iv meds

Penicillin G sodium (burette)

IU 5 000 000 (benzylpenicillin)

MOA: inhibits bacterial cell wall by binding w PBPs

Dosage : 3-6 MU (not exceed 50MU/day)

Administration: dilute 50-100ml infuse over 1-2 hrs

Special : NO RAPID = thrombophelbitis

Indications : bacteremia , empysema , severe pneumonia, endocarditis, meningitis

Reactions : blood dyscrasia , myocardial infract, myocarditis, convulsions , jerks

contraindications: dose reduction for renal pts

1g amoxicillin / 200mg clavulanic acid (burette/bolus)

AUGMENTIN

*do not dilute w dextrose

MOA: inhibits cell wall by binding w PBP, clavu acid prevents brkdown of amoxicillin

Special : do not mix w bloods , or add to glucose containing solutions

Indications : bacterial infections URTI, UTI, skin tissue bone infection

Reactions : diarrhea, rash , rise in AST ALT ,

Contraindications : Adequate fluid intake , n output to reduce crystalluria , administer electrolytes

1g Cefazolin (bolus/burette)

MOA: inhibits cell wall by binding w PBPs

Dosage : 1g / 8hrly

Indication : Aerobic gram positive (staphylococcus) , bacterial infection in lung skin bone joints , uti and bloodstream

Reactions : Diarrhea, nausea vomitting

*bolus → dilute with sterile water

burette and IV → NS, D5, D10

DO NOT inject less den 3 mins = thrombophlebitis

reduce dose for renal failure

1-2g Ceftriaxone (ROCEPHIN)

3rd gen cephalosporin

bolus / burette

MOA : inhibits bacterial cell wall synthesis by binding w PBP

max 4g daily

Indications : meningitis, pneumonia, urinary or abdominal infections

Reactions : diarrhoea , headache

* bolus → 2-4 mins

burette → D5 , NS in 30 mins

DO NOT RAPID SERVE causes phlebitis , cnt mix with hartman

not for penicillin allergy ppl

1g Ceftazidime (bolus/burette)

3rd gen (board spectrum)

MOA : inhibits bacterial cell wall by binding w PBP

Dosage : up to 9g/day

Indications : bacterial infections skin , uti , blood , brain lungs

Reactions : diarrhea, rash

Contraindications: dose reduction in renal failure

* bolus → 3-5 mins using sterile water burette

burette → over 15-30 mins

1g Ertapenem (burette)

MOA: exerts bactericidal action by interfering w vital bacterial cell wall synthesis

Dosage : 1g daily

Indications: Pneumonia, UTI , surgical site infection (colorectal)

Reaction: Diarrhea, nausea, rash, headache, hypotension

Contraindications: cns patients (brain lesions and seizures

DO NOT use dextrose to dilute

500mg/1g Meropenem

carbapenem antiobiotic

burette / bolus

MOA : exerts bactericadal action by interfering w vital bac wall synthesis

Dosage : 500mg/8hrs (pneumonia,UTI), 1g/8hrs nosocomial pneumonia) , 2g/hrs meningitis

indications : severe bacterial infections , pneumonia, intra abdominal infections , UTI , skin infections

Reactions : Diarrhoea, nausea vomitting , rash , headache , inflammation

* dilute w NS, D50

500mg Amikacin (burette)

potenet , broad aminoglycoside antibiotic

MOA : act on ribosomes , inhibiting bacterial internal protein synthesis

Dosage: 7.5 mg/kg over 30 mins

indications : severe , mutidrug resistent bacterial infections

Reactions : nephrotoxicity , oto toxicity, neuromuscular blockage

contraindications: renal insufficiency

* dilute with 500mg in 200ml of D5 or NS infuse 30-60 mins

80g Gentamicin Sulfate (burette)

MOA: bacterial ribosomes, inhibiting bacterial internal protein synthesis

indications : severe life theatening bacterial infections, bloodstream infections

reactions : nausea vomitting diarrhea, kidney damage

* causes hypotension

500mg Vancomycin (burette)

potent glycopeptide

MOA : binds to bacterial cell , inhibiting synthesis

Dosage : 15-20mg/kg/day every 12-24 hrs

indications: srs staphylococcus infection , MRSA , C diff , life threatening infections

Reactions: Red man syndrome, nausea , stomach pain , fatigue

* dilute to no more den 5mg/ml, every 500mg over at least 30 mins

NO RAPID IV INJECTION = hypot, rash

adjust according for renal inpairment n elderly

500mg/100ml Metronidazole (FLAGYL)

burette

MOA: disrupts bacterial DNA in dividing and non dividing cells

Dosage : usually 500mg / 8 hrly over 20-60 mins

Indications : anaerobic bacteria (thrive wo O2) , bacteria vaginosis, abdominal infections , Hpylori , C diff , parasitic

Reactions : Nausea , metallic taste in mouth , dizzy

* max rate 5ml/min

dose reduction in hepatic failure pts , no alcohol, pregnancy 2-3 trimester cnt give

200mg /100ml Ciprofloxicin (burette)

MOA : interfer w enzymes w transmission of genetic info

Dosage : 400-800mg / day divided into 2 dose

indications: UTI , gonarrhae

reactions : nausea, dyspepsia

contraindications: history of fits, renal failure and phycosis pts , no children , preg moms , G6PD deficiency

* administered slowly, incompatible w other solutions and drugs , ensure fluid intake

50mg Amphotericin B Liposomal (Ambisome)

Antifungal (slow IV)

MOA : antifungal by binding to sterols

Indications : severe systemic fungal infections, parasite diseases

reactions : decreased renal functions , kidney damage , fever chills rigors , nausea , phlebitis

* infuse 1-2mg/ml over 60-120mins

Potassium Chloride (1mol of K+ / ml)

burette / IV

indication : treat hypokalemia

• dilute 10mmol in 100ml

• less den 20mEq/100ml thru cvc (max 40 for severe metabolic states only)

Reaction : confusion, paresthesias, hyperK

NO BOLUS

Magnesium Sulphate 49.3% x 5ml ampoule

(bolus, burette, IV infusion)

MOA: replaces n maintain magn lvl

indication : treat hypomag

reactions : diarrhea, flushing, hypot, vasodilation

contraindications: active labour, heart block, myocardial damage

mild hypomag: 1g every 6 hr 4 dose

mild-mod hypomag : 1-4g at 1g or less/hr

severe hypomag: 4-8 g at 1g/hr

Can dilute with D5, NS, DS

general rate : 10mmol/hr (max 20)

IV push rate :150mg/min

(no iv bolus without dilution unless in resus )

Ranitidine Hydrochloride 50mg in 2ml

bolus / burette / IV

MOA: inhibits histamine release by acting at the H2 receptor sites on gastric parietal cells , reducing secretion of gastric acid

indications : duodenal n gastric ulcer , reflux oesophagitis , post op ulcer , zollinger-ellison syndrome

Morphine Sulphate

bolus / burette / IV

*antidote : Naloxone

MOA: binds to opiate receptors in CNS, relief severe pain , produces generalised CNS depression , inhibition of peristalsis leading to constipation

indications : for severe pain

reactions : dizzy, sedation, nausea , vommiting, hypot

contraindications: physical and psychological dependence, tolerance develop

* bolus → dilute w water (inject over 4-5mins)

IV→ D5 or NACL

Dopamine 200mg in 40mg/ml

IV via infusion pump

MOA: direct stimulation effect on dopaminergic receptor beta 1 and alpha 1 adrenergic receptors

Indications: hypotension, poor organ profussion ,correction of hemodynamic imbalances present in shock syndrome due to MI , trauma

MUST DILUTE (0.9% NS, D5, 0.9%NS 5%D5, 0.45%NS 5%D5, hartmann )

MUST USE PUMP

no alkaline IV solutions (sodium bicarbonate)

Reaction : palpitations, arrhythmias, chest pain, nausea vomitting , headache

Heparin 5000iu/ml and 25000iu/5ml

bolus / burette / IV

MOA : blocks endogenous clotting mechanisms n inhibits clotting

• IV injection dilute to 50-100ml of NACL0.9%

• IV infusion give in NS OR D5 (use pump)

• no IM (will form hematoma)

Indication: treatm of DVT (deep vein thrombosis) and pulmonary embolism, MI

Reactioms : haemorrhage, thrombocytopenia (thrombocytopenia), increase in AST ALT

monitor PT n APTT

Souble Insulin 1000iu

bolus/ IV

MOA: secreted by beta cells of pancreas for proper glucose use

Indication: For type 1 and type 2 diabetes , hyperkal treatment (tgt w glucose infusion) , severe ketoacidosis and dm coma

Reactions : hypogly, palpitation, tachy, fatigue, headache

• dilute in NS for bolus or continuous infusion

• only souble insulin cn b given in IV

• need to monitor patient (insulin absorbs to iv tubing)

Dexamethasone 4mg

STEROID

bolus / burette / IV

MOA : Synthesic adrenocorticosteriod w glucocorticoid activity , mimic action of endogenous cortisol to suppress inflammation and immune response

Indication : severe allergy , asthma , autoimmune conditions, arthritis, treatm of shock

Reaction : hypert , arrhythmia. bradycardia, hypergly

contraindications: fungal infection

dilute w NS or D5

store at 2-8°

hydrocortisone 100mg

STERIOD

bolus / burette

MOA : mimics action of endogenous cortisol and suppress inflammation, adrenal function and immune response

indications : claims immune system to reduce inflammation swelling and itching

Reactions : nausea , peptic ulcer , pancreatitis, diarrhea, constipation, electrolytes disturbance, crushing syndrome, headache

• high dose therapy shd nt continue for more den 48-72 hrs

• dose shd be tailed down gradually

• may mask signs of infection

Promethazine 50mg in 2ml

Bolus / burette / IV

MOA : antihistamine which act on brain and periphery , relieves symptoms of histamine

indications: treat allergy symptoms, nausea and vomiting , preop for surgery (for sedation), allergy conditions

Reactions : psychosis , hallucinations, sedation, tachy, brady, hypo , nausea vomitting

• no subq or intra arterial injection

• cnt exceed rate ot 25mg/min =hypot

Diazepam 10mg

bolus

MOA: acts on benzodiazepine to cause systemic effects

indications : severe anxiety, seizure , alcohol withdrawal symptoms, spasms

Reactions : drowsy dizzy, thrombophlebitis, hypot

not recommended for preg

Metoclopramide 10mg in 2ml

bolus/burette

MOA: acts on dopamine receptors in brain and periphery, stimulates motility of upper G1 tract , enhance gastric emptying

indications : antiemetic in chemo and post op vomitting , gastric stasis

Reaction : drowsy , dizzy , diarrhea

• bolus → slowly undiluted over 3 mins

• burette → D5, NS0.9%, hartmann

• AVOID RAPID ADM

• X parkinson disease

Furosemide 20mg in 2ml

DIURETIC

Bolus / burette / IV

MOA : acts on nephrons in kidneys to increase water excretion , mobilise excess fluid from body lower bp

Indications : peripheral oedema , pulmonary congestion, oliguria due to renal failure

reactions : hypoK , hyponatramia, hypergly , hyperuricemia, hypomag , nausea vomitting , diarrhea constipation

• bolus → slowly over 1-2 mins

• burette → NS0.9% lactated ringers

• DO NOT exceed rate 4mg/min

formula for drop per min for IV

total volume fluid (ml) x drop factor (drop/ml) / total time (in mins)

calculation of dose

insulin calculation