Drug Name
Patient
Dose
Why is the patient on this
medication?
Special Considerations
(for IV meds, include ml/hr and
duration of infusion)
Mild pain (1 – 3), fever
Infuse over 15 minutes. Don’t exceed 4,000
mg per day from all sources
Albumin (Albuminar)
25% IV soln
1,000 mg IV
every 6 hrs
PRN
1,000 mg IV
every 6 hrs
PRN
1,000 mg IV
every 6 hrs
PRN
650 mg tab
every 4 hrs
PRN
650 mg tab
every 4 hrs
PRN
325 mg tab
every 4 hrs
PRN
650 mg tab
every 4 hrs
PRN
650 mg rectal
suppository,
every 4 hrs
PRN
650 mg tab
every 4 hrs
PRN
650 mg PO
every 4 hrs
PRN
500 mg oral
every 6 hrs
PRN; 15.6 mL
= 500 mg of 32
mg/mL
650 mg rectal
suppository,
every 4 hrs
PRN
650 mg tab
every 4 hrs
PRN
100 mL IV
2x/day @ 0900
Albumin (Albuminar)
25% IV soln
Acetaminophen
(Ofirmev)
Acetaminophen
(Ofirmev)
Acetaminophen
(Ofirmev)
Acetaminophen
(Tylenol)
Acetaminophen
(Tylenol)
Acetaminophen
(Tylenol)
Acetaminophen
(Tylenol)
Acetaminophen
(Tylenol)
Acetaminophen
(Tylenol)
Acetaminophen
(Tylenol)
Acetaminophen
(Tylenol)
Fever
Infuse over 15 minutes. Don’t exceed 4,000
mg per day from all sources
Fever, rectal temp greater than
101
Infuse over 15 minutes. Don’t exceed 4,000
mg per day from all sources
Fever
For temp greater than 101 oral. Don’t exceed
4,000 mg per day from all sources
Mild pain (1-3)
Do not exceed 4,000 mg per day from all
sources.
Mild pain (1-3), headache
Do not exceed 4,000 mg per day from all
sources.
Mild pain (1-3), fever, headache,
temp greater than 101 F (38.3 C)
Don’t exceed 4,000 mg per day from all
sources
Mild pain (1-3), fever, headache,
temp greater than 101 F (38.3 C)
If NPO or not tolerating oral intake. Don’t
exceed 4,000 mg/day from all sources
Mild pain (1-3), fever, headache,
temp greater than 101 F (38.3 C)
Don’t exceed 4,000 mg per day from all
sources. Give in PACU ONLY when tolerating
oral fluids; discontinue on transfer from PACU
Don’t exceed 4,000 mg per day from all
sources
Non anginal mild pain (1-3)
Mild pain (1-3), headache
Do not exceed 4,000 mg per day from all
sources.
Mild pain (1-3), fever, headache,
temp greater than 101 F (38.3 C)
If NPO or not tolerating oral intake. Don’t
exceed 4,000 mg/day from all sources
Mild pain (1-3), fever, headache,
temp greater than 101 F (38.3 C)
Don’t exceed 4,000 mg per day from all
sources
Use within 4 hrs of opening. Give prior to Lasix.
50 mL IV every
6 hrs, @ 1000
Adjunct in treatment of adult
respiratory distress syndrome,
promote diuresis
Promote diuresis, fluid overload,
CHF
Albumin (Albuminar)
25% IV soln
100 mL IV PRN
conditional
Hypotentension, to support BP
during hemodialysis treatment.
Use within 4 hrs of opening – 0.25 g/mL
Albuterol (Proventil)
2.5 mg/0.5 mL
nebulizer soln
2.5 mg every 4
hrs
COPD
Administered by Respiratory Therapist
Acetaminophen
(Tylenol)
Acetaminophen
(Tylenol)
Use within 4 hrs of opening. Give prior to Lasix.
Albuterol (Proventil)
2.5 mg/0.5 mL
nebulizer soln
2.5 mg every 2
hrs PRN
5 mg/mL neb
soln every 4 hrs
when awake
2.5 mg/0.5 mL
nebulizer soln,
2.5 mg every 4
hrs when
awake
2.5 mg every 4
hrs PRN
For wheezing, shortness of breath
Administered by Respiratory Therapist
Pneumonia, bronchodilator,
history of asthma
Administered by respiratory therapist
As needed for shortness of breath
Administered by Respiratory Therapist. Dilute
in 3 ml of NS
Dyspnea/wheezing
Administered by respiratory therapist. Dilute in
3 mL NS.
90
mcg/actuation
inhaler 2 Puff.
Every 4 hrs
PRN
1 mg every 8
hrs PRN
For wheezing, shortness of breath
Administered by Respiratory Therapist
Anxiety
Adverse effects: drowsiness, sedation.
Atrial fibrillation, atrial flutter
Crush to admin via NG tube. One possible
cause of interstitial lung disease. Peak 2-7hr
Antiarrhythmic, Antianginal.
(prevention or suppression of
cardiac arrhythmias)
Antiarrhythmic, Antianginal
Admin over 10 mins
Amiodarone
(Cordarone)
0.25-.05 mg PO
every 8 hrs
PRN
200 mg tab, NG
Tube, 2x/day
@ 0900
150-300 mg
IVP over 10
mins
360 mg IV over
6 hrs.
Amiodarone
(Cordarone)
540 mg IV over
18 hrs.
Antiarrhythmic, Antianginal
Maintenance infusion (over 18 hrs)
Amlodipine (Norvasc)
5 mg tab daily
Antihypertensive (calcium
channel blocker)
Monitor blood pressure (no parameters given)
Amlodipine (Norvasc)
5 mg tab daily
Antihypertensive, calcium channel
blocker
Hold for Systolic BP < 110
Amlodipine (Norvasc)
Antihypertensive, calcium channel
blocker
Hold for Systolic BP < 90. Admin via G tube
Amlodipine (Norvasc)
5 mg tab,
2x/day, due @
0900
10 mg tab daily
Antihypertensive (calcium
channel blocker)
Monitor blood pressure (no parameters given)
Ascorbic acid (Vitamin
C)
500 mg tab,
oral, daily
Vitamin C deficiency
Ascorbic acid (Vitamin
C)
500 mg tab,
oral, daily, due
@0900
325 mg tab @
0900
Vitamin C deficiency
Albuterol (Proventil)
Albuterol (Proventil)
Albuterol (Proventil)
nebulizer solution
Albuterol HFA
(Proventil HFA)
Alprazolam (Xanax)
Alprazolam (Xanax)
Amiodarone
(Cordarone)
Amiodarone
(Cordarone)
Aspirin
Aspirin
325 mg tab @
0900
Anxiety
Atrial fibrillation, atrial flutter
Patient on ventilator, NG Tube
Acute MI
May be administered with food to avoid GI
upset.
Aspirin
Aspirin
Aspirin (Bayer
children’s aspirin)
Atorvastatin (Lipitor)
Atorvastatin (Lipitor)
Atropine
Enteric coated
325 mg tab
daily
325 mg tab @
0900
81 mg
chewable tab
@ 0900
10 mg tab daily
80 mg tab daily,
at bedtime
1mg IVP
Azithromycin
(Zithromax)
1200 mg tab
Azithromycin
(Zithromax)
Benazepril (Lotensin)
500 mg in D5W
250 mL
injection IV
every 24 hrs
500 mg in D5W
250 mL
injection IV
every 24 hrs
due @ 1300
1g in D5W 100
mL IVPB at 200
mL/hr every 8
hrs, due @
0900
Topical
ointment
applied 2x/day
to affected
areas, @0900
Topical
ointment
applied 2x/day
to affected
areas, @0900
10 mg tab daily
Benazepril (Lotensin)
Benzocaine-menthol
(Cepacol sore throat)
(max strength)
Benzonatate (tessalon
perles)
Azithromycin
(Zithromax)
Aztreonam (Azactam)
Bacitracin (Baciguent)
Bacitracin (Baciguent)
Acute MI, Antiplatelet
May be administered with food to avoid GI
upset.
Atrial fibrillation, suspected MI
Patient on ventilator, NG Tube. May be
administered with food to avoid GI upset
Acute MI, NSTEMI
May be administered with food to avoid GI
upset. Intubated.
To reduce LDL cholesterol and
triglyceride levels (Antilipemic),
prevention of cardiovascular
disease (pt. has had MI)
To reduce LDL cholesterol and
triglyceride levels (Antilipemic),
history of hyperlipidemia, pt. has
had MI
Bradycardia, complete heart
block, or escape rhythms with
symptoms of hemodynamic
compromise. (Anticholinergic,
Antiarrhythmic)
Suspected infection
Avoid grapefruit juice
Notify health care provider
Cautious use in debilitated patients.
UTI
COPD, possible lung infection.
Suspected infection
Antibiotic, prophylaxis for infection
Prevent bacterial infection of
scalp laceration. Polypeptide
antibiotic ointment, inhibits cell
wall synthesis, effective against
many gram pos. organisms.
Prevent bacterial infection
laceration. Polypeptide antibiotic
ointment, inhibits cell wall
synthesis, effective against many
gram pos. organisms.
Antihypertensive, ACE inhibitor
Apply to scalp laceration only
20 mg tab daily
Hypertension, antihypertensive
ACE inhibitor
Check BP before giving
1 Lozenge
every 6 hrs
PRN
100 mg cap
every 8 hrs
Sore throat
Cough suppressant
Apply to affected area
Hold for Systolic BP < 110
Swallow whole, don’t crush or chew
Bisacodyl (Dulcolax)
Bisacodyl (Dulcolax)
Bisacodyl (Dulcolax)
Bupropion (Wellbutrin)
10 mg rectal
suppository
daily PRN
5 mg tab
2x/day PRN
10 mg rectal
suppository
every other day
PRN
100 mg tab
daily
constipation
Constipation
Swallow whole, do not crush, chew, or split.
constipation
Antidepressant
Buspirone (Buspar)
10 mg tab daily
Antianxiety
Calcium chloride
1g in NS 50 mL
IV PRN
conditional rate:
50 mL/hr
2g in NS 100
mL IV PRN
conditional rate:
50 mL/hr
3g in NS 150
mL IV PRN
conditional
1 g in D5W 100
mL injection,
PRN
conditional
12.5 mg PO
every 8 hrs
Calcium replacement
For ionized Ca of 4.1-4.5, infuse over 1 hr.
Calcium replacement
For ionized Ca of 3.7-4.0, infuse over 90 mins.
Calcium replacement
For ionized Ca less than 3.7, infuse over 2-3
hours.
Calcium replacement
Ion Ca 4.1 to 4.5. Max infusion rate NOT TO
EXCEED 1 g per hour
Antihypertensive
Hold for SBP < 110. Common adverse effects:
cough, maculopapular rash. Life threatening
adverse effects: Agranulocytosis, Angioedema
350 mg tab
4x/day
Fibromyalgia
Carvedilol (Coreg)
3.125 mg tab
due @ 0800,
2x/day w/
meals
For CHF.
Antihypertensive, Adrenergic
blocker
Cefazolin (Ancef)
2g/20 mL IV,
dose: 2g, every
8 hrs, @ 0800
Cefepime (Maxipime)
2g in D5W 100 mL
IVPB
Ceftriaxone
(Rocephin)
2 g, 200 mL/hr,
IVPB, every 12
hrs
1 g in D5W 100
mL IVPB @
200 mL/hr
every 24 hrs
1 g in D5W 100
mL IVPB @
200 mL/hr
every 24 hrs,
due @ 1200
Antibiotic, prevention of infection
after surgery, cephalosporin
antibiotic. Inhibits cell wall
synthesis.
Antibiotic
Calcium chloride
Calcium chloride
Calcium gluconate in
D5W
Captopril
Carisoprodol (Soma)
Ceftriaxone
(Rocephin)
Hold for HR less than 50 bpm. Hold for
Systolic BP less than 100 mmHg. Administer
with food if not NPO.
Alpha and Beta-Adrenergic antagonist.
Decreases myocardial O2 demand and lowers
cardiac workload. Common adverse effect:
dizziness. Life threatening: thrombocytopenia
(low patelets).
Cautious use: Coagulopathy. Peak: 5 mins IV,
half-life: 90-130 mins. Promptly report onset of
diarrhea, possible sign of pseudomembranous
colitis.
Infuse over 30 mins
Pneumonia
Infuse over 30 mins, do not infuse thru same IV
line as Calcium containing IV solutions
(including LR and TPN)
E. Coli Pneumonia. Broad
spectrum cephalosporin antibiotic.
Broad spectrum against gram
pos, gram neg coverage
Infuse over 30 mins, do not infuse thru same IV
line as Calcium containing IV solutions
(including LR and TPN)
Ceftriaxone
(Rocephin)
Clindamycin (Cleocin)
Clonidine (Catapres)
Clonidine (Catapres)
Clonidine (Catapres)
Clonidine (Catapres)
Clopidogrel (Plavix)
2 g in D5W 100
mL mini-bag
IVPB @ 200
mL/hr every 12
hrs, due @
1600
600 mg in NS
50 mL IV, every
6 hrs, due @
0930
0.1 mg tab
every 6 hrs
PRN
0.2 mg tab
every 4 hrs
PRN
0.1 mg tab
every 6 hrs
PRN
0.1 mg tab
every 6 hrs
PRN
75 mg tab @
0900
COPD, possible lung infection.
Broad spectrum cephalosporin
antibiotic. Broad spectrum
against gram pos, gram neg
coverage
Infuse over 30 mins, do not infuse thru same IV
line as Calcium containing IV solutions
(including LR and TPN)
Antibiotic, prophylaxis for infection
Hypertension
For systolic BP greater than 160 or diastolic BP
greater than 100.
Hypertension, SBP > 170, or DBP
> 110
For systolic greater than 170 or diastolic
greater than 110.
High BP, administer if systolic BP
> 170 mm Hg
Only give if meets parameters for high BP
HTN, administer if systolic BP >
170 mm Hg
Only give if meets parameters for high BP,
check BP prior to admin.
Blood thinner, helps prevent MI,
stroke
Adverse effects: hemorrhage, severe
neutropenia, thrombotic thrombocytopenia
purpura
Adverse effects: hemorrhage, severe
neutropenia, thrombotic thrombocytopenia
purpura
Apply to affected area
300 mg PO 1st
dose, then 75
mg PO daily
Topical, daily
(time not
stated)
5 mg tab
3x/day PRN
Blood thinner, helps prevent MI,
stroke. (Antiplatelet,
Antithrombotic)
Pressure ulcers, skin abrasions
D10W 1,000 ml IV
soln
10-125 mL/hr
IV PRN
conditional
Fluid intake
D10W 1,000 ml IV
soln
10-125 mL/hr
IV PRN
conditional
Fluid intake
D10W 1,000 ml IV
soln
10-125 mL/hr
IV PRN
conditional
Fluid intake, glucose intake
D5 ½ NS – KCL 20
mEq
1,000 mL IV
soln @ 75
mL/hr
continuous
100 mL/hr
continuous
Fluid intake, nutrition, electrolyte
balance
1,000 mL IV
soln @ 125
mL/hr
continuous
25 g IV push,
QID AC & HS
PRN
Nutrition, potassium, and fluid
intake (electrolyte replacement)
Hypervolemia and hyperkalemia, monitor blood
glucose
Hypoglycemia
Admin SLOW IV push as needed for blood
glucose less than 70 mg/dL (if unable to
tolerate oral glucose). Recheck glucose after
15 mins, and repeat D50W 25 g if blood
glucose is less than 80 mg/dL. Continue to
Clopidogrel (Plavix)
Collagenase (Santyl)
topical ointment
Cyclobenzaprine
(Flexeril)
D5 ½ NS 1,000 ml IV
soln
D5 LR with KCL 20
mEq/L
D50W injection 25 g
Muscle spasm
If tube feeding is held. Begin at same mL/hr
rate as tube feeding. Discontinue when tube
feeding resumes AND blood glucose is greater
than 100 mg/dL
If tube feeding is held. Begin at same mL/hr
rate as tube feeding. Discontinue when tube
feeding resumes AND blood glucose is greater
than 100 mg/dL. Pt. has fluid volume overload.
If tube feeding is held. Begin at same mL/hr
rate as tube feeding. Discontinue when tube
feeding resumes AND blood glucose is greater
than 100 mg/dL.
Fluid intake
monitor glucose every 15-20 mins until glucose
returns to greater than 100 mg/dL x 2
Dextromethorphan Guaifenesin
(Robitussin)
Dextromethorphan Guaifenesin
(Robitussin)
Dextrose prefill IV
syringe 12.5 g
Dextrose prefill IV
syringe 12.5 g
Dextrose prefill IV
syringe 25 g
Digoxin (Lanoxin) 250
mcg/mL
10-100 mg/5
mL oral liquid 5
mL
10-100 mg/5
mL oral liquid
15 mL, Dose:
15 mL, every 4
hrs PRN
12.5 g IV QID
AC & HS PRN
Dose 25 mL,
Admin dose
12.5 g, IV PRN
conditional
Dose 50 mL,
Admin dose: 25
g, IV PRN
conditional
250 mcg IV
daily @ 0900
Cough
Cough
Hypoglycemia
Hypoglycemia
Hypoglycemia
BG less than 50, give 50 mL D50W (1 amp)
and re-check blood glucose every 15 mins.
Atrial fibrillation.
Mechanism: Inhibits the sodiumpotassium ATPase, which makes
more calcium available for
contractile proteins, resulting in
increased cardiac output (positive
inotropic effect), increases force
of contraction, decreases heart
rate (negative chronotropic
effect), decreases AV conduction
speed
Admin over at least 5 mins. IV: onset 5-30min,
peak 1-5hr, duration variable. Apical pulse for 1
min before giving product; if pulse <60 in adult,
take again in 1 hr; if <60 in adult, call
prescriber; note rate, rhythm, character;
monitor ECG continuously during parenteral
loading dose. Precautions: Pregnancy C,
breastfeeding, renal disease, acute MI, AV
block, severe respiratory disease,
hypothyroidism, geriatric patients, sinus nodal
disease, hypokalemia . Side Effects:
Headache, drowsiness, apathy, confusion,
disorientation, fatigue, hallucinations,
dysrhythmias, hypotension, bradycardia, AV
block, blurred vision, yellow-green halos,
photophobia, diplopia, N/V, anorexia,
abdominal pain, diarrhea
Antianginal, Antiarrhythmic,
Antihypertensive. (Calcium
channel blocker)
Tachycardia, HR > 120
Onset 30-60min,
Peak 2-3hr immediate rel; Half-life 31/2 -9 hr
Diltiazem (Cardizem)
30 mg PO
every 6 hours
Diltiazem (Cardizem)
5mg/mL
Diphenhydramine
(Benadryl)
20 mg/4 mL IV
every 6 hrs
PRN
25 mg IV, every
4 hrs PRN
Diphenhydramine
(Benadryl)
25 mg IV, every
4 hrs PRN
Itching, insomnia
Diphenhydramine
(Benadryl)
50 mg/mL IV,
every 6 hrs
PRN
Base dose 5
mcg/kg/min x
73.3 kg, Admin
dose 366.5
mcg/min  11
Itching, hives, pruritus
Dobutamine
(Dobutrex) drip (conc:
2,000 mcg/mL)
As needed for blood glucose less than 70
mg/dL (if unable to tolerate oral glucose).
Recheck blood glucose after 15 mins, may
repeat x 1 if blood glucose less than 70 mg/dL.
BG 51-69 and if patient cannot take PO, give
D50W, 25 mL (1/2 amp) IV push.
For elevated HR above 120. Administer bolus
dose over 2 mins. Onset 30-60min,
Peak 2-3hr immediate rel; Half-life 31/2 -9 hr
Itching
Heart failure, cardiogenic shock
Continuous drip, calculate dose per pt. weight.
mL/hr
Docusate sodium
(Colace)
100 mg cap
2x/day PRN
Stool softener
Swallow whole, don’t crush or chew
Docusate sodium
(Colace)
250 mg cap,
2x/day
Stool softener
Swallow whole, do not crush or chew.
Docusate sodium
(Colace)
100 mg/10 mL
oral liquid,
2x/day, @ 0900
Stool softener
Possibly administer via NG tube
Docusate sodium
(Colace)
100 mg/10 mL
oral liquid,
2x/day, @ 0900
Stool softener
Administer via PEG tube
Docusate sodium
(Colace)
100 mg cap
daily
Stool softener
Swallow whole, do not crush or chew. Do not
give if diarrhea occurs, then reevaluate daily.
Docusate sodium
(Colace)
100 mg cap
2x/day due @
0900
100 mg oral
liquid 2x/day
Stool softener
Swallow whole, don’t crush or chew
Stool softener
.
5mcg/kg/minute
IV infusion
Cardiac stimulant, vasopressor
Base dose 5
mcg/kg/min x
68 kg, Admin
dose 340
mcg/min 
12.75 mL/hr
continuous drip
60 mg cap
2x/day
Circulation problems due to MI,
CHF, kidney failure 
vasopressor.
Titrate to keep systolic greater than 100
mmHg. Obtain patient’s weight. Common
adverse effects: hypotension, tachycardia.
Continuous drip. Begin at 5 mcg/kg/min.
Titrate to maintain rate based on parameters.
Parameters: Aug Dias > 90. Not to exceed 20
mcg/kg/min.
1,000 mL IV
soln @ 20
mL/hr
continuous
100 mg tab,
daily
Electrolyte replacement
Control of HIV
Patient’s own medication, supplied as a unit
dose package, request med from 6th floor
pharmacy
0.625 IV, every
6 hrs PRN
Hypertension, SBP >180
For systolic greater than 180. Check to see if
Clonidine was administered.
1.25 mg IV,
every 6 hrs
PRN
0.625 mg IV,
every 6 hrs
PRN
40 mg/0.4 mL
SubQ
Hypertension, SBP >140
For systolic greater than 140. Check to see if
other antihypertensive administered.
Hypertension
Systolic BP greater than 160. Max initial single
dose in non-critical care areas is 0.625
Anticoagulant
Notify physician for dosing or holding plan if
invasive procedure, LP, or surgery is to be
performed in next 24 hrs.
Docusate sodium
(Colace) 100
mg/10mL
Dopamine
Dopamine 800 mg in
D5W 500 mL drip
Duloxetine (Cymbalta)
Electrolyte-R (pH 7.4)
(Normosol-R) IV soln
Elvitegr-cobicistemtric-tenof 150-150200-300 mg tab 100
mg *Patient Own
Med*
Enalaprilat (Vasotec)
1.25 mg/mL
Enalaprilat (Vasotec)
1.25 mg/mL
Enalaprilat (Vasotec)
1.25 mg/mL injection
0.625 mg
Enoxaparin (Lovenox)
Shingles (herpes zoster)
Swallow whole, do not crush, chew, or spit.
Capsules may be opened and the contents
taken without crushing or chewing.
Hypervolemia
Enoxaparin (Lovenox)
40 mg/0.4 mL
SubQ every 24
hrs
30 mg/0.3 mL
SubQ
Anticoagulant
40 mg/0.4 mL
SubQ every 24
hrs @ 1800
40 mg/0.4 mL
SubQ every 24
hrs, @ 0830
40 mg/0.4 mL
SubQ every 24
hrs, due @
0900
1 mg/kg SQ
every 12 hours
Anticoagulant (prophylaxis for
blood clots)
Famciclovir (Famvir)
500 mg tab
3x/day
Shingles (herpes zoster)
Famotidine (Pepcid)
20 mg tab daily
Antiulcer drug
Famotidine (Pepcid)
20 mg/2mL IV
2x/day
GERD (H2 receptor antagonist)
Famotidine (Pepcid)
20 mg tab
2x/day
Antiulcer drug
Famotidine (Pepcid)
20 mg/2mL IV
2x/day, @ 0900
GERD (H2 receptor antagonist),
antiulcer drug
Fentanyl (Duragesic)
75 mcg/hr
transdermal
patch, dose: 1
patch, every 48
hrs, due @
1700
Pain, patient is allergic to
morphine.
Fentanyl (Sublimaze)
5,000 mcg in
no diluent, 100
mL drip (conc:
50 mcg/mL).
Dose 50 mcg/hr
: 1 mL/hr,
continuous.
Peripheral IV R.
Forearm, 20 g
Moderate to severe pain
Enoxaparin (Lovenox)
Enoxaparin (Lovenox)
Enoxaparin (Lovenox)
Enoxaparin (Lovenox)
Enoxaparin (Lovenox)
Anticoagulant
Anticoagulant
Anticoagulant
Anticoagulant, Antithrombotic
Notify physician for dosing or holding plan if
invasive procedure, LP, or surgery is to be
performed in next 24 hrs.
Dose adjusted for renal function (estimated
CrCl 23 mL/min using SCr 1.68 on 8/3)
Notify physician for dosing or holding plan if
invasive procedure, LP, or surgery is to be
performed in next 24 hrs.
Notify physician for dosing or holding plan if
invasive procedure or surgery is to be
performed in next 24 hrs. Half-life 4 ½ hr
Notify physician for dosing or holding plan if
invasive procedure, LP, or surgery is to be
performed in next 24 hrs.
Notify physician for dosing or holding plan if
invasive procedure, LP, or surgery is to be
performed in next 24 hrs.
Caution if creatinine clearance less than 30.
Life threatening adverse effects: Angioedema,
Hemorrhage, Thrombocytopenia.
Dilute in 5 mL NS and administer over 2 mins.
Dilute in 5 mL NS and administer over 2 mins.
Life threatening adverse side effect:
thrombocytopenia. Peak: 0.5-3 hr, duration:
10-12 hr
Should ONLY be used in patients already
receiving opiod therapy demonstrated opioid
tolerance, and require daily dose equivalent to
fentanyl 25 mcg/hr or greater. Patients
considered opioid tolerant are those who have
been taking, for a week or longer,
equianalgesic doses of at least morphine 60
mg, oxycodone 30 mg, or hydromorphone 8
mg per day. ** Use in non-opioid tolerant
patients may lead to fatal respiratory
depression.
Apply to clean, dry area of the chest, back,
flank or upper arm..
If goal pain score not achieved: Use up to 2
bolus doses before increasing rate by 25
mcg/hr every 15 mins until goal pain score
achieved. If at goal pain score: continue
current dose. Max dose: 600 mcg/hr.
Recommended max dose: 10 mcg/kg/hr. Notify
intensivist if patient on max dose.
Contraindications: substance abuse,
significant respiratory compromise; cautious
use: head injuries. Life threatening adverse
side effect: circulatory depression, cardiac
arrest, respiratory depression or arrest;
Fentanyl (Sublimaze)
5,000 mcg in
no diluent, 100
mL drip (conc:
50 mcg/mL).
Dose 50 mcg/hr
: 1 mL/hr,
continuous.
Peripheral IV
#1 L. Wrist,
pumping at 100
mcg/hr on
planning day.
Moderate to severe pain
Fentanyl (Sublimaze)
50 mcg/mL IV
injection every
5 mins PRN
25 mcg dose of
50 mcg/mL, IV
injection, every
5 mins PRN
5,000 mcg in
no diluent, 100
mL drip (conc:
50 mcg/mL).
Dose 05
mcg/kg/hr x 83
kg : Admin
dose 41.5
mcg/hr. 0.83
mL/hr IV
continuous
Pain
Fentanyl (Sublimaze)
Fentanyl (Sublimaze)
Pain
IVP every 5 mins up to 2 doses PRN pain
before increasing continuous infusion rate.
Moderate to severe pain,
palliative care
Initiate drip at 50 mcg/hr; titrate by 50 mcg/hr
every 30 mins until target pain score of 0 is
achieved and respiratory rate is less than 14
per hour. Max rate of 300 mcg/hr. Notify
physician if target pain score and respiratory
rate is not achieved at max hourly rate for
further orders.
Life threatening adverse side effect:
circulatory depression, cardiac arrest,
respiratory depression or arrest; Common
adverse effect: nausea. Onset: immediate IV,
peak 3-5 min IV, duration: 30-60 min IV
If goal pain score not achieved: Use up to 2
bolus doses before increasing rate by 25
mcg/hr every 15 mins until goal pain score
achieved. If at goal pain score: continue
current dose. Max dose: 600 mcg/hr.
Recommended max dose: 10 mcg/kg/hr. Notify
intensivist if patient on max dose.
Contraindications: substance abuse,
significant respiratory compromise; cautious
use: head injuries. Life threatening adverse
side effect: circulatory depression, cardiac
arrest, respiratory depression or arrest;
Common adverse effect: nausea. Onset:
immediate IV, peak 3-5 min IV, duration: 30-60
min IV
IVP every 5 mins up to 2 doses PRN pain
before increasing continuous infusion rate.
Fentanyl (Sublimaze)
5,000 mcg in
no diluent, 100
mL drip (conc:
50 mcg/mL).
Dose 50 mcg/hr
: 1 mL/hr,
continuous.
Moderate to severe pain
Fentanyl (Sublimaze)
50 mcg/mL,
dose: 25 mcg
IV injection
every 5 mins
PRN
5,000 mcg in
no diluent, 100
mL drip (conc:
50 mcg/mL).
Dose 50 mcg/hr
Pain
Fentanyl (Sublimaze)
Common adverse effect: nausea. Onset:
immediate IV, peak 3-5 min IV, duration: 30-60
min IV
If goal pain score not achieved: Use up to 2
bolus doses before increasing rate by 25
mcg/hr every 15 mins until goal pain score
achieved. If at goal pain score: continue
current dose. Max dose: 600 mcg/hr.
Recommended max dose: 10 mcg/kg/hr. Notify
intensivist if patient on max dose. Requires
dual sign off! Contraindications: substance
abuse, significant respiratory compromise;
cautious use: head injuries. Life threatening
adverse side effect: circulatory depression,
cardiac arrest, respiratory depression or arrest;
Common adverse effect: nausea. Onset:
immediate IV, peak 3-5 min IV, duration: 30-60
min IV.
IVP every 5 mins up to 2 doses PRN pain
before increasing continuous infusion rate.
Moderate to severe pain
If goal pain score not achieved: Use up to 2
bolus doses before increasing rate by 25
mcg/hr every 15 mins until goal pain score
achieved. If at goal pain score: continue
current dose. Max dose: 600 mcg/hr.
: 1 mL/hr,
continuous.
Fentanyl (Sublimaze)
Fentanyl (Sublimaze)
Fentanyl (Sublimaze)
Ferrous sulfate
(Feosol)
Fluticasone –
salmeterol (Advair
HFA) 230-21
mcg/actuation inhaler
Fluticasone (Flonase)
50 mcg/actuation
nasal spray
Fluticasone (Flonase)
50 mcg/actuation
nasal spray
Furosemide (Lasix) 10
mg/mL
Furosemide (Lasix)
500 mg in no diluent,
50 mL drip (straight
drug)
Gabapentin
(Neurontin)
25 mcg dose of
50 mcg/mL, IV
injection, every
5 mins PRN
5,000 mcg in
no diluent, 100
mL drip (conc:
50 mcg/mL).
Dose 50 mcg/hr
: 1 mL/hr,
continuous.
25 mcg dose of
50 mcg/mL, IV
bolus, every 5
mins PRN
325 mg tab
2x/day
Pain
Moderate to severe pain
Pain
Recommended max dose: 10 mcg/kg/hr. Notify
intensivist if patient on max dose.
Contraindications: substance abuse,
significant respiratory compromise; cautious
use: head injuries. Life threatening adverse
side effect: circulatory depression, cardiac
arrest, respiratory depression or arrest;
Common adverse effect: nausea. Onset:
immediate IV, peak 3-5 min IV, duration: 30-60
min IV
IVP every 5 mins up to 2 doses PRN pain
before increasing continuous infusion rate.
Dose to be given from IV infusion pump.
If goal pain score not achieved: Use up to 2
bolus doses before increasing rate by 25
mcg/hr every 15 mins until goal pain score
achieved. If at goal pain score: continue
current dose. Max dose: 600 mcg/hr.
Recommended max dose: 10 mcg/kg/hr. Notify
intensivist if patient on max dose.
Contraindications: substance abuse,
significant respiratory compromise; cautious
use: head injuries. Life threatening adverse
side effect: circulatory depression, cardiac
arrest, respiratory depression or arrest;
Common adverse effect: nausea. Onset:
immediate IV, peak 3-5 min IV, duration: 30-60
min IV
IVP every 5 mins up to 2 doses PRN pain
before increasing continuous infusion rate.
Dose to be given from IV infusion pump
Iron deficiency
Swallow whole, don’t crush, chew, or spit.
2 Puffs.
Inhalation with
spacer. 2x/day
@0900
1 spray, both
nares, daily
Acute respiratory failure
(interstitial lung disease)
Administered by RT
2 sprays, both
nares, 2x/day
@ 0900
40 mg = 4 mL
IV every 12 hrs
@ 1200
Acute respiratory failure
(interstitial lung disease)
Dose: 30
mg/hr, infusion:
3 mL/hr, IV
continuous drip
800 mg cap
3x/day
Rhinitis
Pulmonary edema; CHF, HTN.
Loop diuretic. Action:
Inhibits reabsorption of sodium
and chloride at proximal and
distal tubule and in the loop of
Henle
Pulmonary edema; CHF, HTN,
fluid volume overload. Loop
diuretic. Action:
Inhibits reabsorption of sodium
and chloride at proximal and
distal tubule and in the loop of
Henle
Neuropathic pain
May not be able to take due to NG
tube/occluded nares. Onset 12hr, peak
several days, duration 1-2 wk
Life threatening adverse side effects:
circulatory collapse, leukopenia, aplastic
anemia, agranulocytosis (rare)
Life threatening adverse side effects:
circulatory collapse, leukopenia, aplastic
anemia, agranulocytosis (rare). Protect from
light.
Gabapentin
(Neurontin)
1,600 mg cap
daily
Neuropathy, neuropathic pain,
fibromyalgia, insomnia
Gabapentin
(Neurontin)
400 mg cap
3x/day
Neuropathic pain, migraine
prophylaxis
Glucagon (Glucagen)
injection 1 mg
1 mg IM, QID
AC & HS PRN,
1 mL = 1mg of
1 mg/mL
Hypoglycemia
Guaifenesin
(Robitussin)
100 mg/5 mL,
200 mg, dose:
10 mL, every 4
hrs PRN
200 mg/10 mL
every 4 hrs
PRN
15 mL, 300 mg,
oral, every 6
hrs PRN
7500 units SQ
every 12 hours
Cough
Guaifenesin
(Robitussin)
Guailfenesin
(Robitussin) 100 mg/5
mL oral liquid 300 mg
Heparin
Heparin 5,000
units/0.5 mL injection
10,000 units
Heparin 5,000
units/0.5 mL injection
5,000 units
Heparin 5,000
units/0.5 mL injection
5,000 units
Heparin D5W 25,000
unit/500 mL (50
unit/mL) drip
Heparin D5W 25,000
unit/500 mL (50
unit/mL) drip
Heparin dosing per
pharmacy 1 each
Heparin dosing per
pharmacy 1 each
Hydralazine
(Apresoline) 20
mg/mL injection
If patient glucose less than 70 mg/dL, has a
decreased level of consciousness, is unable to
take glucose orally, and IV access cannot be
established within 5 mins, administer glucagon
1 mg IM then continue to attempt IV access.
Place pt. in lateral recumbent position in
anticipation of vomiting. Monitor glucose every
15-20 mins and repeat 1mg IM if glucose
remains less than 80 mg/dL. Continue to
monitor glucose every 15-20 mins until it
returns to greater than 100 mg/dL x2.
Sore throat, cough
Congestion, cough
Anticoagulant
Requires 2 nurse check. Life threatening
adverse effects: spontaneous bleeding,
thrombocytopenia, bronchospasm,
anaphylactoid reactions.
2 nurse check, potential for bleeding.
10,000 units
Intracatheter,
PRN
conditional,
post
hemodialysis tx
5,000 units
SubQ every 12
hrs-STD
5,000 units
SubQ every 12
hrs-STD, due
@ 0900
2,000 units/hr,
40mL/hr, IV
continuous drip
1,550 units/hr,
31 mL/hr, IV
continuous drip
1 each, daily
PRN
For post hemodialysis treatment;
Anticoagulant
1 each, daily
PRN,
Pharmacy
consult
10 mg IV, every
4 hrs PRN;
admin 0.5 mL =
10 mg of 20
mg/mL
For NSTEMI, Anticoagulant
Heparin dosing and monitoring (including
platelets) in accordance with medical centerapproved guideline and policy and procedure.
HTN, For Systolic BP > 170.
Non-nitrate vasodilator
Only give if meets parameters for high BP,
check BP prior to admin.
Anticoagulant, deep venous
thrombosis
2 nurse check
Anticoagulant, DVT prophylaxis
2 nurse check, potential for bleeding.
Anticoagulant
Requires 2 nurse check
For NSTEMI, Anticoagulant.
Venous thromboembolism
prophylaxis
Anticoagulant
Requires 2 nurse check
Requires 2 nurse check.
Hydrochlorothiazide
(Hydrodiuril)
25 mg tab daily
Hypertension, and also edema
associated with CHF
Check BP before giving
Hydrocodone –
acetaminophen
(Norco)
7.5 - 325 mg
tab 1-2 Tabs,
every 4 hrs
PRN
10 – 325 mg
tab 1 Tab,
every 4 hrs
PRN
7.5 – 325 mg
tab 1 Tab,
every 4 hrs
PRN
7.5-325 mg tab
1-2 Tabs, every
4 hrs PRN
5 – 325 mg tab
1 Tab, every 4
hrs PRN
10 – 325 mg
tab 1 Tab,
every 4 hrs
PRN
7.5 – 325 mg
tab 1 Tab,
every 4 hrs
PRN
5 – 325 mg tab
1-2 Tab, every
4 hrs PRN
Mod pain (4 – 6) 1 tab, severe
pain (7-10) 2 tabs
Don’t exceed 4,000 mg of acetaminophen per
day from all sources
Mod pain (4 – 6)
Don’t exceed 4,000 mg of acetaminophen per
day from all sources
Mild pain (1-3)
Don’t exceed 4,000 mg of acetaminophen per
day from all sources
Mild pain (1-3) 1 tab, Mod pain (4
– 6) 2 tabs
Don’t exceed 4,000 mg of acetaminophen per
day from all sources
Mild pain (1-3)
Don’t exceed 4,000 mg of acetaminophen per
day from all sources
Mod pain (4 – 6)
Don’t exceed 4,000 mg of acetaminophen per
day from all sources
Mild pain (1-3)
Don’t exceed 4,000 mg of acetaminophen per
day from all sources
Mild pain (1-3), Mod pain (4-6)
Don’t exceed 4,000 mg of acetaminophen per
day from all sources. If an injectable analgesic
is concurrently ordered for the same severity of
pain, use oral when patient is consistently
tolerating oral intake.
Do not exceed 4,000 mg of acetaminophen per
day from all sources. If an injectable analgesic
is concurrently ordered for the same severity of
pain, use oral when patient is consistently
tolerating oral intake.
Apply to left chest wall rash as needed.
Hydrocodone –
acetaminophen
(Norco)
Hydrocodone –
acetaminophen
(Norco)
Hydrocodone –
acetaminophen
(Norco)
Hydrocodone –
acetaminophen
(Norco)
Hydrocodone –
acetaminophen
(Norco)
Hydrocodone –
acetaminophen
(Norco)
Hydrocodone –
acetaminophen
(Norco)
Hydrocodone –
acetaminophen
(Norco) 5-325 mg tab
1 tab, every 4
hrs PRN
Mild pain (1-3)
Hydrocortisone
(Cortizone-10)
1% topical
cream, 2x/day
PRN
1 mg/1 mL, IV,
every 3 hrs
PRN
Skin rash
Hydromorphone
(Dilaudid) injection
Severe pain (7-10)
Hydromorphone
(Dilaudid) injection
1 mg IV, every
4 hrs PRN
Severe pain (7-10)
Hydromorphone
(Dilaudid) injection
2 mg IV, 2x/day
PRN
Severe pain (7-10)
Hydromorphone
(Dilaudid) injection
1.5 mg IV,
every 2 hrs
PRN
Severe pain (7-10)
Hydromorphone
(Dilaudid) injection
1 mg IV, every
2 hrs PRN
Moderate pain (4 – 6), if patient is
not tolerating oral intake or if oral
analgesics ineffective
If an oral analgesic is concurrently ordered for
the same severity of pain, only use injectable
route if patient is not tolerating oral intake or if
oral analgesics are ineffective.
If oral analgesic is concurrently ordered for
same severity of pain, only use injectable route
if pt. is not tolerating oral intake or if oral
analgesics ineffective.
Premedicate for dosage change. If oral
analgesic is concurrently ordered for same
severity of pain, only use injectable route if pt.
is not tolerating oral intake or if oral analgesics
ineffective.
If oral analgesic is concurrently ordered for
same severity of pain, only use injectable route
if pt. is not tolerating oral intake or if oral
analgesics ineffective.
If oral analgesic is concurrently ordered for
same severity of pain, only use injectable route
if pt. is not tolerating oral intake or if oral
analgesics ineffective.
0.5 mg IV,
every 4 hrs
PRN
Moderate pain (4 – 6)
Hydroxyzine (atarax)
25 mg tab
every 6 hrs prn
Itching
Insulin glargine
(Lantus) 100 unit/mL
injection 10 units
10 units, SubQ,
daily @ 0900
Glucose control, Steroid induced
diabetes (solumedrol)
Insulin glargine
(Lantus) 100 unit/mL
injection 16 units
16 units, SubQ,
daily at bedtime
Type 2 diabetes
Insulin Lispro
(Humalog) 100
unit/mL injection 1-6
Units
1 – 6 Units
SubQ, every 6
hrs per
correction
scale, due
@1200
2 – 12 Units
SubQ, QID AC
& HS PRN for
elevated
glucose per
correction scale
2 – 12 Units
SubQ, every 6
hours PRN for
elevated
glucose per
correction scale
2 – 12 Units
SubQ, 4x/day –
before meals &
at bedtime.
Due @ 0800 &
1200. For
elevated
glucose per
correction scale
2 – 12 Units
SubQ, 4x/day –
before meals &
at bedtime.
Due @ 0800 &
1100.
2-12 units
SubQ every 6
hrs PRN
Type 2 diabetes
Hydromorphone
(Dilaudid) injection
Insulin Lispro
(Humalog) 100
unit/mL injection 2-12
Units
Insulin Lispro
(Humalog) 100
unit/mL injection 2-12
Units
Insulin Lispro
(Humalog) 100
unit/mL injection 2-12
Units
Insulin Lispro
(Humalog) 100
unit/mL injection 2-12
Units
Insulin regular human
(NovoLin R, HumuLIN
R), 100 unit/mL,
injection 2-12 units
If oral analgesic is concurrently ordered for
same severity of pain, only use injectable route
if pt. is not tolerating oral intake or if oral
analgesics ineffective.
Drowsiness
To be given when insulin drip discontinued.
Long acting insulin, duration up to 24 hrs. If
patient becomes NPO or other nutrition is
interrupted for more than 1 hr or a bolus
feeding is missed, contact physician for orders
which may include insulin dose reduction,
addition of D10 infusion, and more frequent
glucose monitoring.
Long acting insulin, duration up to 24 hrs. If
patient becomes NPO or other nutrition is
interrupted for more than 1 hr or a bolus
feeding is missed, contact physician for orders
which may include insulin dose reduction,
addition of D10 infusion, and more frequent
glucose monitoring.
2 nurse check. Use correction scale. Call MD
if glucose greater than 400 mg/dL
Type 2 diabetes
2 nurse check. Use correction scale.
Type 2 diabetes
2 nurse check. Use correction scale.
Type 2 diabetes
2 nurse check. Use correction scale.
Type 2 diabetes
2 nurse check. Use correction scale.
For elevated blood glucose per
correction scale. Type 2 DM.
Requires 2 nurse check. BG 151-200 = 2
units, BG 201-250 = 4 units, BG 251-300 = 6
units, BG 301-350 = 8 units, BG 351-400 = 10
units, BG > 400 = 12 units and call MD
Insulin regular human
(NovoLin R, HumuLIN
R), 100 units in NS
100 mL drip
1-5 units/hr, 15mL/hr,
continuous IV
drip
Glucose control, Steroid induced
diabetes (solumedrol)
Insulin regular human
U-500 “Concentrated”
(HumuLIN R U-500
“concentrated”), 500
unit/mL
40 Units, SubQ,
3x/day before
meals
Type 2 Diabetes
Insulin regular human
U-500 “Concentrated”
(HumuLIN R U-500
“concentrated”), 500
unit/mL
5-15 Units,
SubQ, 3x/day
before meals
as needed
Type 2 Diabetes
Insulin regular human
U-500 “Concentrated”
(HumuLIN R U-500
“concentrated”), 500
unit/mL
Ipratropium – albuterol
(Duo-neb) 0.5 mg3mg (2.5 mg base/ 3
mL nebulizer soln
Ipratropium – albuterol
(Duo-neb) 0.5 mg3mg (2.5 mg base/ 3
mL nebulizer soln
5-15 Units,
SubQ, HS PRN
Type 2 Diabetes
3 mL nebulizer
4x/day, due @
0800 & 1200.
RT Admin
3 mL nebulizer
every 4 hrs,
due @ 0800 &
1200. RT
Admin
0.02%
nebulizer soln
0.5 mg every 4
hrs
0.02%
nebulizer soln
0.5 mg every 2
hrs PRN
0.02%
nebulizer soln
0.5 mg every 4
hrs @ 0815
and 1215
0.02%
nebulizer soln
0.5 mg PRN
conditional:
dyspnea
10 mg PO
4x/day
Wheezing, shortness of breath
Administered by Respiratory Therapist
Wheezing, shortness of breath
Administered by Respiratory Therapist
COPD, bronchodilator
Administered by Respiratory Therapist
Wheezing, shortness of breath
Administered by Respiratory Therapist
Acute respiratory failure
(interstitial lung disease)
Shortness of breath,
bronchodilator
Administered by Respiratory Therapist
Dyspnea, Acute respiratory
failure, ARDS, bronchodilator
Administered by Respiratory Therapist
Nitrate vasodilator, Antianginal
Adverse effects: light headedness, flushing.
Ketorolac (Toradol)
30 mg IV every
6 hrs PRN
Mild pain (1 – 3), Mod pain (4 – 6)
Labetalol
(Normodyne)
20 mg IV every
4 hrs PRN
Hypertension, SBP >140
Ipratropium (Atrovent)
Ipratropium (Atrovent)
Ipratropium (Atrovent)
Ipratropium (Atrovent)
Isosorbide Dinitrate
Requires 2 nurse check. Same caution as
above. BG < 180 = 0 units/hr, BG 181-200 = 1
unit/hr, BG 201-250 = 2 units/hr, BG 251-300 =
3 units/hr, BG 301-400 = 4 units/hr, BG > 400
= 5 units/hr (on care planning day insulin was
not being titrated according to this scale).
Requires 2 nurse check. Caution: Insulin U-500
is five times more concentrated than insulin U100. 40 units U-500 equals 8 units marking on
U-100 syringe (Blood sugar 100 or higher). If
blood sugar less than 100 mg/dl, give 25 units
U-500, equals 5 units marking on U-100
syringe. If pt. is NPO, HOLD insulin.
Requires 2 nurse check. Same caution as
above. If glucose 200-300, give 5 units, U-500
equals 1 unit marking on U-100 syringe. If
glucose 301-400, give 10 units U-500 equals 2
unit marking on U-100 syringe. If over 400,
give 15 units U-500 equals 3 unit marking on
U-100 syringe.
Requires 2 nurse check. For elevated blood
sugar per correction scale at 2100. Same
caution and instructions as immediately above.
For systolic greater than 140. Check to see if
other antihypertensive administered.
Lansoprazole
(Prevacid)
30 mg soluble
tab, via NG
tube @ 0700
GI Prophylaxis
Levalbuterol
(Xopenex)
1.25 mg/0.5 mL
nebulizer soln
@ 0800 and
1200
1,000 mg in
D5W 100 mL,
2x/day, @
0900, infuse
over 15 mins
500 mg tab
2x/day, due @
0900
Acute respiratory failure
(interstitial lung disease)
Levetiracetam
(Keppra)
Levetiracetam
(Keppra)
Levothyroxine
(Synthroid)
Levothyroxine
(Synthroid)
Lidocaine – D5W 4
mg/mL (0.4%) drip
(conc: 4000 mcg/mL
Lidocaine (Xylocaine)
Lidocaine 1%
(Xylocaine)
125 mcg tab
before
breakfast
300 mcg tab
before
breakfast @
0700
Dose: 1
mg/min, 15
mL/hr, IV PRN
conditional
100 mg/5 mL
(2%) prefill
syringe 75 mg
Dose: 75 mg IV
PRN
conditional.
3.75 mL = 75
mg of 100 mg/5
mL
Before breakfast. Per P&T approved policy,
automatically substituted for protonix 40 mg d/t
NG tube. Plasma half-life 1 ½ -2hr. Adverse
Reactions: CVA, MI, shock, hematuria,
hemolysis .
Administered by Respiratory Therapist
Prevention of epileptic seizures
(anticonvulsant). Inhibtis complex
partial seizures and prevents
epileptic and seizure activity
Contraindications: suicidal ideation;
Cautious use: history of psychosis or
depression, suicidal tendencies. Peak: 1hr,
Half-life: 7.1 hr.
Prevention of epileptic seizures
(anticonvulsant). Inhibits complex
partial seizures and prevents
epileptic and seizure activity
Hypothyroidism
Contraindications: suicidal ideation;
Cautious use: history of psychosis or
depression, suicidal tendencies. Peak: 1hr,
Half-life: 7.1 hr.
Hyponatremia and
Hypothyroidism
Ventricular tachycardia
For sustained ventricular
tachycardia (class IB
antiarrhythmic). Surpresses
automaticity in His-Purkinje
system. Inhibits sodium influx
into myocardial cells, elevates
electrical stimulation threshold of
ventricle during diastole.
0.1 mL, once
For use by RT (as needed prior to
drawing ABG)
Lorazepam (Ativan)
1 – 2 mg IV
every 4 hrs
PRN
Agitation, seizures, tremor, give
for withdrawal symptoms
Lorazepam (Ativan)
1 mg IV every 6
hrs PRN
Anxiety, agitation, seizures,
tremor, history of
methamphetamine use.
Lorazepam (Ativan)
2 mg IV every 2
hrs PRN
Anxiety, Agitation
Contraindications: severe cardiovascular
conditions, acute MI. Cautious: cardiac
disease, angina pectoris, cardiac arrhythmias,
older adult, impaired kidney function. Common
adverse: insomnia. Other adverse:
palpitations, tachycardia, arrhythmias, angina
pectoris, hypertension
Start after push for sustained ventricular
tachycardia.
Contraindications: supraventricular
arrhythmias, untreated sinus bradycardia,
severe degrees of sinoatrial, atrioventricular,
and intraventricular heart block. Cautious use:
Liver or kidney disease, CHF, shock, older
adults.
Onset: 45-90 sec IV, Duration 10-20 min IV,
Half-life: 1.5-2 hr.
Life threatening adverse effects: difficulty in
breathing or swallowing; convulsions,
respiratory distress (high doses);
cardiovascular collapse, cardiac arrest.
Administered by Respiratory Therapist
Dilute with an equal amount of NS and give
over 1 – 2 mins. Hold for any compromise of
respirations; unarousable, alteration in mental
status. Call MD immediately.
Dilute with an equal amount of NS and give
over 1 – 2 mins. Common adverse effects:
drowsiness, sedation. Onset: 1-5 min IV,
Duration: 12-24 hr
Dilute with an equal amount of NS and give
over 1 – 2 mins. Usual maximum dose per 12
hours: 8 mg. Hold for any compromise of
respirations; unarousable, alteration in mental
status. Call MD immediately.
Lorazepam (Ativan)
2 mg IV every 1
hr PRN
Anxiety, Agitation
Dilute with an equal amount of NS and give
over 1 – 2 mins.
Losartan (Cozaar)
50 mg tab daily
@ 0900
CHF, HTN; angiotensin II receptor
antagonist; antihypertensive
Patient on ventilator, NG Tube. Hold for
Systolic BP < 100. Peak: 6h, duration: 24 h,
half-life: 1.5-2 h. Cautious use: patients on
diuretics, heart failure
Maalox TC
(Loperamide)
15 mL PO
every 4 hours
PRN
Concentrated
oral liquid, 10
mL daily PRN
Dose 2g, IVPB,
over 1 hr, PRN
conditional, for
Mg 1.9-2.0
Indigestion
Magnesium hydroxide
(Milk of magnesia)
Magnesium sulfate 2g
in D5W 50 mL IVPB
Magnesium sulfate 2g
in D5W 50 mL IVPB
Dose 2g, IVPB,
over 1 hr, PRN
conditional, for
Mg 1.9-2.0
Magnesium sulfate 2g
in D5W 50 mL IVPB
Dose 2g, IVPB,
over 1 hr, PRN
conditional, for
Mg 1.9-2.0
Magnesium sulfate 3g
in D5W 100 mL IVPB
Dose 3g, IVPB,
over 90 mins,
PRN
conditional, for
Mg 1.6-1.8
Dose 3g, IVPB,
over 90 mins,
PRN
conditional, for
Mg 1.6-1.8
Dose 4g, IVPB,
over 2 hrs,
PRN
conditional, for
Mg less than
1.6
Dose 4g, IVPB,
over 2 hrs,
PRN
conditional, for
Mg less than
1.6
12.5 mg tab
4x/day
Magnesium sulfate 3g
in D5W 100 mL IVPB
Magnesium sulfate 4g
in D5W 100 mL IVPB
Magnesium sulfate 4g
in D5W 100 mL IVPB
Meclizine (Antivert)
constipation
Hypomagnesemia (electrolyte
replacement)
Hypomagnesemia (electrolyte
replacement)
Hypomagnesemia (electrolyte
replacement)
10 mL concentrate equivalent to 30 mL MOM
Contraindications: myocardial damage; AV
heart block; cardiac arrest except for certain
arrhythmias. Cautious: renal disease, renal
failure, renal impairment; acute MI.
Life threatening adverse effects: complete
heart block, circulatory collapse, respiratory
paralysis, flaccid paralysis
Conditional, for Mg 1.9-2.0, admin over 1 hour.
Contraindications: myocardial damage; AV
heart block; cardiac arrest except for certain
arrhythmias. Cautious: renal disease, renal
failure, renal impairment; acute MI.
Life threatening adverse effects: complete
heart block, circulatory collapse, respiratory
paralysis, flaccid paralysis
Contraindications: myocardial damage; AV
heart block; cardiac arrest except for certain
arrhythmias. Cautious: renal disease, renal
failure, renal impairment; acute MI.
Life threatening adverse effects: complete
heart block, circulatory collapse, respiratory
paralysis, flaccid paralysis
Hypomagnesemia
Hypomagnesemia
Conditional, for Mg 1.6-1.8, admin over 90
mins.
Hypomagnesemia
Hypomagnesemia
Nausea/vomiting and dizziness
(antihistamine)
Conditional, for Mg less than 1.6, admin over 2
hours
Contraindicated for GI obstruction or ileus
Meperidine PF
(Demerol)
100 mg every 4
hrs PRN IVPB
Shivering
Meropenem (Merrem)
1g in NS 100
mL IVPB every
12 hrs @ 0900
Methylprednisolone
PF (Solu-medrol)
Methylprednisolone
PF (Solu-medrol)
40 mg IV every
6 hrs taper
@0700, 1300
40 mg IV every
12 hrs @ 0630
Antibiotic, for respiratory culture
positive for gram pos cocci and
gram neg bacilli. Broad-spectrum
carbapenem antibiotic that
inhibits cell wall synthesis of
bacteria by its strong affinity for
penicillin binding proteins of
bacterial cell wall. Effective
against both gram pos and gram
neg bacteria.
Anti-inflammatory agent for
COPD (bronchial asthma)
Methylprednisolone
PF (Solu-medrol)
40 mg IV every
12 hrs @ 0900
Metoclopramide
(Reglan)
Metoclopramide
(Reglan)
10 mg tab
every 6 hrs
PRN
10 mg IV every
6 hrs
Metoclopramide
(Reglan)
10 mg IV every
12 hrs @ 0830
If an oral analgesic is concurrently ordered for
the same severity of pain, only use injectable
route if patient is not tolerating oral intake or if
oral analgesics are ineffective..
Adjusted based on estimated CI = 41 ml/min
from Vancomycin
Acute respiratory failure
(interstitial lung disease). Has
anti-inflammatory and
immunosuppressive properties.
For COPD. Has antiinflammatory and
immunosuppressive properties.
Anti-inflammatory agent for
COPD (bronchial asthma)
Nausea
Led to steroid induced diabetes mellitus in this
patient.
Nausea
IV Administration: Doses > 10 mg – Dilute in
50 mls D5W or NS and infuse over 15 minutes
Nausea
IV Administration: Doses > 10 mg – Dilute in
50 mls D5W or NS and infuse over 15 minutes
Metolazone
(Zaroxolyn)
10 mg tab @
0900
Metoprolol
(Lopressor)
5 mg IV every 4
hrs PRN
Atrial fibrillation, CHF, HTN
For heart rate > 110, administer over 1 minute
Metoprolol
(Lopressor)
12.5 mg tab,
2x/day, @0900
Hold for HR < 50, Hold for systolic BP < 100,
administer with food if not NPO. Cautious use:
major depression. Life threatening effects:
laryngospasms, complete heart block, cardiac
arrest. Onset: 15 min, Peak: 20 min IV,
Duration 13-19 hr, Half-life: 3-4 hr.
Metoprolol
(Lopressor)
5 mg IVP
slowly every 5
mins x3 doses
total
50 mg PO
every 12 hrs
Blood pressure/hypertension
management, replacement med
for Nicardipine. Beta-adrenergic
antagonist with preferential effect
on beta1 receptors located
primarily on cardiac muscle.
Reduces HR and cardiac output
at rest, lowers BP.
Acute MI, HTN management.
(Antihypertensive, Antianginal)
Acute MI, HTN management
Hold for HR < 60 or SBP < 110.
HTN management
Hold for HR < 60 or Systolic BP < 100. Admin
with food if not NPO.
Hypertension management, long
term treatment of angina pectoris
 reduce risk of mortality after
Hold for heart rate less than 60 bpm. Hold for
Systolic BP less than 110 mmHg. Swallow
whole, don’t crush or chew, tablet is scored
Metoprolol
(Lopressor)
Metoprolol
(Lopressor)
Metoprolol ER (Toprol
- XL)
50 mg tab PO
2x/day due @
0900
50 mg tab daily
Diuretic (thiazide like), for fluid
volume overload, CHF
Leads to elevated blood glucose 
Glucocorticoid. Patient also has Type 2 DM.
Immunosuppressant.
May be administered with food or milk.
Only admin if not done in ED. Admin slowly.
Hold for HR < 60 or SBP < 110.
MI, migraine prophylaxis
and may be split
If goal RASS (Richmond Agitation Sedation
Scale) not achieved: use up to 2 bolus doses
before increasing rate by 1 mg/hr every 15m
ins until goal RASS score achieved. If goal
RASS surpassed: lower rate by 1 mg/hr every
15 mins until goal RASS score achieved. If at
goal RASS score: continue current dose. Max
dose: 12 mg/hr. Recommended max dose: 0.2
mg/kg/hr. Notify intensivist: if patient on max
dose. Common adverse effects: retrograde
amnesia; Life threatening adverse effects:
laryngospasm, respiratory arrest. Onset: 1-5
min IV, peak: 20-60 min, Duration: less than
2hr IV.
Admin IV push over 2-5 mins, every 5 mins up
to 2 dosees PRN agitation before increasing
continuous infusion rate.
Admin IV push over 2-5 mins. Hold for Systolic
BP < 100.
Midazolam (Versed)
100 mg in D5W
100 mL
continuous drip
IV; dose:
1mg/hr. Held
on care
planning day
(not needed)
Agitation (CNS depressant with
muscle relaxant, sedativehypnotic, anticonvulsant, and
amnestic properties)
Midazolam (Versed)
1 mg IV, every
5 mins PRN
agitation
Midazolam (Versed)
1 mg IV, every
hrs PRN
Midazolam (Versed)
100 mg in D5W
100 mL
continuous drip
IV; dose:
1mg/hr. 1mL/hr
Not currently
running.
Agitation (CNS depressant with
muscle relaxant, sedativehypnotic, anticonvulsant, and
amnestic properties)
Agitation (CNS depressant with
muscle relaxant, sedativehypnotic, anticonvulsant, and
amnestic properties)
Midazolam (Versed)
1 mg IV, every
5 mins PRN
agitation
Midazolam (Versed)
100 mg in D5W
100 mL
continuous drip
IV; dose:
1mg/hr. 1mL/hr
Agitation (CNS depressant with
muscle relaxant, sedativehypnotic, anticonvulsant, and
amnestic properties)
Midazolam (Versed)
1 mg IV, every
5 mins PRN
Agitation
Midazolam (Versed)
100 mg in D5W
100 mL
continuous drip
IV; dose:
Agitation (CNS depressant with
muscle relaxant, sedativehypnotic, anticonvulsant, and
amnestic properties)
If goal RASS (Richmond Agitation Sedation
Scale) not achieved: use up to 2 bolus doses
before increasing rate by 1 mg/hr every 15
mins until goal RASS score achieved. If goal
RASS surpassed: lower rate by 1 mg/hr every
15 mins until goal RASS score achieved. If at
goal RASS score: continue current dose. Max
dose: 12 mg/hr. Recommended max dose: 0.2
mg/kg/hr. Notify intensivist: if patient on max
dose. Common adverse effects: retrograde
amnesia; Life threatening adverse effects:
laryngospasm, respiratory arrest. Onset: 1-5
min IV, peak: 20-60 min, Duration: less than
2hr IV.
Admin IV push over 2-5 mins, every 5 mins up
to 2 doses PRN agitation before increasing
continuous infusion rate.
If goal RASS (Richmond Agitation Sedation
Scale) not achieved: use up to 2 bolus doses
before increasing rate by 1 mg/hr every 15
mins until goal RASS score achieved. If goal
RASS surpassed: lower rate by 1 mg/hr every
15 mins until goal RASS score achieved. If at
goal RASS score: continue current dose. Max
dose: 12 mg/hr. Recommended max dose: 0.2
mg/kg/hr. Notify intensivist: if patient on max
dose. Common adverse effects: retrograde
amnesia; Life threatening adverse effects:
laryngospasm, respiratory arrest. Onset: 1-5
min IV, peak: 20-60 min, Duration: less than
2hr IV.
Every 5 mins up to 2 doses PRN agitation
before increasing continuous infusion rate.
Dose to be given from IV infusion pump.
If goal RASS (Richmond Agitation Sedation
Scale) not achieved: use up to 2 bolus doses
before increasing rate by 1 mg/hr every 15
mins until goal RASS score achieved. If goal
1mg/hr. 1mL/hr
RASS surpassed: lower rate by 1 mg/hr every
15 mins until goal RASS score achieved. If at
goal RASS score: continue current dose. Max
dose: 12 mg/hr. Recommended max dose: 0.2
mg/kg/hr. Notify intensivist: if patient on max
dose. Common adverse effects: retrograde
amnesia; Life threatening adverse effects:
laryngospasm, respiratory arrest. Onset: 1-5
min IV, peak: 20-60 min, Duration: less than
2hr IV.
Every 5 mins up to 2 doses PRN agitation
before increasing continuous infusion rate.
Dose to be given from IV infusion pump.
Midazolam (Versed)
1 mg IV, every
5 mins PRN
Agitation
Milk of magnesia
(magnesium
hydroxide)
Morphine
30 mL PO daily
PRN
Constipation
1 – 2 mg IV
every 3 hrs
PRN
1-4 mg IVP
every 5 minutes
Mod pain (4-6), severe pain (710)
For angina not relieved by
Nitroglycerin
Hold for SBP less than 90
Morphine ER (MS
Contin)
45 mg tab
every 8 hrs
Pain
Swallow whole. Do not crush, chew, or split.
Morphine injection
4 mg IV every 3
hrs PRN
2 mg mod pain (4-6), 4 mg severe
pain (7-10), for breakthrough
pain.
Morphine injection
4-6 mg IV every
4 hrs PRN
Mod pain (4 – 6) 4 mg, severe
pain (7-10) 6 mg
If an oral analgesic is concurrently ordered for
the same severity of pain, only use injectable
route if patient is not tolerating oral intake or if
oral analgesics are ineffective.
Only use injectable route if patient isn’t
tolerating oral intake or if oral analgesics
ineffective (see: Norco)
Morphine injection
2 mg IV, every
3 hrs PRN
Mod pain (4-6), severe pain (710)
Morphine injection
2 mg IV, every
5 mins PRN
Mild pain (1-3), Mod pain (4-6),
severe pain (7-10)
Morphine injection
2 mg IV, every
2 hrs PRN
Mod pain (4-6), severe pain (710)
Morphine injection
2 mg IV, every
1 hr PRN
Mod pain (4-6), severe pain (710)
Morphine injection
1 mg IV, every
4 hrs PRN
Mod pain (4-6), severe pain (710)
Naloxone (Narcan)
0.2 mg IV every
1 min PRN
Nicardipine (Cardene)
Dose: 2.5
mg/hr; 50 mg in
NS 250 mL
drip, continuous
drip
To counteract morphine
overdose. As needed x5 doses,
to increase patient alertness and
respiratory rate to greater than
10/min
As needed to keep Systolic BP
under 140. Calcium channel
blocker. Significantly decreases
systemic vascular resistance;
reduces BP.
Morphine
Maximum dose = 10 mg. Agent A: give in
PACU ONLY, discontinue on transfer from
PACU.
If an oral analgesic is concurrently ordered for
the same severity of pain, only use injectable
route if patient is not tolerating oral intake or if
oral analgesics are ineffective. . Hold for
Systolic BP < 100.
If an oral analgesic is concurrently ordered for
the same severity of pain, only use injectable
route if patient is not tolerating oral intake or if
oral analgesics are ineffective.
If an oral analgesic is concurrently ordered for
the same severity of pain, only use injectable
route if patient is not tolerating oral intake or if
oral analgesics are ineffective.
If patient difficult to arouse and/or resp rate
less than 10/min.
If 0.1 and 0.2 mg/mL concentration are
administered through a large peripheral vein,
change the infusion site every 12 hours.
Onset: 1 min IV, Peak: 0.5-2 hr, Duration: 3 hr
IV, Half-life: 8.6 hr.
Nicotine (Nicoderm)
21 mg/24 hr
transdermal patch
Nitroglycerin
Nitroglycerin
Nitroglycerin SL
(Nitrostat)
Nitroglycerin SL
(Nitrostat)
Nitropaste
Norepinephrine
(Levophed) 8,000 mcg
in D5W 250 mL drip
Norepinephrine
(Levophed) 8,000 mcg
in D5W 250 mL drip
NS 1,000 mL IV soln
NS 1,000 mL IV soln
NS 1,000 mL IV soln
NS 1,000 mL IV soln
NS 500 mL IV soln
NS with KCL 20
mEq/L IV soln
NS with KCL 20
mEq/L IV soln
NS with KCL 20
mEq/L IV soln
Nystatin (Mycostatin)
topical powder
1 patch
Tobacco user
Apply to hairless, clean, dry area of upper arm
or hip
50 mg/250mL
D5W IV at
5mcg/minute
0.4 mg SL for
chest pain
PRN. May
repeat 3x every
5 mins
0.4 mg
sublingual
every 5 minutes
PRN
0.4 mg
sublingual
every 5 minutes
PRN
1” topically 3x/
day
Chest pain. Antianginal,
vasodilator
Titrate for chest pain with SBP greater than 90
Chest pain. Antianginal,
vasodilator
May repeat 3x every 5 mins. Call healthcare
provider if chest pain unrelieved by
nitroglycerin
Chest pain (Antianginal,
vasodilator)
Dissolve under tongue
Chest pain (Antianginal,
vasodilator)
Dissolve under tongue
Antianginal, vasodilator
Hold for SBP < 110
Dose: 2
mcg/min, 3.75
mL/hr IV
continuous drip
(32 mcg/mL)
Dose: 2
mcg/min, 3.75
mL/hr IV
continuous drip
(32 mcg/mL)
50 mL/hr
continuous IV
infusion
75 mL/hr
continuous IV
infusion
1,000 mL, 125
mL/hr
continuous IV
100 mL/hr
continuous IV
infusion
20 mL/hr
continuous IV
infusion
1,000 mL, 100
mL/hr IV
continuous
1,000 mL, 75
mL/hr IV
continuous; R.
wrist 20 g
1,000 mL, 40
mL/hr IV
continuous
1 application,
2x/day, due @
0900
Low blood pressure and heart
failure, sepsis.
Low blood pressure, sepsis.
Vesicant (skin, eye, mucosal pain/irritation)
Titrate to keep MAP > 65. Vesicant (skin, eye,
mucosal pain/irritation)
Fluid intake
Hypervolemia
Fluid intake
Hypervolemia
Fluid intake
Fluid intake
Hypervolemia
Fluid intake
Hypervolemia
Fluid intake and electrolyte
balance
Fluid intake and electrolyte
balance
Keep patient euvolemic and minimize IV fluids
if possible per neurosurgery.
Fluid intake and electrolyte
balance
Antifungal antibiotic; Candida
infection
Apply to pannus, groin
Ondansetron (Zofran)
4 mg/2 mL, IV,
every 8 hrs
PRN
4 mg IV , every
6 hrs PRN
Nausea/vomiting
May repeat x1 after 30 mins
Nausea/vomiting
Dizziness
Ondansetron (Zofran)
4 mg IV every 4
hrs PRN
Nausea/vomiting
May repeat x1 after 30 mins
Ondansetron (Zofran)
4 mg/2mL IV ,
every 6 hrs
PRN
4 mg/2 mL, IV,
every 8 hrs
PRN
Dose 1-2 tab
every 6 hrs
PRN
Nausea/vomiting
Dizziness, headache, sedation, diarrhea are
common adverse side effects. Peak: 1-1.5 hr,
half-life: 3 hr.
May repeat x1 after 30 mins. Dizziness. Peak:
1-1.5 hr, half-life: 3 hr.
Ondansetron (Zofran)
Ondansetron (Zofran)
Oxycodone acetaminophen
(Percocet) 5-325 mg
tab
Nausea/vomiting
For moderate to severe
breakthrough pain
Do not exceed 4,000 mg of acetaminophen per
day from all sources. If an injectable analgesic
is concurrently ordered for the same severity of
pain, use oral when patient is consistently
tolerating oral intake. 1 tab for moderate pain,
2 tabs for severe pain.
Therapeutic substitution with formulary agent
per P&T committee. Substituted for Percocet
2.5-325 mg tab.
Do not exceed 4,000 mg of acetaminophen per
day from all sources. If an injectable analgesic
is concurrently ordered for the same severity of
pain, use oral when patient is consistently
tolerating oral intake.
Dilute in 10 mL of NS and admin over a
minimum of 2 mins.
Oxycodone acetaminophen
(Percocet) 7.5-325 mg
tab
2 tab, every 4
hrs PRN
Mild pain (1-3), mod pain (4-6)
Pantoprazole
(Protonix)
40 mg IV daily
@ 0900
GI prophylaxis
Pantoprazole
(Protonix)
40 mg IV every
12 hrs
GI prophylaxis
Dilute in 10 mL of NS and admin over a
minimum of 2 mins.
Pantoprazole EC
(Protonix)
40 mg tab daily
GI prophylaxis (Antiulcer, proton
pump inhibitor)
Swallow whole. Do not crush, chew, or split
Pantoprazole EC
(Protonix)
20 mg tab daily
@ 0900
GI prophylaxis (Antiulcer, proton
pump inhibitor)
Swallow whole. Do not crush, chew, or split
Piperacillin –
tazobactam (Zosyn)
3.375 g in D5W
100 mL IVPB
@ 200 mL/hr
every 6 hrs
3.375 g in D5W
100 mL IVPB
@ 200 mL/hr
every 6 hrs,
due @ 1045
Antibiotic
Piperacillin –
tazobactam (Zosyn)
Piperacillin –
tazobactam (Zosyn)
3.375 g in D5W
100 mL IVPB
@ 200 mL/hr
every 6 hrs,
due @ 1200
Antibiotic; two drug combination
has antibiotic activity against an
extremely broad spectrum of
gram-positive, gram-negative,
and anaerobic bacteria.
Tazobactam extends the
spectrum of bacteria susceptible
to piperacillin. Heavy growth of
multiple colony types of gram
negative bacilli, clinical
significance uncertain. Possible
aspiration pneumonia.
Antibiotic; two drug combination
has antibiotic activity against an
extremely broad spectrum of
gram-positive, gram-negative,
and anaerobic bacteria.
Tazobactam extends the
Infuse over 30 mins. Life threatening adverse
effect: pseudomembranous colitis.
Infuse over 30 mins @ 200 mL/hr. Life
threatening adverse effect:
pseudomembranous colitis.
Pneumococcal
vaccine (Pneumovax
23)
Pneumococcal
vaccine (Pneumovax)
0.5 mL IM PRN
conditional
Polyethylene glycol
(Miralax)
17g oral
packet, daily
PRN
1.4% opthalmic
soln 1 drop,
both eyes,
every 4 hours
Dose: 20
mEq/100 mL,
IV, PRN
conditional, 20
mEq = 100 mL
Dose: 40 mEq
tab daily @
0900
Dose: 10 mEq,
IV, PRN
conditional, 10
mEq = 100 mL
Dose: 10 mEq,
IV, PRN
conditional, 10
mEq = 100 mL
25 mg rectal
suppository
every 12 hrs
PRN
10 mg tab
every 6 hrs
PRN
12.5 mg IV/PO
every 4-6 hours
PRN
5 mcg/kg/min x
90.3 kg, Admin
dose: 451.5
mcg/min: 2.71
mL/hr
continuous,
10mg/mL drip
Polyvinyl alcohol
(Teargen)
Potassium chloride
Potassium chloride
(K-Dur)
Potassium chloride 10
mEq/100 mL
Potassium chloride 10
mEq/100 mL
Prochlorperazine
(Compazine)
Prochlorperazine
(Compazine)
Promethazine
Propofol (Diprivan)
spectrum of bacteria susceptible
to piperacillin. Heavy growth of
multiple colony types of gram
negative bacilli, clinical
significance uncertain. Patient
has Health Care Associated
Pneumonia.
Vaccine
0.5 mL IM
Vaccine
Constipation
Indicated per screening. Consider subQ admin
if patient anticoagulated
Prior to discharge, admin when pt. temp is less
than 100.4
Dissolve in 4 to 8 ounces of liquid; give only if
no BM today, use as PRN for constipation. 1
fl. Oz. = 30 mL
Artificial tears
Hypokalemia
Infuse each 20 mEq over 1 hr. Use correction
scale in MAR
Hypokalemia
Swallow whole. Don’t crush or chew. Scored
tablet may be split.
Hypokalemia
Infuse each 10 mEq over 1 hr. Use correction
scale
Hypokalemia
Daily PRN. Infuse each 10 mEq over 1 hr.
Use correction scale in MAR.
nausea
nausea
Nausea
Agitation, sedation, general
anesthesia. 5 mcg/kg/min is for
conscious sedation of an adult.
Used in induction and
maintenance of anesthesia or
sedation.
Life threatening adverse effects: respiratory
depression, apnea, Leukopenia,
agranulocytosis
If Goal RASS not achieved: Use up to 2 bolus
doses before increasing rate by 5 mcg/kg/min
every 15 mins until goal RASS score achieved.
If goal RASS surpassed: Lower rate by 5
mcg/kig/min every 15 mins until goal RASS
score achieved. If at goal RASS score:
continue current dose. Maximum dose: 50
mcg/kg/min. Notify Intensivist: If patient on
max dose. Notify Intensivist: If propofol
continues greater than or equal to 72 hours to
consider change to Versed.
Contraindications: patients w/ increased
intracranial pressure or impaired cerebral
circulation. Onset: 9-36 sec, Duration: 6-10
mins, Half-Life: 5-12 hr.
Propofol (Diprivan)
Propranolol (Inderal)
Pyridostigmine
(Mestinon)
Quetiapine (Seroquel)
Quinapril (Accupril)
25 mg, every 5
mins PRN, 10
mg/mL drip
10 mg tab
60 mg tab, oral,
every 8 hrs
STD
300 mg tab
daily
Agitation
Hypertension
IV Push every 5 mins up to 2 doses PRN
agitation before increasing continuous infusion
rate.
Hold for heart rate less than 60 bpm, hold for
systolic BP less than 115 mmHg.
Myasthenia gravis
Add-on therapy for major
depressive disorder, bipolar
disorder
ACE Inhibitor, anithypertensive
2.5 mg PO on
admission, 20
mg daily
Dose: 1 packet,
250 mg, NG
Tube, 2x/day
@ 0900
10 mL IV PRN
conditional
Treatment/prevention of diarrhea
as a result of antibiotics (strain of
yeast).
Admin via NG Tube, however NG Tube was
removed.
Lock flush
“Flush after each use and after blood draws.
Use ONLY a 10cc syringe.”
Saline lock flush 3 mL
3 mL IV Daily
Lock flush, line patency
Saline lock flush 3 mL
3 mL, daily, @
0900
Lock flush, line patency
Saline lock flush 3 mL
3 mL IV every 8
hrs.
Lock flush, line patency
Sennosides (Senokot)
2 tabs, 2x/day,
@ 0900
Constipation (retains water in
intestine)
Simvastatin
10 mg PO daily
at HS
Sodium chloride tab
1 g tab, 4x/day
@ 0800 & 1200
HMG-CoA reductase inhibitor
(Statin), Antihyperlipemic.
(increases HDL and decreases
LDL cholesterol)
Hyponatremia and hypochloride
(fluid volume overload)
Sodium hypochlorite
(Dankin’s) 0.125%
(1/4 strength)
irrigation
Sodium phosphate
Topical, daily
Saccharomyces
boulardii (Florastore)
packet 250 mg
Saline lock flush 10
mL
Sodium phosphate
Sodium phosphate
Sodium phosphate
15 mmol in NS
100 mL IVPB,
PRN
conditional
24 mmol in NS
100 mL IVPB,
PRN
conditional
36 mmol in NS
150 mL IVPB,
PRN
conditional
45 mmol in NS
150 mL IVPB,
PRN
conditional
Infection, topical antiseptic
Life threatening adverse effect: Angioedema
And after each IV med for IV line patency. Use
10 mL for PICC, use 20 mL after blood or TPN
8.6 mg sennosides is equivalent to 187 mg
senna.
Onset: 2 week; Peak: 4-6 week. Avoid
grapefruit.
For irrigation use only.
Electrolyte replacement
For Phosphate of 2.0-2.3. Infuse slowly over 2
hrs.
Electrolyte replacement
For Phosphate of 1.6-1.9. Infuse slowly over 3
hrs.
Electrolyte replacement
For Phosphate of 1.0-1.5. Infuse slowly over 4
hrs.
Electrolyte replacement
For Phosphate less than 1.0-1.5. Infuse slowly
over 5 hrs.
Tamsulosin (Flomax)
0.4 mg cap
daily
Urination, Benign prostatic
hypertrophy
Temazepam (Restoril)
30 mg cap HS
PRN
Insomnia
Temazepam (Restoril)
15 mg PO at
bedtime PRN
Sleep aid, Insomnia
Therapeutic
multivitamin
(Theravite)
Therapeutic
multivitamin
(Theravite)
Tolvaptan (Samsca)
1 tablet, daily
Vitamin deficiency
1 tablet, daily,
due @0900
Vitamin deficiency
Administer 30 mins after a meal. Swallow
whole, don’t crush, chew, or spit.
May repeat x1
15 mg tab, daily
@ 1200
Hyponatremia (associated with
CHF), increases urine output.
50 mg tab
every 4 hrs
PRN
150 mg tab
daily at bedtime
Mild pain (1-3), Moderate pain (46)
0.1% topical
cream, 3x/day
Anti-inflammatory
Apply to face and back
Empiric Bactrim prophylaxis,
Pneumocystis pneumonia (PCP)
prophylaxis
Dose in mgs represents trimethoprim
component – Administer on an empty stomach
1 hour prior or 2 hrs after meals.
Vancomycin
(Vanconcin) 1,500 mg
in D5W 300 mL IVPB
Vancomycin dosing
per pharmacy 1 each
160-800 mg
tab, 1 tab, Mon
Wed Fri, due @
0900
1,250 mg in
D5W 250 mL
IVPB @ 167
mL/hr every 12
hrs
1,250 mg in NS
250 mL IVPB
@ 167 mL/hr
every 18 hrs @
0200
1,000 mg in
D5W 250 mL
IVPB @ 250
mL/hr every 6
hrs, due @
1200
1,500 mg, 200
mL/hr, IVPB,
every 16 hrs
1 each, daily
PRN,
Vancomycin dosing
per pharmacy 1 each
1 each, daily
PRN,
Tramadol (Ultram)
Trazodone (Desyrel)
Triamcinolone
(Aristocort)
Trimethoprim –
sulfamethoxazole ds
(Bactrim DS)
Vancomycin
(Vancocin)
Vancomycin
(Vancocin)
Vancomycin
(Vancocin)
Water (Free water)
200 mL every 8
hrs via NG
Tube @ 1245
Patient should NOT be on fluid restriction for
the first 24 hrs of therapy. Hold for sodium
greater than 140 or sodium increase greater
than or equal to 12 meq/L per 24 hr period.
Request from pharmacy. Potassium checks
every 12 hrs.
Major depression
(Antidepressant)
Antibiotic
Antibiotic, for respiratory culture
positive for gram pos cocci and
gram neg bacilli. Inhibits bacterial
wall synthesis.
Life threatening adverse effects:
Nephrotoxicity, fatal uremia, Anaphylaxis,
Leukopenia. Peak: 30 mins after end of
infusion, half-life: 4-8 hrs.
Antibiotic
Life threatening adverse effects:
Nephrotoxicity, fatal uremia, Anaphylaxis,
Leukopenia. Peak: 30 mins after end of
infusion, half-life: 4-8 hrs.
Antibiotic
Antibiotic
Needs pharmacy consult
Antibiotic, for respiratory culture
positive for gram pos cocci and
gram neg bacilli.
Hypernatremia
Needs pharmacy consult
Admin via NG Tube
Water (Free water)
Zinc sulfate (Orazinc)
Zolpidem (Ambien)
200 mL oral
every 6 hrs due
@ 1000 and
@1600
220 mg tab,
daily
5 mg tab HS
PRN
Fluid intake
Nursing to chart on MAR and record intake on
the Doc Flow sheet.
Zinc deficiency
Insomnia
Do not give after 2400