Acute Care1111Page
Floor Nurses’
Guide:
1 of 8
Intravenous Push (IVP) Drug List – Approved for RN Administration
University of Kentucky Chandler Medical Center
4/10/07
If medication is not approved for the IV push administration and alternative routes of administration are not available, approval for this individual situation must be
obtained through collaboration with pharmacy and the patient care manager
GENERIC NAME
(BRAND NAME(S))
RESTRICTED
AREA
THERAPEUTIC
CATEGORY
TYPICAL
ADULT
DOSE
MAXIMUM
ADULT
DOSE
MAXIMUM
CONCENTRA
TION*
MAXIMUM RATE
OF
ADMINISTRATION
**
ADMINISTRATION
CONSIDERATIONS
ADVERSE EFFECTS/COMMENTS
MONITORING PARAMETERS
Bumetanide
(Bumex)
-
Diuretic/Acute
Pulmonary Edema,
CHF, and Renal
disease
0.5-2 mg
over 1-2
minutes
10 mg/day
0.25 mg/ml
2 mg over 2
minutes
Pain at injection
Site
Monitor labs; Multiple drug
interactions; dizziness; N&V,
hypotension, and decrease
calcium and K+
Chlorothiazide Sodium
(Diuril)
-
Diuretic/Antihypertensive agent
0.5 – 1 g
2 g/day
28 mg/ml
Slow IVP
Extravasation
MUST be
avoided. Do
NOT give SC or
IM
Monitor electrolytes, rash,
hypotension
Cosyntropin (Cortrosyn) -
Diagnostic Agent
1 mcg or
250 mcg
250 – 750
mcg
-
Over 2 minutes
Blood draws
must be at
specific times
indicated by MD
order. No
steroids or
spironolactone
day before or
day of test.
Hypertension, flushing.
Peak cortisol concentration
occurs 45-60 min after
administration
Dexamethasone Sodium Phosphate
(Decadron)
Antiemetic; Antiinflammatory
4 mg
10 mg
4 mg/ml
Maximum rate:
Over 1 minute
Slower if itching
Over 3-5 minutes
-
Insomnia, nervousness,
increased appetite, fluid
retention
Dextrose 50%
Carbohydrate/
Symptomatic
hyperglycemia
25 gm
-
25 gm/50ml
10 ml/min
Phlebitis risk,
pain at injection
site; Large bore
IV access
Hyperglycemia, confusion
-
Page 1 of 8
Acute Care2222Page
Floor Nurses’
Guide:
2 of 8
Intravenous Push (IVP) Drug List – Approved for RN Administration
University of Kentucky Chandler Medical Center
4/10/07
If medication is not approved for the IV push administration and alternative routes of administration are not available, approval for this individual situation must be
obtained through collaboration with pharmacy and the patient care manager
GENERIC NAME
(BRAND NAME(S))
RESTRICTED
AREA
THERAPEUTIC
CATEGORY
TYPICAL
ADULT
DOSE
MAXIMUM
ADULT
DOSE
MAXIMUM
CONCENTRA
TION*
MAXIMUM RATE
OF
ADMINISTRATION
**
ADMINISTRATION
CONSIDERATIONS
ADVERSE EFFECTS/COMMENTS
MONITORING PARAMETERS
Diazepam
(Valium)
-
Benzodiazepine;
Anti-anxiety,
Anticonvulsant,
2-10mg/
dose
30 mg/8hrs
5 mg/ml
5 mg/minute
Phlebitis risk,
pain at injection
site
0.22 micron
filter required for
IVPB admin
Bradycardia; tachycardia,
drowsiness, hypotension,
hypoventilation
Dihydroergotamine
(D.H.E 45)
-
Antimigraine Agent
0.31mg/dose
6 mg/week
1mg/ml
Over 2-3minutes
-
HTN, Headache, dizziness, N/V
Diphenhydramine HCL (Benadryl)
Antihistamine;
Histamine 1
Antagonist
12.5-50 mg
q 2-4H
50 mg/dose
400 mg/day
50 mg/ml
25 mg/minute
Dilute to 25 mg/
ml in D5W or
NS
Hypotension, tachycardia,
sedation, dizziness, insomnia
Dolasetron Mesylate
(Anzemet)
-
Antiemetic
12.5 mg
over 30
seconds
25 mg
12.5 mg/
0.625 ml
25 mg over 30
seconds
Caution in
patients at risk
for prolonged
QT interval
HTN, headache, urinary
retention, tachycardia
Epinephrine
(Adrenaline Chloride)
-
Anaphylaxis/
Sympathomimetic
0.3-0.5 mg
IM/SQ
every 1520 minutes
as needed
-
1mg/ml
1mg/min
Watch for
injection site
blanching/
Extravasation
Use 1:1000 in
anaphylaxis
Tachycardia, hypertension,
nervousness, restlessness,
headache, dizziness
HR, BP
-
Gastrointestinal;
Histamine 2
Antagonist
20 mg q
12H
40 mg
20 mg/5ml
20 mg over 2
minutes
-
Headaches, dizziness, confusion,
mental status changes
Anaphylaxis Only
Famotidine
(Pepcid)
Page 2 of 8
Acute Care3333Page
Floor Nurses’
Guide:
3 of 8
Intravenous Push (IVP) Drug List – Approved for RN Administration
University of Kentucky Chandler Medical Center
4/10/07
If medication is not approved for the IV push administration and alternative routes of administration are not available, approval for this individual situation must be
obtained through collaboration with pharmacy and the patient care manager
GENERIC NAME
(BRAND NAME(S))
RESTRICTED
AREA
THERAPEUTIC
CATEGORY
TYPICAL
ADULT
DOSE
MAXIMUM
ADULT
DOSE
MAXIMUM
CONCENTRA
TION*
MAXIMUM RATE
OF
ADMINISTRATION
**
ADMINISTRATION
CONSIDERATIONS
ADVERSE EFFECTS/COMMENTS
MONITORING PARAMETERS
Flumazenil
(Rumazicon)
-
Benzodiazepine
Antagonist
0.2 mg
over 30
seconds
initial, can
repeat with
0.3mg
Give no
more than
1 mg per
dose or
3mg/hour
0.1mg/ml
0.2 mg over
15-30 seconds
Use large vein
and free flowing
IV to minimize
pain
Pt. may need additional doses in
case of re-sedation. Caution with
seizure patient.
Furosemide
(Lasix)
-
Loop Diuretic/
Volume overload
20 - 40 mg
80 mg but
can vary
widely
10 mg/ml
1-2 minutes
(Consider IVPB
over 5-10
minutes)
-
Hypotension, headache, and
dizziness
Glucagon
-
Emergency treatment
of symptomatic
hypoglycemia
0.5-1 mg/
min
(May be
repeated 12 times)
-
1 mg/ml
1 mg/min
May precipitate
with NS, K+
and Calcium;
Compatible
with D5W
Unstable hypoglycemic diabetic
may not respond & will need IV
Dextrose instead;
N/V, hypokalemia in overdose,
urticaria, respiratory distress and
hypotension
5HT3 Blocker
Prevention of N/V
secondary to
chemotherapy
10 mcg/kg
given 30
minutes
prior to
chemo
Antipsychotic/
Agitation
2-5 mg
Granisetron HCL
(Kytril)
Haloperidol Lactate
(Haldol)
-
Undiluted over
30 seconds
Varies with
patient
5 mg/ml
5 mg/min
Headache, diarrhea,
constipation, hypertension, fever
Start with lower
doses in geriatric
patients
Drowsiness, hypotension,
Extrapyramidal effects,
bradycardia, tachycardia
Page 3 of 8
Acute Care4444Page
Floor Nurses’
Guide:
4 of 8
Intravenous Push (IVP) Drug List – Approved for RN Administration
University of Kentucky Chandler Medical Center
4/10/07
If medication is not approved for the IV push administration and alternative routes of administration are not available, approval for this individual situation must be
obtained through collaboration with pharmacy and the patient care manager
GENERIC NAME
(BRAND NAME(S))
RESTRICTED
AREA
THERAPEUTIC
CATEGORY
TYPICAL
ADULT
DOSE
MAXIMUM
ADULT
DOSE
MAXIMUM
CONCENTRA
TION*
MAXIMUM RATE
OF
ADMINISTRATION
**
ADMINISTRATION
CONSIDERATIONS
ADVERSE EFFECTS/COMMENTS
MONITORING PARAMETERS
Heparin Bolus
(Heparin Drip
Protocol)
-
Anti-coagulant
Varies3,000-8,000
units
8,000 units
Usual:
10,000
units/mL
Over 1 minute
Antagonist is
Protamine
Bleeding, APTT, HCT, Hgb
Thrombocytopenia (HITHeparin induced)
Heparin
(for flush of Central
line catheter)
-
Anti-coagulant
-
100 units/ml
-
Antagonist is
Protamine
Bleeding, APTT, HCT, Hgb
Thrombocytopenia (HITHeparin induced)
Hydrocortisone
Sodium Phosphate
(Hydrocortone
Phosphate)
-
Anti-inflammatory
agent Corticosteroid
300 units
instilled
into Central
Catheter
15-240 mg
-
50 mg/ml
Over 3-5 minutes
-
Insomnia, nervousness
BP
Hydrocortisone
Succinate (SoluCortef)
-
Anti-inflammatory
(IV given usually in
emergency)
15-240 mg
1 gm/24
hour
-
Over 1 minute
Caution in
elderly
May need to
taper therapy
Monitor electrolytes; May mask
signs of infection
Hydromorphone
(Dilaudid)
-
Narcotic Analgesic
1-4 mg
-
4 mg/ml
Each 1 mg over
2-3 minutes
Reversal agent –
Naloxone
(Narcan)
Palpitations, hypotension,
dizziness, drowsiness, BP, RR
Insulin (Regular only)
-
Pancreatic Hormone/
Hyperglycemia
5-10 units
over 10
seconds
10 units
-
10 seconds
Push for
hyperkalemia
only; Only
Regular Insulin
can be given IV
Monitor Finger Stick Blood
Sugars
Push for
hyperKalemia only
Page 4 of 8
Acute Care5555Page
Floor Nurses’
Guide:
5 of 8
Intravenous Push (IVP) Drug List – Approved for RN Administration
University of Kentucky Chandler Medical Center
4/10/07
If medication is not approved for the IV push administration and alternative routes of administration are not available, approval for this individual situation must be
obtained through collaboration with pharmacy and the patient care manager
GENERIC NAME
(BRAND NAME(S))
RESTRICTED
AREA
THERAPEUTIC
CATEGORY
TYPICAL
ADULT
DOSE
MAXIMUM
ADULT
DOSE
MAXIMUM
CONCENTRA
TION*
MAXIMUM RATE
OF
ADMINISTRATION
**
ADMINISTRATION
CONSIDERATIONS
ADVERSE EFFECTS/COMMENTS
MONITORING PARAMETERS
Ketorolac
(Toradol)
-
NSAID/Short-term
management of modsevere pain
15- 30 mg
IV q 6
hours
120 mg/day
Max. 5
days
30 mg/ml
Over > 15
seconds
Requires renal
dose adjustment
Edema, drowsiness, headache
Avoid in patients with active or
recent bleeds
Levothyroxine
(Synthroid)
-
Thyroid hormone
50-100mcg
-
100 mcg/ml
100mcg/min
-Prepare
immediately
before
administration,
with 5ml Normal
saline.
-Do not mix with
any other IVF
-Do not further
dilute drug
Symptoms of hyperthyroidism –
nervousness, tremor, headache,
tachycardia, heat intolerance,
etc.
(½ of oral
dose)
Lorazepam
(Ativan)
-
Benzodiazapine
2-4 mg
diluted
with equal
volume of
IVF
8 mg/12hrs
2 mg/ml
2 mg/minute
Can easily cause
infiltration with
IVP,
Consider IVPB
over 5-10 min;
Reversal agentFlumazenil
Sedation, hypotension, dizziness,
headache, HR, BP, RR
Meperidine
(Demerol)
-
Narcotic Analgesic
25-100 mg
q 2-4 hours
-
100 mg/ml
Over 5 minutes
Dilute to 10 mg/
ml with NS
Reversal agentNaloxone
(Narcan)
Sedation, hypotension, dizziness,
BR, RR
Page 5 of 8
Acute Care6666Page
Floor Nurses’
Guide:
6 of 8
Intravenous Push (IVP) Drug List – Approved for RN Administration
University of Kentucky Chandler Medical Center
4/10/07
If medication is not approved for the IV push administration and alternative routes of administration are not available, approval for this individual situation must be
obtained through collaboration with pharmacy and the patient care manager
GENERIC NAME
(BRAND NAME(S))
RESTRICTED
AREA
THERAPEUTIC
CATEGORY
TYPICAL
ADULT
DOSE
MAXIMUM
ADULT
DOSE
MAXIMUM
CONCENTRA
TION*
MAXIMUM RATE
OF
ADMINISTRATION
**
ADMINISTRATION
CONSIDERATIONS
ADVERSE EFFECTS/COMMENTS
MONITORING PARAMETERS
Methylprednisolone
Sodium Succinate
(Solu-Medrol)
-
Anti-inflammatory
agent/ Adrenal
Corticosteroid
40-250 mg
-
62.5 mg/ml
125 mg over 3-5
minutes
Higher doses
give IVPB
Only the
succinate form
can be given IV;
Rapid admin. Of
high doses can
cause circulatory
collapse
Insomnia, nervousness
BP, Monitor Na+ and K+, FSBS
Metoclopramide
(Reglan)
-
Cholinergic/ GI
stimulant
Antiemetic
5-10 mg
10 mg
5 mg/ml
10mg or fraction
thereof over 2
minutes
>10 mg IVPB
over 15 minutes
Too rapid rate
may cause
intense anxiety
& restlessness
Hypotension, SVT, sedation,
dizziness, rash, extrapyramidal
effects treat with Benadryl:
Caution with hypertension
Morphine
-
Narcotic Analgesic
1-4 mg
8 mg
10 mg/ml
1 mg/min
Reversal agent
– Naloxone
(Narcan)
Sedation, dizziness, heart
palpitation, hypotension,
bradycardia, and respiratory
depression
BP, RR, Oxygen saturation
Muromonab-CD3
(Orthoclone, OKT3)
8E
Immunosuppressive
Agent/ Rejection
5 mg
5 mg
1 mg/ml
<1-2 minute
Filter each dose
through a low
protein binding
0.22 micron
filter
Fever, chilling, dyspnea,
wheezing, chest pain,
tachycardia, dizziness, shortness
of breath,
HR, BP, RR, Temperature
Page 6 of 8
Acute Care7777Page
Floor Nurses’
Guide:
7 of 8
Intravenous Push (IVP) Drug List – Approved for RN Administration
University of Kentucky Chandler Medical Center
4/10/07
If medication is not approved for the IV push administration and alternative routes of administration are not available, approval for this individual situation must be
obtained through collaboration with pharmacy and the patient care manager
GENERIC NAME
(BRAND NAME(S))
RESTRICTED
AREA
THERAPEUTIC
CATEGORY
TYPICAL
ADULT
DOSE
MAXIMUM
ADULT
DOSE
MAXIMUM
CONCENTRA
TION*
MAXIMUM RATE
OF
ADMINISTRATION
**
ADMINISTRATION
CONSIDERATIONS
ADVERSE EFFECTS/COMMENTS
MONITORING PARAMETERS
Naloxone
(Narcan)
-
Pure Opioid
Antagonist
0.1-0.8 mg
24 mg
1 mg/ml
Administer a
dilute solution of
naloxone (0.4mg
in 10 ml of saline)
IV, very slowly
(0.5ml over 2
minutes) while
you watch for the
desired effect
(titrate to effect).
The patient should
open his eyes
within one to two
minutes. If not,
continue giving
naloxone at the
same rate up to 0.8
mg or 20 mls of
dilute solution.
If patient does
not arouse after
the initial
administration
of Naloxone
(total dose of
0.8mg) begin
looking for
other causes of
sedation and
respiratory
depression.
Tachycardia, narcotic withdraw,
hypertension, hypotension,
anxiety, restlessness, Pulmonary
Edema, HR, BP, RR
Ondansetron (Zofran)
-
Antiemetic
1-4 mg
4 mg
-
1-4 mg over 2-5
minutes
Incompatible
with numerous
drugs
Observe closely for respiratory
distress; Ambulate Slowly
Reconstitute
with 10ml, 0.9%
Normal Saline
Injection site reactions,
headache, dyspepsia, and nausea
¾
Pantoprazole
(Protonix)
-
Gastrointestinal;
Proton pump
inhibitor
40 mg
80 mg
4 mg/ml
4 mg
consider
IVPB
over 15
minutes
40 mg over 2
minutes
Page 7 of 8
Acute Care8888Page
Floor Nurses’
Guide:
8 of 8
Intravenous Push (IVP) Drug List – Approved for RN Administration
University of Kentucky Chandler Medical Center
4/10/07
If medication is not approved for the IV push administration and alternative routes of administration are not available, approval for this individual situation must be
obtained through collaboration with pharmacy and the patient care manager
GENERIC NAME
(BRAND NAME(S))
RESTRICTED
AREA
THERAPEUTIC
CATEGORY
Promethazine
Antiemetic/
(Phenegran) IVP only
Antihistamine
with Central or
PICC Line or IVPB
over 20 mins
* Alter volume based upon dosage to be administered
ƒ
TYPICAL
ADULT
DOSE
12.5-25 mg
MAXIMUM
ADULT
DOSE
50 mg
MAXIMUM
CONCENTRA
TION*
MAXIMUM RATE
OF
ADMINISTRATION
**
ADMINISTRATION
CONSIDERATIONS
50 mg/ml
IVP: 25 mg/min
Monitor for
infiltration
ADVERSE EFFECTS/COMMENTS
MONITORING PARAMETERS
Hypotension, tachycardia,
dizziness, and drowsiness
IVPB: 20
minutes
** Alter duration based upon dose to be administered.
If the medication is not approved for IV push administration and alternative routes of administration are not available, approval for this
individual situation must be obtained through collaboration with pharmacy and the patient care manager
Updated: 04/10/07
Revised by: Christy Taylor, PharmD and Lori Proeschel, PharmD
Contact person for revisions: Kimberley Hite (khite2@uky.edu)
Page 8 of 8