Pediatrics Unit Intravenous Push (IVP) Drug List - Approved for RN ...

[Pages:9]Generic Name (Brand Names) Adenosine

Amiodarone

Ampicillin

Atropine Sulfate Calcium Chloride

Pediatrics Unit Intravenous Push (IVP) Drug List - Approved for RN Administration

Ventura County Medical Center

Therapeutic Category Antiarrhythmic

Antiarrhythmic (Class III)

Antibiotic Beta-Lactam (Penicillin)

Anticholinergic Agent Electrolyte HIGH ALERT

Typical Pediatric Dose Maximum Pediatric Dose

0.1 mg/kg (max: 6 mg) Max single dose:

Second dose:

12 mg

0.2 mg/kg (max: 12 mg)

5 mg/kg May repeat dose up to 15 mg/kg/DAY.

Max single dose: 300 mg Max daily dose: 15 mg/kg/DAY

100-200 mg/kg/DAY divided every 6 hours

0.02 mg/kg/dose. May repeat once. Minimum dose = 0.1 mg. 10-20 mg/kg* *dose expressed in mg of calcium chloride

Max single dose: 2000 mg Max daily dose: 400 mg/kg/DAY, up to 12 GM/day for meningitis Max single dose: 0.5 mg

Max single dose: 1000 mg

Maximum Concentration Give undiluted (3 mg/mL)

Dilute in D5W only. PIV: 2 mg/mL Central: 6 mg/mL

Neonates/infants: 50 mg/mL Pediatrics: 100 mg/mL

Maximum rate of Administration Adverse Effects/

Administration Considerations Monitoring

Parameters

Rapid IVP over 2- EMERGENCY Monitor for transient

3 seconds.

USE ONLY.

bradycardia, asystole,

Follow dose with and ventricular

rapid 5-10 mL NS arrhythmias.

flush.

PSVT may re-occur.

Monitor EKG, HR, BP

Give over 10 mins. IV PUSH FOR

& RR. HR, BP, EKG.

For perfusing

EMERGENCY For long-term therapy,

tachycardias, give USE ONLY.

consider monitoring

over 20-60 mins. Carefully monitor chest X-ray and lung

for rate-related function.

hypotension.

Black Box Warning:

pulmonary toxicity,

hepatotoxicity, and

proarrhythmic effects. IVP over 3-5 mins. Do not administer Contraindicated in

with gentamicin in patients with a history of

the same tubing or penicillin allergy.

administer

concurrently.

May give undiluted IVP over 1-2

Doses < 0.1 mg Monitor VS & EKG.

(0.1 mg/mL)

minutes.

may cause

Minor side effects: Dry

paradoxical

mouth, dizziness &

bradycardia.

palpitations.

For IV push, may IVP over 3-5

IV PUSH FOR Bradycardia, cardiac

give undiluted minutes.

EMERGENCY arrhythmias, lethargy,

(100 mg/mL). IV infusion over 1 USE ONLY.

EEG. Stop infusion if

For IV infusion, hour

Do not use scalp patient complains of

dilute to 20

vein or small hand pain at injection site.

mg/mL.

or foot vein.

Do NOT give IM

or SQ.

Page 1 of 9

MEC Approved: 10/9/2012

Pediatrics Unit Intravenous Push (IVP) Drug List - Approved for RN Administration

Ventura County Medical Center

Generic Name (Brand Names) Calcium Gluconate

Cefazolin (Ancef, Kefzol) CefoTAXime

CefTAZidime

CefTRIAXone (Rocephin)

Therapeutic Category Electrolyte

HIGH ALERT

Antibiotic (Cephalosporin, 1st Generation) Antibiotic (Cephalosporin, 3rd Generation)

Antibiotic (Cephalosporin, 3rd Generation) Antibiotic (Cephalosporin, 3rd Generation)

Typical Pediatric Dose Maximum Pediatric Dose

50-100 mg/kg/dose* *dose expressed in mg of calcium gluconate

Max daily dose: 500 mg/kg/DAY

25-100 mg/kg/DAY Max daily dose:

divided every 6-8 hours. 100 mg/kg/DAY,

up to 6 gm/day in

children.

50 mg/kg/dose every 8 Max single dose:

hours

2000 mg

Meningitis: 75

mg/kg/dose every 6

hours

50 mg/kg/dose every 8 Max single dose:

hours

2000 mg

50-75 mg/kg/DAY divided every 12-24 hours Meningitis: 50 mg/kg/dose every 12 hours

Max single dose: 2000 mg

Maximum Concentration

For IV push, may give undiluted (100 mg/mL). For IV infusion, dilute to 50 mg/mL.

100 mg/mL For IV infusion, dilute to 20 mg/mL. 60 mg/mL

180 mg/mL. For IV infusion, dilute to 40 mg/mL. 40 mg/mL

Maximum rate of Administration Adverse Effects/

Administration Considerations Monitoring

Parameters

IVP over 3-5 min, IV PUSH FOR Bradycardia, cardiac

not to exceed 50- EMERGENCY arrhythmias, lethargy,

100 mg/per min. USE ONLY.

EEG. Stop infusion if

IV infusion over 1 Do not use scalp patient complains of

hour.

vein or small hand pain at injection site.

or foot vein.

Do NOT give IM

IVP over 3-5

or SQ. None

Caution in patients with

minutes.

a history of penicillin

IV infusion over

allergy.

10-60 minutes.

IVP over 5

Fast IVP (5

mcg/kg, slow IVP

over 5-10 minutes.

Adverse Effects/ Monitoring Parameters Headaches, dizziness.

RR, BP, HR, bowel sounds.

Antidote: GABA receptor antagonist

Loop Diuretic

0.01 mg/kg (max: 0.2 Max single dose: May give undiluted Infuse over 15 to

mg); may repeat dose 0.2 mg

(0.1 mg/mL)

30 seconds via a

every minute up to

Max total dose:

freely running IV

maximum of 0.05 mg/kg 1 mg

infusion into a

or 1 mg total 0.5-1 mg/kg/dose every Do not exceed

large vein. May give undiluted IVP over 1-2

6-12 hours

10mg/kg total for a (10 mg/mL)

minutes.

24-hour period.

EMERGENCY Black Box Warning:

USE ONLY.

administration has been

Do not exceed 0.2 associated with

mg/min.

seizures.

Rapid & high dose Contraindicated in

administration can sulfonamide allergy.

cause irreversible Hypotension, headache

hearing loss.

& dizziness. Monitor for

hearing loss.

Black Box Warning:

may cause profound

diuresis and

water/electrolyte

depletion.

Anticholinergic Agent

Control of secretions: Max single dose:

4-10 mcg/kg every 6-8 100 mcg

hours.

(May exceed max

Neuromuscular blockade single dose when

reversal:

used with

0.2 mg for every 1mg neostigmine

neostigmine used

reversal).

May give undiluted IVP over 1-2

(0.2 mg/mL)

minutes.

Dysrhythmias have Blurred vision, dry been reported with mouth, N/V, urinary administration. hesitancy & retention.

Page 4 of 9

MEC Approved: 10/9/2012

Pediatrics Unit Intravenous Push (IVP) Drug List - Approved for RN Administration

Ventura County Medical Center

Generic Name (Brand Names) Haloperidol Lactate (Haldol)

HydrALAZINE

Therapeutic Category

Antipsychotic

Typical Pediatric Dose Maximum Pediatric Dose

0.01-0.2 mg/kg/dose

0.1 mg/kg/dose, not to exceed 5 mg.

Maximum Concentration

Maximum rate of Administration Administration Considerations

May give undiluted Slow IVP (5 mg/mL)

Do NOT inject haloperidol decanoate. QT-prolongation and torsades de pointes have been reported with IV administration.

Adverse Effects/ Monitoring Parameters Hypotension, extrapyramidal symptoms, dystonic reactions, QTprolongation, torsades de pointes. ECG should be monitored. Black Box Warning: increased risk of death in elderly patients with dementia

Antihypertensive: 0.1-0.2 mg/kg/dose

Vasodilator

every 4-6 hours

Max single dose: 20 mg

May give undiluted IVP over 1-2

(20 mg/mL)

minutes, not to

exceed 0.2

mg/kg/minute.

May cause reflex tachycardia.

Palpitations, flushing, tachycardia, hypotension, arthralgias. Monitor heart rate, BP.

Hydrocortisone Succinate (Solu-Cortef)

Hydromorphone (Dilaudid)

Anti-inflammatory 1-5 mg/kg/DAY every 6- None

Agent:

8 hours

Corticosteroid

Opioid analgesic HIGH ALERT

Initial dose: 5-15 mcg/kg/dose

None

50 mg/mL

IVP over 30 seconds

May give undiluted IVP over 2-3

(2 mg/mL)

minutes

Medication is

Hypertension,

usually placed hyperglycemia,

inline, but may be insomnia, nervousness

pushed.

Reversal agent ? Respiratory rate,

naloxone (Narcan) hypotension.

Black Box Warning:

risk of respiratory

depression, drug

interactions with other

CNS depressants, abuse

and medication errors.

Page 5 of 9

MEC Approved: 10/9/2012

Generic Name (Brand Names) Insulin

Ketoralac (Toradol)

Levothyroxine (Synthroid) Lidocaine

Pediatrics Unit Intravenous Push (IVP) Drug List - Approved for RN Administration

Ventura County Medical Center

Therapeutic Category

Insulin

HIGH ALERT

Typical Pediatric Dose Maximum Pediatric Dose

0.1 unit/kg

N/A

Maximum Concentration

100 units/mL

Maximum rate of Administration Administration Considerations

For life-threatening FOR

hyperkalemia: EMERGENCY

give over 10

USE ONLY.

seconds after

Use only regular

dextrose 25%. insulin for IV

For non-life-

administration

threatening

hyperkalemia:

Give over 15-30

minutes with

dextrose 25%.

Adverse Effects/ Monitoring Parameters Monitor blood sugars, signs/symptoms of hypoglycemia

Non-steroidal anti- Loading dose:

Age 16 years &

0.5 mg/kg/dose every 6- >50 kg:

8 hours

30 mg

30 mg/mL

Give over >15 seconds.

Requires dose Edema, drowsiness,

adjustment in renal renal toxicity.

dysfunction.

Contraindicated in pts

with active or recent

bleeds, or taking aspirin

or other NSAIDs.

Black Box Warning:

Increased risk of

bleeding,

nephrotoxicity, and

cardiovascular

thrombotic events.

Thyroid Product 2-8 mcg/kg/dose Antiarrhythmic 1 mg/kg

Not established.

Max single dose: 100 mg/dose Max cumulative dose: 5 mg/kg

100 mcg/mL; dilute in NS only

20 mg/mL

Give over 2-3 Use immediately Palpitations,

minutes.

after

tachycardia, cardiac

reconstitution. arrhythmias,

nervousness, tremor.

IVP over 5-10 min, EMERGENCY Contraindicated in

not to exceed 0.7 USE ONLY.

patients with severe

mg/kg/min or 50 Can be given via heart block.

mg/min.

ETT at 2-2.5 times

the normal dose.

Page 6 of 9

MEC Approved: 10/9/2012

Pediatrics Unit Intravenous Push (IVP) Drug List - Approved for RN Administration

Ventura County Medical Center

Generic Name (Brand Names)

LORazepam (Ativan)

Therapeutic Category

Typical Pediatric Dose Maximum

Maximum

Pediatric Dose Concentration

Benzodiazepine 0.05-0.1 mg/kg/dose

Max single dose: 4 1 mg/mL mg

Magnesium Sulfate

Electrolyte HIGH ALERT

25-50 mg/kg/dose

100 mg/kg/dose Max single dose: 2 GM

200 mg/mL

MethylpredniSOLON E Sodium Succinate (Solu-Medrol)

Anti-inflammatory Varies by indication:

Agent:

Asthma:

Corticosteroid 2-4 mg/kg/DAY

Pulse dose:

15-30mg/kg/DAY x 3

days

30 mg/kg/dose

125 mg/mL

Metoclopramide (Reglan)

Antiemetic Prokinetic gastrointestinal agent

0.1-0.2 mg/kg/dose every 6-8 hours

Max single dose: 5 mg/mL 10 mg

Maximum rate of Administration Administration Considerations

0.05 mg/kg over 2- Can cause

5 minutes, not to infiltration with

not exceed 2

IVP.

mg/min.

Slow IVP over at IV PUSH FOR

least 5 minutes in EMERGENCY

emergencies only. USE ONLY.

IV infusion over 2-

4 hours.

Adverse Effects/ Monitoring Parameters Sedation, hypotension, dizziness, headache, HR, RR

Hypotension, CNS depression, loss of deep tendon reflexes, heart block.

Dose 15 mg/kg, Rapid

infuse over 30 administration of

minutes

doses 15 mg/kg

can cause cardiac

arrhythmias &

IVP over >2

cardiac arrest. Too rapid rate may Hypotension, sedation,

minutes.

cause intense

dizziness, rash,

If dose is >10mg, anxiety and/or dystonias & other

give IVPB over 15- drowsiness.

extrapyramidal effects.

30 minutes.

Medication usually Black Box Warning:

placed in the line, tardive dyskinesia

but may be pushed.

Page 7 of 9

MEC Approved: 10/9/2012

Generic Name (Brand Names)

MIDazolam (Versed)

Pediatrics Unit Intravenous Push (IVP) Drug List - Approved for RN Administration

Ventura County Medical Center

Therapeutic Category

Typical Pediatric Dose Maximum Pediatric Dose

Benzodiazepine 0.05-0.1 mg/kg

None

Maximum Concentration

5 mg/mL

Maximum rate of Administration Administration Considerations

Give over 2-5 Reversal agentmins, not to exceed Flumazenil 1 mg/min

Adverse Effects/ Monitoring Parameters Respiratory depression, hypotension, drowsiness. Black Box Warning: respiratory depression.

Morphine Sulfate

Opioid Analgesic 0.05-0.1 mg/kg HIGH ALERT

None

5 mg/mL

Give over >5 minutes.

Reversal agent- Sedation, dizziness, Naloxone (Narcan) heart palpitations,

hypotension, bradycardia, respiratory depression. Black Box Warning: risk of respiratory depression, drug interactions with other CNS depressants, abuse and medication errors.

Naloxone (Narcan)

Antidote:

For full reversal:

N/A

Opioid antagonist ................
................

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