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

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

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 painAvailable: Morphine sulfate 10 mg per 1 mlHow 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 MedicationsUses appropriate hand hygiene/gloves for prep & administrationPreparing InjectionChecks expiration dateCompares medication with orderChooses appropriate supplies & equipmentChecks labelCalculates correct doseIdentifies patient (barcoding)Explains procedureAsks about medication allergiesChecks for compatibility of medication & IV fluidProvides information to patient about medicationSelects appropriate site on IV portCleanses site appropriatelyInjects at appropriate site on IV portInjects at appropriate rateWithdraws syringe appropriately from IV portProper syringe disposalObserves patient for reactionDocuments appropriately

List of Medications:

Benadryl Demerol Dilaudid Lasix Morphine Sulfate Narcan

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: 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

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.

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.

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

Drug to diagnostics: ↑ amylase & lipase

Drug to herb: ↑ CNS depression with chamomile, hops, kava, skullcap, valerian

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.

Availability 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 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.

Availability: Injection- 10 mg/ml Oral solution- 10 mg/ml, 40 mg/5 ml Tablets- 20 mg, 40 mg, 80 mg

Dosages: adults 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.

Interactions: 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)

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.

Availability: 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 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.

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.

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.

Interactions:

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 opioid-antagonists; ↑ anticoagulant effect with warfarin

Drug to diagnostics: increased amylase & lipase

Drug to herbs: increased CNS depression with chamomile, hops, kava, skullcap, & valerian

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: 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.

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.

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 dose 0.5-2 mg IV q 3-4h One spray in one nostril = 1 mg q3-4h 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: 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/mlTablets: 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: 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: 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 anti-inflammatory.

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