 9

6 Inj.Dobutamine 9

7 Inj.Adrenaline 10

8 Inj.Nor adrenaline 11

9 Inj.Atropine 11

10 Inj.Milrinone 12

11 Inj.Levosimenden 13

12 Inj.Cordarone 14

13 Inj.Xylocard 14

14 Inj.Labetalol 15

15 Inj.Vasopressin 16

16 Inj.Sodium Nitropruside 17

17 Inj.Nikoran 17

18 Inj.Diltiazem 18

19 Inj.Adenosin 18

20 Inj.Isoprenaline 19

21 Inj.Magnesium sulphate 19

22 Inj.Potassium chloride 20

23 Inj.Pantocid 20

24 Inj.Sandostatin 21

25 Inj.Lasix 21

DEPT OF NURSING NAMPALLY 2

26 Inj.Sedatives -Fentanyl 22

27 Inj.Morphine 22

28 Inj.Profofol 23

29 Inj.Midazolam 23

30 Inj.Dexmedetomidine 24

31 Inj.Etomidate 24

32 Inj.Thrombolytic agents- STK 25

33 Inj.Urokinase 25

34 Inj.Reopro 25

35 Inj.Alteplase 25

36 Inj.Antibiotics -Clarithromycin 26

37 Inj.Azithromycin 26

38 Inj.Imipenem 26

39 Inj.Vancomycin 26

40 Inj.Insulin Infusion and Protocols 27-30

41 Reference- Micromedex Drug Information 32-44

Reference chart for medication information and
Nursing consideration

DEPT OF NURSING NAMPALLY 3

Measurement Converstion
Metric System Equivalents
1 gram (g) = 1000 milligrams (mg)
1000 grams = 1 kilogram (kg)
.001 milligram = 1 microgram (mcg)
1 liter (L) = 1000 milliliters (ml)
1 milliliter = 1 cubic centimeter (cc)
1 meter = 100 centimeters (cm)
1 meter = 1000 millimeters (mm)

Conversion Equivalents
Volume
1 milliliter = 15 drops (gtt)
5 milliliters = 1 teaspoon (tsp)
15 milliliters = 1 tablespoon (T)
30 milliliters = 1 ounce (oz) = 2 tablespoons
500 milliliters = 1 pint (pt)
1000 milliliters = 1 quart (qt)

Weight
1 kilogram = 2.2 pound (lb)
1 gram (g) = 1000 milligrams = 15 grains (gr)
0.6 gram = 600 milligrams = 10 grains
0.5 gram = 500 milligrams = 7.5 grains
0.3 gram = 300 milligrams = 5 grains
0.06 gram = 60 milligrams = 1 grain

Length
2.5 centimeters = 1 inch

Centigrade/Fahrenheit Conversions
C = (F - 32) X 5/9
F = (C X 9/5) + 32

DEPT OF NURSING NAMPALLY 4

 BASIC FORMULAS FOR CALCULATION

Desired Dose x Quantity

Rate of Infusion :
Drug concentration

DEPT OF NURSING NAMPALLY 5

Drug Calculations

Helpful formulas:

mcg/kg/min
If a certain dose is ordered:
_______ mcg/kg/min X _______ kg ÷ ______ mcg/ML = ______ mL/h
Dosage Pt weight concentration
pump setting

If infusion pump is already set and running:

______ mcg/Ml X ______ mL/h ÷ 60 ÷ ______ kg = ______
mcg/kg/min
Concentration pump setting Pt weight
dosage

mcg/min
If a certain dose is ordered:
_______ mcg/min X 60 ÷ ______ mcg/mL = ______ mL/h
Dosage concentration pump
setting

If infusion pump is already set and running:

______ mcg/mL X ______ mL/h ÷ 60 = ______ mcg/min
Concentration pump setting dosage

mg/min
If a certain dose is ordered:
_______ mg/min X 60 ÷ ______ mg/mL = ______ mL/h
Dosage concentration pump
setting

If infusion pump is already set and running:

______ mg/mL X ______ mL/h ÷ 60 = ______ mg/min
Concentration pump setting dosage

mg/h
If a certain dose is ordered:
_______ mg/h ÷ ______ mg/mL = ______ mL/h
Dosage concentration pump setting

If infusion pump is already set and running:

______ mg/mL X ______ mL/h = ______ mg/h
Concentration pump setting dosage

Adapted from Giuliano, Richards & Kaye (1993) A New strategy for calculating medication infusion rates.
Critical Care Nurse. 13(6).

DEPT OF NURSING NAMPALLY 6

 Drug Calculation Guide -Nampally
S.No Name of the drug Calculation Remarks
1 Inj.Nitroglycerine 1 ampule = 5ml =25mg
5ml diluted in 500ml NS
(Nitrates -vasodilator ) 25mg x 1000 =25000mcg Mcg/ Infusion Syringe
1ml = 50 mcg/ml
mt pump pump
If through syringe pump : 5ml in 45ml NS Ml/hr Ml/hr
1ml = 500 mcg/ml
Formula 2.5 3 0.3
Dose is ordered for mcg/min 5 6 0.6
Infusion pump
10 12 1.2
Mcg / min 15 18 1.8
mcg/mL = mL/h
20 24 2.4
25 30 3.0
5mcgx60/50 = 6ml/hr

Syringe pump
Mcg x min
Note
mcg/mL = mL/h Maximum recommended final
concentration for nitroglycerine solution is
5mcgx60/500 = 0.6 ml/hr 400mcg/ml

DEPT OF NURSING NAMPALLY 7

2 Inj.Heparin sodium
1amp = 25000 units= 5ml
Units/ Infusion Syringe
(Anticoagulant) 5ml diluted in 500ml NS hr pump pump
1ml = 50 units Ml/hr Ml/hr
500 10 1
In syringe pump
700 14 1.4
5ml diluted in 50ml NS 800 16 1.6
1ml =500 units
900 18 1.8
Formula 1000 20 2

Dose (units/hr) = Dose Rate (units/kg/hr) x Weight (kg) Heparin Nomogram

aPTT Bolus Stop Rate Repeat
Drip rate ml/hr = desired dose x total volume in sec (Units) infus /hr aPTT
Total units of heparin ion
<50 5000 0 +3ml 6 hours
Infusion pump = 1000 x 500 / 25000 = 20ml/hr 50-59 0 0 2ml 6 hours
60-85 0 0 No Next
In syringe pump = 1000 x 50 /25000 = 2ml/hr change morning
86 0 0 -2ml 6 hours
-100
101 0 30 -3ml 6 hours
-150
>150 0 60 -4ml 6 hours

DEPT OF NURSING NAMPALLY 8

3 Inj.Dopamine 1 amp = 200 mg =5 ml Mcg/ 30 40 50 60 70
kg/mt kg kg kg kg kg
200 mg x1000 = 200000 mcg 2 0.9 1.2 1.5 1.8 2.1
(vasopressor) ml ml ml ml ml
Formula (syringe pump) 3 1.3 1.8 2.3 2.6 3.2
Mcg x body weight x 60 x volume 4 1.8 2.4 3.0 3.6 4.2
Drug concentration 5 2.3 3.0 3.8 4.5 5.4
10 4.5 6.0 7.5 9.0 10.5
Eg: 15 6.8 9.0 11.3 13.5 15.8
5 x 50 x 60 x 50

200000 = 3.75 ml/hr

Inj.Dobutamine
4 1amp = 250mg =5ml Mcg/ 30 40 50 60 70
(Positive inotrope) kg/mt kg kg kg kg kg
250 mg x1000 = 250000 mcg 2 0.7 1.0 1.2 1.4 1.7
ml ml ml ml ml
Formula 3 1.1 1.4 1.8 2.2 2.5
4 1.4 1.9 2.4 2.9 3.4
Mcg x body weight x 60 x volume 5 1.8 2.4 3.0 3.6 4.2
Drug concentration 10 3.6 4.8 6.0 7.2 8.4
15 5.4 7.2 9.0 10.8 12.6
Eg : 5 x 50 x 60 x 50

250000 = 3 ml/hr

DEPT OF NURSING NAMPALLY 9

5 Inj.Adrenaline 1 amp =1mg (1:1000) For single strength
4 amp diluted in 46 ml NS = 50ml (1ml= 80mcg) Mcg/ 30 40 50 60 70
(sympathomimetic kg/mt kg kg kg kg kg
agents)
Formula
Mcg X kg 3 1.1 1.5 1.9 2.3 2.6
ml ml ml ml ml
Mcg/ml = mL/h 4 1.5 2.0 2.5 3.0 3.5

Eg: 5 x 50/80 = 3.1ml/hr 5 1.9 2.5 3.1 3.8 4.4

Single strength infusion = 4mg adrenaline in 10 3.8 5.0 6.2 7.6 8.8
50ml 0.9% sodium chloride (80micrograms /ml)
15 5.7 7.5 9.3 11.4 13.2
Double strength infusion = 8mg adrenaline in 20 11.4 15.0 18.6 22.8 26.4
50ml 0.9% sodium chloride (160micgrograms
/ml).

For double strength,concerned dose to be divide

by 2

DEPT OF NURSING NAMPALLY 10

6 For single strength
Inj.Nor adrenaline 1amp = 2ml
(sympathomimetic drug) 1ml = 1mg ; 2 amp = 4 mg diluted in 46 Mcg/kg 30 40 50 60 70
/mt kg kg kg kg kg
ml of NS
1 ml = 80 mcg 3 1.1 1.5 1.9 2.3 2.6
ml ml ml ml ml
Formula 4 1.5 2.0 2.5 3.0 3.5
5 1.9 2.5 3.1 3.8 4.4
Mcg/kg/mt X kg
10 3.8 5.0 6.2 7.6 8.8
mcg/ML = mL/h 15 5.7 7.5 9.3 11.4 13.2
20 11. 15.0 18.6 22.8 26.4
Eg: 5 x 50/80 = 3.1ml/hr
4
Single strength infusion = 4mg adrenaline in
50ml 0.9% sodium chloride (80micrograms /ml)

Double strength infusion = 8mg adrenaline in

50ml 0.9% sodium chloride (160micgrograms
/ml).

7 Inj.Atropine
(Antimuscarinic agent )
Give a bolus loading dose of 0.6 to 3 mg, rapidly  Once the patient is atropinized, give an
IV 2mg, 4mg, 6mg every 5 minutes
Then administer doubling doses every 5 min
until the patient is atropinized
(HR >80 bpm, SBP > 80 mmHg , clear lungs)
For Atropine infusion
Atropine 1mg= 1ml available (in 100ml bottle)
Maintenance dose is 3mg/hr = 3ml/hr
infusion of 10–20% of the total dose
required to atropinize the patient each
hour in 0.9% saline chloride
 If the patient becomes atropine toxic
(tachycardia, absent bowel
sounds,hyperthermia, delirium, urinary
retention), stop the infusion for 30 min
and then start again at a 20% lower
dose

DEPT OF NURSING NAMPALLY 11

8 Inj.Milrinone
1amp =10 ml ; 1ml = 1mg Inj.Hydrocortisone 100mg and inj.Heparin
1000 units are based on doctors
(Bipyridine
10ml diluted in 40 ml of 5% dextrose prescription
inotropic/vasodilator
agents with 1ml =200mcg (10000/50 =200mcg)
phosphodiesterase
inhibitor activity) IV: (Adults)
Loading dose– 50 mcg/kg followed by
continuous infusion at 0.5 mcg/kg/min (range
0.375–0.75 mcg/kg/min).

Formula
Loading dose calculation = wt X mcg

Mcg/ml

Example : 50 x50/200 = 12.5ml/hr

(25ml over 1/2 hour)

Maintenance dose = Mcg x kg x min

Mcg/ML
= 0.5 x 50 x 60 /200
= 7.5 ml/hr

DEPT OF NURSING NAMPALLY 12

9 Inj.levosimendan Levosimendan 12.5 mg in 5mL (1 vial)
ONE VIAL OF THE DRUG IS
(calcium sensitiser - Infusion dilution ADEQUATE FOR A 24 HOUR
heart failure) ADMINISTRATION, if the dose finishes
5ml drug+ 45 ml of 5% dextrose =50ml in under 24hours, there is no need to top
(12.5mg) up the dose to make the 24 hour time
1ml =0.25mg period except in patients weighing >
1ml= 0.25x 1000 = 250 mcg 100kg.

Bolus = 10 -12mcg /kg over 10 mts  Initial IV bolus of 12 micrograms/kg

(600-720mcg over 10 mts ) delivered over 10 minutes
 If 10 mcg/kg = 600mcg = 600/250 = 2.4 ml  Followed by Continuous IV infusion
over 10mts of levosimendan
 If 12 mcg/kg =720mcg = 720/250 =2.9 ml 0.1micrograms/kg/minute.
over 10mts

Maintenance dose Mcg/k 30kg 40kg 50kg 60kg

Formula g/mt
0.05 0.36 0.48 0.6 0.72
Mcg X kg x mt ml ml ml ml
0.1 0.72 0.96 1.2 1.44
mcg/ML = mL/h

0.1 x 60x 60/250 =1.44ml/hr

0.05 x 60 x 60 /250 = 0.72ml/hr

DEPT OF NURSING NAMPALLY 13

10 Inj.Cordarone 1amp = 3ml = 150mg Cordarone I.V. concentrations
Inj.cardorone 150 mg in 20 ml 5% greater than 2 mg/mL should be
Anti arrythmic dextrose, bolus IV over 10mts administered via a central venous
 Inj.Cordarone 360 mg over 6 hours
catheter
(1mg/kg/mt over 6 hrs)
 dilute 7.2ml of cordarone in 42.8ml 5%D
 360mg= 50ml ( 1ml=7.2mg)=8.3ml/hr

 Inj.Cordarone 540mg over 18 hours

(0.5mg/kg/hr over 18hrs)
 10.8 ml in 39.2ml 5% dextrose
 540mg =50ml (1ml =10.8 mg) =2.8ml/hr

11 1 vial = 50ml =1000mg

Inj.Xylocard
1ml = 20mg
Anti arrythmic
Bolus : 1-1.5 mg/kg slow IV bolus over
2-3 minutes , up to 3 mg/kg total if
refractory VF or pulseless VT

Infusion :1-4 mg/min continuous infusion

Formula

Mg/min X 60
Mg/mL = mL/h

2 x 60 / 20 = 6 ml/hr
DEPT OF NURSING NAMPALLY 14
12 Inj.Labetalol
1 amp =4ml = 20mg  Standard starting rate is 1 mg per minute.
 Do not increase rate more than every 30 mins
(Beta blockers)
1ml= 5mg (rate reductions may be made more
frequently)
To lower severely  Do not increase rate by more than 1 mg/ min
Bolus : 4ml+ 6ml NS = 10ml
elevated blood = 20mg ( 1ml= 2mg) at each stage (maximum rate
pressure before or after20mg (4mL) administered by slow IV injection over two 6 mg/ min).
the administration of (2) minutes  Check BP 10, 20 and 30 min post any rate
alteplase for change
thrombolysis in acute Infusion -syringe pump
 Asthma and allergic disorders with a
ischaemic stroke, predisposition to bronchospasm.
defined as: 5amp = 20ml (100mg) + 30ml NS
▪ Systolic BP greater  Monitor for bradycardia , heart
= 50ml =100 mg ( 1ml = 2 mg)
than 185 mmHg block ,hypotension and cardiogenic shock
▪ Diastolic BP greater
than 110 mmHg
Start the infusion at 20mg/hour.

1ml = 2mg ; if 20mg/hr = 10ml/hr

Note that the maximum dose for 24 hours

is 300mg

DEPT OF NURSING NAMPALLY 15

13 Inj.Vasopressin 1 amp = 20 units =1ml
Severe hypotension and shock
(Antidiuretic hormone)
Infusion via syringe pump
 Dilute 40 units(2ml) vasopressin in 38 mL sterile
0.9% sodium chloride to achieve a concentration of give a concentration of 1unit/ml.
1unit/ml
 Start at 0.01 - 0.04 units/minute
(0.01 x60 = 0.6 units/hr =0.6ml/hr
0.04 x 60 = 2.4units/hr = 2.4ml/hr)
DO NOT EXCEED MORE THAN 2.4ml/hr.
NOTE: In order to prevent extravasation,it should be IV Infusion - Dilute 40 units vasopressin in 38
preferably administered by central line
Bleeding oesophageal varices
Bolus: IV injection of 20 units (1mL) diluted in
20ml sterile 0.9% sodium chloride infused over
5 to 30 minutes.
Continuous infusion ;Dilute 40 units (2
mL) in 38mL sterile 0.9% sodium chloride to
Infuse at a rate of 5 units – 24 units (5 to 24mL)
per hour.
Diabetes Insipidus
• IM or SC injection of 5 – 10 units (0.25 to 0.5
ml) repeated two to three times daily as needed.
Post traumatic Diabetes Insipidus
(unlabeled use):
mL sterile 0.9% sodium chloride to achieve a
concentration of 1unit/ml Initial
2.5 units/hour; titrate to adequately reduce urine
output.

DEPT OF NURSING NAMPALLY 16

14 Inj. Sodium 1vial =50mg (dry powder)
nitropruside 50mg diluted in 5ml NS (Pre dilution)
then dilute in 45ml NS (final dilution) Mcg/kg/mt 50kg 60kg 70kg
(SNP)
1ml =1mg
1mg x 1000= 1000mcg 1 0.05 0.06 0.07
Sodium nitroprusside is ml ml ml
intravenously infused in 2 0.1 0.12 0.14
Formula
cases of acute 5 0.25 0.3 0.35
hypertensive crises
Mcg/kg/min X kg 10 0.5 0.6 0.70
Mcg/ML = mL/h

10 x 60/1000 = 0.6ml/hr Start- 0.3 mcg/kg/min.

Titrate dose to desired blood pressure
Maximum dose 10 mcg/kg/min.

Protect from light using the protective

sleeve provided or use aluminium
foil.
Use a separate lumen for SNP only.

15 Inj.Nikoran Bolus ; 2mg vial (powder) diluted in 10 ml over 10

minutes
(Potassium channel
activators) Infusion ; 48mg diluted in 48ml NS

1mg = 1ml

Infusion based on prescription mg/hr

DEPT OF NURSING NAMPALLY 17

16 Inj.Diltiazem 1 vial = 25mg
Bolus Injection:
(calcium channel 5ml = 25mg ; 1ml = 5mg -Initial bolus dose: 0.25 mg/kg IV as
blocker ) a bolus administered over 2 minutes.
2 vial =10ml =50mg diluted in 40ml NS
0.25mg x 60 = 15mg =3ml
50ml =50mg; 1ml=1mg Continuous Infusion:
-Initial infusion rate: 10 mg/hr IV
Infusion based on prescription mg/hr -Maintenance infusion rate: The infusion
rate may be increased up to 15 mg/hr.
-Maximum duration: 24 hours
1 amp =2ml = 6mg
17 Inj.Adenosin
 Put iv cannula in anticubital fossa with 3 way
Antiarrythmic for SVT
 A saline flush should follow.
 Initial dose: 6 mg given as a rapid
intravenous bolus (administered over a 1-2
second period).
Repeat administration: 12 mg should be given
as a rapid intravenous bolus.
This 12 mg dose may be repeated a second time
if required.
Paediatric dose
Initial dose: Give 0.05 to 0.1 mg/kg as a rapid IV
bolus given
Maximum single dose of 0.3 mg/kg is used.

DEPT OF NURSING NAMPALLY 18

18 Inj.Isoprenaline 1 amp =1ml = 200microgram =0.2 mg/ml
Bolus dose
Bolus : 1ml + 9 ml NS =10 ml
(β adrenoreceptor 1ml= 20 micrograms
agonist)
Recommended dose : 0.05–1 microgram/kg/minute

Infusion via syringe pump :

5 amp = 1mg
5 ml of isoprenaline+ 45 ml of NS
50 ml =1000mcg Intravenous infusion
1ml =20mcg
Infusion pump Indications Dose range Titrate to
5ml of isopreneline +495ml of NS below (goals
500ml =1000mcg set by ICU)
1ml = 2mcg Beta blocker 0.5- HR,Bp
Recommended dose : Over dose 5mcg/mt
Formula if diluted in 50ml Heart block 5mcg/mt HR
Mcg/kg/min X kg Torsedes 1-4 mcg/mt HR.> 90 amd
Mcg/ML = mL/h rhythm
Brady 2-10 HR, rhythm
1 x 60 arrythmia mcg/mt
20 = 3/hr

If diluted in 500 ml NS

1 x 60
2 = 30 ml/hr
19 Inj.Magnesium 1 amp = 2ml = 1 gm Total daily dose should not exceed 30 –
sulphate 1ml = 500mgs =0.5gms 40g in 24 hours

Hypomagnesemia Add 1 amp in 100 ml NS over 2hrs

(prophylaxis and (1ml= 10mgs)
treatment)

DEPT OF NURSING NAMPALLY 19

 Peripheral Line Concentration =
20 Inj. Potassium 1 amp = 10ml =20mEq 0.1mEq/mL; (10 mEq/100ml i.e 5ml KCL
Chloride 1ml = 2 mEq over 1 hour
Potassium chloride must always be administered
by slow IV infusion, diluted in 0.9% sodium Central Line Concentration
chloride = > 0.1mEq/mL
20 mEq added in 200ml over 2 hours 20 - 40 mEq/100ml at a maximum rate of
40 mEq/hour
Never give without dilution!!!!
Maximum daily dose =200mEq

Maximum administration rate:

10mEq/hr when serum K >2.5mEq/l
40mEq/hr when serum K <2 mEq/l

1vial =40 mg
21 Inj.Pantocid 2 vial diluted in 20 ml NS Solution is stable for 21 hours at
(Proton pump inhibitor) LOADING DOSE : room temperature
Pantoprazole 80 mg (2 vials) IV
Mix medication in 20 mL 0.9% NS in a syringe and
give IV push

Maintenance dose
80mg added in (20+20) 40ml NS
1ml = 2mg
8mg/hr = 4ml/hr

DEPT OF NURSING NAMPALLY 20

22 Inj.Sandostatin 1 amp =1ml= 50mcg
(Octreotide) 5 amp diluted in 45 ml NS = 250 mcg in 50ml
NS
somatostatin analog.
1ml = 5mcg
Rate range : 25-50 microgram/hr (5-10
mL/hr).
Maximum rate : 50 microgram/hr (10 mL/hr).

Length of infusion: As decided by

Gastrointestinal Unit, usually for 48 hours.
23 Inj.Lasix 1amp=20 mg (2ml)
Children
1ml=10 mg Bolus -0.5 -2mg/kg can be given IV every
Loop diuretic
6 hours
Infusion dilution
5 amp (10ml = 100mg ) + 40 ml NS = 50ml Infusion
1 ml = 2mg Initial dose - 1mg/kg dose through slow IV
Initial dose 1-4mg/h maximum up to 20mg/hr It may increase by 1mg/kg after 2 hrs of previous
dose infusion
Based on prescription, dose can be
adjusted

When patient on fluid restriction, Inj.lasix

can be given without dilution ****

DEPT OF NURSING NAMPALLY 21

 Sedatives
24
Inj.Fentanyl 1amp = 2ml Intravenous Bolus 0.5 to 1 microgram/kg,
1ml= 50 micro gram
(Narcotics) 5 amp =10ml Fentanyl + 40ml NS =50ml Analgesia and Sedation in Ventilated Patients
1ml =10 mcg 0.35 to 1.5 mcg/kg intermittent IV dosing every
30mts to 60mts

Formula Maximum hourly dose: 0.7 to 10

Mcg/kg/min X kg micrograms/kg/hr continuous IV infusion
mcg/ML = mL/h Mcg/ 30kg 40kg 50kg 60kg
kg/mt
2 x 60 0.5 1.5 2 2.5 3
= 12ml/hr ml ml ml ml
10
1 3 4 5 6
2 6 8 10 12
3 9 12 15 18
4 12 16 20 24
25 Inj.Morphine 1 amp =1ml =10mg

(Narcotic ) Infusion
5 amp =5ml=50mg

5ml Morphine+ 45ml of NS =50mg

1ml= 1mg

Based on Prescription mg/hr can be infused

DEPT OF NURSING NAMPALLY 22

26 Inj.Profofol 1 vial =10ml
Mcg/ 30kg 40kg 50kg 60kg
1ml = 10mg
kg/mt
Sedative 5 0.9 1.2 1.5 1.8
Bolus = 0.03-0.15mg/kg =eg; for 60 kg bolus is 9mg ml ml ml ml
=1ml approximately and maximum can be given 20mg
10 1.8 2.4 3.0 3.6
(2ml)
20 3.6 4.8 6.0 7.2
30 5.4 7.2 9.0 10.8
Infusion 5-80mcg/kg/mt
40 7.2 9.6 12.0 14.4
Formula
Mcg/kg/min X kg x mt
mcg/ML = mL/h

Eg : 5x60 x 60/10000 = 1.8ml/hr

27 Inj.Midazolam 1 vial; =10ml = 10mg

1ml = 1mg
Benzodiazepines
Bolus dose =1-6 mg = 1ml to 6ml

Maintenance dose = (1mg to 10mg /hr )

1 ml/hr or based on prescription

28 Inj.Dexmedetomidine
1amp = 1ml
selective α2-adrenergic 1ml=100mcg
agonist. 2amp =2ml =200mcg in 48ml NS = 4 mcg/ml

Anxiolytics, Sedatives, and Recommended maintenace dose is 0.2-1

Hypnotics microgram/kg/hr
It is recommended that 0.4 microgram/kg/hr should
be the initial maintenance infusion
Dose should be titrated based on prescription

DEPT OF NURSING NAMPALLY 23

29 Inj.Etomidate 1amp = 10 ml
1 ml = 2 mg of Etomidate
10 = 20 mg of Etomidate
Usual range: 0.2–0.6mg/kg.
Usual dose: 0.3mg/kg.
Administer over 1mt

Administer undiluted by direct IV injection

Do not administer by prolonged IV infusion

DEPT OF NURSING NAMPALLY 24

 Thrombolytic agents
15 lakh units(1 vial) dilute in 100ml NS and transfuse
30 Inj.Steptokinase over 1 hour
(STK)
1 vial = 5 lakh units
31 Inj.Urokinase 15 lakh units to be transfused
Bolus : 2.5 lakh units from first vial
Maintenance infusion :
12.5 lakh units in 100ml NS over 1 hour

PERCUTANEOUS CORONARY INTERVENTION

32 Inj.Reopro
 IV BOLUS: 0.25mg/kg, administered over ONE
minute using 0.2- 5 micron filter, 10-60 minutes
prior to the intervention, followed by
 IV INFUSION at a dose of 0.125 mcg/kg/minute, to
a maximum of 10 mcg/mt) over 12 hours.
 UNSTABLE ANGINA (deferred for 18-24 hours)

33 Inj.Alteplase ALTEPLASE r tPA

50 mg and 20 mg vial is available

For CVA,acute or Ischemic :

Dose calculation : 0.9mg /Kg with

10% of total dose – Bolus over 1 min
90% of total dose – infuse over 60 min

Maximum total dose 90mg

DEPT OF NURSING NAMPALLY 25

 Antibiotics
34 Clarithromycin  Add 10ml of sterile water for injection into
(lyophilised) 500mg vial and shake
 Vigorously for 5-10 minutes to obtain clear
colourless solution
 Add 10ml of reconstituted solution to 250ml
NS to obtain 2mg/ml of solution
 Administered over the period of 60minutes

35 Azithromycin  500 mg in 5 ml of sterile water for injection

 For 1mg/ml
 500mg in 500ml NS over 3hrs

Or
 For 2mg/ml
 500 mg in 250ml NS over 60mts
36 Imipenem  500 mg in 10 ml of NS should be agitated
250mg+cilastatin until clear
250mg Or
 1000mg in 20 ml NS should be agitated until
Or clear
Imipenem  Add the reconstituted solution in 90ml NS to
500mg+cilastatin obtain (5mg/ml) over 20-30mts
500mg Or
 1000mg in 180ml NS (5mg/ml) over 60mts
37 Vancomycin 1 gm 1 gm in 10ml of NS should be agitated until clear or
2gm in 20ml of NS should be agitated until clear
Add the reconstituted solution in 100ml/NS to obtain
Or vancomycin 2gm
(10mg/ml) over 2 hours
Or
2gm in 200ml NS (10mg/ml)over 4 hours

DEPT OF NURSING NAMPALLY 26

 Insulin infusion calculation and protocol
38 Inj.Insulin - Human 1ml= 40 units
actrapid 1ml H.actropid + 39 ml of NS = 40ml Refer insulin infusion chart or as per order
1ml= 1 unit

Based on hourly blood sugar ,dose will be titrated

DEPT OF NURSING NAMPALLY 27

DEPT OF NURSING NAMPALLY 28
DEPT OF NURSING NAMPALLY 29
DEPT OF NURSING NAMPALLY 30
 NOTE
Please refer the below chart for comments and nursing follow up only (for your reference only)
Some drugs dosage form is different in our setup

REFERENCE /CROSS CHECKED WITH MICROMEDEX DRUG INFORMATION

DEPT OF NURSING NAMPALLY 31


MEDICATION
Adenosine
(Adenocard®)
Slows conduction time through the AV
node, interrupting the re--‐ entry
pathways through the AV node,
restoring normal sinus rhythm.
Onset of action: immediate Duration:
seconds
Amiodarone
(Cordarone®)
Antiarrhythmic agent that
depresses conduction velocity,
slows AV node conduction, raises the
threshold for VF, and exhibits some α
and β blockade activity. It possesses
vasodilatory effects which decrease
cardiac workload and decrease
myocardial oxygen demand.
Myocardial uptake is rapid and
anti--‐ arrhythmic effects are clinically
relevant within hours, but full effect
may take days.
Exceptionally long half life of 40--‐ 55 days
DEPT OF NURSING NAMPALLY
ADULT INTRAVENOUS MEDICATIONS
STANDARD AND MAXIMUM ALLOWABLE CONCENTRATIONS,
GUIDELINES FOR CONTINUOUS OR TITRATED INFUSIONS
STANDARD
ADMIXTURE
6 mg/2 mL vial
(3 mg/mL) given undiluted
Load: Dilute 150 mg (3mL) in
100 mL D5W (1.5 mg/mL)
(PVC bag suitable for loading
dose)
Maintenance infusion:
Dilute 900 mg (18 mL) in
500 mL D5W (1.8 mg/mL)
INFUSION MUST BE ADMIXED
IN GLASS BOTTLE OR NON--‐ PVC
BAG.
Amiodarone will leach
plastic from PVC bag
Maximum daily dose:
2.1 g/day
MAXIMUM CONC./
INFUSION INSTRUCTIONS
Give undiluted directly into vein
over 1--‐ 2 seconds.
Administer as proximal as
possible to trunk (i.e., not in
lower arm, hand, lower leg, or
foot). If administered through
IV line, administer as close to
pts heart as possible. NS flush
must be given rapidly,
immediately following injection
of adenosine
Peripheral line: Up to 2
mg/mL
(Concentrations over 2 mg/mL
administered for longer than 1
hour must be infused via
central line)
Central line: Up to 6mg/mL
32
DOSING
6 mg initially. If SVT not
resolved in 1--‐ 2 minutes, may
follow with 12 mg dose. If not
resolved in 1--‐ 2 minutes, may
follow with an additional 12 mg
dose.
Load: 150 mg/100 mL over 10
minutes.
(Not to exceed 30 mg/mL)
THEN
Infusion: 1 mg/min for 6
hours (33.3 mL/hr = 360 mg),
followed by 0.5 mg/min for 18
hours (16.6 mL/hr = 540 mg)
ACLS: 300 mg IV push, may
repeat with 150 mg x 1.
*Shaded medications requireadoublecheck*
Revised 9/08
MONITORING/COMMENTS
ECG, heart rate, blood pressure
Extremely short half life:
< 10 seconds
Not effective for converting A.
flutter, A. fib, or ventricular
tachycardia.
Contraindicated if symptomatic
bradycardia, sick sinus syndrome,
2nd or 3rd degree AV block (unless
pt. has functioning pacemaker)
Telemetry monitoring, BP
(hypotension occurs frequently with
initial rates), HR (arrhythmias: AV
block, bradycardia, VT/VF, torsades
de pointes), electrolytes
Pulmonary function test within 1
week if possible
Thyroid function
Liver enzymes (AST/ALT)
Significant interactions with
digoxin and warfarin (enhances
effect of each, ↓ dose, monitor
digoxin levels, PT/INR)
 MEDICATION STANDARD MAXIMUM CONC./ DOSING MONITORING/COMMENTS
ADMIXTURE INFUSION INSTRUCTIONS
Atropine 1 mg/10 mL Abboject May be administered without Asystole/PEA: No longer Vital signs and/or EKG
syringe (0.1 mg/mL) further dilution recommended per 2010
Blocks the action of acetylcholine at ACLS guidelines Doses < 0.5 mg may lead to
parasympathetic sites in smooth
paradoxical bradycardia
muscle, secretory glands, and the
CNS; increases cardiac output Bradycardia: 0.5 mg IV

Onset of action: very rapid Duration: 2--‐ 3

hours
® 0.25 mg/mL (2 mL, 4 mL, 10 May be given undiluted. Not IV push: 0.5--‐ 1 mg/dose HR, BP, electrolytes, UOP, CO2,
Bumetanide (Bumex )
mL) usually added to IV solutions May repeat in 2--‐ 3 hours BUN, glucose
Potent loop diuretic. Works in the but compatible with D5W, NS,
ascending Loop of Henle and Infusion: 12 mg/48 mL and LR Infusion: 0.25--‐ 2 mg/hr Routine BMP and uric acid
proximal renal tubule to excrete (0.25 mg/mL) checks necessary during
+ + -‐
H 2O, Na , K , Cl
DO NOT EXCEED 10 MG/24 treatment
Onset of action: 2--‐ 3 minutes PROTECT FROM LIGHT HOURS
Duration: 4--‐ 6 hours 1 mg Bumex = 40 mg Lasix

Calcium Chloride 1 g/10 mL Abboject syringe May be administered without 8--‐ 16 mg/kg IV at 100 mg/min Vital signs
further dilution (Typical dose = 1g)
Electrolyte May repeat as necessary at 10 Central line recommended
minute intervals
Calcium chloride not
recommended for uses other than
cardiac resuscitation or
management of calcium channel
blocker toxicity.
Contains three times more
elemental calcium than calcium
gluconate.

DEPT OF NURSING NAMPALLY 33

 MEDICATION STANDARD MAXIMUM CONC./ DOSING MONITORING/COMMENTS
ADMIXTURE INFUSION INSTRUCTIONS

Calcium Gluconate
Electrolyte
Diltiazem (Cardizem ®)
Non--‐ dihydropyridine calcium channel
2+
blocker that blocks Ca ion influx
during depolarization of cardiac and
vascular smooth muscle. It
decreases SVR and causes
relaxation of the vascular smooth
muscle resulting in ↓BP. Slows
conduction through the AV node,
prolongs the refractory period, and
reduces ventricular rate. Decreases
HR by 10% with a single dose.
1 g/10 mL (10%)
Bolus: 5 mg/mL vial May
be given undiluted through
Y--‐ tube or 3--‐ way stopcock of
tubing containing NS,
D5W, or D5 ½ NS
Infusion: Add 125 mg (25mL) to
100mL D5W or NS
(1 mg/mL)
May be administered without
further dilution or may be
further diluted in up to 1,000
mL of NS
Bolus: No dilution required
Infusion: 1 mg/mL
Emergency elevation of Vital signs, EKG
serum calcium: 15--‐ 30 mL
(7--‐ 14 mEq). Repeat in 1--‐ 3 Rapid administration may cause
days per pt. Response vasodilation, ↓BP, arrhythmias,
Hyperkalemia: 4.1--‐ 30 mL syncope, or cardiac arrest.
(2.25 --‐ 14 mEq). May repeat
in 1--‐ 2 minutes if indicated as
per EKG
Do not exceed 2mL/min
Bolus: 0.25 mg/kg IV ↓HR, arrhythmias
(typical dose = 20 mg) ↓BP, flushing, edema
May repeat with 0.35 mg/kg if
no response after 15 min. EKG monitoring during infusion
(typical repeat dose (25 mg) preferred
Infusion: 5 – 15 mg/hr (5 Stored in refrigerator
- ‐ 15 mL/hr). Initiate at 5
mg/hr.
Max dose: 15 mg/hr
May only use for 24 hours

Dobutamine
(Dobutrex®)
Synthetic sympathomimetic
catecholamine that stimulates the β
receptors of the heart. Positive
inotrope (↑ CO, ↑contractility,
↑CI). Produces minimal increases in
rate and BP. Provides the extra
“squeeze” in patients with cardiac
decompensation.
Onset of action: 1--‐ 10 minutes
Infusion: 500 mg/250 mL
D5W premixed bag (2,000
mcg/mL)
[concentrated 1000 mg/250 mL Preferably given via central
available if necessary (4,000 line
mcg/mL)]
Vial: 250 mg/20 mL
(12.5 mg/mL)
MAX: 5 mg/mL (1,250
mg/250 mL) in D5W or NS
Infusion: 2 – 20 mcg/kg/min ↑HR, ↑BP or ↓BP (typically
associated with overdose)
Gradually adjust rate at 2 to 10 Arrhythmia, myocardial
minute intervals. AHA ischemia, ↑CO
guidelines recommend titrating
so that HR does not increase Decreased effect seen in profoundly
by > 10% from baseline. acidotic patients.
If rates > 20 – 30
mcg/kg/min required, should
consider alternate inotropic
agent

DEPT OF NURSING NAMPALLY 34

 MEDICATION
Dopamine (Inotropin®)
Catecholamine precursor to
norepinephrine that activates α, β,
and DA receptors.
5--‐ 10 mcg/kg/min: renal,
mesenteric, coronary dilation
10--‐ 20 mcg/kg/min: increased
contractility, HR
>20 mcg/kg/min : vasoconstriction,
increased HR and BP
Onset of action: 5 minutes
Epinephrine
(Adrenalin®)
Natural symmpathomimetic
catecholamine, both an α and β
agonist. Can ↑SVR, ↑BP (via
vasoconstriction). It is a potent
cardiac stimulant (↑HR,
↑contraction) and dilates bronchi
STANDARD
ADMIXTURE
Infusion: 400 mg/250 mL
D5W premixed bag (1,600
mcg/mL)
Vial: 200 mg/5 mL
1 mg/10 mL (1:10,000)
Abboject syringe
1 mg/1 mL (1:1000) vial
Infusion: 1 mg/250 mL NS
(4 mcg/mL)
[concentrated 2 mg/250 mL
or 4 mg/250 mL available if
necessary)
10 mg/250 mL NS (cardiac
arrest infusion)
MAXIMUM CONC./
INFUSION
INSTRUCTIONS
MAX: 6.4 mg/mL
(1,600 mg/250 mL)
Preferably given via central
line
4 mg/ 250 mL NS or D5W
(16 mcg/mL)
Some institutions report
higher concentrations, if
needed
(Duke = 10mg/250 mL)
(Lit = 30 mg/250 mL)
DOSING MONITORING/COMMENTS
Infusion: 2.5 – 20 ↑BP, palpitations, arrhythmias,
mcg/kg/min ↑HR, peripheral necrosis with
↑doses
If more than 20 mcg/kg/min is
required to maintain BP, Infuse via central line to avoid
consider use of extravasation
norepinephrine in addition
Fluid resuscitate pts. prior to
vasopressor therapy.
Effect diminished in acidosis. Do not
administer through same line as sodium
bicarbonate!
ACLS Bolus: 1 mg/10 mL ↑HR, ↑BP (monitor BP and HR q5min)
(1:10,000 syringe) q3--‐ 5 min Arrhythmias, tremor, anxiety, pulmonary
[1mg/ mL (1:1,000) must be edema, myocardial ischemia
diluted in 10 mL NS before
IV administration] Monitor for signs of peripheral necrosis
ACLS infusion: *30mg/250
mL at 100 mL/hour then
titrate
*10mg/250 mL at .01--‐ 1.2
mcg/kg/min
Vasopressor or maintenance
infusion: 1 – 10 mcg/min
Rates > 10 mcg/min, should
consider alternate or
additional vasopressor

*Shaded medications requireadoublecheck*

DEPT OF NURSING NAMPALLY 35

 MEDICATION
Eptifibatide (Integrilin®)
Blocks platelet glycoprotein IIb/IIIa
receptor, the binding site for
fibrinogen, von Willebrand factor,
and other ligands. Reversibly
blocks platelet aggregation and
prevents thrombosis
Esmolol (Brevibloc®)
Short acting β1selective adrenergic
blocker (may have some β2 activity at
high doses). Has antiarrhythmic
properties and acts to ↓HR, ↓BP, and
↓ contractility in a dose--‐ related
manner. Used for Tx of SVT with
RVR or HTN
Onset of action: 2--‐ 10 minutes.
Duration is 10--‐ 30 minutes.
Etomidate (Amidate®)
Short--‐ acting, non--‐ barbiturate
hypnotic without analgesic activity.
Able to produce the full spectrum of
CNS depression, from light sleep to
coma.
Onset of action: 60 seconds
Duration: ~ 5 minutes.
STANDARD
ADMIXTURE
200 mg/100 mL vial
(2,000 mcg/mL)
Bolus: Dose administered
from 100mL vial, given
undiluted over 1--‐ 2 minutes
***Give with heparin or
lovenox***
Bolus: May be given
undiluted
***Only use 10 mg/mL
amp***
Infusion: 2,500 mg/250 mL NS
premixed bag (10 mg/mL)
2 mg/mL vial
May be given undiluted
MAXIMUM CONC./
INFUSION
INSTRUCTIONS
Bolus: Over 1--‐ 2 minutes
Infusion: Administered directly Bolus: 180 mcg/kg
from vial
Max bolus dose = 22.6 mg
Max infusion rate = 15
mg/hr
20 mg/mL
(5,000 mg/250 mL)
D5W or NS
Dose may be given
undiluted, administered
over 30 – 60 seconds
DOSING MONITORING/COMMENTS
ACS Platelets, Hgb, SCr, PT/aPTT
Signs of bleeding – avoid BP
administered over 1--‐ 2 cuffs, watch IV sites, monitor for
minutes black tarry stools etc.
Infusion: 2 mcg/kg/min (max of Modified Cockroft--‐ Gault
15 mg/hr) equation to determine CrCl:
(140 – age/SCr) [x 0.85 if
Renal Dysfunction: If CrCl < female]
50 mL/min, ↓ infusion to 1 (this equation provides a rough
mcg/kg/min. estimation of CrCl in order to
determine an approximation of
the patients renal function)
SVT ↓HR, ↓BP, arrhythmias, CHF,
Bolus: 500 mcg/kg over 1 bronchospasm, thrombophlebitis
minute
Should taper off slowly
Infusion: Start infusion at 50 Infuse via central line to prevent
mcg/kg/minute. Titrate to extravasation
response q4min up to a
maximum dose of 200
mcg/kg/min
HTN control = up to 300
mcg/kg/min
0.3 mg/kg Pain with infusion common
Myoclonus commonly seen
May increase EEG activity in
focal seizures
Will cause transient adrenal
suppression, use caution in
septic patients.

DEPT OF NURSING NAMPALLY 36 *Shaded medications requireadoublecheck*

 MEDICATION
Fentanyl (Sublimaze®)
Opium derived narcotic analgesic
which is a descending CNS
depressant. Approximately 100
times more potent than morphine
mg for mg. Has definite respiratory
depressant actions that outlast its
analgesic effects.
Onset of action: almost immediate
Duration: 0.5--‐ 1 hour.
Furosemide (Lasix®)
Potent loop diuretic. Works in the
+
loop of Henle to excrete H20, Na , K +,
-‐
Cl
Onset of action: ~ 5 minutes
Duration: 2 hours
Heparin
Potentiates the action of
antithrombin III, thereby
inactivating thrombin (as well as
factors IX, X, XI, XII, and plasmin).
Prevents conversion of fibrinogen to
fibrin
Onset of action: almost immediate
DEPT OF NURSING NAMPALLY
STANDARD ADMIXTURE
Bolus: Small volumes may be
given undiluted (50 mcg/mL)
Infusion: 1,250 mcg/250 mL (5
mcg/mL)
PCA: 1,250 mcg/25 mL
(50 mcg/mL)
See Standard PCA Order Form
Epidural: 2 or 5 mcg/mL with
bupivicaine 0.125% in 250 mL
NS
Bolus: 10 mg/mL undiluted
drug
Infusion: 100 mg/100 mL NS
(1 mg/mL)
Protect from light
Infusion: 25,000 units/500 mL
D5W
(50 units/mL)
MAXIMUM CONC./
INFUSION
INSTRUCTIONS
50 mcg/mL undiluted drug
Other bupivicaine
concentrations available
per request
(e.g., 0.0625%)
Bolus: 10 mg/mL
May be further diluted
upon request
Infusion: 100 mg/mL (1
mg/mL) D5W or NS
(infusion bag stable for 24
hours)
Preprinted weight--‐ based
forms available
37
DOSING
Titrate to effect using pain
scale or RASS score
Infusion: 25 – 100 mcg/hr
Titrate to desired effect
Infusion rate should not
exceed 4 mg/min
A 1 gram dose should infuse
over at least 3 hours to
prevent ototoxicity
See preprinted weight based
protocols
*Shaded medications requireadoublecheck*
MONITORING/COMMENTS
↓RR, ↓HR, ↓BP
Pain scale assessment for analgesia
RASS score for sedation
Naloxone (Narcan) is antidote
Use caution in obese patients.
Fentanyl distributes to adipose
tissue, requiring a larger initial
dose to see effect. Duration of
effect will be greatly extended as
drug is slowly released from
adipose tissue. Monitor
respiratory status closely.
HR, BP, electrolytes, UOP
Over--‐ diuresis may precipitate a
contraction alkalosis
Platelets, Hgb, aPTT
Signs of bleeding – watch IV
sites, monitor for black tarry
stools, etc
Antidote: Protamine – each 1mg
will reverse 100 units of heparin.
 MEDICATION
Insulin, Regular
(Novolin R®)
Pancreatic hormone responsible for
storage, metabolism, and uptake of
carbohydrates, fats, and protein.
Facilitates entry of glucose into
muscle, adipose and other tissues.
Onset of action: 30 minutes
Isoproterenol (Isuprel®)
Synthetic sympathomimetic that
stimulates β1 and β2 receptors
resulting in relaxation of bronchial, GI,
and uterine smooth muscle, increased
heart rate and contractility, and
vasodilation of peripheral vasculature
Onset of action: immediate Duration:
10--‐ 15 minutes
Labetalol (Trandate®)
Blocks α, β1, and β2 adrenergic
receptor sites. Decreases heart rate
and peripheral vascular resistance.
Ratio of alpha--‐ to beta--‐ blockade
depends upon the route of
administration (1:3 oral versus 1:7 IV)
Onset of action: 2--‐ 5 minutes
Duration: 2--‐ 4 hours
DEPT OF NURSING NAMPALLY
STANDARD ADMIXTURE
Vial: 100 units/mL
Infusion: 100 units/100 mL NS
(1 unit/mL)
1 mg/250 mL D5W (4
mcg/mL)
Bolus: 5 mg/mL undiluted
Infusion: 200 mg/200 mL (Add
200mg [40 mL] labetalol to 160
mL D5W, NS, LR, or D5/NS)
Final concentration: 1 mg/mL
MAXIMUM CONC./ DOSING
INFUSION
INSTRUCTIONS
1 unit/mL Infusion: Titrate to desired
Usually diluted in NS or blood glucose goals – follow
½NS. Also compatible with protocol
D5W
If pt in DKA, please titrate
May adhere to IV tubing IVF’s, not insulin drip
20 mcg/mL D5W or NS Infusion: 2--‐ 20 mcg/min
(Up to 30 mcg/min in severe
shock)
IV Bolus: 20 mg over at Bolus: 20 mg as initial dose,
least 2 minutes may repeat with doses of
40--‐ 80 mg q10min
Max concentration: 5 Do not exceed total dose of
mg/mL 300 mg
Infusion: starting 2 mg/min (2
mL/min) – 8 mg/min titrated to
response. Do not exceed
total dose of 300
mg.
*Shaded medications requireadoublecheck*
38
MONITORING/COMMENTS
Hypoglycemia (FSBS)
ONLY Regular insulin may be
given IV
Do not lower BG by >100 mg/dL
per hour. Rapid lowering may lead
to cerebral edema
↑HR, arrhythmias, ↑or↓BP,
flushing, HA, pulmonary edema
BP – before & 5--‐ 10 minutes after
injection or during infusion.
Keep patient supine and assist
with ambulation (postural
hypotension)
As cumulative dose nears 300mg
IV, duration of action extends to
nearly 18 hours.
 MEDICATION
Lidocaine
Local anesthetic and class Ib
antiarrhythmic. Suppresses
automaticity of conduction tissue by
increasing the electrical
stimulation threshold of the
ventricle. With usual therapeutic
doses does not change myocardial
contractility, systemic arterial
pressure, or absolute refractory
period.
Onset of action: 2 minutes Duration:
10--‐ 20 minutes (half life increases with
repeat dosing)
Magnesium
Electrolyte
Midazolam (Versed®)
Short acting benzodiazepine with
sedative, anxiolytic, and amnestic
properties. Three to four times as
potent as diazepam.
Onset of action: 1--‐ 5 minutes Duration:
average 2 hours
DEPT OF NURSING NAMPALLY
STANDARD ADMIXTURE
Bolus: 100 mg/5 mL Abboject
syringe (2%)
Infusion: 2,000 mg/500 mL
D5W (4 mg/mL) premade bag
(Concentrated 4,000 mg/500
mL available if necessary)
1 gm/50 mL D5W
2 gm / 100 mL D5W
4 gm/100 mL D5W
100 mg/mL NS pre--‐ made bag (1
mg/mL)
MAXIMUM CONC./ DOSING
INFUSION
INSTRUCTIONS
8 mg/mL in D5W Bolus: 1--‐ 1.5 mg/kg (avg.
50--‐ 100 mg) Infuse over 2--‐ 3
minutes.
May repeat bolus dose in
3--‐ 5 minutes to a max of 3
doses
Infusion: With return of
perfusion, initiate at 1--‐ 4
mg/min. Do not exceed 4
mg/min.
Decrease dose by 50% for
CHF, impaired liver
function, elderly, use of
drugs that may decrease
hepatic clearance of
lidocaine (e.g., beta
blockers), shock
1 gm / hr Case based (suggested doses):
1.5 --‐ 2.0: give 2 g TRO 2 hrs
1.0 --‐ 1.5: give 4 g TRO 4 hrs
< 1.0: give 8 g TRO 8 hrs
1 mg/mL Titrate to effect using RASS
RSI induction: 0.2--‐ 0.3
mg/kg
Infusion: Initially 1--‐ 7
mg/hr, then titrate
according to RASS
Use lower initial dose if
receiving concurrent
sedatives/analgesics
39
MONITORING/COMMENTS
Monitor EKG continuously Monitor
HR, BP, CNS effects (confusion,
nervousness, seizure),
cardiovascular collapse,
arrhythmias
Lidocaine levels (if maintained
on lidocaine drip, would draw
level 12 hours after initiating drip
then q24h thereafter)
ACLS note: If pt. has received
amiodarone, there is no evidence
supporting the use of concurrent
lidocaine. Once an antiarrhythmic
agent has been chosen per the
ACLS algorithm, need to stay with
that agent.
↓BP
Mg levels
↓RR, ↓BP, ↓HR
Drowsiness, impaired memory or
coordination, agitation (paradoxical)
Flumazenil (Romazicon) is
antidote but its use is strongly
discouraged, especially if pt. has a
h/o benzo use or Sz history.
May precipitate seizures via
irreversible binding of BZD
receptors (GABA) – Duration~1hr
 MEDICATION
Morphine
Opium--‐ derived narcotic analgesic,
CNS depressant, respiratory
depressant. Relieves pulmonary
congestion, reduces myocardial
oxygen demand, and reduces
anxiety.
Onset of action: Almost immediate
Duration: Average of 2 hours
Naloxone (Narcan®)
Pure opioid antagonist that
competes and displaces narcotics at
opioid receptors.
Onset of action: ~ 2 minutes
Duration: 30--‐ 45 minutes (up to 2
hours if given IM)
Nesiritide (Natrecor®)
Recombinant human BNP, dilates
veins & arteries. Produces dose
dependent decrease in PCWP &
systemic arterial pressure. Used for
treatment of acutely
decompensated CHF in pts with
dyspnea at rest or with minimal
activity
Onset of action: 15 minutes
Duration: >60 minutes (up to
several hours)
DEPT OF NURSING NAMPALLY
STANDARD ADMIXTURE
Bolus: may be given undiluted Usually 1 mg/mL
Infusion: 100 mg/mL in D5W
(1 mg/mL)
PCA: 30 mg/30 mL (1 mg/mL)
See standard PCA order form
May be given undiluted,
diluted with SW for injection,
or further diluted in NS or
D5W and given as an infusion.
Infusion: 2 mg/500 mL NS or
D5W (0.004 mcg/mL [4
mcg/mL])
1.5 mg in 250 mL D5W or NS
(6 mcg/mL)
[reconstitute vial with 5 mL
gently rolling vial in hand to
dilute. DO NOT SHAKE]
MAXIMUM CONC./ DOSING MONITORING/COMMENTS
INFUSION
INSTRUCTIONS
Bolus: average 2.5 – 15 mg. ↓BP, ↓RR, HR, GI effects (constipation)
Repeat q2--‐ 4h as needed Pain scale assessment for analgesia.
Recommend lower initial Active metabolite
dose for renal or hepatic Morphine--‐ 6--‐ Glucuronide accumulates in
dysfunction and in elderly. renal dysfunction.
Naloxone (Narcan) is antidote
Infusion: Titrate to effect
using pain scale or RASS
1 mg/mL Narcotic overdose: RR, HR, BP, temp, level of
0.4 – 2 mg. May repeat in consciousness, O2 sat
2--‐ 3 minutes if indicated.
Typically start with lower Monitor for withdrawal symptoms
dose then increase as
needed. (May initiate with Ineffective against respiratory depression
0.1 mg in patients with caused by barbiturates, anesthetics, other
known opioid dependence non--‐ narcotic agents, or pathological
to prevent withdrawal conditions
reaction)
Opioid induced pruritis:
0.25 mcg/kg/min. Monitor
pain control to ensure
naloxone is not reversing
analgesia
6 mcg/mL Bolus: 2 mcg/kg over 1 BP (may last for hours) UOP, renal
minute (withdraw bolus function Continuous tele monitoring
from the prepared infusion PCWP
bag)
Infusion: 0.01 mcg/kg/min
40
 MEDICATION
Nicardipine
(Cardene®)
Dihydropyridine calcium
channel blocker. Causes
coronary and peripheral
blood vessel dilation leading
to ↓SVR, ↑ CO, ↑ coronary
blood flow, and myocardial
oxygen supply without
increasing cardiac oxygen
demand.
Onset of action: 10
minutes Duration: <8
hours
Nitroglycerin
Causes relaxation of smooth
muscle, producing a vasodilator
effect on the peripheral veins and
arteries with more prominent
effects on the veins. Primarily
reduces cardiac oxygen demand by
decreasing preload. May modestly
reduce afterload. Dilates coronary
arteries and improves collateral
flow to ischemic regions
Onset of action:
Immediate Duration:
3--‐ 5 minutes
DEPT OF NURSING NAMPALLY
STANDARD MAXIMUM CONC./ DOSING MONITORING/COMMENTS
ADMIXTURE INFUSION
INSTRUCTIONS
25 mg/250 mL D5W 0.1 mg/mL Infusion: 5 mg/hr (50 BP, HR
or NS (0.1 mg/mL) mL/hr) HA, nausea/vomiting
(withdraw 10 mL from 250 If infused peripherally, Increase rate by 2.5
mL bag prior to addition change IV site Q12h mg/hr every 5--‐ 15
of nicardipine for minutes up to max of
0.1mg/mL final 15 mg/hr
concentration)
Consider reducing to 3
mg/hr for maintenance
50 mg/250 mL Start with 5 mcg/min Unstable angina or USE EXTREME CAUTION IN PTS WITH RIGHT
D5W (200 then increase by 5 CHF associated VENTRICULAR
mcg/mL) mcg/min Q3--‐ 5min until with MI: INFARCT (these pts are extremely sensitive to effects
desired response 10--‐ 20 mcg/min and of nitroglycerine. Use may cause a precipitous drop in
Pre--‐ mixed in glass bottle obtained. If not increase by 10--‐ 20 BP)
response at 20 mcg/min until desired
mcg/min, may increase effect. May need bolus Monitor: BP, HR, HA
by 10 mcg/min. of 12.5 to 25 mcg. Flushing, postural hypotension, reflex tachycardia,
No fixed maximum dizziness Methemoglobinemia
dose Tolerance may Need nitro free
develop after 12--‐ 24 period for effect to Antidote: Decrease rate, elevate foot of bed, IV fluids,
hours, requiring last oxygen, epinephrine
nitrate free period
41
 Nitroprusside
(Nitropress®)
Potent, rapid acting
antihypertensive. Causes
peripheral vasodilation by
direct action on venous and
arteriolar smooth muscle,
thus reducing peripheral
resistance. Decreases BP and
SVR, but will ↑CO and may
↑HR. Metabolized in RBCs
to cyanide, then in the liver
to thiocyanate. Liver or
kidney dysfunction can affect
metabolism and elimination.
Onset of action: < 2 min
Duration: 1--‐ 10 minutes
Pancuronium
(Pavulon®)
Nondepolarizing
neuromuscular blocking
agent. Blocks neural
transmission at the myoneural
junction by binding with
cholinergic receptor sites.
Onset of action: 2--‐ 3 minutes
Duration: Dose dependent,
60--‐ 100 minutes
Propofol (Diprivan  1000 mg/100 ml glass
Potent, emulsified, sedative-
hypnotic agent. Can provide
conscious or unconscious
sedation, depending on dose.
Onset of action is rapid, as is
recovery after discontinuation.
Minimal impact on cardiac
parameters.
DEPT OF NURSING NAMPALLY
50 mg/250 mL 100 mg/250 mL D5W Infusion: 0.1 HR, ↓BP, flushing, HA Renal function Hepatic
D5W (200 (400 mcg/mL) –5 Function
mcg/mL) mcg/kg/min Cyanide, thiocyanate, or methemoglobin levels
for prolonged use or suspected toxicity.
PROTECT FROM LIGHT AHA recommends Do not use in renal failure – Risk of cyanide toxicity
Solution will have a starting with 0.1 DO NOT USE IN NEUROLOGIC
faint brownish tint. mcg/kg/min, then INJURY (trauma, stroke, etc.). Will lead to ↑CBF,
Discard solution if gradually titrating every causing ↑ICP which may lead to secondary infarct
highly colored, blue, 2--‐ 3 minutes. Small
green, or dark red adjustments can lead
to major fluctuations in
BP. Doses > 3
mcg/kg/min rarely
needed.
Do not
exceed 10
mcg/kg/min
Bolus 1 mg/mL 1 mg/mL Bolus: 0.04 – 0.1 mg/kg Train--‐ of--‐ four & RASS scale monitoring by nursing.
May be given undiluted In manufacturer’s over 1 minute
Vagolytic – will increase heart rate. Not
Infusion: 100 mg/100 mL diluents Infusion: 0.06 – 0.1 recommended in pts w/ cardiovascular disease
undiluted (1 mg/mL mg/kg/hr (1 --‐
1.7 Renal function: If Creatinine clearance < 50 mL/min, use
mcg/kg/min) 50% of dose
Titrate to effect
10 mg/ml undiluted drug Infusion: 5--‐ 100 BP, HR,
bottle mcg/kg/min Triglycerides: Q3 days Lipid profile
(10 mg/ml)
Ventilation status, RASS score May turn urine green
Titrate slowly q5--‐ 10 min Do not exceed 75 mcg/kg/hr – increases risk of
10% Lipid emulsion = 1.1 by 5--‐ 10 mcg/kg/min
Kcal/ml increments to propofol
desired infusion syndrome
sedation
Initial Rate: 5
mcg/kg/min
42
 MEDICATION
Pantoprazole
(Protonix®)
Proton pump inhibitor that
suppresses gastric acid production.
Inhibits both basal and stimulated
gastric acid secretion.
Phenylephrine
(Neosynephrine®)
Synthetic sympathomimetic acting
primarily on  adrenergic
receptors. Causes potent
vasoconstriction, lacks chronotropic
or inotropic properties, HR.]
Potassium Chloride
electrolyte
DEPT OF NURSING NAMPALLY
STANDARD ADMIXTURE MAXIMUM CONC./
INFUSION
INSTRUCTIONS
Bolus: 80 mg/100 mL NS Stable for 12 hours
Withdraw 20 mL from 100 mL
NS bag, reconstituting each
40 mg vial with 10 mL.
(0.8 mg/mL)
Infusion: 40 mg/100 mL NS to
run over 5 hrs (8 mg/hr)
10 mg/250 ml in NS or 40 mg/250 ml in NS or
D5W D5W
(160 mcg/ml)
(40 mcg/ml) Some institutions report up
to 400 mcg/ml
(100 mg/250 ml)
Infuse via central line to
avoid extravasation.
10 mEq/ 100 ml MAXIMUM INFUSION
USE PRE--‐ MIXED IVPBs RATE: 10 mEq/ hr
PER PROTOCOL MAX CONC: 40mEq/1000
ml
43
DOSING
GI bleed: 80 mg bolus over
15 minutes, followed by
continuous infusion of
8 mg/hr x 72 hours
Stress ulcer
prophylaxis/GERD: Infuse
40 mg over 15 minutes
Bolus: 0.1 to 0.5mg/dose
every 10 to 15 minutes
Infusion: 100 to 180
mcg/min initially, then 40
to 60 mcg/min
maintenance rate.
Case based
Rate of Infusion: Not faster
than 10 mEq / hr
MONITORING/COMMENTS
Rash, infusion site reactions
Anaphylaxis has been reported
72 hour infusion only indicated for
active GI bleeds. Not indicated for
variceal bleed!
Convert to oral therapy when/if
appropriate
HR, BP, HA, arrhythmias
Serum Potassium Level
Tachycardia, arrhythmia, muscle aches, GI
upset.
Renal function
 MEDICATION STANDARD ADMIXTURE MAXIMUM CONC./ DOSING MONITORING/COMMENTS
INFUSION
INSTRUCTIONS

Vasopressin (Pitressin )  Vial: 20 units/ml If given per IV Infusion, use Vasopressor/Sepsis : 0.04 BP
central line units/min (2.4 units/hr – Serum and Urine Osmolarity
Increases cyclic adenosine
monophosphate (cAMP) which
Infusion: 50 units/50 ml NS DO NOT TITRATE)
increases water permeability at the (1 unit/ml) Diabetes Insipidus : Serum and Urine Sodium
renal tubule resulting in decreased
5--‐ 10 units 2--‐ 3 times daily SC Concentration
urine volume and increased
osmolality; At greater than or IM
physiologic doses, vasopressin has a Serum Electrolytes
pressor effect due to
vasoconstriction and causes ACLS: 40 units IV single
contraction of the smooth muscle dose Maintains good effect in acidosis
of the gastrointestinal tract

Vecuronium (Norcuron®)
Nondepolarizing neuromuscular
blocking agent with rapid onset and
intermediate duration of action.
Bolus: Dilute to 2mg/ml with
Sterile Water
Infusion: 100mg/100ml NS
(1mg/ml)
0.1--‐ 1 mg/ml in NS or Bolus : 0.08--‐ 0.1 mg/kg
D5W
Infusion : 0.05--‐ 0.1
mg/kg/hr
Titrate to effect
Train--‐ of--‐ Four and RASS scale
monitoring by nursing.
Pt must be intubated & sedated
Renal function
Liver function

DEPT OF NURSING NAMPALLY 44

DEPT OF NURSING NAMPALLY 45