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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