ICU DRUGS.pptx

ICU DRUGS
DR. HEMRAJ SINGH RAJPUT
ASSOCIATE PROFESSOR,
DEPARTMENT OF PHARMACY PRACTICE
SUMANDEEP VIDYAPEETH DEEMED TO BE UNIVERSITY
VADODARA.

HIGH RISK MEDICATIONS
 CATEGORIIZING ACCORDING TO STORAGE.
1. FRIDGE
2. WARD DRUG
3. EMERGENCY TROLLEY

FRIDGE
1. ATRACURIUM INJ
 DOSAGE RANGE (ADULT DOSE):
Initial: 0.4 to 0.5 mg/kg
Maintenance: 0.08 to 1mg/kg at 15 to 25 minute intervals; Infusion : 5 to 15 mcg/kg/min.
 USE:
Neuromuscular blockade: As an adjunct to general anesthesia, to facilitate endotracheal
intubation and to provide Skeletal muscle relaxation during surgery or mechanical ventilation.
NOTE: Atracurium does not relieve pain or produce sedation.
 Usual Infusion Concentration:
IV infusion: 20 mg in 100 ml (concentration: 0.2 mg/ml) or
50 mg in 100 ml ( concentration: 0.5 mg/ml).
Dilution: D5W, D5NS, or NS.

 What to do
1. Epinephrine 1:1000 should be immediately available during use in case of Anaphylactic reaction.
2. Continuous monitoring vital signs, cardiac status, respiratory status, and degree of neuromuscular
block is mandatory during infusion and until full muscle tone has returned.
3. Store intact vials at 2° C to 8°C.
4. Upon removal from refrigeration to room temperature storage conditions should be 25 °C.
5. Use within 14 days even if re-refrigerated.
6. Use the diluted solution within 24 hours.
 What should not be done
1. Mixing with alkaline solution, or drugs (Atracurium undiluted vial have pH: 3.25 to 3.65).
2. Concomitant use with QUININE (Increased neuromuscular blockade)

2. DIAZEPAM INJ (category: D)
DOSAGE RANGE (ADULT DOSE):
Dosage may ranges from 2 to 30mg/dose it is recommended follow instruction strictly.
USE:
Anxiety disorder, Surgery, Seizure disorder, Alcohol Withdrawal, Skeletal Muscle Spasticity,
Sedation, Labor and Delivery, Myocardial Infarction, Drug induced Cardiovascular Emergencies,
Neonatal Opiate Withdrawal.
Usual Infusion Concentration:
Infusion not recommended and mixing with other solution not recommended.
Storage :
Can be stored in refrigerator at 2°C to 8°C or at controlled room temp 20°C to 25°C.
Protect from light.

 What to do
1. Administer undiluted by slow IV push.
2. Look for signs of respiratory depression or hypotension after administration.
 What should not be done
1. Mixing with other solutions.
2. More than 1 to 2 mg/minute IV push in children, and 5mg/minute in adult.
3. Administration through small veins (e.g. dorsum of hand /wrist).
4. Intra-arterial administration.
5. Continuous infusion – as the drug gets precipitated in IV fluids and absorption of drug into infusion
bags and tubing.

3. DILTIAZEM INJ (category C)
 DOSAGE RANGE (ADULT DOSE):
Bolus: 0.25 mg/kg, may repeat 0.35mg/kg after 15 minutes
Infusion: 5-15 mg/hour
 USE:
Control of rapid ventricular rate in patients with atrial fibrillation or atrial flutter; conversion of
paroxysmal supraventricular tachycardia (PSVT).
 USUAL INFUSION CONCENTRATIONS:
IV Infusion: 125 mg in 125 ml (total volume 9 concentration: 1mg/ml) of D5W or NS.

 What to do
1. Bolus doses given over 2 minutes with continuous ECG and blood pressure monitoring.
2. Continuous infusion should be via infusion pump only.
3. Infusion rate should be increased 5 mg/hour up to 15 mg/hour maximum.
4. Store in refrigerator at 2°C to 8°C.
5. Discard the diluted solution if not used within 24 hours even after refrigeration.
6. Monitor patients with impaired ventricular function or conduction abnormalities may have
higher incidence of adverse reactions associated with Cardiovascular system.
 What should not be done
1. Do not freeze.
2. Use of drug in Heart failure patient.

4. DOBUTAMINE INJ (category B)
 DOSAGE RANGE (ADULT DOSE):
IV: 0.5 to 20 mcg/kg/minute (maximum: 40 mcg/kg/minute)
 USE:
short-term management of patients with cardiac decompensation, long-term
management (palliative therapy) in select patient with Stage D HF unresponsive to
guideline-directed medical therapy and device therapy.
 USUAL INFUSION CONCENTRATIONS:
IV Infusion: 250 mg in 500 ml (concentration: 500 mcg/ml),
500 mg in 250 ml (concentration: 2000 mcg/ml),
1000 mg in 250 ml (concentration: 4000 mcg/ml),
of D5W or NS.
 STORAGE:
1. Reconstituted solution under refrigeration for 48 hours or 6 hours at room temp.
2. Stability of parenteral admixture at room temperature (25°C) is 48 hours; at refrigeration
(4°C) stability is 7 days.

 What to do
1. Remix solution every 24 hours. Pink discoloration of solution indicates slight oxidation but no
significant loss of potency.
2. Always administer via infusion device; administer into large vein.
3. Monitor signs of cardiac arrhythmias specially patient with acute heart failure.
4. Reinsure the potassium and magnesium values, hypokalemia or hypomagnesemia increases the
risk of arrhythmias.
1. Patient with recent history (< 1 week) of MI, unstable angina, severe aortic stenosis, atrial
tachyarrhythmia's with uncontrolled tachycardia, uncontrolled hypertension (>200/110) drug cannot
be given.

5. DOPAMINE INJ (category c)
IV: 2 to 20 mcg/kg/minute (maximum: 50 mcg/kg/minute)
 USE:
Adjunct in the treatment of shock (e.g. MI, open heart surgery, renal failure, cardiac
decompensation ) that persists after adequate fluid volume replacement.
IV Infusion: 400 mg in 250 ml (1600 mcg/ml) or 800 mg in 250 ml ( 3200 mcg/ml) of
D5W or NS.
-
 STORAGE:
Store in refrigerator at 2°C to 8°C. protect from light.

 What to do
1. Administer as a continuous infusion with the use of an infusion pump.
2. Administer into larger vein to prevent the possibility of extravasation (central line administration).
3. Monitor continuously for free flow.
4. Administration into an umbilical arterial catheter is not recommended.
5. Gradually decrease the dose of dopamine (sudden discontinuation may cause hypotension).
6. Vials (concentrated solution) must be diluted prior to use
7. Vesicant; Ensure proper needle or catheter placement prior to and during infusion; avoid
extravasation.
8. If extravasation occurs, infiltrate the area with diluted Phentolamine( 5 to 10 mg in 10 to 15 ml of
saline) with a fine hypodermic needle.
9. Phentolamine should be administered as soon as possible after extravasation is noted to prevent
sloughing/necrosis.
10.Monitor cardiac status and renal function.
1. Use of solution darker than slightly yellow.
2. Use in patient with uncorrected tachyarrhythmia's, ventricular fibrillation

6. ENOXAPARIN INJ (category B )
Dose varies greatly depending on indication follow instruction strictly given by
physician.
 USE:
Acute coronary syndromes, DVT prophylaxis, DVT treatment (acute)
Dose varies greatly depending on indication follow instruction strictly given by
physician.
 STORAGE:
Store in refrigerator at 2°C to 8°C.

 What to Do
1. Do not mix or co-administer with other medications may be administered with D5W or NS.
2. Flush IV access site with a sufficient amount of D5W or NS prior to and follow IV bolus
administration.
3. When Administer by deep SubQ injection alteration between left or right anterolateral and left or
right posterolateral abdominal wall is necessary.
4. Only for SubQ- to avoid loss of drug from the 30 mg and 40 mg prefilled syringes, do not expel
the air bubbles from the syringe prior to injection.
5. Patient should be observed closely for bleeding and signs and symptoms of
neurological impairment if therapy is administered during or immediately following
diagnostic lumbar puncture, epidural anesthesia, or spinal anesthesia. If neurological
compromise is noted, urgent treatment is necessary.
1. Rubbing injection site.
2. Administration intramuscularly.
3. Use in patient with current heparin induced thrombocytopenia (HIT).
4. Placement or removal of catheter for at least 12 hours after administration of enoxaparin
and 24 hours after high dosage. Double the time for the patient having CrCl
<30ml/minute.

7. HEPARIN INJ (category C )
IV: Bolus: 60-80 units/kg
Infusion: 10-30 units/kg/hour or
10,000 units (initially), then 50-70 units/kg (5000-10,000 units) every 4-6 hours
intermittently.
SubQ: Thromboprophylaxis: 5000 units every 8-12 hours;
Treatment: 17,500 units ever 12 hours
 USE:
Anticoagulation: Prophylaxis and treatment of thromboembolic disorders. As an
anticoagulant for extracorporeal and dialysis procedures.
IV infusion: 25,000 units in 250 ml (concentration: 100 units/ml) of D5W or NS or ½ NS.
 STORAGE:
Can be Store in refrigerator at 2°C to 8°C or controlled room temperature not to be
exceed more than 40°C, do not freeze.

 What to Do
1. Monitoring for signs and symptoms of bleeding.
2. Must care fully examine each prefilled syringe or vial prior to use ensure that the correct
concentration is chosen.
3. Monitoring geriatric patients as incidence of bleeding is higher in patient >60 years and
particularly in female.
4. Discontinue heparin if hemorrhage occurs severe hemorrhage or over dosage may require
protamine.
5. Monitor platelet count closely patient who develop heparin induced thrombocytopenia are at risk
for developing thrombosis.
6. Continuous IV infusion via infusion pump only, and mix prepared solution thoroughly.
7. central venous catheters: Must be flushed with heparin solution when newly inserted, daily (
at the time of tubing change), after blood withdrawal or transfusion, and after an intermittent
infusion through an injectable cap.
8. A volume of at least 10 ml of blood should be removed and discarded from a heparinized line
before blood sample are sent for coagulation testing.
9. SubQ Injection sites should be rotated
1. concomitant use of heparin with Streptokinase, Urokinase, dabigatran.
2. Administer IM.

8. INSULIN INJ (category B)
 DOSAGE RANGE (ADULT DOSE): Units/kg/day
IV, SubQ: Initial: 0.2 to 0.6 units/kg/day in divided doses.
Maintenance: 0.5 to 1 units/kg/day in divided doses.
 USE:
Treatment of Diabetes mellitus, type 1 or 2 .
IV infusion: 100 units in 100 ml (concentration: 1 unit/ml) of NS
 STORAGE:
Store in refrigerator at 2°C to 8°C. Do Not freeze. Keep away from heat and
sunlight. Vial may be stored for up to 30 days in the refrigerator once punctured.
storage condition and duration may vary with brand and preparation follow storage
instruction carefully.

 What to Do
1. Monitoring for Hypoglycemia as it is most common adverse defect of insulin.
2. Monitoring patient for hypokalemia specially in renal or hepatic impairment.
3. Check the insulin concentration before administration cross check with syringe. Different
formulation may have different concentration.(e.g. 100 U, 500 U )
4. Check for IV and SubQ Injection compatibility.
5. Frequent monitoring of blood glucose.
6. Insulin should be administered within 30 minutes to 60 minutes before meal.
7. Follow instruction for dilution as SubQ dilution differs from IV dilution.
1. Use of sliding scale in geriatric patient due to increase risk of hypoglycemia without
benefits in managing of hyperglycemia regardless of care setting (beers criteria).
2. Concomitant use of insulin regular with Rosiglitazone.
3. Using solution looks viscous or cloudy.
4. Using cold insulin.

9. LABETALOL INJ (category C)
IV: Bolus: 20 mg, may give 40 to 80 at 10-minute intervals.
Infusion: 2mg/minute (maximum: 300 mg total cumulative dose)
 USE:
Treatment of sever hypertension
IV infusion: 500 mg in 250 ml (concentration: 2mg/ml) of D5W
 STORAGE:
Store in refrigerator at 2°C to 8°C. protect from light, do not freeze.

 What to Do
1. Bolus dose should be administered via IV push at the rate of 10 mg/minute.
2. Maintain patient in supine position after IV administration for 3 hours to prevent orthostatic
hypotension.
3. Monitor blood pressure and heart rate prior to and following first dose and with change in
dosage.
4. Monitoring blood pressure in patient having impaired hepatic function more carefully.
5. Monitor for orthostatic hypotension which is most common ADR and report.
1. Abrupt withdrawal in patient cardiac disease.

10. LIGNOCAINE + ADRENALINE INJ (Lidocaine and Epinephrine) (category B)
Do not exceed 7mg/kg body weight up to a maximum range of 300 mg to 500 mg of
lidocaine hydrochloride and 3 mcg (0.003mg) of epinephrine/kg of body weight or 0.2mg.
 USE:
Local infiltration anesthesia; AVS for nerve block
 STORAGE:
Store in refrigerator at 2°C to 8°C. protect from light, do not freeze.

 What to Do
1. Injection solution for infiltration: before injecting, withdraw syringe plunger to ensure injection is
not into vein or artery. As major ADR associated with systemic administration.
2. Aspirate the syringe after tissue penetration and before injection to minimize chance of direct
vascular injection. Careful and constant monitoring of the patients state of consciousness
should be done following each local anesthetic injection; at such times, restlessness, anxiety,
dizziness, blurred vision, tremors, depression or drowsiness may be early warning signs of CNS
toxicity.
3. Treatment is primarily symptomatic and supportive.
1. IV administration

11. LIGNOCAIN HCL 2% INJ (category B)
IV: Bolus: 1 to 1.5 mg/kg, may repeat 0.5 to 0.75 mg/kg up to a total of 3 mg/kg.
Infusion: 1 to 4 mg/minute
Local injection: Maximum: 4.5 mg/kg/dose; do not repeat within 2 hours
 USE:
Local and regional anesthesia by infiltration; acute treatment of ventricular
arrhythmias from myocardial infarction or cardiac manipulation (e.g. cardiac surgery)
IV infusion: 1000 mg in 250 ml (concentration: 4 mg/ml) or 2000 mg in 250 ml
(concentration: 8mg/ml) of D5W
 STORAGE:
Store in refrigerator at 2°C to 8°C. though stable at room temperature of 25°C.

 What to Do
1. Constant ECG monitoring is necessary during IV administration.
2. Monitoring closely for signs and symptoms of CNS toxicity.
3. Keep patient supine to reduce hypotensive effects.

12. LORAZEPAM INJ (category D)
IM: 0.5 to 1 mg every 30 to 60 minutes as needed or 0.05 mg/kg as a single dose
(maximum dose: 4mg).
IV: 0.044 mg/kg as a single dose (maximum dose: 4mg) or 4 mg (may repeat).
 USE:
Anesthesia premedication, status epileptics.
 STORAGE:
Store in refrigerator at 2°C to 8°C. protect from light.

 What to Do
1. According to manufacturer, dilute IV dose prior to use with an equal volume of compatible
diluent (D5W, NS, SWFI).
2. Do not exceed 2mg/minute or 0.05mg/kg over 2 to 5 minutes.
3. Monitoring IV site during administration.
4. IM Administer undiluted.
5. When used as preanesthesia, monitor for heavy sedation and airway obstruction.
6. Equipment necessary to maintain airway and ventilator support should be available.
1. intra-arterial administration.
2. extravasation.

13. METOPROLOL INJ (category C)
IV: 1.25 to 5 mg every 6 to 12 hours (maximum: 15 mg every 3 hours) or 5 mg every 2
minutes for 3 doses (acute MI).
 USE:
Treatment of hemodynamically stable acute myocardial infarction when used in conjunction
with metoprolol oral maintenance therapy, acute coronary syndrome, heart failure, hypertension,
coronary artery disease.
IV infusion: 5 to 10 ml of metoprolol in 50ml diluent according manufacturer instruction.
 STORAGE:
Store in refrigerator at 2°C to 8°C. can be stored at room temperature, protect from
light and heat.

 What to Do
1. Monitor ECG and blood pressure during administration.
2. May administer by rapid infusion (IV push) over 1 minute.
3. May also be administered by slow infusion.
4. Monitoring for signs of first-degree heart block. As common side effect.
5. Stop the therapy if sever heart block occurs.
6. Monitoring geriatric patient as they have been observed more frequently for Bradycardia.
1. therapy withdrawn abruptly (particularly in patient with CAD).
2. treatment of anaphylaxis with adrenalin (epinephrine) as may be ineffective or promotes
undesirable effects.
3. giving drug to patient having brochospastic disease.

14. NORAD INJ (NORADRENALINE or Norepinephrine) (category C)
IV: Initial: 8-12 mcg/kg/minute
Maintenance: Titrate to desired effect (usual maintenance range: 2-4
mcg/minute.
 USE:
Treatment of shock which persists after adequate fluid volume replacement; severe
hypotension, Recommended as the first-choice vasopressor for the treatment of sepsis and
septic shock in adult patients.
IV infusion: 4 mg in 250 ml (concentration: 16 mcg/ml),
8 mg in 250 ml ( concentration: 32 mcg/ml) of D5W or NS.
 STORAGE:
Store in refrigerator at 2°C to 8°C. can be stored at room temperature, protect from
light and heat. Parenteral admixture at room temperature for 24 hours.

 What to Do
1. Monitoring blood pressure closely and adjust infusion rate.
2. Vesicant; ensure proper needle or catheter placement prior to and during infusion.
3. If extravasation occurs, infiltrate the area with diluted Phentolamine (5-10 mg in 10-15ml of
saline) with a fine hypodermic needle. Phentolamine should be administered as soon as
possible after extravasation is noted to prevent sloughing/necrosis.
4. Monitoring for Arrhythmias, bradycardia, dyspnea, respiratory difficulty, skin necrosis
1. using solution if brown coloration appears.
2. during anesthesia with cyclopropane or halothane.
3. Extravasation
4. infusion in small vein (wrist)
5. infusion in leg vein
6. co-administration with Inhalation Anesthetics.

15. PROPOFOL INJ (category B )
IV: Dosage varies greatly depending on indication
 USE:
For monitored anesthesia care sedation during procedures, intubation, mechanically-
ventilated ICU patients.
IV infusion: Dosage varies greatly depending on indication
 STORAGE:
Store between 4°C to 22°C refrigeration is not required. Do not Freeze.
if transferred to a syringe or other container prior to administration, use within 6 hours.

 What to Do
1. Tubing and any unused portion of Propofol vials should be discarded after 12 hours.
2. To reduce pain associated with injection, use large veins of forearm or antecubital fossa.
Lidocaine IV ( 1ml of a 1% solution) may also be used prior to administration or it may be added to
Propofol immediately before administration in a quantity not exceed 20 mg lidocaine per 200 mg
Propofol.
3. Do not use filter < 5 micron for administration.
4. Does not required dilution however if required can be diluted in 5% dextrose in water to a
concentration of >2 mg/ml.
5. Wean the infusion rate so the patient awakens slowly.
1. Administration through the same IV catheter with blood and plasma.
2. Using solution if oil and water layers seen.
3. Giving to Patient having history of hypersensitivity of eggs and soya products.
4. Rapid bolus in elderly patients.
5. Ejection fraction less than <50%.
6. Concomitant use with opioids may leads to increased sedative or anesthetic effects of
Propofol.
7. Abrupt discontinuation – can lead to awakening, anxiety , agitation , and resistance to
mechanical ventilation.

16. RETEPLASE INJ (category C )
IV: 10 units; repeat after 30 minutes.
 USE:
Management of STEMI for the improvement of ventricular function, the reduction of
the incidence of CHF, and the reduction of mortality following STEMI.
 STORAGE:
Storage kit should be stored at 2°C to 25°C and remain sealed until use in order to
protect from light.

 What to Do
1. Reteplase should be reconstituted using the diluent, syringe, needle and dispensing pin
provided with each kit.
2. Do not shake while reconstituting; swirl gently.
3. Once reconstituted, use within 4 hours.
4. Reconstituted dose should be administered IV over 2 minutes; no other medication should be
added to the injection.
5. Use with caution in patients receiving oral anticoagulants
6. Venipunctures should be performed carefully and only when necessary.
7. If serious bleeding occurs then the infusion of Reteplase and heparin should be stopped.
8. If arterial puncture is necessary, use an upper extremity vessel that can be manually
compressed.
1. Administration in patient with known bleeding condition.

17. SUCCINYLCHOLINE INJ (category C )
IV: Intubation: 0.6mg/kg (range: 0.3 to 1.1mg/kg)
Rapid sequence intubation: 1 to 1.5 mg/kg
Long surgical procedures: Initial: 0.3 TO 1.1 mg/k; administer 0.04 to 0.07 mg/kg at
appropriate intervals as needed.
IM: Up to 3 to 4 mg/kg ( maximum: 150 mg total dose)
 USE:
Neuromuscular blockade: As an adjunct to general anesthesia, to facilitate tracheal
intubation, and to provide skeletal muscle relaxation during surgery or mechanical
ventilation.
Note: Does not relieve pain or produce sedation.
 STORAGE:
Store in refrigerator at 2°C to 8°C. can be stored at room temperature for 14 days.

 What to Do
1. Administer deep IM only when IV access is not available.
2. May be administered undiluted by rapid IV injection.
3. Monitor for hyperkalemic rhabdomyolysis.
4. Maintenance of an adequate airway and respiratory airway and respiratory support is critical .
5. Drug is not an anesthetic or analgesic; pain must be treated with appropriate analgesic agents.
6. Continuous monitoring of vital signs, cardiac status , respiratory status and degree of
neuromuscular block till full muscle tone is returned.
1. Concomitant use of Succinylcholine with QUINNE

18. Tenecteplase(category C )
IV: Adult: <60kg: 30 mg as a single dose.
Adult: ≥60 to <70 kg: 35 mg as a single dose.
Adult: ≥90 kg: 50 mg as a single dose.
 USE:
Management of ST- elevation myocardial infarction (STEMI) for the lysis of thrombin in
the coronary vasculature to restore perfusion and reduce mortality.
 STORAGE:
Store in refrigerator at 2°C to 8°C. If reconstituted and not used immediately, store in
refrigerator and use within 8 hours.

 What to Do
1. Tenecteplase should be reconstituted using supplied 10 ml syringe with TwinPak Dual cannula
device and 10 ml sterile water for injection.
2. Do not shake when reconstituting.
3. Any unused solution should be discarded.
4. Monitoring in patient receiving oral anticoagulant. (enoxaparin , heparin, Fondaparinux).
1. Use in patient with history of active internal bleeding, history of CVA (within 2 month).
2. Use in patient with history of Ischemic stroke within 3 months, Prior intracranial hemorrhage,
active bleeding (excluding menses), suspected aortic dissection, significant closed head or
facial trauma within 3 months

19. Tirofiban inj (category b )
IV: Adult: Loading dose: 25 mcg/kg administered over 5 minutes or less;
Maintenance infusion: 0.15 mcg/kg/minute continue for up to 18 hours.
 USE:
Management of ST- elevation myocardial infarction (STEMI), Unstable angina: decreases
the rate of thrombotic cardiovascular events.
 STORAGE:
Storage at 25°C; storage is permitted between 15 °C to 30 °C, do not freeze, protect from
light during storage.

 What to Do
1. Use with extreme caution in patients with platelet count < 150,000, patient with hemorrhagic
retinopathy, previous history of GI disease.
2. Minimize other procedures including arterial and venous punctures, IM injections, nasogastric
tubes etc.
3. Monitoring for thrombocytopenia, if confirmed discontinue the drug.
4. Dose reduction of the maintenance infusion rate is necessary in patients with CrCl ≤
60ml/minute.
5. Percutaneous coronary intervention: Sheath removal: prior to pulling the sheath, ACT should be
<180 seconds. Use standard compression technique after sheath removal.
6. Surgery: discontinue at least 2 to 4 hours prior to coronary artery bypass graft surgery.
1. Concomitant use of Tirofiban with Urokinase

20. Vasopressin inj (category c )
IM, SubQ: Adult: 5 to 10 units 2 to 4 times daily as need for central diabetes insipidus.
IV: Post-cardiotomy shock: 0.03 units per minute can be titrated up by 0.005 units at 10
to 15 minute interval max 0.1 units per minute.
Septic shock: not more than 0.03 units per minute with combination of other
catecholamine's.
Cadaveric organ donation: Initial 1 unit bolus followed by infusion 0.5 to 4 units/hour to
brain dead donor.
 USE: Central diabetes insipidus, Post-cardiotomy shock, Septic shock, Cadaveric organ
donation, Gastroesophageal variceal hemorrhage.
 USUAL INFUSION CONCENTRATIONS: 50 Units in 500 ml (concentration: 0.1units
100 units in 100 ml (concentration: 1 unit/ml) of D5W or NS.
 STORAGE:
Storage 2°C to 8°C, do not freeze. Discard unused diluted solution after 18 hours
discard vial after 48 hours after first entry.

 What to Do
1. If extravasation occurs, stop infusion immediately and disconnect (leave cannula/needle in
place); gently aspirate extravasated solution (do not flush the line); remove needle/cannula;
elevate extremity. Initiate Phentolamine or alternative antidote.
2. Phentolamine: Dilute 5 to 10 ml in 10 to 15 ml NS and administer into extravasation site as soon
as possible after extravasation.
3. Alternative to Phentolamine: 1. Nitroglycerine topical 2 % ointment ( based on limited case
reports in neonates/infants): Apply 4 mm/kg as a thin ribbon to the affected areas; may repeat
after 8 hours if needed.
4. 2. Terbutaline : infiltrate extravasation area using a solution of terbutaline 1 mg diluted to 10 ml
in NS ) large extravasation site; administration volume varied from 3 to 10 ml) or 1 mg diluted in
1 ml NS .
5. Extravasation may lead to severe vasoconstriction and localized tissue necrosis; also, gangrene
of extremities, tongue, and ischemic colitis.
6. Precautions in patient with Asthma, Renal impairment , cardiovascular disease, Goiter, Seizure
1. Concomitant use with Phenytoin, Furosemide.

21. Fentanyl inj (category c )
Surgery premedication: 50 -100 mcg/dose or slow IV 30-60 min prior to surgery.
Adjunct to regional anesthesia : 25-100 mcg/dose slow iv over 1-2 minute.
General anesthesia: minor surgery: 0.5-2 mcg/kg dose iv, major surgery: 2-20/kg/dose
initially; 1-2 mcg/kg/hr inf
Adjunct to general anesthesia : 20-50 mcg/kg/dose IV.
 USE: Surgery premedication, adjunct to reginal anesthesia, general anesthesia, Analgesia.
 USUAL INFUSION CONCENTRATIONS: dilution according to requirement compatible with
D5W or NS.
 STORAGE:
Storage 20°C to 25°C, do not freeze. Protect from light, use within 24 hours once
diluted with NS.

 What to Do.
1. Monitoring for signs of CNS DEPRESSION, Hypotension, Syncope, Respiratory depression,
Seizures.
2. Inject slow 3 to 5 minutes
1. Concomitant use with Azithromycin, phenytoin. Variable (consult detailed
reference): Doxapram, pantoprazole.

22. Haloperidol inj (category c )
IM lactate: 2-5 mg q4-8hr not more than 20 mg/day
IM decanoate: not more than 100 mg/day
IV : ONLY Lactate form: 2-10 mg may repeated in 15 to 30 minutes.
 USE: Schizophrenia, Psychosis, Tourette disorder.
 USUAL CONCENTRATIONS: 0.5 to 100 mg/50 to 100 mL D5W.
 STORAGE:
Storage decanoate: Store at 15°C to 30°C (59°F to 86°F). Protect from light. Do not
refrigerate or freeze.
lactate: Store at 15°C to 30°C (59°F to 86°F). Protect from light. Do not refrigerate or
freeze.

 What to Do.
1. The decanoate injectable formulation should be administered IM only; do not give decanoate
IV. A 21-gauge needle is recommended. The maximum volume per injection site should not
exceed 3 mL. Administer in the gluteal muscle by deep IM injection; Z-track injection techniques
are recommended to limit leakage after injections
2. Inject over 1 to 2 minutes
3. IV administration usually associated with QT interval prolongation
1. Haloperidol decanoate should not be administered IV.

23. Morphine inj (category c )
IM, SubQ: The rout is no longer recommended due to local irritation and pain full
administration. Dosing range 5 to 15 mg every 4 hours as needed.
IV: Initial: 2.5 to 5 mg every 3 to 4 hours
 USE: Diabetic neuropathy, STEMI, NSTEMI,
 USUAL CONCENTRATIONS: IV, SubQ infusion: 0.8 to 10mg/ hour up to 80 mg/ hour
 STABILITY: Stable in dextran 6% in dextrose, dextran 6% in NS, D5LR, D5
1/4NS, D5
1/2NS, D5NS,
D5W, D10W, LR, 1/2NS, NS;
 STORAGE: Store at controlled room temperature of 20°C to 25°C (68°F to 77°F); do not
freeze. Protect from light. Degradation depends on pH and presence of oxygen; relatively
stable in pH ≤4; darkening of solutions indicate degradation.

 What to Do.
1. Monitoring signs while and after administration of drug, CNS depression, constipation,
hypotension, Respiratory depression.
2. When giving morphine IV push, it is best to first dilute with sterile water or NS for a final
concentration of 1 to 2 mg/mL and then administer slowly over 4 to 5 minutes.
1. Co-adminstration with Alteplase, alatrofloxacin, amphotericin B cholesteryl sulfate complex,
azithromycin, doxorubicin liposome, gallium nitrate, lansoprazole, micafungin, minocycline,
phenytoin, sargramostim. Variable (consult detailed reference):Acyclovir, cefepime,
ceftriaxone, furosemide, nesiritide, pantoprazole, propofol, thiopenta.

ICU DRUGS.pptx

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