(High Alert Drugs : HAD)

3
2557





Alteplase
Adrenaline
Calcium injection
Digoxin
Dobutamine
Dopamine
Heparin (Unfractionated)
Heparin, Low Molecular Weight (Innohep/Tinzaparin)
Heparin, Low Molecular Weight (Clexane/Enoxaparin)
Heparin, Low Molecular Weight (Arixtra/Fondaparinux)
Insulin
K+ (Potassium) Injection
Magnesium Sulphate injection
Morphine
Nicardipine
Nitroglycerine
Norepinephrine
Warfarin

2
3
8
20
24
28
32
38
43
49
52
55
61
69
72
76
83
87
90
94

( 2 2557)

Page 1


Onset

Peak

Peak
Duration

.. 2550

1.

2. High Alert Drug Cards


3. Guidelines Heparin Low Molecular Weight Heparin

Concurrent Trigger Tool

4.

( 2 2557)

Page 2


1.

2.



3.
3.1

3.2


3.3

3.4

3.5

3.6

4.
(High Alert Drugs)

High Alert Drugs ..

1. Adrenergic agonist Adrenaline, Dopamine, Dobutamine, Norepinephrine
2. Alteplase injection, Nicardepine injection,
Nitroglycerine injection
( 2 2557)

Page 3

3. Calcium IV Calcium gluconate injection Calcium chloride injection

4. Digoxin (Lanoxin)
5. Heparin (unfractionated) low molecular weight heparin (LMWH)
Enoxaparin, Fondaparinux Tinzaparin
6. Insulin
7. Magnesium IV 50% MgSO4 injection, 20% MgSO4 injection
8. Morphine
9. Potassium injection KCl injection, K2HPO4 injection
10. Warfarin tablet
11.
12.
13. Chloral hydrate
14. Benzodiazepine injection
15. Neuromuscular blocking agents
16. Lidocaine IV injection
17. Nitroprusside injection
18. Hypertonic saline 3% NaCl
1-10
11-18

5.
Cohen MR, Kilo CM. High-alert medication: safeguarding against errors. In Cohen
MR,ed. Medication Errors. WashingtonDC: American Pharmaceutical Association, 1999,
5.1-5.40.
Patient Safety Alert : High-alert medications and patient safety ; International Journal
for Quality in Health Care 2001 ,Volume 13, No.4 :pp 339-340.
Hayes ER., Kee JL. Pharmacology Pocket Companion for nurses. Pensylvania: W.B.
Saunders Company,1996.
6.
6.1
6.1.1

( 2 2557)

Page 4

6.1.2

6.2
6.2.1
( )
6.2.2


13
MAR

6.2.3

6.3
6.3.1

6.3.2
6.3.3
6.3.4

6.3.5

6.3.6

6.3.7

6.3.8 (protocol)


6.4
6.4.1
(drug interaction)
( 2 2557)

Page 5

6.4.2

6.4.3

6.4.4

(contraindication)

****

6.5
6.5.1
(

6.5.2
6.5.3
6.6
6.6.1

6.6.2

6.6.3

6.6.4

( 2 2557)

Page 6

6.7
6.7.1

6.7.2

6.7.3

6.8
6.8.1 6

6.8.2 (Root
Cause Analysis/ RCA)

7.

( 2 2557)

Page 7

Actiilyse (alteplase)

1. AAlteplase inj 2 mg
2. Alteplase
A
inj 50
5 mg

alteplase1-3
onset

Altepplase inj. 2 mg
m
IV: coronaary
thrombolysis
30

Altepplase inj.
50 m
mg

4-8

IV: coronaary
thrombolysis
30

peak
IVV: 60

duration

IVV: 60

Screeningg
acute isschemic cerebrovascula r accident, acute
a
myocardial infarcttion, pulmonaary embolismm venouss
catheeter occlusionn
ACEIs enalapril, ccaptopril,
lisinoppril, quinapril, perindopril, imidapril ramipril

orolingual anngioedema (
antihistamines, stteroids
epineephrine)
nitroglycerin alteplase

reocclusionn
nitroglyycerin

(
2 2557)

Page 8

 gentamycin

1.

1.1
6

1.2
warfarin (INR >1.3)
1.3
(aneurysm)
1.4
(subarachnoid)
1.5
1.6 10
(
)
1.7
(cardiopulmonary resuscitation)
( 2 ) 10

( subclavian jugular
vein)
1.8
( )
1.9 bacterial endocarditis pericarditis
1.10
1.11 3

1.12
1.13
( 2 2557)

Page 9

2.

2.1

2.2
transient ischaemic attack (TIA) 6

4.5
3.

3.1 4.5

3.2

3.3 /
imaging technique
( NIHSS > 25)
3.4
3.5 (stroke)
3
3.6
3.7 heparin 48
aPTT
3.8 100,000/mm3
3.9 (systolic) >
185mmHg (
diastolic) > 110mmHg

3.10 < 50 > 400mg/dL
4. alteplase
18

( 2 2557)

Page 10


1.

1.1 alteplase


alteplase
(resuscitation)

1.2 alteplase 100 mg

90 mg
alteplase

1.3


-

(biopsies)

-

-
alteplase

2.

:
2.1 (systolic) > 160mmHg
( 2 2557)

Page 11

2.2
(intracerebral haemorrhage)
alteplase

3.
:
3.1 (arrhythmias)
(coronary)

(reperfusion)

(reperfusion arrhythmias)

(conventional antiarrhythmic therapies)
3.2 Glyco-Protein II b / III a antagonists
GPIIb / IIIa

3.3 (thrombo-embolism)


mitral stenosis artrial fibrillation
4.
:
4.1

4.2


-

( 2 2557)

Page 12

-
- (late time-totreatment onset)
- acetylsalicylic acid (ASA)
(intracerebral
haemorrhage)
alteplase alteplase 0.9mg/kg
( 90 mg)
- 80

4.3 4.5

-
- ASA
-
4.4 24
systolic>180mmHg
diastolic > 105mmHg

4.5
(stroke)


4.6 (mild stroke)
alteplase

4.7 (severe
stroke) alteplase
(intracerebral haemorrhage)

4.8
( 2 2557)

Page 13

 alteplase

4.9



(intracranial bleeding)
alteplase
( / imaging techniques
)
< 50mg/dL > 400mg/dL
4.10

24
alteplase

Double check

1. Acute myocardial infarction

2
1.1 90-Minute (Accelerated Infusion)
- 67
15 mg IV bolus 1 2 IV infuse 0.75
mg/kg ( 50 mg) 30 IV infuse
0.5 mg/kg ( 35 mg) 1 (
100 mg)
- 67 ( 100 mg 1.5
)
15 mg IV bolus 1 2 50 mg
30 35 mg 1
( 2 2557)

Page 14

1.2 Three Hour Infusion

- 6-12

10 mg IV bolus
50 mg IV infuse 1
IV infuse 10mg 30
( 100 mg) 3
- 65
1.5 mg/kg


antithrombotic therapy
ST-elevation
2. Acute ischemic stroke
: acute ischemic stroke alteplase
3 0.9 mg/kg (maximum 90 mg)
10% IV bolus 90 %
continuous infusion 60

24
acetylsalicylic acid heparin
24
heparin
( )
heparin 10,000 IU
3. Pulmonary embolism
- 100 mg 2

10 mg IV bolus 1-2
90 mg IV infuse 2
- 65
1.5 mg/kg
( 2 2557)

Page 15

/4

4-5

alteplase heparin
heparin aPTT 2
aPTT 50-70
(1.5-2.5 )

acute myocardial infarction, pulmonary embolism
ischemic stroke systemic thromboses
Chest, 2008 alteplase 0.1-0.6 mg/kg/hr
6 plasminogen
deficiency
plasminogen thrombolysis therapy


Double check
Double check
sterile water NSS
SWI dextrose

(
heparin)


0.2 mg/mL
24

30 C
8


24
2- 8 C

( 2 2557)

Page 16

3,5-6

monitor
acute ischemic stroke: neurological status
acute myocardial infarction: evidence cardiac
reperfusion
catheter occlusion: catheter
pulmonary embolism:
monitor pulse, BP, hemodynamic respiratory status
acute ischemic stroke:

vital sign anaphylaxis
Adverse reaction

cholesterol embolization,
reperfusion arrhythmia
signs and symptoms of bleeding, arterial
puncture sites : bleeding 15 1
15 30 8
4 internal bleeding
neurologic,
, ,

Lab test: hematocrit, hemoglobin, platelet count,
fibrin/fibrin degradation product titer, fibrinogen
concentration, prothrombin time, thrombin time
activated partial thromboplastin

- monitor vital signs, CBC, renal function
hepatic enzymes
- monitor urine stool occult blood.
- monitor hematocrit, hemoglobin, partial
thromboplastin time, prothrombin time/INR, platelet

( 2 2557)

Page 17

count, serious bleeding

- Hemorrhage: fresh frozen plasma fresh
blood / cryoprecipitate, packed RBCs
active bleeding
- Hypotensive episode: IV 0.9% NaCl, blood
products bleeding dopamine
norepinephrine
(Bleeding)
alteplase
heparin


( cutdown
)
alteplase


heparin
protamine
heparin 4

(transfusion products)
cryoprecipitate, fresh frozen plasma (platelets)


cryoprecipitate 1 g/L
(antifibrinolytic agents)

( 2 2557)

Page 18


1. Klasco RK (Ed): DRUGDEX System. Truven Health Analytics, Greenwood Village,
Colorado (Vol. 159 expires [6/2014]).
2. , , . Siriraj
Drug List 2013 [online]. Version 26. Feb 2014.
3. Deglin JH, Vallerand AH, editors.Daviss drug guide for Nurses. 11th ed. PA: F. A. Davis
Company; 2009. p. 1164-1168.
4. . High Alert
Drugs. 2. : 25 2550.
5. Product information: Actilyse, Alteplase, BoehringerIngelheim, Thailand.
6. Smith KM, Riche DM, Henyan NN, editors. Clinical Drug Data. 11th ed. NY:McGraw-Hill,
Medical; 2010. p. 731-732.
7. American Pharmacists Association. Drug Information Handbook with International Trade
name index. 22nd ed. OH: Lexicomp; 2013-2014. p.86.
8. American Pharmacists Association.Pediatric and Neonatal Dosage Handbook. 19th ed. OH:
Lexicomp; 2012-2013. p.91.

( 2 2557)

Page 19

Adrenaaline (Epineephrine)

Adreenaline injectioon 1 mg/mL (1
( mL)

Adreenaline
injecction
1 mgg/mL (1 mL)

Onset1
SCC: 5-10
IM
M: 6-12
IVV: rapid

Peak1
SC: 20
IM:
IV: 20

Duratioon1
SC: < 1- 4
IM: < 1-4

IV: 20 - 30

Sccreening

(caardiac
arrest) (coaagulation disoorders)2

dihydroergotaminne linezolid
(
BP )2
halogenated hydrrocarbon anaaesthetic
( halothhane)
sympatthomimetic2

(vasoconsttriction and gangrene)
g

seecond
stage
, (closed-angle
glaucoma) ) , organic brainn damage
shock (non-anaphylactic)2

(
2 2557)

Page 20

Double check
For Anaphylaxis;
o IVinfusion 1 mg (1 mL of
1:1000(1 mg/mL)solution) D5W 250
mL ( 4 mcg/mL)
1 mcg/min (15 mL/hr)
10 mcg/min
1 mg (1 mL of
1:1000 solution 100 mL of NSS (10 mcg/mL))
5 -15 mcg/min
(30 -90 mL/hr)
/
2
o IM/SC 0.2-0.5 mg 5-10 2
o IV , IM SC 0.01 mg/kg maximum dose
0.3 mg IV infusion
10 mcg/min2
For Cardiac arrest;2
1 mg IV 3- 5
0.01 mg/kg (0.1 mL/kg of a 1:10,000 (0.1
mg/mL)solution) IV/Intraosseously ; 3 to 5 minutes
maximum dose 1 mg
For Post-cardiac arrest hypotension;2
0.1 -0.5 mcg/kg/min IV
0.1 -1 mcg/kg/min IV/INTRAOSSEOUS

Double check
1 mg/mL

( 2 2557)

Page 21

Double check
IV infusion Infusion pump
4 mcg/mL
1 - 10 mcg/min
10 mcg/mL 5 - 15 mcg/min
(30 - 90 mL/hr)
D5W, NSS
24 3


3,4
IV
Vital signs (BP, pulse rate) 3-5
tachycardia, palpitation, BP
ventricular fibrillation, pulmonary
edema
vital signs , BP 5
BP 160/90 .
BP 1 120/80 .
BP 1 100/70 .
HR 120 /
HR 1 180 /
HR 1 220 /

IV site 1
(extravasation)
(blanching)
(graying) 2

( 2 2557)

Page 22

 :
1. DDeglin JH, Vaallerand AH, editors.Davisss drug guidde for Nursess. 11th ed. PAA: F. A. Davvis
Com
mpany; 2009.. p. 480-3.
2. KKlasco RK (Edd): DRUGDEEX System.. Truven Heaalth Analyticss, Greenwoodd Village,
Coloorado (Vol. 160 expires [66/2014]).
3. PProduct inform
mation: Adrennaline injectioon, Adrenalinne, Atlantic Pharmaceutic
P
cal Co., Ltd,
Thaiiland.
4. PProduct inform
mation: Adrennaline injectioon, Adrenalinne, GPO, Thailand.
5. .
High Aleert
Druggs. 2. : 25 2550. 8.

(
2 2557)

Page 23

Calccium injecction

Calcium gluconate Injectioon
Calcium chloride injection

Calccium
glucoonate
Injecction

Calccium Chloride
Injecction

onset
IVV 1

peak
p
IV1

duratiion
IV 0.5 2
1

IVV 1

IV 1

IV 0.5 2
1

SScreening
serum calcium
m (Ca2+ ) = 4 .2 - 5.1 mEq//L
digoxin Ca2+ digoxin
d

digoxin

digoxin
intoxication
ceftriaxone
ventricular fibrillaation

ccardiac glycooside

K+
Ca2+
IV push 5 (
emergency case)
Ca2+ IV drip

(
2 2557)

Page 24

Calcium gluconate Calcium chloride

Ca2+ mEq
Calcium Chloride 10% (1.36 mEq/mL), Calcium
Gluconate 10% (0.45 mEq/mL)1


Double check
Double check
D5W, D10W LRS
bicarbonate 5
Ca++IV
phosphate
IV IM SC
necrosis
Calcium gluconate rate 200 mg/min


Calcium chloride
45-90 mg/Kg/hour (0.6-1.2 mEq/Kg/min)
100 mg/min
Hyperkalemia Calcium
monitor EKG IV push
Ca2+

Ca2+
IV site 30

Monitor EKG
- Hypocalcemia: ST segment QT prolongation
bradycardia, ventricular arrhythmia heart block
- Hypercalcemia: ST segment QT interval

( 2 2557)

Page 25

(
2 2557)

Page 26

 :
1. Deglin JH, Vallerand AH, editors.Daviss drug guide for Nurses. 11th ed. PA: F. A. Davis
Company; 2009.p.256-9.
2. Klasco RK (Ed): DRUGDEX System. Truven Health Analytics, Greenwood Village,
Colorado (Vol. 160 expires [6/2014]).
3. American Pharmacists Association. Drug Information Handbook with International Trade
name index. 22nd ed. OH: Lexicomp; 2013-2014.p.317-9.
4. . High Alert
Drugs. 2. : 25 2550. 9-10.
5. Trissel LA. Handbook on injectable drugs. 15th ed. Bethesda (MD): American Society of
Health-System Pharmacists;2009.p.176-81.
6. . Electrolyte Emergencies.: ().
First hour in Emergency Room: The practical approach 2008. 1. . .
., 2551. 148-53.

( 2 2557)

Page 27

Digooxin (Lanooxin)

1. Lanoxinn 0.25 mg taablet
2. Lanoxinn PG 0.06255 mg tablet
3. Lanoxinn elixir 0.05 mg/mL (60 mL)
4. Lanoxinn injection 0.25
0 mg/mL (2 mL)

Lanoxin 0.25
mg ttablet

onseet
0.5 - 2

peak
2 8

duration
2-4 1

Lanoxin PG
0.06625 mg tableet

0.5 - 2

2 - 8

2-4 1

Lanoxin elixir
0.055mg/mL
(60 m
mL)

0.5 - 2

2- 8

2-4 1

Lanoxin
injecction 0.25
mg/mL (2 mL)

5-30

1- 4

2-4 1

Screening
ventricuular fibrillatioon

(
2 2557)

Page 28

( )
electrolyte imbalance (hypokalemia, hypo hypercalcemia, hypomagnesemia (
)
Calcium parenteral
( )
erythromycin
clarithromycin
digoxin

Double check

1 10
2 12 3
monitor heart rate
IM: 500 mcg single injection site
200 mcg single injection site

oral IM IV 20
25%3
70 impaired renal function,
lean body mass 0.125 mg
3


Double check
0.25 mg D025
0.0625 mg D06

( 2 2557)

Page 29

K+ Digoxin K+ 3.5 mEq/L

( K+
)
60
/

o <1 HR 100 /
o 1-6 HR 80 /
o >6 HR 60 /
Double check
IV
IV Push 4 ( 1 mL
NSS D5W 4 mL)
5
IV Drip 250 ( 1
mL NSS D5W 250 mL)
10 20

1
2 12
Digoxin vital sign 15 2
30 3 1 5

monitor EKG 1

EKG

Digoxin toxicity

( 2 2557)

Page 30

 :
1. Deglin JH, Vallerand AH, editors.Daviss drug guide for Nurses. 11th ed. PA: F. A. Davis
Company; 2009.p.412-5.
2. Klasco RK (Ed): DRUGDEX System. Truven Health Analytics, Greenwood Village,
Colorado (Vol. 160 expires [6/2014]).
3. American Pharmacists Association. Drug Information Handbook with International Trade
name index. 22nd ed. OH: Lexicomp; 2013-2014.p.594-6.
4. . High Alert
Drugs. 2. : 25 2550. 11-3.
5. Product information: Lanoxin injection, GlaxoSmithKline Manufacturing SpA, Italy.

( 2 2557)

Page 31

DDoBUtaminne

1.
2.
3.
4.
5.

Dobuutamine
injecction
250 mg/20 mL
(12.55 mg/mL)
Dobuutamine
(U-sqquare)
injecction 250
mg/220 mL (12.5
mg/m
mL)
Dobuutamine Siriraaj
(PFSS) Injection
1,2 6 mg/mL
20 mL
30 mL

Dobutam
mine injection 250 mg/20 mL
m (12.5 mg/m
mL)
Dobutam
mine (U-squaree) injection 2550 mg/20 mL (12.5 mg/mLL)
Dobutam
mine Siriraj (P FS) Injection 1 mg/mL 20 mL 30 mL
Dobutam
mine Siriraj (P FS) Injection 2 mg/mL 20 mL 30 mL
Dobutam
mine Siriraj (P FS) Injection 6 mg/mL 20 mL 30 mL

onset
o
1--2

peak
10

duraation
Single Dose
: 10
Multiplee Dose
: 1

1--2

10

Single Dose
: 10
Multiplee Dose
: 1

1--2

10

Single Dose
: 10
Multiplee Dose
: 1

Screeening
DDouble check
DoPAmine

hypovolemia


hypovolemmia

(
2 2557)

Page 32

 atrial fibrillation ventricular

digitalis

myocardial infarction infarction
linezolid


hypersensitivity to dobutamine
idiopathic hypertrophic subaortic stenosis

monitor HR, BP, RR

Double check
DoPAmine
Double check
DoPAmine

cardiac output
0.51 mcg/kg/min
maintenancedose 2 40 mcg/kg/min
: IV 2 20mcg/kg/min



40
mcg/kg/min

infusion pump
doBUtamine Sodium bicarbonate


( 2 2557)

Page 33

:
50 mL ( premixed)
: D5W , D5S/2 , D5S, D10W, NSS , LRS
1(Maximum concentration) : 5 mg/mL
: 24
oxidation


(EKG),

BP, HR 1
BP 160/90 mmHg
BP 1 120/80 mmHg
BP 1 100/70 mmHg
HR 120 /
HR 1 180 /
HR 1 220 /

:

15

electrolytes ( potassium 3.55.5mEq/L) hypokalemia1
100 mL/4 hr
30 mL/hr 0.5-1 mL/ Kg/hr

( 2 2557)

Page 34

 ( 2 2557)
Pagge 35

(
2 2557)

Page 36

 :
1. Deglin JH, Vallerand AH, editors.Daviss drug guide for Nurses. 11th ed. PA: F. A. Davis
Company; 2009.p.437-8.
2. Klasco RK (Ed): DRUGDEX System. Truven Health Analytics, Greenwood Village,
Colorado (Vol. 160 expires [6/2014]).
3. . High Alert
Drugs. 2. : 25 2550. 14-5.

( 2 2557)

Page 37

DoPAmine

1.
2.
3.
4.

mL (25 mg/mLL)
Inoppin (Dopaminne) injection 250 mg/ 10m
Dopaamine Siriraj (PFS) Injectioon 1 mg/mL 20 mL
30 mL
Dopaamine Siriraj (PFS) Injectioon 2 mg/mL 20 mL
30 mL
Dopaamine Siriraj (PFS) Injectioon 6 mg/mL

20 mL 30 mL

Inoopin (Dopamine)
injection 250 mg/
100mL (25 mg/m
mL)

Doopamine Siriraaj
(PPFS) Injection
1 mg/ml
2 mg/ml
6 mg/ml

onset
5

peak

10 1

10 1

durattion
10

10

Screeening
DDouble check
DoBUtamine

Dilantin (Pheenytoin)

ccardiac arresst
tachyyarrhythmias ventricuular
ffibrillation
MAOI dopaamine metabbolized
MAO
M

(
2 2557)

Page 38

tachycardia, hypertension, arrhythmias

linezolid

ergot
vasoconstriction peripheral constriction
gangrene

monitor BP, HR

rate of infusion 1
( )
Initial : IV 2 - 5 mcg/kg/min 5
10 mckg/min 50 mcg/kg/min
50 mcg/kg/min renal
shutdown monitor urine flow
infusion rate
( )
Initial : IV 2 - 5 mcg/kg/min 50
mcg/kg/min


Double check
DoBUtamine
Double check

D5W,D5S, NSS, D5S/2
IV bolus
DoBUtamine
Sodium bicarbonate
Dopamine
(central vein) infusion pump/

( 2 2557)

Page 39

syringe pump central line

peripheral line
(maximum concentration) 3.2
mg/mL



vital sign , BP 1

BP 160/90 mmHg
BP 1 120/80 mmHg
BP 1 100/70 mmHg
HR 120 /
HR 1 180/
HR 1 220 /
infusion pump 1


24

( 2 2557)

Page 40

 ( 2 2557)
Pagge 41

 :
1. DDeglin JH, Vaallerand AH, editors.Davisss drug guidde for Nursess. 11th ed. PAA: F. A. Davvis
Com
mpany; 2009..p.448-50.
2. KKlasco RK (Ed): DRUGDEEX System.. Truven Heaalth Analyticss, Greenwoodd Village,
Coloorado (Vol. 160 expires [66/2014]).
3. .

High Alert
A
Drugs. 2. : 25 25500. 16-8.

( 2 2557)

Pagge 42

Heparinn (Unfractiionated)

1. Heparin 50000 Units/mL (5 mL)
2. Heparin PFFS 100units/m
mL (5mL)
3. Heparin PFFS 50 units/m
mL (5 mL)
Onset1-2
SC:20-30
IV:

peak
durattion
SC: 2
SC: 8 - 12
1
IV: 5 - 10 IV: 2-6 1

Hepaarin
100 units/mL
(5 m
mL)

IV:

IV: 5 - 10 1 IV: 2-6 1

Hepparin PFS
50 uunits/mL
(5 m
mL)

SC: 20-330

IV:

SC:: 2
IV: 5-10

Hepaarin
50000 units/mL
(5 m
mL)

SC: 8-12
IV: 2-6

Screeninng
(platelet) 1100,000/mm3

keep arteriaal line ceentral line

benzyl alcohol
neonnates innfants 100 kg;
100 unitss/mL
systtemic anticoaagulation
60

enoxapaarin
enoxaparrin 12

heparin10 11
enooxaparin dose

( 2 2557)

Pagge 43

enoxaparin 24 heparin 22 23
enoxaparin dose 5
Contraindication

Double check
U unit

indication


Double check
2-8
insulin
Double check
insulin


D5W, NSS NSS/24
IM hematoma
infusion pump
infusion pump 2
aPTT
Heparin
aPTT
6
CBC 7
neuro sign

Protamine sulphate

Heparin 5,000 unit/mL 14 ( )

2-8 prefilled syringe 24
( 2 2557)

Page 44

( 2 2557)

Pagge 45

 :
1. American Pharmacists Association. Drug Information Handbook with International Trade
name index. 22nd ed. OH: Lexicomp; 2013-2014. p. 958-62.
2. Deglin JH, Vallerand AH, editors.Daviss drug guide for Nurses. 11th ed. PA: F. A. Davis
Company; 2009. p. 616-9.
3. . High Alert
Drugs. 2. : 25 2550. 21-3.
4. Klasco RK (Ed): DRUGDEX System. Truven Health Analytics, Greenwood Village,
Colorado (Edition expires [6/2014]).
5. DIS revisit: the next step in patient safety 2556
14-16 2556.

( 2 2557)

Page 46

 sticker
Siriraj guideline for adult patients with Heparin administration

(1) heparin
Indication : Acute coronary syndrome (ACS)
Atrial fibrillation (AF)
Intracardiac thrombosis
Pulmonary embolism (PE)
Deep vein thrombosis (DVT)
Acute ischemic stroke
Arterial occlusion
Bridging therapy
Baseline : CBC, Coagulogram
Dose calculation : Adjusted by weight
Stability : at room temperature :
in NSS 24 hour, in D5W 8 hour

Heparin
Modified early warning sign

Heparin IV (1)
Yes

No

(2) Risk factor a

Peptic ulcer disease : Hx GI bleeding
Drugs : antiplatelets, NSAIDs, Fibrinolytic
Presence of any potential bleeding site
Severe hypertension
Congenital or acquired hemostatic defect
Severe renal failure
Severe hepatic failure
Anemia
Recent surgery
Trauma (or risk of trauma)
Recent intracerebral hemorrhage
Large cerebral infarction
Age over 60 years
Platelet < 100,000/mm3
Note : Thin women are at high risk (BMI < 18.5)

Risk factor (2)

Individualized dose of Heparin
b

Monitoring
Clinical
Record V/S (BP, HR, RR)
Observe neurological sign
Observe bleeding
Lab
PTT ( keep < 70 sec)
aPTT ratio (keep < 2.5) q 4-6 hr
(as indicated)
Platelet, Hematocrit q 2 day
(as indicated)
Heparin infusion

Initial dose of
Heparin (3)

No

1. Avoiding or decreasing boluses

of unfractionated heparin
2. Slow titration upward to target
PTT, aPTT ratio

V/S, neurological sign change ..

PTT 70 sec ...
aPTT ratio 2.5 ...
3
Platelet < 100,000/mm .
Hematocrit drop > 3% from baseline
Invasive catheter ..
Heparin infusion error ..

Yes

Continue heparin
(4)

No

Bleeding (5)

Yes

(5) Bleeding
1. Internal
Intracerebral hemorrhage
Hemothorax
Hemoperitoneum, Retroperitonial hematoma
Hematoma, Ecchymosis, Petechiae
2. External
Hematemesis, Melena, Bleeding per rectum
Hematuria
Hemoptysis
Bleeding per gum
Puncture site bleeding
Bleeding per vagina

infusion pump
Notify

Hold heparin / ...............................................................

Repeat PTT, aPTT ratio /............................................

Antidote : Protamine sulfate 1 mg/heparin 100 unit

(recent dose) / ..............................................................

Bleeding management /...........................................

Blood component transfusion as indicated

/ ..........................................................................................

Version 2 : 24/03/2014

(3) Initial dose of heparin c

Indication

Bolus dose
(units/kg)

Maximum bolus
(units)

Initial infusion
(units/kg/hr)

Maximum initial
infusion rate
(units/hr)
1,000

Acute MI treated with fibrinolytic

60
4,000
12
Acute coronary syndrome,
70
5,000
15
1,200
mechanical valve
Pulmonary embolism &
80
10,000
18
1,800
ventricular/atrial thrombus
Peripheral arterial embolism/deep
80
5,000
18
1,000
vein thrombosis
Note: 1) Adjust by weight and clinical correlation
2) Total dose: 48,000 units/day (2,000 units/hr)
3) MI: myocardial infarction
(4) unfractionated heparin (UFH) aPTT d
Repeated
Stop infusion
Change rate (dose) of infusion
Time of next aPTT
aPTT ratio bolus dose
duration (min)
(Adjusted dose)
(hours)
(units)
(1)
(2)
(3)
>7.0
_____
180
Reduce rate by 500 units/hour
3
5.1-7.0
_____
60
Reduce rate by 500 units/hour
6
4.1-5.0
_____
30-60
Reduce rate by 300 units/hour
6
3.1-4.0
_____
30-60
Reduce rate by 200 units/hour
6
2.6-3.0
_____
30-60
Reduce rate by 100 units/hour
6
1.8-2.5
_____
0
No change
Next morning
1.2-1.7
2,500
0
Increase rate by 100-200 units/hour
6
<1.2
5,000
0
Increase rate by 400 units/hour
6
Note: (1) (2) (3)
aPTT ratio > 7.0 aPTT, aPTT ratio
(High alert drug)
heparin 2 ml (10,000 unit) NSS 100 ml ( heparin 100 unit NSS 1 ml)
iv drip rate 10 ml/hr (= heparin 1,000 unit/hr)
References

a. Risk factor: Garcia DA, Baglin TP, Weitz JI, et al. Antithrombotic therapy and prevention of thrombosis,
9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST
2012; 141(2) (Suppl): e24Se43S.
b. Salzman EW, et al. Management of heparin therapy; a controlled prospective trial. N Engl J Med 1975;
292;1046-50. http://www.rxkinetics.com/heparin.html
c. http://www.ugapharmd.com/ebook/pages/heparin.pdf
Guidelines for antithrombotic therapy last updated December 2003
d. aPTT ratio (Therapeutic
range)
Siriraj guideline for adult patients with Heparin administration

Version 2 : 24/03/2014

H
Heparin,
Loow Molecuular Weightt (Innohep//Tinzaparinn)

1. Tinzapparin inj 10,0000 anti-Xa IU//mL 2 mL (Innnohep)
2. Tinzapparin inj PFS 20,000 anti-XXa IU/mL 0.5 mL (Innohep)
3. Tinzapparin inj PFS 20,000 anti-XXa IU/mL 0.7 mL (Innohep)

Tinzaaparin inj
10,000
anti-Xa IU/mL
2 mL
(Innoohep)
Tinzaaparin inj
PFS
20,000 anti-Xa
IU/m
mL
0.5 mL
(Innoohep)
Tinzaaparin inj
PFS
20,000 anti-Xa
IU/m
mL
0.7 mL
(Innoohep)

onset
SC: 2- 3

peaak
SC: 4 5

duuration
SC: 161 24

SC: 2- 3

SC: 4-55

SC: 16-24
1

SC: 2- 3

SC: 4-55

SC: 16-24
1

SScreening



70

( 2 2557)

Pagge 49

NSAIDs, platelet inhibitors,

anticoagulant neuraxial
anesthesia, spinal puncture,
indwelling epidural catheters
spinalsurgery
epidural spinal hematoma
signs symptoms neurological
impairment

benzyl alcohol
Contraindication
2
benzyl alcohol 3

Heparin Induced Thrombocytopenia (HIT)

Double check
U
unit
indication ( Guideline
)


Double check
heparin insulin
Double check
heparin insulin
subcutaneous
anti-factor Xa (anti-Xa) level (
recurrent
thrombosis renal
impairment
)
CBC 7

( 2 2557)

Page 50


2 <
100,000/mm3 1,3
renal liver function
neuro sign


Protamine sulphate

30
:
1. Klasco RK (Ed): DRUGDEX System. Truven Health Analytics, Greenwood Village,
Colorado (Edition expires [6/2014]).
2. American Pharmacists Association. Drug Information Handbook with International Trade
name index. 22nd ed. OH: Lexicomp; 2013-2014. p. 1968-71.
3. Product information: Innohep, tinzaparin, Leo, Ballerup, Denmark.

( 2 2557)

Page 51

H
Heparin,
Loow Molecullar Weight (Clexane/Enoxaparinn)

- Enoxaparin (PFS) inj 40 mg/0.4 mL (CClexane)
- Enoxaparin (PFS) inj 60 mg/0.6 mL (CClexane)
- Enoxaparin (PFS) inj 80 mg/0.8 mL (CClexane)

Enoxxaparin
(PFSS) inj
40 m
mg/0.4 mL
(Clexxane)
Enoxxaparin
(PFSS) inj
60 m
mg/0.6 mL
(Clexxane)
Enoxxaparin
(PFSS) inj
80 m
mg/0.8 mL
(Clexxane)

onsset
1

peak
SC
C: 3 5

duration
SC: 12

SC
C: 3 5

SC: 12

SC
C: 3 5

SC: 12

SScreening


NSAIDss, platelet inhhibitors,
anticcoagulant ,
neuraxial
anessthesia, spinaal puncture,
indwwelling epidurral catheters
spinaal surgery

epidural spinnal hematom

ma

signss symptooms neuurological imppairment

( 2 2557)

Pagge 52

 45
57
renal impairment (

Crcl 30 mL/minute)

renal
dysfunction 45

heparin enoxaparin
heparin enoxaparin
1 4
Contraindication

Heparin Induced Thrombocytopenia (HIT)

Double check
indication


Double check
heparin insulin
Double check
heparin insulin
IM
D5W NSS
SC
2
spinal column bleeding
enoxaparin (
deep vein thrombosis)
spinal catheter 12
(1 mg/kg
1.5 mg/kg )

( 2 2557)

Page 53

spinal catheter 24 5
post-procedure dose
enoxaparin catheter 4 5
risk benefit
thrombosis bleeding5
anti-factor Xa (anti-Xa) level (
recurrent
thrombosis renal
impairment
)
CBC 7
serum creatinine1
neuro sign


Protamine sulphate

25
:
1. Deglin JH, Vallerand AH, editors.Daviss drug guide for Nurses. 11th ed. PA: F. A. Davis
Company; 2009. p. 619-23.
2. Klasco RK (Ed): DRUGDEX System. Truven Health Analytics, Greenwood Village,
Colorado (Edition expires [6/2014]).
3. Product information: Clexane, enoxaparin, sanofi-aventis, Bangkok, Thailand.
4. DIS revisit: the next step in patient safety 2556
14-16 2556
5. FDA Drug Safety Communication: Updated recommendations to decrease risk of spinal
column bleeding and paralysis in patients on low molecular weight heparins. [Homepage on
Internet]. USFDA; [Accessed 04/04/2014]; Available from:
http://www.fda.gov/Drugs/DrugSafety/ucm373595.htm

( 2 2557)

Page 54

H
Heparin,
Low Molecular Weight (Arixtra/Foondaparinuux)

Fondaparinux (PFS) injj 2.5 mg/0.55 mL (Arixtraa)

Fondaparinux
(PFSS) inj
2.5 mg/0.5 mL
(Arixxtra)

onset
1

peak
p
3 1

Duration
24 1

SScreening

NSAAIDs, platelet inhibitors, aanticoagulant
neuraxial aneesthesia

spinal puuncture indwelling eepidural cathheters

spinal surgeery
epidural
e
spinal hemaatoma
signs symptoms neurologgical
impairmeent



177 2
75


CrCl 30 mL/minute

50


CContraindicaation
-
- Acute baacterial endoocarditis

( 2 2557)

Pagge 55

- severe renal impairment (CrCl

30mL/minute)
- 50 .
venous thromboembolism

Double check
indication
SC : 2.5 mg



Double check
Double check
IM
100,000 /mm3

2

CBC
plasma anti-factor Xa significant renal
impairment bleeding coagulation
parameters

blood pressure
hepatic function
renal function, stool occult blood tests
neuraxial anesthesia
spinal puncture neurological
impairment spinal epidural
hematoma

( 2 2557)

Page 56

 :
1. Deglin JH, Vallerand AH, editors.Daviss drug guide for Nurses. 11th ed. PA: F. A. Davis
Company; 2009. P. 575-7.
2. Micromedex Healthcare Series, Truven Health Analytics, Greenwood Village, Colorado
(Edition expires [6/2014]).
3. Product information: Arixtra, fondaparinux, GlaxoSmithKline, Bangkok, Thailand.
4. American Pharmacists Association. Drug Information Handbook with International Trade
name index. 22nd ed. OH: Lexicomp; 2013-2014. p. 881-3.

( 2 2557)

Page 57

 sticker

Siriraj guideline for adult patients with

Low Molecular Weight Heparin (LMWH) administration

LMWH
(1)
Yes LMWH

Indication:Acutecoronarysyndrome(ACS)
Atrialfibrillation(AF)

Pulmonaryembolism(PE)
Deepveinthrombosis(DVT)
Acuteischemicstroke

Arterialocclusion
Bridgingtherapy

Baseline:CBC,Coagulogram,BUN,Cr,BW
Dosecalculation: Adjustedbyweightand
Creatinineclearance

(2)Riskfactor

sign

Pepticulcerdisease:HxGIbleeding
Drugs:antiplatelets,NSAIDs,Fibrinolytic
Presenceofanypotentialbleedingsite
Severehypertension
Congenitaloracquiredhemostaticdefect
Severerenalfailure
Severehepaticfailure
Anemia
Recentsurgery
Trauma(orriskoftrauma)
Recentintracerebralhemorrhage
Largecerebralinfarction
Ageover60years
3
Platelet<100,000/mm

LMWH (1)

Modified early warning

No

Risk factor (2)

Yes

Monitoring
Clinical
RecordV/S(BP,HR,RR)
Observeneurologicalsign
Observebleeding
Lab
ConsidermonitoringantiXa
forweight>120kgor<60kg,4hr
( request)
Platelet,Hematocritq3day
(asindicated)
LMWHadministration

Doseof
LMWH(3)

1. Individualizeddosing
2. Dailyassessmentfor
signs/symptomsofbleeding,
essentiallabasindicated

(4)

No

V/S,neurologicalsignchange..
Yes
3
Platelet<100,000/mm ...
Hematocritdrop>3%frombaseline.
LMWHerror..
Other....

Notify

No

ContinueLMWH

(3)

Bleeding(5)
Yes

(5)Bleeding

1.Internal
Intracerebralhemorrhage

Hemothorax
Hemoperitoneum,Retroperitonialhematoma
Ecchymosis,Petechiae

2.External
Hematemesis,Melena,Bleedingperrectum
Hematuria

Hemoptysis
Bleedingpergum
Puncturesitebleeding

Bleedingpervagina

HoldLMWH / ..........................................................................
RepeatantiXa / .....................................................................
Notify /consulthematologist/ ...............................

Bleedingmanagement/ ...................................................
Bloodcomponenttransfusionasindicated

/ ...................................................................................................

Version 2 : 24/03/2014

(3) Initial dose of Low Molecular Weight Heparin (LMWH)

3.1 Enoxaparin : Clexane
3.1.1 Unstable Angina /non ST Elevation Myocardial Infarction:
1 mg/kg SC q 12 hrs (2-8 days)
3.1.2 ST Elevation Myocardial Infarction (STEMI) :
< 75 years of age
30 mg single IV bolus plus 1 mg/kg SC q 12 hrs
30 mg single IV bolus plus 1 mg/kg SC q 24 hrs
(Creatinine Clearance : CrCl < 30ml/min)
> 75 years of age ( Elderly )
No initial IV bolus; 0.75 mg/kg SC q 12 hrs
No initial IV bolus; 1 mg/kg SC q 24 hrs (CrCl < 30ml/min)
3.1.3 Deep Vein Thrombosis (DVT)
DVT treatment with or without Pulmonary embolism (PE)
1 mg/kg SC q 12 hrs for 10 days or 1.5 mg/kg SC q 24 hrs for 10 days
1 mg/kg SC OD (CrCl < 30ml/mim)
DVT prophylaxis
40 mg SC q 24 hrs for 7 10 days extended to 4 wks
20 mg SC OD (CrCl < 30ml/mim)
3.2 Fondaparinux
3.2.1 Deep Vein Thrombosis (DVT)
DVT treatment with or without PE
5 mg SC q 24 hrs for 5-9 days
BW < 50 kg
7.5 mg SC q 24 hrs for 5-9 days
BW 50-100 kg
10 mg SC q 24 hrs for 5-9 days
BW > 100 kg
DVT prophylaxis
2.5 mg SC q 24 hrs for 5-9 days
3.2.2 Acute Coronary Syndrome
2.5 mg SC q 24 hrs for 8 days or until patients discharged
IV = intravenous, SC = subcutaneous
Note: Severe renal impairment = Creatinine Clearance < 30 ml/min
Creatinine Clearance
Male : Creatinine Clearance (ml/min) =
(140 age) x (Wt in kg) x 1
(72 x serum creatinine : mg/dl)
Female : Creatinine Clearance (ml/min) =
(140 age) x (Wt in kg) x 0.85
(72 x serum creatinine : mg/dl)
Siriraj guideline for adult patients with LMWH administration

Version 2 : 24/03/2014

(4) Low Molecular Weight Heparin (LMWH)

References
a. Risk factor: Garcia DA, Baglin TP, Weitz JI, et al. Antithrombotic therapy and prevention of
thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice
Guidelines. CHEST 2012; 141(2) (Suppl): e24Se43S.
b. Salzman EW, et al. Management of heparin therapy; a controlled prospective trial. N Engl J Med
1975; 292;1046-50. http://www.rxkinetics.com/heparin.html
c. Uspharmacist Low Molecular Weight Heparins for Deep Vein Thrombosis Vol. 26:05 , 2001
(www.uspharmacist.com)
d. (Work Instruction) NS-00-3-162-01 Low Molecular Weight
Heparin (LMWH)

Siriraj guideline for adult patients with LMWH administration

Version 2 : 24/03/2014

Insulin

1. Humulin R 10 mL
2. Gensulin R 10 mL
3. Actrapid HM 10 mL
4. Humulin N 10 mL
5. Gensulin N 10 mL
6. Insulatard HM 10 mL
7. Humulin 70:30 10 mL
8. Gensulin M30 10 mL
9. Mixtard 30 HM 10 mL
10. Lantus 10 mL
11. Insulin aspart penfill 3 mL (Novorapid)
12. Insulin aspart , biphasic penfill 3 mL (Novomix)
13. Insulin aspart, biphasic Flexpen 3 mL (Novomix 30)
14. Insulin detemir flexpen 3 mL (Levemir)
15. Insulin glulisine Prefilled pen 3 mL (Apidra solostar)
16. Insulin glargine PFS 3 mL + needle (Lantus Solostar)
17. Insulin isophane (NPH) Penfill 3 mL (Gensulin N)
18. Insulin isophane (NPH) Penfill 3 mL (Humulin N)
19. Insulin isophane (NPH) Penfill 3 mL (Insulatard HM)
20. Insulin Isophane+regular Penfill 3 mL (Gensulin M30)
21. Insulin Isophane+regular Penfill 3 mL (Humulin 70/30)
22. Insulin Isophane+regular Penfill 3 mL (Mixtard 30 HM)
23. Insulin lispro Penfil 3 mL (Humalog)
24. Insulin lispro, biphasic Penfil 3 mL (Humalog Mix 25)
25. Insulin regular Penfill 3 mL (Actrapid HM)
26. Insulin regular Penfill 3 mL (Gensulin R)
: (tradename)

( 2 2557)

Page 61

 insuulin1,2
Onset1,2

Peak1,2

Duration1,2

30-600

2-3

5-8

Genssulin R 10 mLL

30-600

2-3

5-8

Actraapid HM 10 mL
m

30-600

2-3

5-8

Hum
mulin N 10 mLL

2-4

4-10
4

10 16

Genssulin N 10 mLL

2-4

4-10
4

Insulatard HM
mL
10 m

2-4

4-10
4

10-16

Hum
mulin 70:30
10 m
mL

30-600

4-8
4

10 16

Genssulin M30
10 m
mL

30-600

4-8
4

10 16

Mixtaard 30 HM
10 m
mL

30-600

4-8
4

10-16

Lanttus 10 mL

2-4

Peakless
(

20 - 244

Hum
mulin R 10 mLL

10-16

( 2 2557)

Pagge 62

Onset1,2

Peak1,2

Duration1,2

Insuulin aspart
penffill 3 mL
(Novvorapid)

5 155

30-90
3

3 5

Insuulin aspart ,
biphhasic penfill 3
mL ((Novomix)

5 155

1 4

24

Insuulin aspart,
biphhasic Flexpenn
3 mL
(Novvomix 30)

5 155

1 4

24

Insuulin detemir
flexppen 3 mL
(Levvemir)

2 -4

6-14
6

16-20

Insuulin glulisine
Preffilled pen 3 mL
m
(Apidra solostar))
Insuulin glargine
PFSS 3 mL +
needdle (Lantus
Soloostar)

5-15

30-90
3

3-5

2-4

20 - 24

Insuulin isophane
(NPH) Penfill 3
mL ((Gensulin N))
Insuulin isophane
(NPH) Penfill 3
mL (Humulin N))

2-4

Peakless
(

)
4-10
4

2-4

4-10
4

10 16

Insuulin isophane
(NPH) Penfill 3
mL
(Insuulatard HM)

2-4

4-10
4

10-16

10 16

( 2 2557)

Pagge 63

Onset1,2

Peak1,2

Duration1,2

Insuulin
Isopphane+regulaar
Penffill 3 mL
(Gennsulin M30)
Insuulin
Isopphane+regulaar
Penffill 3 mL
(Hum
mulin 70/30)
Insuulin
Isopphane+regulaar
Penffill 3 mL
(Mixxtard 30 HM)
Insuulin lispro
Penffil 3 mL
(Hum
malog)

30-600

4-8
4

10 16

30-600

4-8
4

10-16

30-600

4-8
4

10-16

5-15

30-90
3

3-5

Insuulin lispro,
biphhasic Penfil
3 mL
malog Mix 255)
(Hum
Insuulin regular
Penffill 3 mL
(Actrapid HM)

5-15

10-16

30-600

2-3

5-8

30-600

2-3

5-8

Insuulin regular
Penffill 3 mL
(Gennsulin R)

Screening
Inssulin ,
ACE inhibitors enalapril, octreotide
o
(saandostatin)
salicyylates aspirin2
Insulin

corticcosteroids, thhyroid supplements, estrrogens, INH, niacin,

( 2 2557)

Pagge 64

rifampicin, phenothiazine-type antipsychotics

chlorpromazine2
(masking) hypoglycemia beta-blockers
propranolol, clonidine, reserpine2
fluoroquinolones
hypoglycemia hyperglycemia
3

Double check
U unit

Regular insulin, NPH, glargine : Type 1 DM

//

Usual maintenance dose: 0.5-1 units/kg/day

:
1.2 units/kg/day

Non-obese : 0.4 -0.6 units/kg/day
Obese : 0.8 -1.2 units/kg/day4


Double check
Heparin
insulin 2-8 ( )
Insulin 1

Insulin penfilled

Double check Insulin

Heparin

( 2 2557)

Page 65

Insulin

Insulin IV Regular Insulin (RI, Humulin R Gensulin

R, Actrapid), Aspart (Novorapid), Lispro (Humalog), Glulisine
(Apidra)
RI IV infusion flush 20
mL 4,5
RI IV infusion monitor Capillary
Blood Glucose
IV infusion infusion pump


60 Hypoglycemia

Vital signs Tachycardia
(HR 60-100 /)


60-100 mg/dL
70-110 mg/dL
baseline 5

( 2 2557)

Page 66

( 2 2557)

Pagge 67

 :
1. . . :
(). . 1. : ,
2555. . 1-11.
2. Deglin JH, Vallerand AH, editors.Daviss drug guide for Nurses. 11th ed. PA: F. A. Davis
Company; 2009.
3. Klasco RK (Ed): DRUGDEX System. Truven Health Analytics, Greenwood Village,
Colorado (Vol. 160 expires [6/2014]).
4. American Pharmacists Association. Drug Information Handbook with International Trade
name index. 22nd ed. OH: Lexicomp; 2013-2014. p. 1050-62.
5. . High Alert
Drugs. 2. : 25 2550. 26.

( 2 2557)

Page 68

K+ (Pottassium) Innjection

m ( K+ 2 mEEq/mL)
1. KCl inj. [Potassium chloride] 200 mEq/10 mL
2. K2HPO4 Inj. [Dipotaassium phossphate] 20 mL
m ( K+ 1 mEEq/mL)

Onset1

Peak1

Duraation1

KCl inj. 10 mL
( K+ 2 mEq/m
mL)

(end oof
infusion)

K2HPO4 Inj. 20 mL
( K+ 1 mEq/m
mL)

(end oof
infusion)

Sccreening
Lab K+ 3.5-5.0 mEEq/L2

IV push IVV bolus

100 mEq/L peeripheral line
200-400 mEq/L central
c
line
D5W
W, NSS3

K-sparing
K
diuuretics2 (
spironolacttone, amiloridde)
K+

( 2 2557)

Pagge 69

ACE inhibitors2 enalapril,

ramipril K
Treatment of Hypokalemia3
-
: Serum K 2.5 3.5 mEq/L
10mEq/
40mEq/L
200mEq
:Serum K 2.5mEq/L
hypokalemia (
cardiac arrest) central
line 40 mEq/
EKG 400 mEq
- 0.5-1 mEq/kg/dose (maximum
dose 40 mEq)
0.5mEq/kg/hr
bedside EKG monitoring
40
mEq/L (peripheral line) 200 mEq/L
(central line)4
Double check


Double check
IV push IV bolus
IV fluid K+ loading
Infusion pump

K+

infusion pump infusion pump
4

( 2 2557)

Page 70

40 mEq/L HR , BP
2
20-40 mEq/L HR 4
BP
BP 160/110 90/60 mmHg
HR 60-100 /
Lab K+ 3.5-5 mEq/L
K+ sparing diuretics spironolactone
K+


K+ arrhythmia

:
1. Deglin JH, Vallerand AH, editors.Daviss drug guide for Nurses. 11th ed. PA: F. A. Davis
Company; 2009. p. 997.
2. Klasco RK (Ed): DRUGDEX System. Truven Health Analytics, Greenwood Village,
Colorado (Vol. 160 expires [6/2014]).
3. American Pharmacists Association. Drug Information Handbook with International Trade
name index. 22nd ed. OH: Lexicomp; 2013-2014. p. 1619-20.
4. Phelps SJ, Hagemann TM, LEE KR, Thompson AJ, editors. Pediatric injectable drugs (The
teddy bear book). 10th ed. Bethesda, MD: American Society of Health-System Pharmacists;
20 p. 536.
5. . High Alert
Drugs. 2. : 25 2550. 29.

( 2 2557)

Page 71

Magnesiuum sulfatee Injection

1. 50% MgSSO4 inj. 2 mL
2. 20% MgSSO4 inj. 20 mL
3. 50% MgSSO4 inj. 20 mL
4. MgSO4 inn D5W 40 mgg/mL 1000 m
mL

Peak1

Duratioon1

50%
%
MgSSO4 inj.
2 mL

IV:
unknown
u
IM: 1

IV: 30
IM : 3 -44 hr

20%
%
MgSSO4 inj.
20 m
mL

IV:

unknown
u

IV: 30

50%
%
MgSSO4 inj.
20 m
mL

IV:

unknown
u

IV: 30

MgSSO4 in
D5W
W
40 m
mg/mL
1000 mL

IV:

unknown
u

IV: 30

Onset
O 1

Magnesiuum sulfate injection

MggSO4, MSO

( 2 2557)

Pagge 72

 Morphine sulfate injection

renal impairment
magnesium toxicity
For pre-eclampsia, eclampsia:2
Loading dose 20% Magnesium sulfate inj.
4 (20 .)
6
(30 .)
Maintenance dose 50% Magnesium sulfate
inj. 80 . D5W 920 .
50mL/hr
4% Magnesium sulfate in D5W 1000 mL
serum creatinine

1.5 mg/dL
25 mL/hr
Magnesium (Hypomagnesemia)3,4
Adult
mild hypomagnesemia; 1 g (magnesium sulfate
50% solution 2 mL) IM 6 4
doses serum magnesium
severe hypomagnesemia; 250 mg/kg (
magnesium sulfate 50% solution undiluted)
IM 4 magnesium sulfate inj 5 g
D5W NSS 1000 mL IV infusion
3
TPN, maintenance; 8-24 mEq/day
Pediatric
TPN, maintenance (prophylaxis); infants; 2-10
mEq/day
Neonates children magnesium sulfate 25 50 mg/kg IV 30 60 ; MAX 2 g/ dose
( 2 2557)

Page 73

Torsades de Pointes: Adult4

1 - 2 g 10 mL D5W IV/intraosseous
15
Torsades de Pointes :Pediatric4
Torsades de pointes: 25 - 50 mg/kg
IV/intraosseous 10 - 20 ; maximum dose
2 g


Double check
Magnesium sulfate

IV Dilute ( D5W
NSS) 20% (
200mg/mL)
IM 25% 50%
20%4
Max infusion rate 150mg/min4 severe
eclampsia with seizure
rapid bolus infusion
pulseless torsades, 10 - 20 minutes
hypomagnesemia/torsades with pulses,
30 - 60 minutes hypomagnesemia
15 - 30 minutes status asthmaticus4
magnesium
loading dose 1.9-2.9
mg/dL preeclampsia therapeutic level
4-8 mg/dL6

Magnesium

( 2 2557)

Page 74

 (neuromuscular
blockade)
heart block 6
RR, HR 4 6
RR 14 /
HR 60-100 /
Urine output 100 mL/ 4 hr6
Deep tendon reflex knee jerk reflex
4 negative bicep jerk reflex
negative 6

:
1. Deglin JH, Vallerand AH, editors.Daviss drug guide for Nurses. 11th ed. PA: F. A. Davis
Company; 2009.
2. , - .
.. 2553. ... 2553. . 18.
3. American Pharmacists Association. Drug Information Handbook with International Trade
name index. 22nd ed. OH: Lexicomp; 2013-2014. p. 1221-3.
4. Klasco RK (Ed): DRUGDEX System. Truven Health Analytics, Greenwood Village,
Colorado (Vol. 160 expires [6/2014]).
5. Phelps SJ, Hagemann TM, LEE KR, Thompson AJ, editors. Pediatric injectable drugs (The
teddy bear book). 10th ed. Bethesda, MD: American Society of Health-System Pharmacists;
20 p. 429.
6. . High Alert
Drugs. 2. : 25 2550. 33.

( 2 2557)

Page 75

Morphine

:
1.
Morphine innj. 10 mg/mLL
Morphine inn NSS PFS 1 mg/mL (11, 2 mL)
2.
3.
Morphine inn NSS Inj 1 mg/mL (10 mL)
4.
Morphine inn NSS Inf 0..5 mg/mL (1100 , 200 mL)
:
5.
: Moorphine syrup GPO 2 mg/mL (60 mL)
6.
: Moorphine GPOO Tab. 10 mg(Immediat
m
teRelease)
7.
: MST continnus tablet 110, 30, 60 mg
m

8.
: Kapanool capsule 220, 50, 100 mg
1-6
Morphine
M

Morpphine inj. 10
mg/m
mL

Morpphine in NSSS
PFSS 1 mg/mL (11, 2
mL)
Morpphine in NSSS Inj
1m
mg/mL (10 mL)
Morpphine in NSSS Inf
0.5 m
mg/mL
(1000 , 200 mL)

Onset
Peeak
SC:
S 20
SC: 500-90
IM:
I 10-30
IV:
I rapid
IM: 30--60

IV: 20
IV:
I rapid
IV: 20

Duration
4 - 5

4 - 5

IV:
I rapid

IV: 20

4 - 5

IV:
I rapid

IV: 20

4 - 5

( 2 2557)

Pagge 76

Onset

Duration

Peeak

Morpphine syrup GPO

2 mgg/mL 60 ml

30
3

1 -2

4--5

Morpphine GPO 10
1
mg
mediateReleaase)
(Imm

30
3

1 2

4 5

MSTT tablet 10 mg
m

30
3 45

4 -5

122

m
MSTT tablet 30 mg

30
3 45

4 -5

122

MSTT tablet 60 mg
m

30
3 45

4 -5

122

Kapanol cap 20 mg

30
3 - 60

8.5

244

Kapanol cap 50 mg

30
3 - 60

8.5

244

Kapanol cap 1000 mg

30
3 - 60

8.5

244

( 2 2557)

Pagge 77

Screening
Double check
:

(bronchial asthma)
/
(paralytic ileus)

(delirium tremens)


MAOIs MAOIs 14

anticholinergic
diuretics zidovudine lidocaine
enzyme inducers phenytoin rifampicin

5 (.5) (
)
:


-IM , SC : 5 - 15 mg 4

- IV : opioid-nave 2.5 - 5 mg 34 opioid

- Oral :
immediate release tablet : 10 30 mg 4

( 2 2557)

Page 78

solution : 10 20 mg 4
Kapanol : opioid-naive 20 40 mg 24
40 mg 20 mg
2 ( 12 )
MST continus :
20 mg 12 70

30 mg 12 70

mL mg


Double check
syrup
Double check
NSS D5W
IV push 5-10
Usual infusion concentrations : IV infusion : 1
mg / mL
24

MST Kapanol
Kapanol6
French gastrostomy tube 16
gastrostomy tube
10
gastrostomy tube
10
Kapanol

30 ( 30
)

( 2 2557)

Page 79

600

(monitoring) : heart rate,
respiratory rate, pain score, sedation score
IV push 5 4
30 2

IV continuous drip 1
4 4
SC IM 15 4
30 2
respiratory rate (RR) 10
heart rate (HR) 60

overdose
10
( 1 30 / 1 20
/ )
continuous drip



Naloxone
Opioid intoxication :
Naloxone 0.4 2 mg
2-3 ( 10 mg)

( 2 2557)

Page 80

5 20
Naloxone 0.1 mg/kg/dose (maximum
dose : 2 mg)
5 20
2 mg 2-3 (
10 mg)

10
Naloxone
(Duration 45 ) Morphine

Morphine

( 2 2557)

Page 81

 :
1.
, , .
Siriraj Drug List 2014 [online]. Version 5.0 March 2014.
2.
Deglin JH, Vallerand AH, editors.Daviss drug guide for Nurses. 11th ed. PA: F. A.
Davis Company; 2009. p.843-7.
3.
Product information: Morphine sulfate oral solution GPO, morphine sulfate, GPO,
Bangkok, Thailand.
4.
Product information: Morphine sulfate IR tablet GPO, morphine sulfate, GPO,
Bangkok, Thailand.
5.
Prodruct information, MST CONTINUS, Morphine sulfate, BARD
PHARMACEUTICALS, Cambridge, United Kingdom.
6.
Product information, Kapanol, morphine sulfate, GlaxoSmithKline, Boronia,
Australia.
7.
. High
Alert Drugs. 2. : 25 2550. 34-7.
8.
Klasco RK (Ed): DRUGDEX System. Truven Health Analytics, Greenwood Village,
Colorado (Vol.160 expires [6/2014]).
9.
American Pharmacists Association. Drug Information Handbook with International
Trade name index. 22nd ed. OH: Lexicomp; 2013-2014. p 1344-9, p 1368-70.
10. . . : Printing Place; 2552. 145-67.
.

( 2 2557)

Page 82

Nicardipine (Carddepine)

1. Nicardipine inj 2 mg/22 mL

2. Nicardipine inj 10 mg/10 mL
Nicarddipine1-2

onset

ppeak

duratioon

Nicaardipine inj
2mg/2mL

IVV : 1

intracoronnary: 2

IV : 3

Nicaardipine inj
10mg/10mL

IVV : 1

intracoronnary: 2

IV : 3

2-5

Sccreening
Hypertension, Postoperaative Hyperteension
chronic staable angina
advanced aortic stennosis
myocardial oxygen balaance afterload
vecurronium neuromuscula
e
ar
block vecuroniumm (500%)
amioddarone
bradycardiia, atrioventricular block / sinuus arrest
fentannyl severe
s
hypotensioon

( 2 2557)

Pagge 83

/2-5

acute cerebral infarction

hemorrhage
heart failure significant left ventricular
dysfunction, exacerbation possible negative
inotropic beta blocker

hepatic impairment reduced hepatic

blood flow

small peripheral veins
peripheral venous irritation
mild - moderate renal impairment drug
clearance

Double check

IV : Acute hypertension
- 5 mg/hr 2.5
mg/hr 5 ( rapid titration) 15 (
gradual titration) 15 mg/hr

3 mg/hr
:

cardepine 1

hypotension tachycardia, nicardipine

infusion.
( 3 - 5 mg/hr)

Double check

( 2 2557)

Page 84

 2-5

2-5

Double check
sodium bicarbonate
lactated ringer solution ( Cardepine)
0.1 0.2 mg/mL
infusion pump
D5W, D5S/2, D5S, Sodium Chloride
0.45%, NSS.
24
venous thrombosis, phlebitis,
vascular impairment small veins dorsum
peripheral vein infusion site
12
24
(angina)
,

hypotension tachycardia
serum potassium ( hypokalemia
arrhythmias)

: IV calcium infusions (
7007)
Hypotensive episode:
refractory hypotension IV calcium, vasopressors, high
dose insulin/dextrose, glucagon

( 2 2557)

Page 85


1. , , .
Siriraj Drug List 2014 [online]. Version 5.0 March2014.
2. Klasco RK (Ed): DRUGDEX System. Truven Health Analytics, Greenwood Village,
Colorado (Vol.160 expires [6/2014]).
3. American Pharmacists Association.Drug Information Handbook with International
Trade name index.22nd ed. OH: Lexicomp; 2013-2014. p1394-6.
4. Product information, Cardepine, nicardipine hydrochloride, Westmont
Pharmaceuticals, San Juan, Philippines.
5. Deglin JH, Vallerand AH, editors.Daviss drug guide for Nurses.11th ed. PA: F. A.
Davis Company; 2009. p.879-81. Deglin JH, Vallerand AH, editors. Daviss drug guide for
Nurses. 11th ed. PA: F. A. Davis Company; 2009. p.879-81.

( 2 2557)

Page 86

NNitroglyceriin

1. Nitroglyccerin inj. 50 mg/10mL
m

Nitrooglycerin inj.
50 m
mg/10mL

onsset

peak

duration
5-10
5

anggina (
organic nittrates betta
blockers)4
anngina
acutte angina pectoris
commplications

induuction maintenance

Screenning
Doouble check

phospphodiesterasse type 5 (PDDE-5)
inhibitoors sildennafil, ,

( 2 2557)

Pagge 87

mL mg mcg


Double check
Double check
D5W , NSS
continuous I.V. infusion : 0.25-0.5
mcg/kg/min; 0.5-1 mcg/kg/min
3-5 minutes ; usual dose 1 - 3
mcg/kg/min; usual maximum dose 5 mcg/kg/min.
continuous I.V. infusion : 5
mcg/min 5 mcg/min 3-5
20 mcg/min 10-20
mcg/min 3-5 (
400 mcg/min)


24


set infusion PVC Viaflex
Steriflex
80%
400 mcg/mL
infusion pump rate

blood pressure pulse
IV heart rate , blood pressure ECG


,

( 2 2557)

Page 88


1. Klasco RK (Ed): DRUGDEX System. Truven Health Analytics, Greenwood Village,
Colorado (Vol. 160 expires [6/2014]).
2. , , . Siriraj
Drug List 2013 [online]. Version 26. Feb 2014.
3. . High Alert
Drugs. 2. : 25 2550.
4.Product information: Nitroject, Nitroglycerin, Unimed Technologies Ltd., India
5. American Pharmacists Association. Drug Information Handbook with International Trade
name index. 22nd ed. OH: Lexicomp; 2013-2014. p.1412.
6. American Pharmacists Association. Pediatric and Neonatal Dosage Handbook. 19th ed.
OH: Lexicomp; 2012-2013. p. 1125.

( 2 2557)

Page 89

Noorepinephrine

1. Norepinnephrine inj. 4 mg/4mL vial 1 mL NEE base 1 m g

2. Norepinnephrine inj. 40 mcg/mLL in NSS 2 ml
m

Noreepinephrine inj.
i
4 mgg/4mL

Noreepinephrine
40 m
mcg/mL in NSSS
2 mll

onset
1-2

duration
1-22

1-2

1-22

peaak
4

Adjuunct

Prrofound
Hypoteension
Acutte Hypotensiion
Screenning
Doouble check

blood volume


linezolid ( BP
)
MAOIs ( rasagilline, selegilinne
moclobem
mide )
tricyclic antidepressaants
( amitriptylinne, nortriptyline imiprramine )
metabissulfite

( 2 2557)

Pagge 90

mL mg mcg


Double check
Double check
dextrose

D5W , D5S


,

veins
occlusive vascular diseases
extravasation
:

Acute hypotension :
Continuous I.V. infusion : 0.1
mcg/kg/min
. recommended dose 0.05 - 0.3
mcg/kg/min
: 6 mcg/min
continuous I.V. infusion : 8-12
mcg/min; ;
: 2-4 mcg/min
Cardiac arrest:
continuous I.V. infusion :

( 2 2557)

Page 91

0.1 2 mcg/kg/min

continuous I.V. infusion : 8-12
mcg/min ; ;
: 2-4 mcg/min

24

blood pressure 2 target
blood pressure 5 infusion
heart rate, electrolytes, plasma volume, urine output
signs extravasation vasoconstriction (
, )

1. Klasco RK (Ed): DRUGDEX System. Truven Health Analytics, Greenwood Village,
Colorado (Vol. 159 expires [6/2014]).
2. , , . Siriraj
Drug List 2013 [online]. Version 26. Feb 2014.
3. Karen CC editors. Nursing 2011 Drug Handbook.Lippincott Williams & Wilkins.Drug
Handbook.Wolters Kluwer Health; 2011.p. 461.
4. Product information: Levophed, Norepinephrine,Indochina Healthcare, Thailand.
5. . High Alert
Drugs. 2. : 25 2550.

( 2 2557)

Page 92


( 2 2557)

Page 93

Warfarin

1. Warffarin (Maforan) 2 mg tabblet
2. Warffarin (Orfarin) 3 mg tableet
3. Warffarin (Orfarin) 5 mg tabllet
Warfaarin 1-2

Onset

Peak

duration

Warfarrin
(Maforran) 2 mg
tablet

24 72 full theerapeutic effeect : 5 7

2-5

Warfarrin
(Orfarin)3 mg
tableet

24 72 full theerapeutic effeect : 5 7

2-5

Warfarrin
(Orfarin)5 mg
tablet

24 72 full theerapeutic effeect : 5 7

2-5

2-5

Screening
basseline INR (Innternational NNormalized RRatio)

INR 2-3

( 2 2557)

Page 94


(bleeding)

(clotting)
65
Vitamin K INR response vitamin K INR

Contraindication
warfarin ,
(hemorrhagic tendencies),
, lumbar block anesthesia ,
, malignant hypertension , blood dyscrasias ,
pericarditis pericardial effusion , bacterial endocarditis,
( mechanical heart valve
thromboembolism) , , eclamsia pre-eclamsia

/
2-5

Double check
O2, O3, O5

compliance
20 (
/ total weekly dose)
NSAIDs bleeding
INR indication
:Initial dose : 2 - 5 mg once daily
usual maintenance : 2 - 10 mg once daily


Double check

( 2 2557)

Page 95


2-5

2-5

2 mg 3 mg 5 mg

OPD

// Warfarin
warfarin card

5-10
bleeding, clotting
NSAIDs

bleeding

clotting:
bleeding/clotting
warfarin
INR
Warfarin
Vitamin K Fresh Frozen Plasma (FFP) INR
bleeding

Drug Interaction Warfarin5

( )
Abciximab (major, theoretical)
Acarbose (moderate, probable)
Acemetacin (moderate, probable)
Acenocoumarol (major, theoretical)
Acetaminophen (moderate, established)
Alefacept (major, theoretical)
Alipogene Tiparvovec (major, theoretical)
( 2 2557)

Page 96

Allopurinol (moderate, probable)

Alteplase, Recombinant (major, theoretical)
Amifampridine (contraindicated, theoretical)
Aminoglutethimide (moderate, probable)
Amiodarone (major, established)
Amitriptyline (moderate, probable)
Amoxicillin (major, probable)
Ampicillin (major, probable)
Amprenavir (moderate, probable)
Anistreplase (major, theoretical)
Apazone (moderate, probable)
Apixaban (major, theoretical)
Aprepitant (major, probable)
Argatroban (moderate, probable)
Aspirin (major, established)
Atovaquone (moderate, probable)
Avocado (moderate, probable)
Azathioprine (moderate, probable)
Azithromycin (major, probable)
Bee Pollen (moderate, probable)
Benorilate (moderate, probable)
Benzbromarone (moderate, probable)
Bivalirudin (major, probable)
Black Tea (moderate, probable)
Bosentan (moderate, probable)
Bromfenac (moderate, probable)
Butabarbital (moderate, probable)
Butalbital (moderate, probable)
Capecitabine (major, established)
Carbamazepine (moderate, probable)

( 2 2557)

Page 97

Carbenicillin (major, probable)

Carbimazole (moderate, probable)
Carboplatin (major, probable)
Cefadroxil (major, probable)
Cefamandole (moderate, probable)
Cefazolin (moderate, probable)
Cefdinir (major, probable)
Cefepime (major, probable)
Cefixime (major, probable)
Cefotaxime (major, probable)
Cefpodoxime (major, probable)
Ceftazidime (major, probable)
Ceftibuten (major, probable)
Ceftizoxime (major, probable)
Ceftriaxone (moderate, probable)
Celecoxib (major, probable)
Cephalexin (major, probable)
Cephalothin (major, probable)
Cephapirin (major, probable)
Cephradine (major, probable)
Chamomile (major, theoretical)
Chitosan (moderate, probable)
Chloral Hydrate (moderate, probable)
Cholestyramine (moderate, probable)
Choline Magnesium Trisalicylate (moderate, probable)
Chondroitin (moderate, probable)
Cimetidine (moderate, probable)
Ciprofloxacin (major, probable)
Cisapride (moderate, probable)
Cisplatin (moderate, probable)

( 2 2557)

Page 98

Citalopram (major, probable)

Clarithromycin (major, probable)
Clopidogrel (major, theoretical)
Cloxacillin (major, established)
Coenzyme Q10 (moderate, probable)
Colesevelam (moderate, probable)
Curcumin (moderate, probable)
Cyclophosphamide (major, probable)
Cyclosporine (moderate, probable)
Dabigatran Etexilate (major, theoretical)
Dabrafenib (major, theoretical)
Dalteparin (major, theoretical)
Danaparoid (major, theoretical)
Danazol (moderate, probable)
Dapsone (major, probable)
Darunavir (moderate, established)
Deferasirox (major, theoretical)
Desogestrel (moderate, probable)
Desvenlafaxine (major, probable)
Dexamethasone (moderate, probable)
Dexlansoprazole (moderate, probable)
Dextrothyroxine (moderate, probable)
Dicloxacillin (major, established)
Dienogest (moderate, probable)
Diflunisal (moderate, probable)
Dihydroartemisinin (major, theoretical)
Dipyridamole (major, theoretical)
Disopyramide (moderate, probable)
Disulfiram (moderate, probable)
Dong Quai (moderate, probable)

( 2 2557)

Page 99

Doxepin (moderate, probable)

Doxorubicin (major, probable)
Doxorubicin Hydrochloride Liposome (major, probable)
Dronedarone (major, probable)
Drospirenone (moderate, probable)
Drotrecogin Alfa (major, theoretical)
Duloxetine (moderate, probable)
Econazole (major, probable)
Enoxacin (major, probable)
Enoxaparin (major, theoretical)
Enzalutamide (major, probable)
Eptifibatide (major, theoretical)
Erlotinib (major, probable)
Erythromycin (major, established)
Escitalopram (major, probable)
Eslicarbazepine Acetate (major, probable)
Esomeprazole (moderate, probable)
Estradiol Cypionate (moderate, probable)
Estradiol Valerate (moderate, probable)
Eterobarb (moderate, probable)
Ethinyl Estradiol (moderate, probable)
Ethynodiol Diacetate (moderate, probable)
Etonogestrel (moderate, probable)
Etoposide (major, probable)
Etravirine (major, theoretical)
Exenatide (moderate, probable)
Felbamate (moderate, probable)
Fenofibrate (major, theoretical)
Fenofibric Acid (major, probable)
Fish Oil (major, probable)

( 2 2557)

Page 100

Fluconazole (major, established)

Fluorouracil (major, established)
Fluoxetine (major, probable)
Fluoxymesterone (moderate, probable)
Fluvastatin (moderate, probable)
Fluvoxamine (major, probable)
Garlic (major, probable)
Gatifloxacin (major, probable)
Gefitinib (moderate, established)
Gemcitabine (moderate, probable)
Gemfibrozil (moderate, probable)
Gemifloxacin (major, probable)
Ginger (moderate, probable)
Ginkgo (major, probable)
Ginseng (moderate, probable)
Glucagon (moderate, probable)
Glucosamine (moderate, probable)
Glyburide (moderate, probable)
Green Tea (moderate, established)
Griseofulvin (moderate, probable)
Heparin (moderate, probable)
Ifosfamide (moderate, probable)
Imatinib (major, probable)
Indomethacin (moderate, probable)
Indoprofen (moderate, probable)
Infliximab (major, theoretical)
Influenza Virus Vaccine (major, probable)
Isoniazid (moderate, probable)
Isoxicam (moderate, probable)
Itraconazole (major, probable)

( 2 2557)

Page 101

Ivermectin (moderate, probable)

Ketoconazole (major, probable)
Ketoprofen (major, probable)
Lactulose (moderate, probable)
Lansoprazole (moderate, probable)
Leflunomide (major, probable)
Lepirudin (major, theoretical)
Levamisole (moderate, probable)
Levofloxacin (major, established)
Levomilnacipran (major, theoretical)
Levonorgestrel (moderate, probable)
Levothyroxine (moderate, probable)
Liothyronine (moderate, probable)
Lixisenatide (moderate, probable)
Lomitapide (major, probable)
Lopinavir (moderate, probable)
Lornoxicam (moderate, probable)
Lycium (major, probable)
Marijuana (major, theoretical)
Mechlorethamine (major, probable)
Medroxyprogesterone Acetate (moderate, probable)
Melatonin (moderate, probable)
Meloxicam (moderate, probable)
Menthol (moderate, probable)
Mephobarbital (moderate, probable)
Mercaptopurine (moderate, probable)
Mesalamine (moderate, probable)
Mesna (moderate, probable)
Mestranol (moderate, probable)
Methicillin (major, probable)

( 2 2557)

Page 102

Methimazole (moderate, probable)

Methotrexate (major, probable)
Methylprednisolone (moderate, established)
Methyl Salicylate (major, probable)
Methyltestosterone (moderate, probable)
Methylthiouracil (moderate, probable)
Metronidazole (major, probable)
Miconazole (major, probable)
Milnacipran (major, probable)
Mitotane (moderate, probable)
Moricizine (moderate, probable)
Moxalactam (major, theoretical)
Moxifloxacin (major, established)
Nafcillin (major, probable)
Nalidixic Acid (major, probable)
Nandrolone (major, theoretical)
Naproxen (major, established)
Nelfinavir (moderate, probable)
Nevirapine (moderate, probable)
Niacin (moderate, probable)
Nilutamide (moderate, probable)
Nimesulide (moderate, probable)
Norelgestromin (moderate, probable)
Norethindrone (moderate, probable)
Norfloxacin (major, probable)
Norgestimate (moderate, probable)
Norgestrel (moderate, probable)
Noscapine (major, probable)
Ofloxacin (major, probable)
Omeprazole (moderate, probable)

( 2 2557)

Page 103

Orlistat (moderate, probable)

Oseltamivir (major, probable)
Oxacillin (major, theoretical)
Oxandrolone (major, probable)
Oxyphenbutazone (moderate, probable)
Pantoprazole (moderate, probable)
Papaya (major, theoretical)
Paroxetine (major, probable)
Penicillin G (major, probable)
Penicillin V (major, probable)
Pentosan Polysulfate Sodium (major, theoretical)
Pentoxifylline (moderate, probable)
Phenindione (major, theoretical)
Phenobarbital (moderate, established)
Phenprocoumon (major, theoretical)
Phenylbutazone (moderate, probable)
Phytonadione (moderate, probable)
Piperacillin (major, probable)
Piracetam (moderate, probable)
Pixantrone (major, theoretical)
Polyacrylamide (moderate, probable)
Posaconazole (major, probable)
Potassium Iodide (moderate, probable)
Prasugrel (major, probable)
Prednisone (moderate, probable)
Primidone (moderate, probable)
Procarbazine (major, probable)
Proguanil (major, probable)
Propafenone (moderate, probable)
Propoxyphene (moderate, probable)

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Propylthiouracil (moderate, probable)

Quetiapine (moderate, probable)
Ranitidine (moderate, probable)
Reteplase, Recombinant (major, theoretical)
Rifabutin (moderate, probable)
Rifampin (moderate, probable)
Rifapentine (moderate, probable)
Ritonavir (moderate, probable)
Rivaroxaban (major, probable)
Rofecoxib (moderate, probable)
Ropinirole (major, probable)
Rosuvastatin (moderate, probable)
Roxithromycin (major, probable)
Salicylamide (moderate, probable)
Salicylic Acid (moderate, probable)
Salsalate (moderate, probable)
Saquinavir (moderate, probable)
Secobarbital (moderate, probable)
Sertraline (major, probable)
Simvastatin (major, established)
Sitaxsentan (major, probable)
Sodium Salicylate (moderate, probable)
Sodium Thiosalicylate (moderate, probable)
Sorafenib (moderate, probable)
Soybean (moderate, probable)
Soy Isoflavones (moderate, probable)
Soy Protein (moderate, probable)
Stanozolol (moderate, probable)
St John's Wort (major, probable)
Streptokinase (major, theoretical)

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Sucralfate (moderate, probable)

Sulfamethoxazole (major, established)
Sulfasalazine (moderate, probable)
Sulfinpyrazone (moderate, probable)
Sulfisoxazole (major, probable)
Sulindac (moderate, probable)
Tamoxifen (contraindicated, probable)
Tan-Shen (major, probable)
Tegafur (major, theoretical)
Telithromycin (major, probable)
Tenecteplase (major, theoretical)
Tenidap (moderate, probable)
Terbinafine (moderate, probable)
Teriflunomide (major, probable)
Testosterone (major, probable)
Thyroglobulin (moderate, probable)
Thyroid (moderate, probable)
Tibolone (moderate, established)
Ticarcillin (major, probable)
Ticlopidine (major, theoretical)
Tigecycline (moderate, probable)
Tinzaparin (major, theoretical)
Tirofiban (major, theoretical)
Tocophersolan (major, theoretical)
Tolterodine (moderate, probable)
Torsemide (major, probable)
Tramadol (moderate, probable)
Trastuzumab (moderate, probable)
Trolamine Salicylate (moderate, probable)
Urokinase (major, theoretical)

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Valdecoxib (moderate, probable)

Valproic Acid (major, probable)
Vancomycin (moderate, probable)
Vemurafenib (moderate, probable)
Venlafaxine (major, probable)
Vilazodone (major, probable)
Vincristine (major, probable)
Vincristine Sulfate Liposome (major, probable)
Vindesine (major, probable)
Vitamin A (moderate, probable)
Vitamin E (moderate, probable)
Voriconazole (major, probable)
Vorinostat (moderate, probable)
Vortioxetine (major, theoretical)
Zafirlukast (moderate, probable)
Zileuton (moderate, probable)

1. , , . Siriraj Drug List 2014
[online]. Version 5.0 March 2014.
2. American Pharmacists Association. Drug Information Handbook with International Trade name index.
22nd ed. OH: Lexicomp; 2013-2014. p 2100-4.
3. . High Alert Drugs.
2. : 25 2550. 38-46.
4. . . : Printing Place; 2552. 193-213.
5. Klasco RK (Ed): DRUGDEX System. Truven Health Analytics, Greenwood Village, Colorado (Vol.160
expires [6/2014]).

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9555
Medication Reconciliation (MR) 6964