drug reference policy

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DRUG REFERENCE POLICYRESPIRATORY
Page 1 of 7
MANUAL
SECTION
POLICY CODE
and NUMBER
Care of The Patient
Treatment
TX-85
PURPOSE
The purpose of this policy is to unify administration of medications.
POLICY
1.
All Respiratory Therapists will abide by the Administration of Medications Policy and this policy.
2.
The ID band prior to drug administration will identify all patients.
3.
All medication errors and adverse reactions will be reported immediately to the Supervisor and the event
reporting system (including entering into the electronic event reporting system and calling extension
681.
PROCEDURE
1.
The therapist against the medical record will verify the medication order.
2.
Remove the appropriate medication from the patient’s medication bin.
3.
Double check with the MAR
4.
Check the patient’s identification bracelet and verify patient’s name.
5.
Administration medication via treatment. Stay with patient during treatment
6.
Document administration and effects of prescription.
7.
The respiratory care department will keep a current list of drugs, used by practitioners, in the policy and
procedure manual for reference to recommended dosage, mode of action, untoward reactions, duration,
and strengths.
.
RACEMIC EPINEPHRINE (Vaponephrine)
a synthetic form of Epinephrine
Strength:
Dosage:
Mode of Action:
Peak effect:
Duration:
Adverse reactions:
2.25%
.25 - .5ml in 3 - 5ml ns
same as Epinephrine having both alpha and beta stimulation with reduced effects;
vasocontriction.
----1.5 - 2 hours
Tachycardia, hypertension, palpitations, tremors, nervousness, insomnia, bronchial
irritation.
ISOPROTERENOL - (Isuprel) (Catecholamine)
DRUG REFERENCE POLICYRESPIRATORY
Strength:
Dosage:
Mode of action:
Peak effect:
Duration:
Adverse reactions:
Page 2 of 7
1:200 of a 0.5% solution
25 - .in 3ml - 5ml NS; 1-2 puffs QID via MDI
One of the purest beta stimulants, giving powerful beta1 and beta2 activation. This
results in bronchial smooth muscle relaxation, pulmonary vasodilatation, and cardiac
excitation; facilitates expectoration.
5 - 30 minutes
1.5 - 2 hours
tachycardia, hypertension, palpitations, nausea, vomiting, tremors, diaphoresis,
headache, dizziness, and nervousness.
ISOETHARINE - (Bronkosol) (Catecholamine)
Strength:
Dosage:
Mode of actions:
Peak effect:
Duration:
Adverse reactions:
1.0% (10mg/ml)
25 - 5ml in 3 - 5ml NS; Q 3-4 for MDI
a primary beta1 stimulant that produces bronchodilation with minimal cardiac side
effects. Beta 2 stimulation, a stimulation for nasal decongestion.
15 - 60 minutes
1.5 - 3 hours
tachycardia, hypertension, tremors, palpitations, nausea, headaches, restlessness,
anxiety, and tension
METAPROTERENOL SULFATE - (Alupent)
Strength:
Dosage:
Mode of action:
Peak effect:
Duration:
Adverse reactions:
5% solution (50mg/ml)
.2 - .3ml in 2 - 3ml NS; 2-3 puffs Q 3-4 via MDI (0.65mg/dose)
primarily a beta2 stimulant. It is twice as potent on bronchial smooth muscle as
metaproterenol while having less cardiac stimulation and minimal beta side effects.
------4 - 6 hours
tachycardia, palpitations, tremors, hypertension, nervousness, nausea, vomiting
ATROPINE SULFATE - (Parasympatholytic)
Strength:
Dosage:
Mode of action:
Peak effect:
Duration:
Adverse reactions:
0.2% or 0.5% solution
.05Mg/kg in 2 - 3ml NS (0.5% solution); 0.025mg/kg (0.2% sol.) TID or QID
competitive inhibition with acetylcholine for receptor sites. Atropine administered by
aerosol has also caused improvement of airways resistance and forced expiratory
flows in asthmatics with measurable air obstruction even between acute episodes.
------------thickening of bronchial secretions. Mucous plugging, tachycardia, dry mouth,
hypertension, mydriasis, blurred vision, difficulty with speech and swallowing.
ALBUTEROL SULFATE - (Proventil)
Strength:
Dosage:
Mode of action:
Peak effect:
Duration:
Adverse reactions:
0.083
0.5ml in 3ml NS (max dose 1ml Q 4 hour); 2puffs (90mcg/dose) via MDI
relatively selective beta2 adrenergic bronchodilator
------up to 6 hours
tremors, dizziness, nervousness, tachycardia, pharyngitis, and nasal congestion
DRUG REFERENCE POLICYRESPIRATORY
Page 3 of 7
NORMAL SALINE, HYPERTONIC AND HYPOTONIC SALINE, DISTILLED WATER
Strength:
Dosage:
Mode of action:
Peak effect:
Duration:
Adverse reactions:
-------3 - 5ml for aerosol therapy or by direct tracheal instillation. Each may be used a
diluting agents for another active ingredient or by themselves to provide
humidification.
reduction in the viscosity of mucous
-------up to 1 hour
bronchospasm, must be used with a bronchodilator
CROMOLYN SODIUM - (Intal, Aarane)
Strength:
Dosage:
Mode of action:
Peak effect:
Duration:
Adverse reactions:
20mg capsules; 20mg solution in 2ml H2O; 2 puffs (800mcg/dose) via MDI
1 capsule in spin-haler qid; or one 20mg ampule qid
cromolyn sodium inhibits degranulation of mast cells during the antigen antibody
reactions of asthma, preventing the chemical release of histamine, heparin, srss-s, etc.
This is used strictly as a prophylactic agent int her treatment of asthma and should not
be used during acute episodes of bronchospasm.
--------------primary cough, bronchospasm, occasional allergic rashes, nasal congestion, and
pharyngeal irritation
EPINEPHRINE HCL - (Catecholamine)
Strength:
Dosage:
Mode of action:
Peak effect:
Duration:
Adverse reactions:
1:100
.25 - .5ml in 3 - 5ml ns
equally stimulates alpha and beta-receptors to relax smooth bronchial muscles and
shrink vasculature of the mucous membranes of the respiratory tract
5 - 20 minutes
1 hour or less
tachycardia, palpitations, hypertension, headache, nervousness, and tremors
SALMETEROL- (Serevent)
Strength:
MDI-21 mcg/actuation, DPI – 50mcg/inhalation
Dosage:
Chronic Asthma: 2 puffs (42mcg) Q12 via MDI. 1 inhalation (50mcg)
Q12 via dry powder inhalation (DPI)
Exercise Induced Asthma: 2puffs 30-60 minutes before exercise via
MDI. Additional doses should not be used for another 12 hours. 1
inhalation 30-60 minutes before exercise via DPI. Additional doses
should not be used for another 12 hours.
Beta-2-adrenergic agonist (long lasting)
-------------
Mode of Action:
Peak effect:
Duration:
Adverse reactions: -------
GENTAMICIN SULFATE & TOBRAMYCIN
Strength:
40mg/ml solution
DRUG REFERENCE POLICYRESPIRATORY
Dosage:
Mode of action:
Peak effect:
Duration:
Adverse reactions:
Complications:
Page 4 of 7
40 or 80 mg/dose, bid, tid, or qid
Antimicrobial
----------Hypersensitivity, bronchospasms, and mucosal irritation
Theoretical risk of neuromuscular blockage (respiratory following
administration).
NOTE: Bronchodilators, if ordered, should precede or be given in conjunction with the anti-infective agent.
Suctioning of bronchial secretions should be done prior to administering all anti-infective agents.
PENTAMIDINE- (Nebupent)
Strength:
Dosage:
Mode of action:
Peak effect:
Duration:
Adverse reactions:
Contraindictions:
300mg vial
300mg w/ 6ml of sterile water (max dose)
200mg w/ 4ml of sterile water
150mg w/ 3ml of sterile water (min dose)
Dosage should start at 300mg unless otherwise ordered and tapered
down to 200mg, then 150mg, if side effects persist. Treatment for
active P. Carinii Pneumonia = 1 treatment daily x 14-28 days.
Prevention of P. Carinii Pneumonia = 1 treatment every 4 weeks.
anti microbial agent
----------Cough, bronchospasm, shortness of breath, fatigue, chest pain,
dizziness, nausea, decreased appetite, rash
History of anaphylactic reaction to inhaled or parenteral pentamidine.
NOTE: Personal Protective Equipment required.
IPRATROPIUM BROMIDE- (Atrovent)
Strength:
Dosage:
Mode of action:
Peak effeect:
Duration:
Adverse reations:
Contraindications:
0.2% pre-mixed solution
2.5ml/dose of 0.2% pre-mixed solution (2.5ml vials supplied, no saline
dilutor necessary) TID or QID via hand-held neb, IPPB, or IPV. 2
puffs (18mcg/dose), qid via MDI
Parasympatholytic (Anticholinergic)
----------Nausea, vomiting, nervousness, dizziness, palpitations, blurred vision,
dry mouth, and cough.
Glaucoma, hypersensitivity to atropine or its derivatives
TERBUTALINE SULFATE- (Brethine, Brethaire)
Strength:
Dosage:
Mode of action:
Peak effect:
Duration:
Adverse reaction:
1mg/ml solution
0.25 – 1.5mg/dose or 0.025ml/kg/dose via hand-held neb., IPPB, IPV.
Max dose 1ml Q4 hr. 2 puffs (0.20mg/dose), Q4-6 via MDI. 1-3
mg/hour continuous aerosol via Heart or Miniheart neb.
B2 stimulation, mild B1 stimulation
----------Tachycardia, palpitations, hypertension, headache, nausea, vomiting,
nervousness, tremors, insomnia
DRUG REFERENCE POLICYRESPIRATORY
Contraindications:
Page 5 of 7
Patients who are hypersensitive to its components.
LEVALBUTEROL – (Xopenex)
Strength:
Dosage:
Mode of action:
Peak effect:
Duration:
Adverse reactions:
Contraindications:
0.63mg/vial and 1.25mg/vial
0.63mg/unit dose or 1.25mg/unit dose Q6-Q8 via hand-held neb.
B2 stimulant, Mild B1 stimulant
----------paradoxical bronchospasm, tachycardia, hypertension, cardiac
arrythmias
Patients on Beta blockers, diuretics, digoxin, MAOI or Tricyclic
antidepressants.
BECLOMETHASONE – (Beclovent, Vanceril)
Strength:
Dosage:
Mode of action:
Peak effect:
Duration:
Adverse reaction:
Contraindications:
-----2 puffs (42mcg/dose), Q6-8 hr., via MDI for adults.
Anti-inflammatory
----------Adrenal insufficiency, throat irritation, dry mouth, hoarseness, rash,
bronchospasm.
Hypersensitivity to its ingredients. Patients taking immunodepressant
drugs.
DEXAMETHASONE – (Decadron)
Strength:
Dosage:
Mode of action:
Peak effect:
Duration:
Adverse reactions:
4mg/ml injectable solution
1.0mg/dose (0.25ml) via hand neb., IPPB, IPV. 2-3 puffs (84mcg/dose) via MDI.
Anti-inflammatory
----------Exacerbates fungal infections, hypersensitivity reaction, nausea,
headache.
Contraindications:
Hypersensitivity to its ingredients. Patients on increased amounts of
Corticosteroids.
FLUTICASONE PROPRIONATE – (Flovent)
Strength:
Dosage:
Mode of action:
Peak effect:
Duration:
Adverse reactions:
NOTE:
FUROSEMIDE – (Lasix)
176mcg/24hrs – max 800mcg/24hrs via MDI or 200mcg/24hrs – 1000mcg/24hrs via
DPI. If prior use of inhaled corticosteriods: 176-440mcg/24hrs – max 800mcg/24hrs
via MDI or 200-500mcg/24 hours max 1000mcg/24 hours. If prior use of oral
corticosteriods: 1760mcg/24hrs via MDI or 2000mcg/24hrs via DPI.
Anti-inflammatory
----------Dyspnea, oral thrush, dermatitis
Rinse mouth after each use.
DRUG REFERENCE POLICYRESPIRATORY
Strength:
Dosage:
Mode of action:
Peak effect:
Duration:
Adverse reaction:
Contraindication:
Page 6 of 7
10mg/ml
1mg/kg Q4 hours via hand-held neb.
Influences airway epithelial transport. Inhibits chloride transport across tracheal
epithelium. Decreased ion transport may reduce airway reactivity by either a direct
effect on airway epithelial responsiveness or by an indirect effect on the local release
of mediators of bronchoconstriction.
----------No known.
No known.
GLYCOPYRROLATE – (Robinul)
Strength:
Dosage:
Mode of action:
Peak effect:
Duration:
Adverse reaction:
Contraindications:
0.2mg/ml solution
1mg/dose via hand-held neb
Anti-cholinergic agent (for the drying of bronchial and mouth
----------As indicated w/ Atropine.
As indicated w/ Atropine.
secretions)
ACETYLCYSTEINE – (Mucomyst)
Strength:
Dosage:
Mode of action:
Peak effect:
Duration:
Adverse reactions:
Contraindications:
10% or 20% solutions
20% solution: 3-5ml tid, qid; 10% solution: 6-10ml tid, qid; either via hand neb.,
IPPB, IPV. 1-2ml of 10% or 20% via direct instillation.
Disrupts disulfide bonds of mucus.
----------Bronchospasm (should always be given with a bronchodilator),
nausea, vomiting,
rhinorrhea, stomatitis.
Bronchorrhea
NOTE: Sodium Bicarbonate is not recommended to be mixed with any bronchodilator.
ALCOHOL
Strength:
Dosage:
Mode of action:
Peak effect:
Duration:
Adverse reactions:
Contraindications:
-----3cc’s of 70% alcohol via hand neb., IPPB, IPV.
Reduces surface tension of foaming pulmonary edema and results in rapid depression
of bubbles.
----------Stomatitis, nausea, rhinorrhea, bronchodilator
Severe bronchodilator, bronchorrhea
SODIUM BICARBONATE
Strength:
Dosage:
Mode of action:
2% solution
2-5ml via hand neb., IPPB alone, or as dilutant. 2-5ml direct tracheal irrigation
Increase bronchial pH weakening bonds of mucus.
DRUG REFERENCE POLICYRESPIRATORY
Peak effect:
Duration:
Adverse reaction:
Contraindications:
8.
Page 7 of 7
----------Stomatitis, Bronchospasms, bronchitis, Rhinorrhea, nausea
Severe bronchodilator, Bronchorrhea
Medication Unit Dose
A. To eliminate the need of medication mixture and increase the availability of medications, the
Respiratory Care Practitioner will utilize unit dose medications when commercially available.
B. Physicians’ orders not specifying unit dose medications will be dispensed by pharmacy and
administered by Respiratory Care with the next lowest dosage available in unit dose.
C. Medications not available in unit dose vials will be mixed and dispensed by pharmacy as ordered by
physician.
References: 1. The Harriet Lane Handbook, Twelfth edition, Mosby, 1991. 2. 1993 Physician’s Desk Reference, 47 th
edition. 3. Medication package inserts, 1994.
JC-HAS:
OTHER:
Original Date
07/17/97
Review/Revision Date
04/28/03
 Supersedes all Previous
Approved: _____________________
Date
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