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Drug NamePatient DoseWhy is the patient on this medication?Special Considerations (for IV meds, include ml/hr and duration of infusion)Acetaminophen (Ofirmev) 1,000 mg IV every 6 hrs PRNMild pain (1 – 3), feverInfuse over 15 minutes. Don’t exceed 4,000 mg per day from all sourcesAcetaminophen (Ofirmev) 1,000 mg IV every 6 hrs PRNFeverInfuse over 15 minutes. Don’t exceed 4,000 mg per day from all sourcesAcetaminophen (Ofirmev) 1,000 mg IV every 6 hrs PRNFever, rectal temp greater than 101Infuse over 15 minutes. Don’t exceed 4,000 mg per day from all sourcesAcetaminophen (Tylenol)650 mg tab every 4 hrs PRNFeverFor temp greater than 101 oral. Don’t exceed 4,000 mg per day from all sourcesAcetaminophen (Tylenol)650 mg tab every 4 hrs PRNMild pain (1-3)Do not exceed 4,000 mg per day from all sources.Acetaminophen (Tylenol)325 mg tab every 4 hrs PRNMild pain (1-3), headacheDo not exceed 4,000 mg per day from all sources.Acetaminophen (Tylenol)650 mg tab every 4 hrs PRNMild pain (1-3), fever, headache, temp greater than 101 F (38.3 C)Don’t exceed 4,000 mg per day from all sourcesAcetaminophen (Tylenol)650 mg rectal suppository, every 4 hrs PRNMild pain (1-3), fever, headache, temp greater than 101 F (38.3 C)If NPO or not tolerating oral intake. Don’t exceed 4,000 mg/day from all sourcesAcetaminophen (Tylenol)650 mg tab every 4 hrs PRNMild pain (1-3), fever, headache, temp greater than 101 F (38.3 C)Don’t exceed 4,000 mg per day from all sources. Give in PACU ONLY when tolerating oral fluids; discontinue on transfer from PACUAcetaminophen (Tylenol)650 mg PO every 4 hrs PRNNon anginal mild pain (1-3)Don’t exceed 4,000 mg per day from all sourcesAcetaminophen (Tylenol)500 mg oral every 6 hrs PRN; 15.6 mL = 500 mg of 32 mg/mLMild pain (1-3), headacheDo not exceed 4,000 mg per day from all sources.Acetaminophen (Tylenol)650 mg rectal suppository, every 4 hrs PRNMild pain (1-3), fever, headache, temp greater than 101 F (38.3 C)If NPO or not tolerating oral intake. Don’t exceed 4,000 mg/day from all sourcesAcetaminophen (Tylenol)650 mg tab every 4 hrs PRNMild pain (1-3), fever, headache, temp greater than 101 F (38.3 C)Don’t exceed 4,000 mg per day from all sourcesAlbumin (Albuminar) 25% IV soln100 mL IV 2x/day @ 0900Adjunct in treatment of adult respiratory distress syndrome, promote diuresisUse within 4 hrs of opening. Give prior to Lasix.Albumin (Albuminar) 25% IV soln50 mL IV every 6 hrs, @ 1000Promote diuresis, fluid overload, CHFUse within 4 hrs of opening. Give prior to Lasix.Albumin (Albuminar) 25% IV soln100 mL IV PRN conditionalHypotentension, to support BP during hemodialysis treatment. Use within 4 hrs of opening – 0.25 g/mLAlbuterol (Proventil)2.5 mg/0.5 mL nebulizer soln 2.5 mg every 4 hrsCOPDAdministered by Respiratory TherapistAlbuterol (Proventil)2.5 mg/0.5 mL nebulizer soln 2.5 mg every 2 hrs PRNFor wheezing, shortness of breathAdministered by Respiratory TherapistAlbuterol (Proventil)5 mg/mL neb soln every 4 hrs when awakePneumonia, bronchodilator, history of asthmaAdministered by respiratory therapistAlbuterol (Proventil)2.5 mg/0.5 mL nebulizer soln, 2.5 mg every 4 hrs when awakeAs needed for shortness of breathAdministered by Respiratory Therapist. Dilute in 3 ml of NSAlbuterol (Proventil) nebulizer solution2.5 mg every 4 hrs PRNDyspnea/wheezingAdministered by respiratory therapist. Dilute in 3 mL NS.Albuterol HFA (Proventil HFA)90 mcg/actuation inhaler 2 Puff. Every 4 hrs PRNFor wheezing, shortness of breathAdministered by Respiratory TherapistAlprazolam (Xanax)1 mg every 8 hrs PRNAnxietyAlprazolam (Xanax)0.25-.05 mg PO every 8 hrs PRNAnxietyAdverse effects: drowsiness, sedation.Amiodarone (Cordarone)200 mg tab, NG Tube, 2x/day @ 0900Atrial fibrillation, atrial flutterCrush to admin via NG tube. One possible cause of interstitial lung disease. Peak 2-7hr Amiodarone (Cordarone)150-300 mg IVP over 10 minsAntiarrhythmic, Antianginal. (prevention or suppression of cardiac arrhythmias)Admin over 10 minsAmiodarone (Cordarone)360 mg IV over 6 hrs.Antiarrhythmic, AntianginalAmiodarone (Cordarone)540 mg IV over 18 hrs.Antiarrhythmic, AntianginalMaintenance infusion (over 18 hrs)Amlodipine (Norvasc)5 mg tab dailyAntihypertensive (calcium channel blocker)Monitor blood pressure (no parameters given)Amlodipine (Norvasc)5 mg tab dailyAntihypertensive, calcium channel blockerHold for Systolic BP < 110Amlodipine (Norvasc)5 mg tab, 2x/day, due @ 0900Antihypertensive, calcium channel blockerHold for Systolic BP < 90. Admin via G tubeAmlodipine (Norvasc)10 mg tab dailyAntihypertensive (calcium channel blocker)Monitor blood pressure (no parameters given)Ascorbic acid (Vitamin C)500 mg tab, oral, dailyVitamin C deficiencyAscorbic acid (Vitamin C)500 mg tab, oral, daily, due @0900Vitamin C deficiencyAspirin325 mg tab @ 0900Atrial fibrillation, atrial flutterPatient on ventilator, NG TubeAspirin325 mg tab @ 0900Acute MIMay be administered with food to avoid GI upset.AspirinEnteric coated 325 mg tab dailyAcute MI, AntiplateletMay be administered with food to avoid GI upset.Aspirin325 mg tab @ 0900Atrial fibrillation, suspected MIPatient on ventilator, NG Tube. May be administered with food to avoid GI upsetAspirin (Bayer children’s aspirin)81 mg chewable tab @ 0900Acute MI, NSTEMIMay be administered with food to avoid GI upset. Intubated.Atorvastatin (Lipitor)10 mg tab dailyTo reduce LDL cholesterol and triglyceride levels (Antilipemic), prevention of cardiovascular disease (pt. has had MI)Atorvastatin (Lipitor)80 mg tab daily, at bedtimeTo reduce LDL cholesterol and triglyceride levels (Antilipemic), history of hyperlipidemia, pt. has had MIAvoid grapefruit juiceAtropine1mg IVPBradycardia, complete heart block, or escape rhythms with symptoms of hemodynamic compromise. (Anticholinergic, Antiarrhythmic)Notify health care providerAzithromycin (Zithromax)1200 mg tab Suspected infection Cautious use in debilitated patients.Azithromycin (Zithromax)500 mg in D5W 250 mL injection IV every 24 hrsUTIAzithromycin (Zithromax)500 mg in D5W 250 mL injection IV every 24 hrs due @ 1300COPD, possible lung infection. Suspected infectionAztreonam (Azactam)1g in D5W 100 mL IVPB at 200 mL/hr every 8 hrs, due @ 0900Antibiotic, prophylaxis for infectionBacitracin (Baciguent)Topical ointment applied 2x/day to affected areas, @0900Prevent bacterial infection of scalp laceration. Polypeptide antibiotic ointment, inhibits cell wall synthesis, effective against many gram pos. organisms.Apply to scalp laceration onlyBacitracin (Baciguent)Topical ointment applied 2x/day to affected areas, @0900Prevent bacterial infection laceration. Polypeptide antibiotic ointment, inhibits cell wall synthesis, effective against many gram pos. organisms.Apply to affected areaBenazepril (Lotensin)10 mg tab dailyAntihypertensive, ACE inhibitorHold for Systolic BP < 110Benazepril (Lotensin)20 mg tab dailyHypertension, antihypertensive ACE inhibitorCheck BP before givingBenzocaine-menthol (Cepacol sore throat) (max strength)1 Lozenge every 6 hrs PRNSore throatBenzonatate (tessalon perles)100 mg cap every 8 hrsCough suppressantSwallow whole, don’t crush or chewBisacodyl (Dulcolax)10 mg rectal suppository daily PRNconstipationBisacodyl (Dulcolax)5 mg tab 2x/day PRNConstipationSwallow whole, do not crush, chew, or split.Bisacodyl (Dulcolax)10 mg rectal suppository every other day PRNconstipationBupropion (Wellbutrin)100 mg tab dailyAntidepressantBuspirone (Buspar)10 mg tab dailyAntianxietyCalcium chloride1g in NS 50 mL IV PRN conditional rate: 50 mL/hrCalcium replacementFor ionized Ca of 4.1-4.5, infuse over 1 hr.Calcium chloride2g in NS 100 mL IV PRN conditional rate: 50 mL/hrCalcium replacementFor ionized Ca of 3.7-4.0, infuse over 90 mins.Calcium chloride3g in NS 150 mL IV PRN conditional Calcium replacementFor ionized Ca less than 3.7, infuse over 2-3 hours.Calcium gluconate in D5W1 g in D5W 100 mL injection, PRN conditionalCalcium replacementIon Ca 4.1 to 4.5. Max infusion rate NOT TO EXCEED 1 g per hourCaptopril12.5 mg PO every 8 hrsAntihypertensiveHold for SBP < 110. Common adverse effects: cough, maculopapular rash. Life threatening adverse effects: Agranulocytosis, AngioedemaCarisoprodol (Soma)350 mg tab 4x/dayFibromyalgiaCarvedilol (Coreg)3.125 mg tab due @ 0800, 2x/day w/ mealsFor CHF.Antihypertensive, Adrenergic blockerHold for HR less than 50 bpm. Hold for Systolic BP less than 100 mmHg. Administer with food if not NPO.Alpha and Beta-Adrenergic antagonist. Decreases myocardial O2 demand and lowers cardiac workload. Common adverse effect: dizziness. Life threatening: thrombocytopenia (low patelets).Cefazolin (Ancef)2g/20 mL IV, dose: 2g, every 8 hrs, @ 0800Antibiotic, prevention of infection after surgery, cephalosporin antibiotic. Inhibits cell wall synthesis.Cautious use: Coagulopathy. Peak: 5 mins IV, half-life: 90-130 mins. Promptly report onset of diarrhea, possible sign of pseudomembranous colitis.Cefepime (Maxipime) 2g in D5W 100 mL IVPB2 g, 200 mL/hr, IVPB, every 12 hrsAntibioticInfuse over 30 minsCeftriaxone (Rocephin)1 g in D5W 100 mL IVPB @ 200 mL/hr every 24 hrsPneumoniaInfuse over 30 mins, do not infuse thru same IV line as Calcium containing IV solutions (including LR and TPN)Ceftriaxone (Rocephin)1 g in D5W 100 mL IVPB @ 200 mL/hr every 24 hrs, due @ 1200E. Coli Pneumonia. Broad spectrum cephalosporin antibiotic. Broad spectrum against gram pos, gram neg coverageInfuse over 30 mins, do not infuse thru same IV line as Calcium containing IV solutions (including LR and TPN)Ceftriaxone (Rocephin)2 g in D5W 100 mL mini-bag IVPB @ 200 mL/hr every 12 hrs, due @ 1600COPD, possible lung infection. Broad spectrum cephalosporin antibiotic. Broad spectrum against gram pos, gram neg coverageInfuse over 30 mins, do not infuse thru same IV line as Calcium containing IV solutions (including LR and TPN)Clindamycin (Cleocin)600 mg in NS 50 mL IV, every 6 hrs, due @ 0930Antibiotic, prophylaxis for infectionClonidine (Catapres)0.1 mg tab every 6 hrs PRNHypertensionFor systolic BP greater than 160 or diastolic BP greater than 100.Clonidine (Catapres)0.2 mg tab every 4 hrs PRNHypertension, SBP > 170, or DBP > 110For systolic greater than 170 or diastolic greater than 110.Clonidine (Catapres)0.1 mg tab every 6 hrs PRNHigh BP, administer if systolic BP > 170 mm HgOnly give if meets parameters for high BPClonidine (Catapres)0.1 mg tab every 6 hrs PRNHTN, administer if systolic BP > 170 mm HgOnly give if meets parameters for high BP, check BP prior to admin.Clopidogrel (Plavix)75 mg tab @ 0900Blood thinner, helps prevent MI, strokeAdverse effects: hemorrhage, severe neutropenia, thrombotic thrombocytopenia purpuraClopidogrel (Plavix)300 mg PO 1st dose, then 75 mg PO dailyBlood thinner, helps prevent MI, stroke. (Antiplatelet, Antithrombotic)Adverse effects: hemorrhage, severe neutropenia, thrombotic thrombocytopenia purpuraCollagenase (Santyl) topical ointmentTopical, daily (time not stated)Pressure ulcers, skin abrasionsApply to affected areaCyclobenzaprine (Flexeril)5 mg tab 3x/day PRNMuscle spasmD10W 1,000 ml IV soln10-125 mL/hr IV PRN conditionalFluid intake If tube feeding is held. Begin at same mL/hr rate as tube feeding. Discontinue when tube feeding resumes AND blood glucose is greater than 100 mg/dLD10W 1,000 ml IV soln10-125 mL/hr IV PRN conditionalFluid intake If tube feeding is held. Begin at same mL/hr rate as tube feeding. Discontinue when tube feeding resumes AND blood glucose is greater than 100 mg/dL. Pt. has fluid volume overload.D10W 1,000 ml IV soln10-125 mL/hr IV PRN conditionalFluid intake, glucose intakeIf tube feeding is held. Begin at same mL/hr rate as tube feeding. Discontinue when tube feeding resumes AND blood glucose is greater than 100 mg/dL. D5 ? NS – KCL 20 mEq 1,000 mL IV soln @ 75 mL/hr continuousFluid intake, nutrition, electrolyte balanceD5 ? NS 1,000 ml IV soln100 mL/hr continuousFluid intakeD5 LR with KCL 20 mEq/L1,000 mL IV soln @ 125 mL/hr continuousNutrition, potassium, and fluid intake (electrolyte replacement)Hypervolemia and hyperkalemia, monitor blood glucoseD50W injection 25 g25 g IV push, QID AC & HS PRNHypoglycemiaAdmin SLOW IV push as needed for blood glucose less than 70 mg/dL (if unable to tolerate oral glucose). Recheck glucose after 15 mins, and repeat D50W 25 g if blood glucose is less than 80 mg/dL. Continue to monitor glucose every 15-20 mins until glucose returns to greater than 100 mg/dL x 2Dextromethorphan - Guaifenesin (Robitussin)10-100 mg/5 mL oral liquid 5 mLCoughDextromethorphan - Guaifenesin (Robitussin)10-100 mg/5 mL oral liquid 15 mL, Dose: 15 mL, every 4 hrs PRNCoughDextrose prefill IV syringe 12.5 g12.5 g IV QID AC & HS PRNHypoglycemiaAs needed for blood glucose less than 70 mg/dL (if unable to tolerate oral glucose). Recheck blood glucose after 15 mins, may repeat x 1 if blood glucose less than 70 mg/dL.Dextrose prefill IV syringe 12.5 gDose 25 mL, Admin dose 12.5 g, IV PRN conditionalHypoglycemiaBG 51-69 and if patient cannot take PO, give D50W, 25 mL (1/2 amp) IV push.Dextrose prefill IV syringe 25 gDose 50 mL, Admin dose: 25 g, IV PRN conditionalHypoglycemiaBG less than 50, give 50 mL D50W (1 amp) and re-check blood glucose every 15 mins.Digoxin (Lanoxin) 250 mcg/mL 250 mcg IV daily @ 0900Atrial fibrillation.Mechanism: Inhibits the sodium-potassium ATPase, which makes more calcium available for contractile proteins, resulting in increased cardiac output (positive inotropic effect), increases force of contraction, decreases heart rate (negative chronotropic effect), decreases AV conduction speedAdmin over at least 5 mins. IV: onset 5-30min, peak 1-5hr, duration variable. Apical pulse for 1 min before giving product; if pulse <60 in adult, take again in 1 hr; if <60 in adult, call prescriber; note rate, rhythm, character; monitor ECG continuously during parenteral loading dose. Precautions: Pregnancy C, breastfeeding, renal disease, acute MI, AV block, severe respiratory disease, hypothyroidism, geriatric patients, sinus nodal disease, hypokalemia . Side Effects: Headache, drowsiness, apathy, confusion, disorientation, fatigue, hallucinations, dysrhythmias, hypotension, bradycardia, AV block, blurred vision, yellow-green halos, photophobia, diplopia, N/V, anorexia, abdominal pain, diarrhea Diltiazem (Cardizem)30 mg PO every 6 hoursAntianginal, Antiarrhythmic, Antihypertensive. (Calcium channel blocker)Onset 30-60min, Peak 2-3hr immediate rel; Half-life 31/2 -9 hrDiltiazem (Cardizem) 5mg/mL20 mg/4 mL IV every 6 hrs PRNTachycardia, HR > 120For elevated HR above 120. Administer bolus dose over 2 mins. Onset 30-60min, Peak 2-3hr immediate rel; Half-life 31/2 -9 hrDiphenhydramine (Benadryl)25 mg IV, every 4 hrs PRNItchingDiphenhydramine (Benadryl)25 mg IV, every 4 hrs PRNItching, insomniaDiphenhydramine (Benadryl)50 mg/mL IV, every 6 hrs PRNItching, hives, pruritusDobutamine (Dobutrex) drip (conc: 2,000 mcg/mL)Base dose 5 mcg/kg/min x 73.3 kg, Admin dose 366.5 mcg/min 11 mL/hrHeart failure, cardiogenic shockContinuous drip, calculate dose per pt. weight.Docusate sodium (Colace)100 mg cap 2x/day PRNStool softenerSwallow whole, don’t crush or chewDocusate sodium (Colace)250 mg cap, 2x/dayStool softenerSwallow whole, do not crush or chew.Docusate sodium (Colace)100 mg/10 mL oral liquid, 2x/day, @ 0900Stool softenerPossibly administer via NG tubeDocusate sodium (Colace)100 mg/10 mL oral liquid, 2x/day, @ 0900Stool softenerAdminister via PEG tubeDocusate sodium (Colace)100 mg capdailyStool softenerSwallow whole, do not crush or chew. Do not give if diarrhea occurs, then reevaluate daily.Docusate sodium (Colace)100 mg cap 2x/day due @ 0900Stool softenerSwallow whole, don’t crush or chewDocusate sodium (Colace) 100 mg/10mL100 mg oral liquid 2x/dayStool softener.Dopamine5mcg/kg/minute IV infusionCardiac stimulant, vasopressorTitrate to keep systolic greater than 100 mmHg. Obtain patient’s weight. Common adverse effects: hypotension, tachycardia.Dopamine 800 mg in D5W 500 mL dripBase dose 5 mcg/kg/min x 68 kg, Admin dose 340 mcg/min 12.75 mL/hr continuous dripCirculation problems due to MI, CHF, kidney failure vasopressor.Continuous drip. Begin at 5 mcg/kg/min. Titrate to maintain rate based on parameters. Parameters: Aug Dias > 90. Not to exceed 20 mcg/kg/min.Duloxetine (Cymbalta)60 mg cap 2x/dayShingles (herpes zoster)Swallow whole, do not crush, chew, or spit. Capsules may be opened and the contents taken without crushing or chewing.Electrolyte-R (pH 7.4) (Normosol-R) IV soln1,000 mL IV soln @ 20 mL/hr continuousElectrolyte replacementHypervolemiaElvitegr-cobicist-emtric-tenof 150-150-200-300 mg tab 100 mg *Patient Own Med*100 mg tab, dailyControl of HIVPatient’s own medication, supplied as a unit dose package, request med from 6th floor pharmacyEnalaprilat (Vasotec) 1.25 mg/mL0.625 IV, every 6 hrs PRNHypertension, SBP >180For systolic greater than 180. Check to see if Clonidine was administered.Enalaprilat (Vasotec) 1.25 mg/mL1.25 mg IV, every 6 hrs PRNHypertension, SBP >140For systolic greater than 140. Check to see if other antihypertensive administered.Enalaprilat (Vasotec) 1.25 mg/mL injection 0.625 mg0.625 mg IV, every 6 hrs PRNHypertensionSystolic BP greater than 160. Max initial single dose in non-critical care areas is 0.625Enoxaparin (Lovenox)40 mg/0.4 mL SubQAnticoagulant Notify physician for dosing or holding plan if invasive procedure, LP, or surgery is to be performed in next 24 hrs.Enoxaparin (Lovenox)40 mg/0.4 mL SubQ every 24 hrsAnticoagulant Notify physician for dosing or holding plan if invasive procedure, LP, or surgery is to be performed in next 24 hrs.Enoxaparin (Lovenox)30 mg/0.3 mL SubQAnticoagulant Dose adjusted for renal function (estimated CrCl 23 mL/min using SCr 1.68 on 8/3)Notify physician for dosing or holding plan if invasive procedure, LP, or surgery is to be performed in next 24 hrs.Enoxaparin (Lovenox)40 mg/0.4 mL SubQ every 24 hrs @ 1800Anticoagulant (prophylaxis for blood clots)Notify physician for dosing or holding plan if invasive procedure or surgery is to be performed in next 24 hrs. Half-life 4 ? hr Enoxaparin (Lovenox)40 mg/0.4 mL SubQ every 24 hrs, @ 0830Anticoagulant Notify physician for dosing or holding plan if invasive procedure, LP, or surgery is to be performed in next 24 hrs.Enoxaparin (Lovenox)40 mg/0.4 mL SubQ every 24 hrs, due @ 0900Anticoagulant Notify physician for dosing or holding plan if invasive procedure, LP, or surgery is to be performed in next 24 hrs.Enoxaparin (Lovenox)1 mg/kg SQ every 12 hoursAnticoagulant, AntithromboticCaution if creatinine clearance less than 30. Life threatening adverse effects: Angioedema, Hemorrhage, Thrombocytopenia.Famciclovir (Famvir)500 mg tab 3x/dayShingles (herpes zoster)Famotidine (Pepcid)20 mg tab dailyAntiulcer drugFamotidine (Pepcid)20 mg/2mL IV 2x/dayGERD (H2 receptor antagonist)Dilute in 5 mL NS and administer over 2 mins.Famotidine (Pepcid)20 mg tab 2x/dayAntiulcer drugFamotidine (Pepcid)20 mg/2mL IV 2x/day, @ 0900GERD (H2 receptor antagonist), antiulcer drugDilute in 5 mL NS and administer over 2 mins. Life threatening adverse side effect: thrombocytopenia. Peak: 0.5-3 hr, duration: 10-12 hrFentanyl (Duragesic)75 mcg/hr transdermal patch, dose: 1 patch, every 48 hrs, due @ 1700Pain, patient is allergic to morphine.Should ONLY be used in patients already receiving opiod therapy demonstrated opioid tolerance, and require daily dose equivalent to fentanyl 25 mcg/hr or greater. Patients considered opioid tolerant are those who have been taking, for a week or longer, equianalgesic doses of at least morphine 60 mg, oxycodone 30 mg, or hydromorphone 8 mg per day. ** Use in non-opioid tolerant patients may lead to fatal respiratory depression.Apply to clean, dry area of the chest, back, flank or upper arm..Fentanyl (Sublimaze)5,000 mcg in no diluent, 100 mL drip (conc: 50 mcg/mL). Dose 50 mcg/hr : 1 mL/hr, continuous. Peripheral IV R. Forearm, 20 gModerate to severe painIf goal pain score not achieved: Use up to 2 bolus doses before increasing rate by 25 mcg/hr every 15 mins until goal pain score achieved. If at goal pain score: continue current dose. Max dose: 600 mcg/hr. Recommended max dose: 10 mcg/kg/hr. Notify intensivist if patient on max dose. Contraindications: substance abuse, significant respiratory compromise; cautious use: head injuries. Life threatening adverse side effect: circulatory depression, cardiac arrest, respiratory depression or arrest; Common adverse effect: nausea. Onset: immediate IV, peak 3-5 min IV, duration: 30-60 min IVFentanyl (Sublimaze)5,000 mcg in no diluent, 100 mL drip (conc: 50 mcg/mL). Dose 50 mcg/hr : 1 mL/hr, continuous. Peripheral IV #1 L. Wrist, pumping at 100 mcg/hr on planning day.Moderate to severe painIf goal pain score not achieved: Use up to 2 bolus doses before increasing rate by 25 mcg/hr every 15 mins until goal pain score achieved. If at goal pain score: continue current dose. Max dose: 600 mcg/hr. Recommended max dose: 10 mcg/kg/hr. Notify intensivist if patient on max dose. Requires dual sign off! Contraindications: substance abuse, significant respiratory compromise; cautious use: head injuries. Life threatening adverse side effect: circulatory depression, cardiac arrest, respiratory depression or arrest; Common adverse effect: nausea. Onset: immediate IV, peak 3-5 min IV, duration: 30-60 min IV.Fentanyl (Sublimaze)50 mcg/mL IV injection every 5 mins PRNPainIVP every 5 mins up to 2 doses PRN pain before increasing continuous infusion rate.Fentanyl (Sublimaze)25 mcg dose of 50 mcg/mL, IV injection, every 5 mins PRNPainIVP every 5 mins up to 2 doses PRN pain before increasing continuous infusion rate. Fentanyl (Sublimaze)5,000 mcg in no diluent, 100 mL drip (conc: 50 mcg/mL). Dose 05 mcg/kg/hr x 83 kg : Admin dose 41.5 mcg/hr. 0.83 mL/hr IV continuousModerate to severe pain, palliative careInitiate drip at 50 mcg/hr; titrate by 50 mcg/hr every 30 mins until target pain score of 0 is achieved and respiratory rate is less than 14 per hour. Max rate of 300 mcg/hr. Notify physician if target pain score and respiratory rate is not achieved at max hourly rate for further orders. Life threatening adverse side effect: circulatory depression, cardiac arrest, respiratory depression or arrest; Common adverse effect: nausea. Onset: immediate IV, peak 3-5 min IV, duration: 30-60 min IVFentanyl (Sublimaze)5,000 mcg in no diluent, 100 mL drip (conc: 50 mcg/mL). Dose 50 mcg/hr : 1 mL/hr, continuous. Moderate to severe painIf goal pain score not achieved: Use up to 2 bolus doses before increasing rate by 25 mcg/hr every 15 mins until goal pain score achieved. If at goal pain score: continue current dose. Max dose: 600 mcg/hr. Recommended max dose: 10 mcg/kg/hr. Notify intensivist if patient on max dose. Contraindications: substance abuse, significant respiratory compromise; cautious use: head injuries. Life threatening adverse side effect: circulatory depression, cardiac arrest, respiratory depression or arrest; Common adverse effect: nausea. Onset: immediate IV, peak 3-5 min IV, duration: 30-60 min IVFentanyl (Sublimaze)50 mcg/mL, dose: 25 mcg IV injection every 5 mins PRNPainIVP every 5 mins up to 2 doses PRN pain before increasing continuous infusion rate.Fentanyl (Sublimaze)5,000 mcg in no diluent, 100 mL drip (conc: 50 mcg/mL). Dose 50 mcg/hr : 1 mL/hr, continuous. Moderate to severe painIf goal pain score not achieved: Use up to 2 bolus doses before increasing rate by 25 mcg/hr every 15 mins until goal pain score achieved. If at goal pain score: continue current dose. Max dose: 600 mcg/hr. Recommended max dose: 10 mcg/kg/hr. Notify intensivist if patient on max dose. Contraindications: substance abuse, significant respiratory compromise; cautious use: head injuries. Life threatening adverse side effect: circulatory depression, cardiac arrest, respiratory depression or arrest; Common adverse effect: nausea. Onset: immediate IV, peak 3-5 min IV, duration: 30-60 min IVFentanyl (Sublimaze)25 mcg dose of 50 mcg/mL, IV injection, every 5 mins PRNPainIVP every 5 mins up to 2 doses PRN pain before increasing continuous infusion rate. Dose to be given from IV infusion pump.Fentanyl (Sublimaze)5,000 mcg in no diluent, 100 mL drip (conc: 50 mcg/mL). Dose 50 mcg/hr : 1 mL/hr, continuous. Moderate to severe painIf goal pain score not achieved: Use up to 2 bolus doses before increasing rate by 25 mcg/hr every 15 mins until goal pain score achieved. If at goal pain score: continue current dose. Max dose: 600 mcg/hr. Recommended max dose: 10 mcg/kg/hr. Notify intensivist if patient on max dose. Contraindications: substance abuse, significant respiratory compromise; cautious use: head injuries. Life threatening adverse side effect: circulatory depression, cardiac arrest, respiratory depression or arrest; Common adverse effect: nausea. Onset: immediate IV, peak 3-5 min IV, duration: 30-60 min IVFentanyl (Sublimaze)25 mcg dose of 50 mcg/mL, IV bolus, every 5 mins PRNPainIVP every 5 mins up to 2 doses PRN pain before increasing continuous infusion rate. Dose to be given from IV infusion pump Ferrous sulfate (Feosol)325 mg tab 2x/dayIron deficiencySwallow whole, don’t crush, chew, or spit.Fluticasone – salmeterol (Advair HFA) 230-21 mcg/actuation inhaler2 Puffs. Inhalation with spacer. 2x/day @0900Acute respiratory failure (interstitial lung disease)Administered by RTFluticasone (Flonase) 50 mcg/actuation nasal spray1 spray, both nares, dailyRhinitisFluticasone (Flonase) 50 mcg/actuation nasal spray2 sprays, both nares, 2x/day @ 0900Acute respiratory failure (interstitial lung disease)May not be able to take due to NG tube/occluded nares. Onset 12hr, peak several days, duration 1-2 wkFurosemide (Lasix) 10 mg/mL40 mg = 4 mL IV every 12 hrs @ 1200Pulmonary edema; CHF, HTN. Loop diuretic. Action:Inhibits reabsorption of sodium and chloride at proximal and distal tubule and in the loop of HenleLife threatening adverse side effects: circulatory collapse, leukopenia, aplastic anemia, agranulocytosis (rare)Furosemide (Lasix) 500 mg in no diluent, 50 mL drip (straight drug)Dose: 30 mg/hr, infusion: 3 mL/hr, IV continuous dripPulmonary edema; CHF, HTN, fluid volume overload. Loop diuretic. Action:Inhibits reabsorption of sodium and chloride at proximal and distal tubule and in the loop of HenleLife threatening adverse side effects: circulatory collapse, leukopenia, aplastic anemia, agranulocytosis (rare). Protect from light.Gabapentin (Neurontin)800 mg cap 3x/dayNeuropathic painGabapentin (Neurontin)1,600 mg cap dailyNeuropathy, neuropathic pain, fibromyalgia, insomniaGabapentin (Neurontin)400 mg cap 3x/dayNeuropathic pain, migraine prophylaxisGlucagon (Glucagen) injection 1 mg1 mg IM, QID AC & HS PRN,1 mL = 1mg of 1 mg/mLHypoglycemiaIf patient glucose less than 70 mg/dL, has a decreased level of consciousness, is unable to take glucose orally, and IV access cannot be established within 5 mins, administer glucagon 1 mg IM then continue to attempt IV access. Place pt. in lateral recumbent position in anticipation of vomiting. Monitor glucose every 15-20 mins and repeat 1mg IM if glucose remains less than 80 mg/dL. Continue to monitor glucose every 15-20 mins until it returns to greater than 100 mg/dL x2.Guaifenesin (Robitussin)100 mg/5 mL, 200 mg, dose: 10 mL, every 4 hrs PRNCoughGuaifenesin (Robitussin)200 mg/10 mL every 4 hrs PRNSore throat, coughGuailfenesin (Robitussin) 100 mg/5 mL oral liquid 300 mg15 mL, 300 mg, oral, every 6 hrs PRNCongestion, coughHeparin7500 units SQ every 12 hoursAnticoagulantRequires 2 nurse check. Life threatening adverse effects: spontaneous bleeding, thrombocytopenia, bronchospasm, anaphylactoid reactions.Heparin 5,000 units/0.5 mL injection 10,000 units10,000 units Intracatheter, PRN conditional, post hemodialysis txFor post hemodialysis treatment; Anticoagulant2 nurse check, potential for bleeding.Heparin 5,000 units/0.5 mL injection 5,000 units5,000 units SubQ every 12 hrs-STDAnticoagulant, deep venous thrombosis2 nurse checkHeparin 5,000 units/0.5 mL injection 5,000 units5,000 units SubQ every 12 hrs-STD, due @ 0900Anticoagulant, DVT prophylaxis2 nurse check, potential for bleeding.Heparin D5W 25,000 unit/500 mL (50 unit/mL) drip2,000 units/hr, 40mL/hr, IV continuous dripAnticoagulantRequires 2 nurse checkHeparin D5W 25,000 unit/500 mL (50 unit/mL) drip1,550 units/hr, 31 mL/hr, IV continuous dripFor NSTEMI, Anticoagulant. Venous thromboembolism prophylaxisRequires 2 nurse checkHeparin dosing per pharmacy 1 each1 each, daily PRNAnticoagulantRequires 2 nurse check. Heparin dosing per pharmacy 1 each1 each, daily PRN, Pharmacy consultFor NSTEMI, AnticoagulantHeparin dosing and monitoring (including platelets) in accordance with medical center-approved guideline and policy and procedure. Hydralazine (Apresoline) 20 mg/mL injection10 mg IV, every 4 hrs PRN; admin 0.5 mL = 10 mg of 20 mg/mLHTN, For Systolic BP > 170. Non-nitrate vasodilatorOnly give if meets parameters for high BP, check BP prior to admin.Hydrochlorothiazide (Hydrodiuril)25 mg tab dailyHypertension, and also edema associated with CHFCheck BP before givingHydrocodone – acetaminophen (Norco)7.5 - 325 mg tab 1-2 Tabs, every 4 hrs PRNMod pain (4 – 6) 1 tab, severe pain (7-10) 2 tabsDon’t exceed 4,000 mg of acetaminophen per day from all sourcesHydrocodone – acetaminophen (Norco)10 – 325 mg tab 1 Tab, every 4 hrs PRNMod pain (4 – 6) Don’t exceed 4,000 mg of acetaminophen per day from all sourcesHydrocodone – acetaminophen (Norco)7.5 – 325 mg tab 1 Tab, every 4 hrs PRNMild pain (1-3)Don’t exceed 4,000 mg of acetaminophen per day from all sourcesHydrocodone – acetaminophen (Norco)7.5-325 mg tab 1-2 Tabs, every 4 hrs PRNMild pain (1-3) 1 tab, Mod pain (4 – 6) 2 tabsDon’t exceed 4,000 mg of acetaminophen per day from all sourcesHydrocodone – acetaminophen (Norco)5 – 325 mg tab 1 Tab, every 4 hrs PRNMild pain (1-3)Don’t exceed 4,000 mg of acetaminophen per day from all sourcesHydrocodone – acetaminophen (Norco)10 – 325 mg tab 1 Tab, every 4 hrs PRNMod pain (4 – 6) Don’t exceed 4,000 mg of acetaminophen per day from all sourcesHydrocodone – acetaminophen (Norco)7.5 – 325 mg tab 1 Tab, every 4 hrs PRNMild pain (1-3)Don’t exceed 4,000 mg of acetaminophen per day from all sourcesHydrocodone – acetaminophen (Norco)5 – 325 mg tab 1-2 Tab, every 4 hrs PRNMild pain (1-3), Mod pain (4-6)Don’t exceed 4,000 mg of acetaminophen per day from all sources. If an injectable analgesic is concurrently ordered for the same severity of pain, use oral when patient is consistently tolerating oral intake.Hydrocodone – acetaminophen (Norco) 5-325 mg tab1 tab, every 4 hrs PRNMild pain (1-3)Do not exceed 4,000 mg of acetaminophen per day from all sources. If an injectable analgesic is concurrently ordered for the same severity of pain, use oral when patient is consistently tolerating oral intake.Hydrocortisone (Cortizone-10)1% topical cream, 2x/day PRNSkin rashApply to left chest wall rash as needed.Hydromorphone (Dilaudid) injection1 mg/1 mL, IV, every 3 hrs PRNSevere pain (7-10)If an oral analgesic is concurrently ordered for the same severity of pain, only use injectable route if patient is not tolerating oral intake or if oral analgesics are ineffective.Hydromorphone (Dilaudid) injection1 mg IV, every 4 hrs PRNSevere pain (7-10)If oral analgesic is concurrently ordered for same severity of pain, only use injectable route if pt. is not tolerating oral intake or if oral analgesics ineffective.Hydromorphone (Dilaudid) injection2 mg IV, 2x/day PRNSevere pain (7-10)Premedicate for dosage change. If oral analgesic is concurrently ordered for same severity of pain, only use injectable route if pt. is not tolerating oral intake or if oral analgesics ineffective.Hydromorphone (Dilaudid) injection1.5 mg IV, every 2 hrs PRNSevere pain (7-10)If oral analgesic is concurrently ordered for same severity of pain, only use injectable route if pt. is not tolerating oral intake or if oral analgesics ineffective.Hydromorphone (Dilaudid) injection1 mg IV, every 2 hrs PRNModerate pain (4 – 6), if patient is not tolerating oral intake or if oral analgesics ineffectiveIf oral analgesic is concurrently ordered for same severity of pain, only use injectable route if pt. is not tolerating oral intake or if oral analgesics ineffective.Hydromorphone (Dilaudid) injection0.5 mg IV, every 4 hrs PRNModerate pain (4 – 6)If oral analgesic is concurrently ordered for same severity of pain, only use injectable route if pt. is not tolerating oral intake or if oral analgesics ineffective.Hydroxyzine (atarax)25 mg tab every 6 hrs prnItchingDrowsiness Insulin glargine (Lantus) 100 unit/mL injection 10 units10 units, SubQ, daily @ 0900Glucose control, Steroid induced diabetes (solumedrol)To be given when insulin drip discontinued. Long acting insulin, duration up to 24 hrs. If patient becomes NPO or other nutrition is interrupted for more than 1 hr or a bolus feeding is missed, contact physician for orders which may include insulin dose reduction, addition of D10 infusion, and more frequent glucose monitoring.Insulin glargine (Lantus) 100 unit/mL injection 16 units16 units, SubQ, daily at bedtimeType 2 diabetesLong acting insulin, duration up to 24 hrs. If patient becomes NPO or other nutrition is interrupted for more than 1 hr or a bolus feeding is missed, contact physician for orders which may include insulin dose reduction, addition of D10 infusion, and more frequent glucose monitoring.Insulin Lispro (Humalog) 100 unit/mL injection 1-6 Units1 – 6 Units SubQ, every 6 hrs per correction scale, due @1200Type 2 diabetes2 nurse check. Use correction scale. Call MD if glucose greater than 400 mg/dLInsulin Lispro (Humalog) 100 unit/mL injection 2-12 Units2 – 12 Units SubQ, QID AC & HS PRN for elevated glucose per correction scaleType 2 diabetes2 nurse check. Use correction scale.Insulin Lispro (Humalog) 100 unit/mL injection 2-12 Units2 – 12 Units SubQ, every 6 hours PRN for elevated glucose per correction scaleType 2 diabetes2 nurse check. Use correction scale.Insulin Lispro (Humalog) 100 unit/mL injection 2-12 Units2 – 12 Units SubQ, 4x/day – before meals & at bedtime. Due @ 0800 & 1200. For elevated glucose per correction scaleType 2 diabetes2 nurse check. Use correction scale.Insulin Lispro (Humalog) 100 unit/mL injection 2-12 Units2 – 12 Units SubQ, 4x/day – before meals & at bedtime. Due @ 0800 & 1100. Type 2 diabetes2 nurse check. Use correction scale.Insulin regular human (NovoLin R, HumuLIN R), 100 unit/mL, injection 2-12 units2-12 units SubQ every 6 hrs PRN For elevated blood glucose per correction scale. Type 2 DM.Requires 2 nurse check. BG 151-200 = 2 units, BG 201-250 = 4 units, BG 251-300 = 6 units, BG 301-350 = 8 units, BG 351-400 = 10 units, BG > 400 = 12 units and call MD Insulin regular human (NovoLin R, HumuLIN R), 100 units in NS 100 mL drip1-5 units/hr, 1-5mL/hr, continuous IV drip Glucose control, Steroid induced diabetes (solumedrol)Requires 2 nurse check. Same caution as above. BG < 180 = 0 units/hr, BG 181-200 = 1 unit/hr, BG 201-250 = 2 units/hr, BG 251-300 = 3 units/hr, BG 301-400 = 4 units/hr, BG > 400 = 5 units/hr (on care planning day insulin was not being titrated according to this scale).Insulin regular human U-500 “Concentrated” (HumuLIN R U-500 “concentrated”), 500 unit/mL40 Units, SubQ, 3x/day before mealsType 2 DiabetesRequires 2 nurse check. Caution: Insulin U-500 is five times more concentrated than insulin U-100. 40 units U-500 equals 8 units marking on U-100 syringe (Blood sugar 100 or higher). If blood sugar less than 100 mg/dl, give 25 units U-500, equals 5 units marking on U-100 syringe. If pt. is NPO, HOLD insulin.Insulin regular human U-500 “Concentrated” (HumuLIN R U-500 “concentrated”), 500 unit/mL5-15 Units, SubQ, 3x/day before meals as neededType 2 DiabetesRequires 2 nurse check. Same caution as above. If glucose 200-300, give 5 units, U-500 equals 1 unit marking on U-100 syringe. If glucose 301-400, give 10 units U-500 equals 2 unit marking on U-100 syringe. If over 400, give 15 units U-500 equals 3 unit marking on U-100 syringe.Insulin regular human U-500 “Concentrated” (HumuLIN R U-500 “concentrated”), 500 unit/mL5-15 Units, SubQ, HS PRNType 2 DiabetesRequires 2 nurse check. For elevated blood sugar per correction scale at 2100. Same caution and instructions as immediately above.Ipratropium – albuterol (Duo-neb) 0.5 mg-3mg (2.5 mg base/ 3 mL nebulizer soln3 mL nebulizer 4x/day, due @ 0800 & 1200. RT AdminWheezing, shortness of breathAdministered by Respiratory TherapistIpratropium – albuterol (Duo-neb) 0.5 mg-3mg (2.5 mg base/ 3 mL nebulizer soln3 mL nebulizer every 4 hrs, due @ 0800 & 1200. RT AdminWheezing, shortness of breathAdministered by Respiratory TherapistIpratropium (Atrovent)0.02% nebulizer soln 0.5 mg every 4 hrsCOPD, bronchodilatorAdministered by Respiratory TherapistIpratropium (Atrovent)0.02% nebulizer soln 0.5 mg every 2 hrs PRNWheezing, shortness of breathAdministered by Respiratory TherapistIpratropium (Atrovent)0.02% nebulizer soln 0.5 mg every 4 hrs @ 0815 and 1215Acute respiratory failure (interstitial lung disease)Shortness of breath, bronchodilatorAdministered by Respiratory TherapistIpratropium (Atrovent)0.02% nebulizer soln 0.5 mg PRN conditional: dyspneaDyspnea, Acute respiratory failure, ARDS, bronchodilatorAdministered by Respiratory TherapistIsosorbide Dinitrate10 mg PO 4x/dayNitrate vasodilator, AntianginalAdverse effects: light headedness, flushing.Ketorolac (Toradol)30 mg IV every 6 hrs PRNMild pain (1 – 3), Mod pain (4 – 6)Labetalol (Normodyne)20 mg IV every 4 hrs PRNHypertension, SBP >140For systolic greater than 140. Check to see if other antihypertensive administered.Lansoprazole (Prevacid)30 mg soluble tab, via NG tube @ 0700GI ProphylaxisBefore breakfast. Per P&T approved policy, automatically substituted for protonix 40 mg d/t NG tube. Plasma half-life 1 ? -2hr. Adverse Reactions: CVA, MI, shock, hematuria, hemolysis .Levalbuterol (Xopenex)1.25 mg/0.5 mL nebulizer soln @ 0800 and 1200Acute respiratory failure (interstitial lung disease)Administered by Respiratory TherapistLevetiracetam (Keppra)1,000 mg in D5W 100 mL, 2x/day, @ 0900, infuse over 15 minsPrevention of epileptic seizures (anticonvulsant). Inhibtis complex partial seizures and prevents epileptic and seizure activityContraindications: suicidal ideation; Cautious use: history of psychosis or depression, suicidal tendencies. Peak: 1hr, Half-life: 7.1 hr.Levetiracetam (Keppra)500 mg tab 2x/day, due @ 0900Prevention of epileptic seizures (anticonvulsant). Inhibits complex partial seizures and prevents epileptic and seizure activityContraindications: suicidal ideation; Cautious use: history of psychosis or depression, suicidal tendencies. Peak: 1hr, Half-life: 7.1 hr.Levothyroxine (Synthroid)125 mcg tab before breakfastHypothyroidismLevothyroxine (Synthroid)300 mcg tab before breakfast @ 0700Hyponatremia and HypothyroidismContraindications: severe cardiovascular conditions, acute MI. Cautious: cardiac disease, angina pectoris, cardiac arrhythmias, older adult, impaired kidney function. Common adverse: insomnia. Other adverse: palpitations, tachycardia, arrhythmias, angina pectoris, hypertensionLidocaine – D5W 4 mg/mL (0.4%) drip (conc: 4000 mcg/mLDose: 1 mg/min, 15 mL/hr, IV PRN conditionalVentricular tachycardiaStart after push for sustained ventricular tachycardia.Lidocaine (Xylocaine) 100 mg/5 mL (2%) prefill syringe 75 mg Dose: 75 mg IV PRN conditional. 3.75 mL = 75 mg of 100 mg/5 mLFor sustained ventricular tachycardia (class IB antiarrhythmic). Surpresses automaticity in His-Purkinje system. Inhibits sodium influx into myocardial cells, elevates electrical stimulation threshold of ventricle during diastole.Contraindications: supraventricular arrhythmias, untreated sinus bradycardia, severe degrees of sinoatrial, atrioventricular, and intraventricular heart block. Cautious use: Liver or kidney disease, CHF, shock, older adults.Onset: 45-90 sec IV, Duration 10-20 min IV, Half-life: 1.5-2 hr.Life threatening adverse effects: difficulty in breathing or swallowing; convulsions, respiratory distress (high doses); cardiovascular collapse, cardiac arrest.Lidocaine 1% (Xylocaine) 0.1 mL, onceFor use by RT (as needed prior to drawing ABG)Administered by Respiratory TherapistLorazepam (Ativan)1 – 2 mg IV every 4 hrs PRNAgitation, seizures, tremor, give for withdrawal symptomsDilute with an equal amount of NS and give over 1 – 2 mins. Hold for any compromise of respirations; unarousable, alteration in mental status. Call MD immediately.Lorazepam (Ativan)1 mg IV every 6 hrs PRNAnxiety, agitation, seizures, tremor, history of methamphetamine use.Dilute with an equal amount of NS and give over 1 – 2 mins. Common adverse effects: drowsiness, sedation. Onset: 1-5 min IV, Duration: 12-24 hrLorazepam (Ativan)2 mg IV every 2 hrs PRNAnxiety, AgitationDilute with an equal amount of NS and give over 1 – 2 mins. Usual maximum dose per 12 hours: 8 mg. Hold for any compromise of respirations; unarousable, alteration in mental status. Call MD immediately.Lorazepam (Ativan)2 mg IV every 1 hr PRNAnxiety, AgitationDilute with an equal amount of NS and give over 1 – 2 mins. Losartan (Cozaar)50 mg tab daily @ 0900CHF, HTN; angiotensin II receptor antagonist; antihypertensivePatient on ventilator, NG Tube. Hold for Systolic BP < 100. Peak: 6h, duration: 24 h, half-life: 1.5-2 h. Cautious use: patients on diuretics, heart failureMaalox TC (Loperamide)15 mL PO every 4 hours PRNIndigestion Magnesium hydroxide (Milk of magnesia)Concentrated oral liquid, 10 mL daily PRNconstipation10 mL concentrate equivalent to 30 mL MOMMagnesium sulfate 2g in D5W 50 mL IVPBDose 2g, IVPB, over 1 hr, PRN conditional, for Mg 1.9-2.0Hypomagnesemia (electrolyte replacement)Contraindications: myocardial damage; AV heart block; cardiac arrest except for certain arrhythmias. Cautious: renal disease, renal failure, renal impairment; acute MI.Life threatening adverse effects: complete heart block, circulatory collapse, respiratory paralysis, flaccid paralysisMagnesium sulfate 2g in D5W 50 mL IVPBDose 2g, IVPB, over 1 hr, PRN conditional, for Mg 1.9-2.0Hypomagnesemia (electrolyte replacement)Conditional, for Mg 1.9-2.0, admin over 1 hour.Contraindications: myocardial damage; AV heart block; cardiac arrest except for certain arrhythmias. Cautious: renal disease, renal failure, renal impairment; acute MI.Life threatening adverse effects: complete heart block, circulatory collapse, respiratory paralysis, flaccid paralysisMagnesium sulfate 2g in D5W 50 mL IVPBDose 2g, IVPB, over 1 hr, PRN conditional, for Mg 1.9-2.0Hypomagnesemia (electrolyte replacement)Contraindications: myocardial damage; AV heart block; cardiac arrest except for certain arrhythmias. Cautious: renal disease, renal failure, renal impairment; acute MI.Life threatening adverse effects: complete heart block, circulatory collapse, respiratory paralysis, flaccid paralysisMagnesium sulfate 3g in D5W 100 mL IVPBDose 3g, IVPB, over 90 mins, PRN conditional, for Mg 1.6-1.8HypomagnesemiaMagnesium sulfate 3g in D5W 100 mL IVPBDose 3g, IVPB, over 90 mins, PRN conditional, for Mg 1.6-1.8HypomagnesemiaConditional, for Mg 1.6-1.8, admin over 90 mins.Magnesium sulfate 4g in D5W 100 mL IVPBDose 4g, IVPB, over 2 hrs, PRN conditional, for Mg less than 1.6HypomagnesemiaMagnesium sulfate 4g in D5W 100 mL IVPBDose 4g, IVPB, over 2 hrs, PRN conditional, for Mg less than 1.6HypomagnesemiaConditional, for Mg less than 1.6, admin over 2 hoursMeclizine (Antivert)12.5 mg tab 4x/dayNausea/vomiting and dizziness (antihistamine)Contraindicated for GI obstruction or ileusMeperidine PF (Demerol)100 mg every 4 hrs PRN IVPBShiveringIf an oral analgesic is concurrently ordered for the same severity of pain, only use injectable route if patient is not tolerating oral intake or if oral analgesics are ineffective..Meropenem (Merrem)1g in NS 100 mL IVPB every 12 hrs @ 0900Antibiotic, for respiratory culture positive for gram pos cocci and gram neg bacilli. Broad-spectrum carbapenem antibiotic that inhibits cell wall synthesis of bacteria by its strong affinity for penicillin binding proteins of bacterial cell wall. Effective against both gram pos and gram neg bacteria.Adjusted based on estimated CI = 41 ml/min from VancomycinMethylprednisolone PF (Solu-medrol) 40 mg IV every 6 hrs taper @0700, 1300Anti-inflammatory agent for COPD (bronchial asthma)Methylprednisolone PF (Solu-medrol) 40 mg IV every 12 hrs @ 0630Acute respiratory failure (interstitial lung disease). Has anti-inflammatory and immunosuppressive properties.Led to steroid induced diabetes mellitus in this patient.Methylprednisolone PF (Solu-medrol) 40 mg IV every 12 hrs @ 0900For COPD. Has anti-inflammatory and immunosuppressive properties. Anti-inflammatory agent for COPD (bronchial asthma)Leads to elevated blood glucose Glucocorticoid. Patient also has Type 2 DM. Immunosuppressant.Metoclopramide (Reglan)10 mg tab every 6 hrs PRNNauseaMetoclopramide (Reglan)10 mg IV every 6 hrs NauseaIV Administration: Doses > 10 mg – Dilute in 50 mls D5W or NS and infuse over 15 minutesMetoclopramide (Reglan)10 mg IV every 12 hrs @ 0830NauseaIV Administration: Doses > 10 mg – Dilute in 50 mls D5W or NS and infuse over 15 minutesMetolazone (Zaroxolyn)10 mg tab @ 0900Diuretic (thiazide like), for fluid volume overload, CHFMay be administered with food or milk.Metoprolol (Lopressor)5 mg IV every 4 hrs PRNAtrial fibrillation, CHF, HTNFor heart rate > 110, administer over 1 minuteMetoprolol (Lopressor)12.5 mg tab, 2x/day, @0900Blood pressure/hypertension management, replacement med for Nicardipine. Beta-adrenergic antagonist with preferential effect on beta1 receptors located primarily on cardiac muscle. Reduces HR and cardiac output at rest, lowers BP.Hold for HR < 50, Hold for systolic BP < 100, administer with food if not NPO. Cautious use: major depression. Life threatening effects: laryngospasms, complete heart block, cardiac arrest. Onset: 15 min, Peak: 20 min IV, Duration 13-19 hr, Half-life: 3-4 hr.Metoprolol (Lopressor)5 mg IVP slowly every 5 mins x3 doses totalAcute MI, HTN management. (Antihypertensive, Antianginal)Only admin if not done in ED. Admin slowly. Hold for HR < 60 or SBP < 110.Metoprolol (Lopressor)50 mg PO every 12 hrsAcute MI, HTN managementHold for HR < 60 or SBP < 110.Metoprolol (Lopressor)50 mg tab PO 2x/day due @ 0900HTN managementHold for HR < 60 or Systolic BP < 100. Admin with food if not NPO.Metoprolol ER (Toprol - XL)50 mg tab dailyHypertension management, long term treatment of angina pectoris reduce risk of mortality after MI, migraine prophylaxisHold for heart rate less than 60 bpm. Hold for Systolic BP less than 110 mmHg. Swallow whole, don’t crush or chew, tablet is scored and may be splitMidazolam (Versed)100 mg in D5W 100 mL continuous drip IV; dose: 1mg/hr. Held on care planning day (not needed)Agitation (CNS depressant with muscle relaxant, sedative-hypnotic, anticonvulsant, and amnestic properties)If goal RASS (Richmond Agitation Sedation Scale) not achieved: use up to 2 bolus doses before increasing rate by 1 mg/hr every 15m ins until goal RASS score achieved. If goal RASS surpassed: lower rate by 1 mg/hr every 15 mins until goal RASS score achieved. If at goal RASS score: continue current dose. Max dose: 12 mg/hr. Recommended max dose: 0.2 mg/kg/hr. Notify intensivist: if patient on max dose. Common adverse effects: retrograde amnesia; Life threatening adverse effects: laryngospasm, respiratory arrest. Onset: 1-5 min IV, peak: 20-60 min, Duration: less than 2hr IV.Midazolam (Versed)1 mg IV, every 5 mins PRNagitationAdmin IV push over 2-5 mins, every 5 mins up to 2 dosees PRN agitation before increasing continuous infusion rate.Midazolam (Versed)1 mg IV, every hrs PRNAgitation (CNS depressant with muscle relaxant, sedative-hypnotic, anticonvulsant, and amnestic properties)Admin IV push over 2-5 mins. Hold for Systolic BP < 100.Midazolam (Versed)100 mg in D5W 100 mL continuous drip IV; dose: 1mg/hr. 1mL/hrNot currently running.Agitation (CNS depressant with muscle relaxant, sedative-hypnotic, anticonvulsant, and amnestic properties)If goal RASS (Richmond Agitation Sedation Scale) not achieved: use up to 2 bolus doses before increasing rate by 1 mg/hr every 15 mins until goal RASS score achieved. If goal RASS surpassed: lower rate by 1 mg/hr every 15 mins until goal RASS score achieved. If at goal RASS score: continue current dose. Max dose: 12 mg/hr. Recommended max dose: 0.2 mg/kg/hr. Notify intensivist: if patient on max dose. Common adverse effects: retrograde amnesia; Life threatening adverse effects: laryngospasm, respiratory arrest. Onset: 1-5 min IV, peak: 20-60 min, Duration: less than 2hr IV.Midazolam (Versed)1 mg IV, every 5 mins PRNagitationAdmin IV push over 2-5 mins, every 5 mins up to 2 doses PRN agitation before increasing continuous infusion rate.Midazolam (Versed)100 mg in D5W 100 mL continuous drip IV; dose: 1mg/hr. 1mL/hrAgitation (CNS depressant with muscle relaxant, sedative-hypnotic, anticonvulsant, and amnestic properties)If goal RASS (Richmond Agitation Sedation Scale) not achieved: use up to 2 bolus doses before increasing rate by 1 mg/hr every 15 mins until goal RASS score achieved. If goal RASS surpassed: lower rate by 1 mg/hr every 15 mins until goal RASS score achieved. If at goal RASS score: continue current dose. Max dose: 12 mg/hr. Recommended max dose: 0.2 mg/kg/hr. Notify intensivist: if patient on max dose. Common adverse effects: retrograde amnesia; Life threatening adverse effects: laryngospasm, respiratory arrest. Onset: 1-5 min IV, peak: 20-60 min, Duration: less than 2hr IV.Midazolam (Versed)1 mg IV, every 5 mins PRNAgitationEvery 5 mins up to 2 doses PRN agitation before increasing continuous infusion rate. Dose to be given from IV infusion pump.Midazolam (Versed)100 mg in D5W 100 mL continuous drip IV; dose: 1mg/hr. 1mL/hrAgitation (CNS depressant with muscle relaxant, sedative-hypnotic, anticonvulsant, and amnestic properties)If goal RASS (Richmond Agitation Sedation Scale) not achieved: use up to 2 bolus doses before increasing rate by 1 mg/hr every 15 mins until goal RASS score achieved. If goal RASS surpassed: lower rate by 1 mg/hr every 15 mins until goal RASS score achieved. If at goal RASS score: continue current dose. Max dose: 12 mg/hr. Recommended max dose: 0.2 mg/kg/hr. Notify intensivist: if patient on max dose. Common adverse effects: retrograde amnesia; Life threatening adverse effects: laryngospasm, respiratory arrest. Onset: 1-5 min IV, peak: 20-60 min, Duration: less than 2hr IV.Midazolam (Versed)1 mg IV, every 5 mins PRNAgitationEvery 5 mins up to 2 doses PRN agitation before increasing continuous infusion rate. Dose to be given from IV infusion pump.Milk of magnesia (magnesium hydroxide)30 mL PO daily PRNConstipationMorphine 1 – 2 mg IV every 3 hrs PRNMod pain (4-6), severe pain (7-10)Morphine1-4 mg IVP every 5 minutesFor angina not relieved by NitroglycerinHold for SBP less than 90Morphine ER (MS Contin)45 mg tab every 8 hrs PainSwallow whole. Do not crush, chew, or split.Morphine injection 4 mg IV every 3 hrs PRN2 mg mod pain (4-6), 4 mg severe pain (7-10), for breakthrough pain.If an oral analgesic is concurrently ordered for the same severity of pain, only use injectable route if patient is not tolerating oral intake or if oral analgesics are ineffective.Morphine injection4-6 mg IV every 4 hrs PRNMod pain (4 – 6) 4 mg, severe pain (7-10) 6 mgOnly use injectable route if patient isn’t tolerating oral intake or if oral analgesics ineffective (see: Norco)Morphine injection2 mg IV, every 3 hrs PRNMod pain (4-6), severe pain (7-10)Morphine injection2 mg IV, every 5 mins PRNMild pain (1-3), Mod pain (4-6), severe pain (7-10)Maximum dose = 10 mg. Agent A: give in PACU ONLY, discontinue on transfer from PACU.Morphine injection2 mg IV, every 2 hrs PRNMod pain (4-6), severe pain (7-10)If an oral analgesic is concurrently ordered for the same severity of pain, only use injectable route if patient is not tolerating oral intake or if oral analgesics are ineffective. . Hold for Systolic BP < 100.Morphine injection2 mg IV, every 1 hr PRNMod pain (4-6), severe pain (7-10)If an oral analgesic is concurrently ordered for the same severity of pain, only use injectable route if patient is not tolerating oral intake or if oral analgesics are ineffective.Morphine injection1 mg IV, every 4 hrs PRNMod pain (4-6), severe pain (7-10)If an oral analgesic is concurrently ordered for the same severity of pain, only use injectable route if patient is not tolerating oral intake or if oral analgesics are ineffective.Naloxone (Narcan)0.2 mg IV every 1 min PRNTo counteract morphine overdose. As needed x5 doses, to increase patient alertness and respiratory rate to greater than 10/minIf patient difficult to arouse and/or resp rate less than 10/min.Nicardipine (Cardene)Dose: 2.5 mg/hr; 50 mg in NS 250 mL drip, continuous dripAs needed to keep Systolic BP under 140. Calcium channel blocker. Significantly decreases systemic vascular resistance; reduces BP.If 0.1 and 0.2 mg/mL concentration are administered through a large peripheral vein, change the infusion site every 12 hours. Onset: 1 min IV, Peak: 0.5-2 hr, Duration: 3 hr IV, Half-life: 8.6 hr.Nicotine (Nicoderm) 21 mg/24 hr transdermal patch1 patchTobacco userApply to hairless, clean, dry area of upper arm or hipNitroglycerin50 mg/250mL D5W IV at 5mcg/minuteChest pain. Antianginal, vasodilatorTitrate for chest pain with SBP greater than 90Nitroglycerin0.4 mg SL for chest pain PRN. May repeat 3x every 5 minsChest pain. Antianginal, vasodilatorMay repeat 3x every 5 mins. Call healthcare provider if chest pain unrelieved by nitroglycerinNitroglycerin SL (Nitrostat)0.4 mg sublingual every 5 minutes PRNChest pain (Antianginal, vasodilator)Dissolve under tongueNitroglycerin SL (Nitrostat)0.4 mg sublingual every 5 minutes PRNChest pain (Antianginal, vasodilator)Dissolve under tongueNitropaste1” topically 3x/ dayAntianginal, vasodilatorHold for SBP < 110Norepinephrine (Levophed) 8,000 mcg in D5W 250 mL dripDose: 2 mcg/min, 3.75 mL/hr IV continuous drip (32 mcg/mL)Low blood pressure and heart failure, sepsis.Vesicant (skin, eye, mucosal pain/irritation)Norepinephrine (Levophed) 8,000 mcg in D5W 250 mL dripDose: 2 mcg/min, 3.75 mL/hr IV continuous drip (32 mcg/mL)Low blood pressure, sepsis.Titrate to keep MAP > 65. Vesicant (skin, eye, mucosal pain/irritation)NS 1,000 mL IV soln50 mL/hr continuous IV infusionFluid intakeHypervolemiaNS 1,000 mL IV soln75 mL/hr continuous IV infusionFluid intakeHypervolemiaNS 1,000 mL IV soln1,000 mL, 125 mL/hr continuous IVFluid intakeNS 1,000 mL IV soln100 mL/hr continuous IV infusionFluid intakeHypervolemiaNS 500 mL IV soln20 mL/hr continuous IV infusionFluid intakeHypervolemiaNS with KCL 20 mEq/L IV soln1,000 mL, 100 mL/hr IV continuousFluid intake and electrolyte balanceNS with KCL 20 mEq/L IV soln1,000 mL, 75 mL/hr IV continuous; R. wrist 20 gFluid intake and electrolyte balanceKeep patient euvolemic and minimize IV fluids if possible per neurosurgery.NS with KCL 20 mEq/L IV soln1,000 mL, 40 mL/hr IV continuousFluid intake and electrolyte balanceNystatin (Mycostatin) topical powder1 application, 2x/day, due @ 0900Antifungal antibiotic; Candida infectionApply to pannus, groinOndansetron (Zofran) 4 mg/2 mL, IV, every 8 hrs PRNNausea/vomitingMay repeat x1 after 30 minsOndansetron (Zofran)4 mg IV , every 6 hrs PRNNausea/vomitingDizzinessOndansetron (Zofran)4 mg IV every 4 hrs PRNNausea/vomitingMay repeat x1 after 30 minsOndansetron (Zofran)4 mg/2mL IV , every 6 hrs PRNNausea/vomitingDizziness, headache, sedation, diarrhea are common adverse side effects. Peak: 1-1.5 hr, half-life: 3 hr.Ondansetron (Zofran)4 mg/2 mL, IV, every 8 hrs PRNNausea/vomitingMay repeat x1 after 30 mins. Dizziness. Peak: 1-1.5 hr, half-life: 3 hr.Oxycodone - acetaminophen (Percocet) 5-325 mg tab Dose 1-2 tab every 6 hrs PRNFor moderate to severe breakthrough painDo not exceed 4,000 mg of acetaminophen per day from all sources. If an injectable analgesic is concurrently ordered for the same severity of pain, use oral when patient is consistently tolerating oral intake. 1 tab for moderate pain, 2 tabs for severe pain.Therapeutic substitution with formulary agent per P&T committee. Substituted for Percocet 2.5-325 mg tab.Oxycodone - acetaminophen (Percocet) 7.5-325 mg tab2 tab, every 4 hrs PRNMild pain (1-3), mod pain (4-6)Do not exceed 4,000 mg of acetaminophen per day from all sources. If an injectable analgesic is concurrently ordered for the same severity of pain, use oral when patient is consistently tolerating oral intake.Pantoprazole (Protonix)40 mg IV daily @ 0900GI prophylaxisDilute in 10 mL of NS and admin over a minimum of 2 mins.Pantoprazole (Protonix)40 mg IV every 12 hrsGI prophylaxisDilute in 10 mL of NS and admin over a minimum of 2 mins.Pantoprazole EC (Protonix)40 mg tab dailyGI prophylaxis (Antiulcer, proton pump inhibitor)Swallow whole. Do not crush, chew, or splitPantoprazole EC (Protonix)20 mg tab daily @ 0900GI prophylaxis (Antiulcer, proton pump inhibitor)Swallow whole. Do not crush, chew, or splitPiperacillin – tazobactam (Zosyn)3.375 g in D5W 100 mL IVPB @ 200 mL/hr every 6 hrsAntibioticPiperacillin – tazobactam (Zosyn)3.375 g in D5W 100 mL IVPB @ 200 mL/hr every 6 hrs, due @ 1045Antibiotic; two drug combination has antibiotic activity against an extremely broad spectrum of gram-positive, gram-negative, and anaerobic bacteria. Tazobactam extends the spectrum of bacteria susceptible to piperacillin. Heavy growth of multiple colony types of gram negative bacilli, clinical significance uncertain. Possible aspiration pneumonia.Infuse over 30 mins. Life threatening adverse effect: pseudomembranous colitis.Piperacillin – tazobactam (Zosyn)3.375 g in D5W 100 mL IVPB @ 200 mL/hr every 6 hrs, due @ 1200Antibiotic; two drug combination has antibiotic activity against an extremely broad spectrum of gram-positive, gram-negative, and anaerobic bacteria. Tazobactam extends the spectrum of bacteria susceptible to piperacillin. Heavy growth of multiple colony types of gram negative bacilli, clinical significance uncertain. Patient has Health Care Associated Pneumonia.Infuse over 30 mins @ 200 mL/hr. Life threatening adverse effect: pseudomembranous colitis.Pneumococcal vaccine (Pneumovax 23)0.5 mL IM PRN conditionalVaccine Indicated per screening. Consider subQ admin if patient anticoagulatedPneumococcal vaccine (Pneumovax)0.5 mL IMVaccinePrior to discharge, admin when pt. temp is less than 100.4Polyethylene glycol (Miralax)17g oral packet, daily PRNConstipationDissolve in 4 to 8 ounces of liquid; give only if no BM today, use as PRN for constipation. 1 fl. Oz. = 30 mLPolyvinyl alcohol (Teargen)1.4% opthalmic soln 1 drop, both eyes, every 4 hoursArtificial tearsPotassium chloride Dose: 20 mEq/100 mL, IV, PRN conditional, 20 mEq = 100 mLHypokalemiaInfuse each 20 mEq over 1 hr. Use correction scale in MARPotassium chloride (K-Dur)Dose: 40 mEq tab daily @ 0900HypokalemiaSwallow whole. Don’t crush or chew. Scored tablet may be split.Potassium chloride 10 mEq/100 mLDose: 10 mEq, IV, PRN conditional, 10 mEq = 100 mLHypokalemiaInfuse each 10 mEq over 1 hr. Use correction scalePotassium chloride 10 mEq/100 mLDose: 10 mEq, IV, PRN conditional, 10 mEq = 100 mLHypokalemiaDaily PRN. Infuse each 10 mEq over 1 hr. Use correction scale in MAR.Prochlorperazine (Compazine)25 mg rectal suppository every 12 hrs PRNnauseaProchlorperazine (Compazine)10 mg tab every 6 hrs PRNnauseaPromethazine12.5 mg IV/PO every 4-6 hours PRNNauseaLife threatening adverse effects: respiratory depression, apnea, Leukopenia, agranulocytosisPropofol (Diprivan)5 mcg/kg/min x 90.3 kg, Admin dose: 451.5 mcg/min: 2.71 mL/hr continuous, 10mg/mL dripAgitation, sedation, general anesthesia. 5 mcg/kg/min is for conscious sedation of an adult. Used in induction and maintenance of anesthesia or sedation.If Goal RASS not achieved: Use up to 2 bolus doses before increasing rate by 5 mcg/kg/min every 15 mins until goal RASS score achieved. If goal RASS surpassed: Lower rate by 5 mcg/kig/min every 15 mins until goal RASS score achieved. If at goal RASS score: continue current dose. Maximum dose: 50 mcg/kg/min. Notify Intensivist: If patient on max dose. Notify Intensivist: If propofol continues greater than or equal to 72 hours to consider change to Versed.Contraindications: patients w/ increased intracranial pressure or impaired cerebral circulation. Onset: 9-36 sec, Duration: 6-10 mins, Half-Life: 5-12 hr.Propofol (Diprivan)25 mg, every 5 mins PRN, 10 mg/mL dripAgitationIV Push every 5 mins up to 2 doses PRN agitation before increasing continuous infusion rate.Propranolol (Inderal)10 mg tabHypertensionHold for heart rate less than 60 bpm, hold for systolic BP less than 115 mmHg.Pyridostigmine (Mestinon)60 mg tab, oral, every 8 hrs STDMyasthenia gravisQuetiapine (Seroquel)300 mg tab dailyAdd-on therapy for major depressive disorder, bipolar disorderQuinapril (Accupril)2.5 mg PO on admission, 20 mg dailyACE Inhibitor, anithypertensiveLife threatening adverse effect: AngioedemaSaccharomyces boulardii (Florastore) packet 250 mgDose: 1 packet, 250 mg, NG Tube, 2x/day @ 0900Treatment/prevention of diarrhea as a result of antibiotics (strain of yeast).Admin via NG Tube, however NG Tube was removed.Saline lock flush 10 mL10 mL IV PRN conditionalLock flush“Flush after each use and after blood draws. Use ONLY a 10cc syringe.”Saline lock flush 3 mL3 mL IV DailyLock flush, line patencySaline lock flush 3 mL3 mL, daily, @ 0900Lock flush, line patencyAnd after each IV med for IV line patency. Use 10 mL for PICC, use 20 mL after blood or TPNSaline lock flush 3 mL3 mL IV every 8 hrs.Lock flush, line patencySennosides (Senokot)2 tabs, 2x/day, @ 0900Constipation (retains water in intestine)8.6 mg sennosides is equivalent to 187 mg senna.Simvastatin10 mg PO daily at HSHMG-CoA reductase inhibitor (Statin), Antihyperlipemic. (increases HDL and decreases LDL cholesterol)Onset: 2 week; Peak: 4-6 week. Avoid grapefruit.Sodium chloride tab1 g tab, 4x/day @ 0800 & 1200Hyponatremia and hypochloride (fluid volume overload)Sodium hypochlorite (Dankin’s) 0.125% (1/4 strength) irrigationTopical, dailyInfection, topical antisepticFor irrigation use only.Sodium phosphate15 mmol in NS 100 mL IVPB, PRN conditionalElectrolyte replacementFor Phosphate of 2.0-2.3. Infuse slowly over 2 hrs.Sodium phosphate24 mmol in NS 100 mL IVPB, PRN conditionalElectrolyte replacementFor Phosphate of 1.6-1.9. Infuse slowly over 3 hrs.Sodium phosphate36 mmol in NS 150 mL IVPB, PRN conditionalElectrolyte replacementFor Phosphate of 1.0-1.5. Infuse slowly over 4 hrs.Sodium phosphate45 mmol in NS 150 mL IVPB, PRN conditionalElectrolyte replacementFor Phosphate less than 1.0-1.5. Infuse slowly over 5 hrs.Tamsulosin (Flomax)0.4 mg cap dailyUrination, Benign prostatic hypertrophyAdminister 30 mins after a meal. Swallow whole, don’t crush, chew, or spit.Temazepam (Restoril)30 mg cap HS PRNInsomniaTemazepam (Restoril)15 mg PO at bedtime PRNSleep aid, InsomniaMay repeat x1Therapeutic multivitamin (Theravite)1 tablet, dailyVitamin deficiencyTherapeutic multivitamin (Theravite)1 tablet, daily, due @0900Vitamin deficiencyTolvaptan (Samsca)15 mg tab, daily @ 1200Hyponatremia (associated with CHF), increases urine output.Patient should NOT be on fluid restriction for the first 24 hrs of therapy. Hold for sodium greater than 140 or sodium increase greater than or equal to 12 meq/L per 24 hr period. Request from pharmacy. Potassium checks every 12 hrs.Tramadol (Ultram)50 mg tab every 4 hrs PRNMild pain (1-3), Moderate pain (4-6)Trazodone (Desyrel)150 mg tab daily at bedtimeMajor depression (Antidepressant)Triamcinolone (Aristocort)0.1% topical cream, 3x/dayAnti-inflammatoryApply to face and backTrimethoprim – sulfamethoxazole ds (Bactrim DS)160-800 mg tab, 1 tab, Mon Wed Fri, due @ 0900Empiric Bactrim prophylaxis, Pneumocystis pneumonia (PCP) prophylaxisDose in mgs represents trimethoprim component – Administer on an empty stomach 1 hour prior or 2 hrs after meals.Vancomycin (Vancocin)1,250 mg in D5W 250 mL IVPB @ 167 mL/hr every 12 hrsAntibioticVancomycin (Vancocin)1,250 mg in NS 250 mL IVPB @ 167 mL/hr every 18 hrs @ 0200Antibiotic, for respiratory culture positive for gram pos cocci and gram neg bacilli. Inhibits bacterial wall synthesis.Life threatening adverse effects: Nephrotoxicity, fatal uremia, Anaphylaxis, Leukopenia. Peak: 30 mins after end of infusion, half-life: 4-8 hrs.Vancomycin (Vancocin)1,000 mg in D5W 250 mL IVPB @ 250 mL/hr every 6 hrs, due @ 1200AntibioticLife threatening adverse effects: Nephrotoxicity, fatal uremia, Anaphylaxis, Leukopenia. Peak: 30 mins after end of infusion, half-life: 4-8 hrs.Vancomycin (Vanconcin) 1,500 mg in D5W 300 mL IVPB1,500 mg, 200 mL/hr, IVPB, every 16 hrsAntibioticVancomycin dosing per pharmacy 1 each1 each, daily PRN, AntibioticNeeds pharmacy consultVancomycin dosing per pharmacy 1 each1 each, daily PRN, Antibiotic, for respiratory culture positive for gram pos cocci and gram neg bacilli. Needs pharmacy consultWater (Free water)200 mL every 8 hrs via NG Tube @ 1245HypernatremiaAdmin via NG TubeWater (Free water)200 mL oral every 6 hrs due @ 1000 and @1600Fluid intakeNursing to chart on MAR and record intake on the Doc Flow sheet.Zinc sulfate (Orazinc)220 mg tab, dailyZinc deficiencyZolpidem (Ambien)5 mg tab HS PRNInsomniaDo not give after 2400 ................
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