دليل اعطاء الادوية الوريدية في المستشفيات 5 PDF

State of Palestine
Ministry Of Health
Guide of
Injectable Medications in
Governmental Hospitals
Gaza
i
State of Palestine
Ministry Of Health
Guide of Injectable Medications in Governmental Hospitals - Gaza
Working Committee:
Amal Ahmed El Shorbassy Pharmacist at El Nassr Hospital

Abeer Mohammed Qishtah Pharmacist at European Gaza Hospital
Amna Abed Al Omari Pharmacist at Al Shifa Hospital
Mai Mohammed El Nwiri Pharmacist at Al Aqsa Hospital
Sabreen Rasmi Wadi Pharmacist at Nasser Medical Complex
Wesam Masoud El-Shaer Pharmacist at Al-Helal Al-Emarat Hospital
i
‫كلمـــــة املديـــــر العــــــام‬
‫صدق اهلل العظيم‬ ‫قال تعالى‪( :‬وقل اعملوا فسريى اهلل عملكم ورسوله و املؤمنون)‬
‫األخوة األكارم‪ ،‬األخوات الفُضميات‪،،‬‬

‫السالم عميكم ورحمة اهلل وبركاتو‪ ،،،‬وبعد‪:‬‬
‫بالرغم من قسوة الظرف الذي نعيشو‪ ،‬وصعوبة الوضع الذي نحياه‪ ،‬فإنو لمن دواعي سروري ومما يثير إعجابي أن أرى مثل ىذا العمل الصيدالني اإلبداعي‬
‫‪ Guide of Injectable Medications in Governmental Hospitals‬والذي يتضمن‬ ‫يخرج إلى النور‪ ،‬والمتمثل في ىذا الدليل الذي يأتي تحت عنوان‪:‬‬
‫توثيقاً وتفصيالً لطرق تحميل األدوية باآللية الصحيحة من ناحية استقرارىا‪ ،‬تركيزىا‪ ،‬جرعتيا‪ ،‬والطريقة السميمة إلعطائيا بما يضمن أداءىا لممفعول المطموب مع‬
‫ٍ‬
‫وبجودة عالية‪.‬‬ ‫المعني بالحصول عمييا‬ ‫المقدم لمخدمة والمريض‬
‫المحافظة عمى سالمة الكادر الصحي ّ‬
‫ّ‬
‫تنبع الحاجة إلى ىذا العمل تأكيداً وترسيخاً لمبدأ العمل بروح الفريق الواحد وتوحيد طرق العمل المبني عمى أسس عممية والذي تنتيجو و ازرة الصحة واإلدارة‬
‫ي كافة مناحي العمل وتطمعاً لمرقي بمينة الصيدلة عمى وجو الخصوص‪ ,‬وبجودة الخدمات الطبية المقدمة في الو ازرة بشكل عام‪.‬‬
‫العامة لممستشفيات ف‬
‫كما يعتبر ىذا العمل امتداداً لمعديد من الخدمات الطبية المقدمة باإلدارة العامة لممستشفيات والتي نعكف حالياً عمى إتماميا والقيام بيا في كافة المجاالت والتخصصات‬
‫األخرى وصوالً إلى األىداف المرجوة بإذن اهلل‪.‬‬
‫وفي الختام ال يسعني إال أن أتقدم بخالص الشكر والتقدير لفريق العمل الصيدالني بدائرة صيدلة المستشفيات‪ ،‬والمجنة التي قامت بإنجاز ىذا العمل الرائع سائالً‬
‫عز وج ّل أن يجعمو في ميزان حسناتيم‪ ،‬كما آمل منيم مواصمة الجيد نحو مزيد من اإلنجازات واهلل الموفق واليادي إلى سواء السبيل‪.‬‬
‫المولى ّ‬
‫د‪ .‬عبد المطيف الحاج‬

‫مديــــــر عــــــــام المستشفيـــــات‬
‫‪ii‬‬
Introduction
Most of medication errors are most likely to happen during preparation and administration
of IV medication.
This guidelines had been organized for dilution, administration, stability of reconstituted
drugs and prepared infusions to ensure the appropriate reconstitution and administration of
intravenous drugs, support and facilitate nurses, students, and other health care providers daily
practices.
Every effort has been made to give a general and short notes about stability of reconstituted
and diluted medication can be valid unless there is any other recommendation from the
manufacture.
It is our hope that this guidelines improves our ability to safely and effectively use of
intravenous medication for all members of medical staff and help you to provide quality care to
your patient.
Working Committee
January 2018
iii
Content
Drug name Page
Acetazolamide 1
Acetylcholine chloride 2
Acetylcystine 3
Acyclovir 4
Adenosine 5
Albumin, normal human serum 6
Alprostadil 7
Amikacin sulphate 8
Aminoacids with glucose 9
Aminophylline 10
Amiodarone 11
Amoxicilline + clavulanic acid 12
Amphoteircin B 13
Ampicillin 14
Antiscorpion serum 15
Atracurium besylate 16
Atropine sulfate 17
Benzyl penicillin 17
Bupivacaine 18
Bupivacaine + Dextrose 19
Caffeine citrate 20
Calcium glubionate 21
Calfactant 22
Cefazolin sodium 23
iv
Drug name Page
Cefotaxime sod 24
Ceftazidime 25
Ceftriaxone 26
Cefuroxime 27
Chloramphenicol 28
Chlorpromazine 29
Ciprofloxacin 30
Clindamycin 31
Cloxacillin 32
Desferrioxamine mesylate 33
Dexamethasone 34
Diazepam 35
Diclofenac sodium 36
Digoxin 37
Diphtheria and Tetanus toxoid 38
Dobutamine 39
Dopamine 40
Enoxaparin 41
Ephedrine 42
Epinephrine 42
Erythropoietin 43
Etanercept 44
Fat emulsion 45
Fentanyl 46
Ferrous sucrose 47
Flumazenil 48
v
Drug name Page
Furosemide 49
Gadodiamide 50
Gentamycin 51
Glucagon 52
Haloperidol 52
Heparin sodium 53
Hydralazine 54
Hydrocortisone 55
Hydroxyethyl starch 56
Hyoscine 56
Immunoglobulin, anti D, Human 57
Immunoglobulin, G human 58
Insulin human 59
Insulin NPH 60
Insulin regular 61
Isosorbide dinitrate 62
Ketamine 63
Lidocaine 64
Magnesium sulphate 65
Meropenem 66
Methotrexate sodium 67
Methyl prednisolone 68
Methylene blue 69
Methylergometrine 70
Metoclopramide 70
Metronidazole 71
vi
Drug name Page
Midazolam 71
Milrinon 72
Morphine 73
Naloxone 74
Neostigmine 75
Nitroglycerin 76
Nitroprusside 77
Norepinephrine 78
Obidoxime chloride 79
Octreatide acetate 80
Omeprazol 81
Oxytocin 82
Pancuronium 83
Pethidine 83
Phenobarbitone 84
Phenylphrine 85
Phenytion 86
Phytomenadione 87
Piperacillin 87
Potassium chloride 88
Promethazine 89
Propofol 90
Propranolol 91
Protamin sulfate 92
Ranitidine 93
Sodium bicarbonate 8.4% 94
vii
Drug name Page
Sodium chloride. 23.4% 95
Streptokinase 96
Suxamethonium 97
Teicoplanin 98
Thiopental 99
Tramadol 100
Tranexamic acid 100
Vaccine, hepatitis B Infant 101
Vancomycin 102
Verapamil 103
Water for injection 103
viii
ABBREVIATIONS
abbreviation Meaning
B/P Blood pressure
BW Body weight
Conc Concentration
CRT Controlled room temperature 15°C to 30°C
D5W Dextrose 5% in water
D10W Dextrose 10% in water
D5NS Dextrose 5% in Sodium Chloride 0.9%
D5 ½ NS Dextrose 5% in 1/2 Normal Saline
DKA Diabetic ketoacidosis
Et Endotracheal
g Gram
HR Heart Rate
hr/hrs Hour/hours
IM Intramuscular
IV Intravenous
IU International Unit
kg Kilogram
LD50 A dose lethal to 50% of the specified animals or
microorganisms
LMWH Low Molecular Weight Heparin
LR Lactated Ringer
Max Maximum
mcg Microgram
ix
abbreviation Meaning
mEq Milliequivalent
ml Milliliter
mmol Millimoles
mg Milligram
min Minute(s)
MU Million unit
Na Sodium
NS 0.9% sodium chloride
½ NS Half normal saline = 0.45% Sodium Chloride
NSAID(s) Nonsteroidal anti-inflammatory drug(s)
PH The negative logarithm of the hydrogen ion concentration
PO Orally, by mouth
PVC Poly(vinyl chloride)
REF Refrigerator (2°C -8°C)
sec Second(s)
SC Subcutaneous
SWFI Sterile Water For Injection
TNF Tumor Necrosis Factor
TPN Total parenteral nutrition
q Every
x
ADMINISTRATION NOTES
DRUG RECONSTITUTION COMPATIBILITY
AND RATE INCLUDED STABILITY
 Each 500 mg vial
should be  Store the intact vial at CRT
reconstituted with  Reconstituted solutions are
 IM not recommended.(painful
Acetazolamide at least 5 mL of stable for 3 days under REF
due to the alkaline pH of
500mg SWFI prior to use or 12 hr at CRT .
drug).
to provide  NS,D5W,D10W  It is preferred to use
 The direct IV route of
Diuretic a solution , R.L , 1/2 NS reconstituted solution within
administration is
Carbonic containing ,D5NS 12 hrs to minimize the risk of
preferred.(500 mg over 3 min
Anhydrase 100 mg/ml. microbial contamination.
and max rate is 500 mg/min)
Inhibitor  Can be diluted if  May cause hypersensitivity
need with suitable due to sulfer containing
diluents structure
1
 Store the intact vial at CRT
 don’t freeze
 The aqueous solution of
acetylcholine chloride is
unstable, it should be prepared
immediately before use
 Used with caution in patients
Acetylcholine affected by cardiac
 Reconstitute the impairment, bronchial asthma,
chloride 20mg
vial of hyperthyroidism, obstruction
intraocular
lyophilized of the urinary tract
product with the  For intraocular use only
Cholinergic ,parkinsonism
solvent (2ml)
Agent  The intraocular irrigation must
immediately
Ophthalmic be slow, a strong jet of solution
before use
Agent, Miotic can cause rupture of the
hyaloids membrane, vitreous
detachment or cause an injury
or perforation of the iris
 The Acetylcholine chloride
may be ineffective when used
as amitotic in patients pre-
treated with NSAIDS
2
 Ready tor use  Store the intact vial at CRT
 For inhalation  For the IV solution
solutions: If vial was previously opened,
3-5 ml of do not use for IV
Acetylcysteine  For inhalation solutions: administration.
Acetylcystine 20% diluted with The nebulized solution  Stability studies indicate that
(2g/10ml) equal volume of may be inhaled directly the diluted solution is stable
 For inhalation:
compatible from the nebulizer. for 24 hrs at CRT
NS , SWFI
Mucolytic diluents Nebulizers may also be  The color of acetylcysteine
 For IV
 For IV infusion attached to plastic face and injection may turn from
mouth pieces. infusion:
Antidote for solutions: colorless to a slight pink or
NS , SWFI,
acetaminophen Must be diluted  For IV infusion purple once the stopper is
D5W
poisoning for IV solutions: punctured. The color change
administration According to the dose and does not affect the quality of
with the body weight. the product.
compatible  Store the remainder of the
diluents. opened vial in REF. and use
for inhalation only within 96
hrs .
3
ADMINISTRATION
DRUG RECONSTITUTION COMPATIBILITY NOTES
AND RATE
INCLUDED STABILITY
 Reconstitute vial
for injection  Store the intact vials at CRT
with SWFI; do  Reconstituted parenteral
not use
solutions remain stable for 12
bacteriostatic
hrs at CRT because high PH
SWFI which cause itching of glass vial
containing surface after 12 hrs (Do not
parabens or
refrigerate)
benzyl alcohol;
 For Slow IV infusion only  Once diluted for infusion, use
(will cause
over at least 1 hr within 24 hrs.
Acyclovir 250mg precipitate).
(nephrotoxicity due to  D5W, NS, LR  Reconstituted or diluted
Then further
crystalluria and renal tubular solution should not be
Antiviral dilute to a final
damage may occur with too- refrigerated
concentration
rapid rate)
not greater than
5 mg/mL  Maintain adequate hydration
with suitable and urine flow before and
diluents during infusion because
(Concentrations dehydration makes further
greater than renal impairment with
10 mg/ml acyclovir more likely
increase risk of
phlebitis
4
 For rapid bolus I.V.

(preferred)
 administer I.V. push over 1-2  Store the intact vial at CRT.
sec. at a peripheral I.V. site
as proximal as possible to  Crystallization occurs if
trunk (not in lower arm, refrigerated.
hand, lower leg, or foot);  if crystallization occurs,
follow each bolus with a dissolve crystals by warming
 Use undiluted
Adenosine 6mg
(may be diluted
rapid normal saline flush  D 5 W, LR, NS. to room temperature
(infants and children ≥5 mL;  Discard any unused solution
with NS if
Antiarrythmic adults 20 mL). immediately because there is
required)
 Use of 2 syringes (one with no preservatives.
adenosine dose and the other  Effect of adenosine are
with NS flush) connected to a antagonized by methyl-
T-connector or stopcock is xanthenes (as caffeine and
recommended. thiophyllin)
 Can be given by continuous
peripheral IV infusion over 6
min
5
 Albumin (human) must be
administered IV.
 The volume of the total dose
and the rate of infusion
depends on the patient's  Store the intact vial at CRT
condition and response.  Solutions of albumin (human)
 25% and 20% solutions:  D5W, NS. should not be used if they
If sodium restriction is  Not in SWFI. appear turbid or if there is
required, solutions should  It may be sediment in the bottle.
Albumin, normal  Ready to use only be administered either administered  Use immediately, discard
human serum.  may be diluted if undiluted or diluted in a either in unused solution after 4 hrs of
20%( necessary with sodium-free carbohydrate conjunction opening vial.
suitable diluents. solution such as D5W. with or  Don't freeze.
Blood product-
derivatives  IV infusion: combined whole  protect from light.
Over 2 – 24 hrs (generally blood, plasma  Albumin (human) 25%, 20%
over 4 hrs or continuous or sodium solutions contain no
infusion) Rapid infusion may lactate. preservative.
cause pulmonary edema  Do not dilute in sterile water,
and/or circulatory overload. fatal hemolysis could occur.
 Infusion (<30min) may
predispose to IVH
"intraventricular
hemorrhage".
6
 Store the intact vial at REF.

 Discontinue infusion immediately
if apnea or bradycardia occurs
 Must bediluted  If undiluted alprostadil sterile
before use Dilute solution comes in direct contact
500 microgram with a plastic container,
 Infusion via syringe
ampoule with plasticizers are leached from the
Alprostadil 0.5mg/ pump at a rate 0.05-
suitable diluents side walls. the solution may turn
ml 0.1 mcg/kg/min
in volume hazy and the appearance of the
 Infuse into a large
dependent on  D5W, D10W, NS container may change, this
Vasodilator – vein or through an
infusion pump appears to be a concentration
prostaglandin umbilical artery
capabilities With dependent phenomenon
catheter placed at
a concentration  To minimize the possibility of
ductal opening
from(2-20) haze formation alprostadil sterile
microgram /ml solution should be added directly
to the intravenous infusion
solution ,avoiding contact with the
walls of plastic containers
 Prepare fresh infusion solution
every 24 hrs.
7
 For IV
administration  Store vials at CRT
add the content  Intermittent IV infusion is
of a 500 mg vial  I.M. injection in large stable for 24 hrs at CRT and
Amikacin sulfate to 100 or 200 ml muscle mass.(undiluted) 48hrs if refrigerated.
500mg  I.V: Infuse over 30-60 min  NS, D5W, 1/2NS,
of suitable  Administer other antibiotics
diluents.  In infant infusion over 1-2 D/S such as penicillin's and
Aminoglycoside
 Final hr is recommended cephalosporin's at a different
Antibiotic
concentration site , If this is not possible
should not then flush the line thoroughly
exceed 10 with compatible solution
mg/mL. between drugs.
8
 Intravenous use (central
 Must not mixed  The medicinal product should
venous infusion).
with other be used immediately.
 Maximum infusion rate for
medicinal  Containers are for single use
adults and adolescents
products. only, Discard any unused
from 15 to 17 years :
Aminoacids with  If it is necessary contents remaining after the
1 ml/kg BW/hr= 0.1 g amino
glucose. 500 ml to add other end of the infusion.
acids/kg BW/hr
(or alike)  ready to use nutrients  Protect from light.
= 25 drops/min for a 70 kg
= 1.17 ml/min for a 70 kg
,admixing must  Do not freeze.
be performed  Cool storage solution in ↓15°C
 Maximum infusion rate for
under strict may lead to formation of
children and adolescents
aseptic crystal, that can be easily
up to 14 years:
conditions. dissolved by gentle warming
1 ml/kg BW/hr= 0.1 g amino
at 25°C until dissolution is
acids/kg BW/hr .
complete
9
 Ready to use.
 may be diluted
Aminophylline with suitable  IM not recommended.
 Store intact ampoule at CRT
250mg/ 10ml diluents to a  Slow IV injection
 NS, D5W,D10W,  Don't freeze.
concentration of  max rate
R.L and 1/2 NS.  Protect from light .
Bronchodilator 1mg/ml; 1ml(25mg/min)when given
 Don’t mix with any drugs
maximum by IV injection or infusion
concentration
25 mg/ml
-
10
 Compatible with D5W only
 IV infusion :over  For infusion for more than 2  Store the intact ampoule at
20min-2hr hrs at room temperature : CRT
Amiodarone  Must be diluted  For infusions longer  Protect from light and
50mg/ ml with suitable than 1 hr, amiodarone excessive heat.
diluents for IV injection  Use carton to protect
antiarrythmic infusion . concentrations should contents from
agent  Use infusion not exceed 2 mg/mL light until used.
pump. unless a central  Amiodarone does not need
venous catheter is to be protected from light
used. during administration.
11
 For IV bolus:  Store at CRT for 4 hrs with
reconstituted NS, 3 hrs with LR
by adding  This drug is less stable in
 NS, SWFI ,
Amoxicilline 1gm 20ml of SWFI solution that contain glucose
LR
and agitating  By IV injection slowly so these solutions should be
+ clavulanic acid  Incompatible
200mg until dissolved over 3-4 min. avoided for intermittent
with: dextrose
 For IV  For IV infusion: infusions
solution ,
infusion: over 30-40 min.  Never mix this product in the
antibiotic, sodium
Reconstitute same perfusion bottle with
Penicillin bicarbonate
in(50- 100ml) aminoglycoside as
of compatible aminoglycoside may loss
fluid activity
12
 Reconstitute 50-  Once reconstituted, vials stable
mg vial with 10 for 8 hrs at CRT and 24 hrs if
ml SWFI (not refrigerated (protected from
bacteriostatic)  D5W only light).
 Further dilute  Amphotericin is  Diluted solutions should be
Amphotericin B with 250–500 ml incompatible used promptly after
 Testing dose over 30
50mg I.V. D5W. with NS, LR, preparation.
min(1mg in 20 ml D5W)
 Final D/S and all  Protect the infusion container
 Required dose by Slow IV
"fungizone®" concentration electrolyte from light throughout
infusion over 2-6 hrs
Antifungal should not solutions administration. It is not
exceed 0.1 necessary to protect giving sets
mg/ml(0.25 from light as short-term
mg/ml for exposure should not affect
central infusion). stability.
 Risk of nephrotoxicity with
amphotericin doses
>1mg/kg/day
13
.
 Ampicillin is incompatible
with D5W and LR .
 Used only freshly prepared
 Reconstitute
solution.
500 mg in 5 ml
SWFI or NS(1000  IV injection should be
mg vial with 10ml administered within 1 hr after
 For IV injection give preparation because the
SWFI or NS)
over 3–5 min (125– potency decreased significantly
Ampicillin 1gm  Max concentration:
500mg) or over 10–15 after this period
100 mg/ml for IV  NS
min (1–2 g).  Avoid too rapid bolus injection
Beta – lactam injection.  SWFI
 For intermittent IV due to convulsion seizure
Antibiotic  For intermittent IV
infusion ,further
infusion over 15–30 min.  If used in combination with an
dilute with aminoglycoside (e.g Amikacin,
50–100 ml NS. gentamycin, tobramycin)
administer at a different site. If
 Max concentration:
this is not possible then flush
30 mg/ml
the line thoroughly with
compatible solution between
drugs .(physicochemical
incompatibility
14
 Protect from light
 Reconstituted vial should not be
stored
 Swirl vial gently for one to five
min after dilution . and not
shake to avoid foaming
 Skin test must be done, inject
Antiscorpion 0.1.-0.2 ml of (1:10) dilution
serum 1ml  Reconstitute  IV , IM , SC intradermally before giving
liquid\lyophilized vial with 1 ml  Grade 0: no treatment antiscorpion
 SWFI
Manufactured by
WFI supplied  Grade 1,2 : 1-2 vials (IM or  Each 1 ml serum contains
SC) antibodies that neutralize the
VINS with  Grade 3 : 5 vials diluted with following venoms:
BIOPRODUCTS, antiscorpion normal saline 1:10. Dried Leiurus quinquestraitus
India 50 LD50
Dried Androctonus ameoreuxi
35 LD50
PARASPECIFICALLY
 Androctonus crassicauda
 Androctonus aeneas
 Androctonus australis
 Scorpiomarus palmatus
 Buthus occitanus
15
 D5W, NS D5NS .
 ready to use  Spontaneous  Store the intact vial in REF.
 For infusion degradation of  Do not freeze.
admixture: atracurium in
 Upon removal from
Infusion  Rapid IV bolus initially Ringer's lactate.
refrigeration to room
Atracurium
solutions of (intubating) .  Don't mix temperature used within 14
atracurium can Atracurium with
besylate 10mg/ ml.  IV infusion intermittent or days.
be prepared by alkaline solutions
5ml continuous for maintenance  Infusion solutions used within
admixing (eg, barbiturate
dose for prolonged surgical 24 hrs of preparation. And can
atracurium with solutions) in the
Neuromuscular procedure . be store either under
an appropriate same syringe or
blocking agent  Do not give by IM route refrigeration or CRT for 24
diluents to get administered
(tissue irritation). hrs.
final desired simultaneously
 Unused solutions should be
concentration: during
0.2 mg/ml and discarded.
intravenous
0.5 mg/ml . infusion through  Antidote: neostigmine
the same needle.
16
 Rapid IV bolus without
Atropine sulfate  Store intact ampule at CRT
 Dilution with dilution.
1mg/ 1ml  SWFI , NS.  don’t freezing.
the suitable  Administered also by SC,IM
 protect from light.
diluents for IV or IV infusion.
Anticholenergic  Antidote: Neostigmine
infusion.  ET (diluted with NS or
agent methyle sulfate
SWFI)
 Reconstitute each
5MU(million unit)
vial with 3.5 ml
SWFI,(10MU vial
with 7 ml SWFI) to
Benzyl penicillin provide
aconcentration of
 ,  After dissolution ,should be
10 mill I.U.  IM
1MU/ml, then used immediately
 IV intermittent infusion  D5W,NS  Na content of the dose
"Penicillin Further dilution with
over 30 min should be considered when
Antibiotic" suitable diluents to
final concentration determining the infusion rate
(100,000Unit/ml-
500,000Unit/ml)
 Infant and neonate
50,000U/ml is
preferred
17
 Store the intact vials at CRT
Bupivacaine 5mg/
ml + dextrose 4ml
 It can be administered in the  the solution should be used
 ready to use right or left lateral position  NS immediately after
Long acting local
or in the sitting position. opening of the ampoule. Any
anaesthetic for
remaining solution
spinal anaesthesia
should be discarded.
18
 Don not freeze.
 Solution without preservative
must be used as soon as
possible after the container
has been opened.
 Bupivacaine is injected  For single use only.
through a needle directly  Solutions containing
Bupivacaine HCI into or near the area to be preservatives should not be
0.5% 20ml numbed. used for epidural or caudal
 Administered only by blocks.
Long acting local  ready to use infiltration or epidural.  NS  Note :The solution for
anaesthetic  Not for IV. or IM injection. injection must not be kept in
such a way that it can act on
metals , e.g. cannulas or
syringes with metal parts,
Metal ions may be released,
which can cause swelling in
the area of the injection.
 Accidental IV injection may
result in cardiac arrhythmia or
cardiac arrest, seizures, coma
or respiratory arrest.
19
 I.V. Infusion or Oral
 Store the intact ampoules at
Route(may administer CRT
injectable formulation
orally).
 Caffeine citrate: Injection and
 Do not inject I.M.
oral solution contain no
 Infuse loading dose over at
preservatives; injection is
 may least 30 min.
chemically stable for at least
Caffeine citrate administer  maintenance dose may be 24 hrs at CRT when diluted.
25mg/ ml (2ml) without infused over at least 10 min.  Baseline serum caffeine levels
dilution or  Loading dose: 10–20 mg/kg  D5W
should be measured in infants
Central Nervous diluted with as caffeine citrate (5–10 Intralipid®
previously treated with
System Stimulant, suitable mg/kg as caffeine base). 20%,
theophylline (preterm infants
Respiratory diluents to Maintenance dose: metabolize theophylline to
Stimulant 10 mg caffeine 5 mg/kg/day as caffeine caffeine).
citrate/mL citrate (2.5 mg/ kg/day as  If theophylline given within
caffeine base) starting 24 hrs previous 72 hrs, a modified
after loading dose. dose (50%– 75%) may be
 Dosage adjusted based on given.
patient response
 caffeine citrate 2mg =
caffeine base 1mg.
20
 Store the intact ampoules at
Calcium  IV injection: Infuse slowly CRT.
glubionate 10%. over 3–5mins or at  Once diluted, stable for 48 hrs
maximum rate of 50–100  NS,D5W
10ml  IV injection: at CRT or for 24 hrs at REF.
mg/min (in cardiac arrest may  Incompatible Solution should be warmed to
Undiluted ( only administer over 10–20 sec)
Each 1 ml with fat body temperature.)
for adults)  IV infusion: infuse over emulsion 10%
contains 94 mg  IV infusion: Dilute  Solution must be clear and
calcium gluconate 30-60 min  Calcium salts free of crystals.
in 100 ml, NS or  Pediatric and neonatal not generally
(elemental D5W rate of administration:  Rapid administration may
calcium 9.4 mixed with
 Pediatric and Slow rate of produce vasodilation,
mg/ml) carbonates,
neonatal dilution: administration hypotension, arrhythmias,
phosphates,
Must be further considerably, Observe syncope, cardiac arrest.
sulfates, or
Calcium Salt, diluted with NS. continuously.  Ca-containing fluid shouldn’t
tartrates.
Electrolyte be co infused with ceftriaxone
supplement  IM route is contraindicated in
infant and small children
21
 Store the intact vial at REF
 Protect from light.
 Unopened, unused vials of
calfactant that have warmed
to room temperature can be
returned to refrigerated
 For intratracheal storage within 24 hrs for
administration only, through future use.
an endotracheal tube.  Calfactant is a suspension
 The dose of calfactant is which settles during storage.
Calfactant
3 ml/kg birth weight. Gentle swirling or agitation of
10mg/ml
 Ready to use  The dose is drawn into a the vial is often necessary for
syringe from the single-use redispersion, do not shake.
Lung surfactant
vial using a 20 gauge or Visible flecks in the
larger needle with care taken suspension and foaming at the
to avoid excessive foaming. surface are normal for
calfactant.
 Repeated warming to room
temperature should be
avoided.
 Vials are for single use only.
After opening, discard unused
drug .
22
 IV injection over 3-5 min at  Store the intact vials at CRT
 For I.V. injection:
a max concentration of 100  protect from light.
Reconstitute each
mg/mL  Reconstituted solution is
1 g with at least
 I.V. intermittent infusion stable for 24 hrs at CRT or 10
10 ml SWFI or NS.
Cefazolin sodium over 10-60 min at a final days when refrigerated.
May further dilute
1g
in 50–100 ml D5W
concentration of 20 mg/mL.  cefazolin and
 In fluid-restricted patients,  D5W, NS, aminoglycosides should not
or NS (decreases
First generation a concentration of 138 D10W, LR be mixed in the same syringe
incidence of
cephalosporin mg/mL has been or perfusion fluid. preferably
thrombophlebitis).
antibiotic administered by IV administer at a different site.
 For I.M.:
injection. If this is not possible then
Reconstitute with
 I.M.: Deep I.M. injection flush the line thoroughly with
4.2 ml of NS or
SWFI into a large muscle mass a compatible solution between
slowly. drugs.
23
 Store the intact vials at CRT;
 protect from light
 For IV  Reconstituted solution and IV
 IV injection over 3-5 min.
injection: infusion is stable for 12-24
(Rapid I.V. injection cause
Reconstitute hrs at CRT, 5 days if
life-threatining arrhythmia.)
with 10 ml refrigerated.(or as
 Intermittent intravenous
SWFI or NS to recommended by the
infusion15-30 min.
provide a max manufacture)
 IM injection by deep IM  NS, D5 W,
Cefotaxime sod. 1g concentration of  Solution appears light yellow
slowly injection into a large D10 W, LR
100 mg/ml, to amber. Discoloration may
muscle mass. Doses of 2g  Incompatible
Third Generation May further suggest loss of potency.
should be distributed with sodium
Cephalosporin dilute with  Discard if precipitate forms.
between two injection sites. bicarbonate.
antibiotic 50–100 ml of
Rotate injection sites for  cefotaxime and
suitable aminoglycosides should not
diluents. subsequent injections. If pain
occurs, 1% lidocaine may be be mixed in the same syringe
 For IM or perfusion fluid. preferably
used for reconstitution..
injection: administer at a different site.
Reconstitute If this is not possible then
with SWFI flush the line thoroughly with
a compatible solution between
drugs)
24
 Reconstituted solution is
 For IV injection: stable for 12 hrs at CRT and
Reconstitute 1 g with 3 days when refrigerated.(or
10 ml SWFI to provide  For IV injection: as recommended by the
concentration of administer over manufacture)
90 mg/ml, May further 3–5 mins.  Solution appears light yellow
dilute with 50–100 ml  For intermittent IV to amber, tends to darken
with compatible  NS, D5W, D10W,
infusion infuse over (color change does not
Ceftazidime 1g LR
diluents. 15–30 min. indicate loss of potency).
 Final concentration for  incompatible with
Third generation  IM injection :  potentially incompatible with
I.V. administration sodium
cephalosporin To minimize aminoglycosides.
bicarbonate
antibiotic
should not exceed discomfort, inject  Do not admix with
100 mg/mL deep IM slowly. Less aminoglycosides in same
 I.M.: add 1.5 ml SWFI painful if injected bottle/bag, If used in
or lidocaine 1% to 500- into Gluteus combination with an
mg vial or 3 ml to 1-g maximus than lateral aminoglycoside), preferably
vial to provide a aspect of thigh. administer at a different site.
concentration of 280 If this is not possible then
mg/ml. flush the line thoroughly with
drugs.
25
 For IV injection:  Store the intact vials at CRT
 For I.V injection: administer over  protect from light.
Reconstitute each 3-5 mins.  Solution appears light yellow
 NS, D5W, D10W,SWFI
1-g vial with  For intermittent IV to amber.
mannitol 5%,
10mL compatible infusion, infuse over 30  Reconstituted vials may be
mannitol 10%,
diluents to min for adult. and over stored at 24 hrs at CRT and
sodium bicarbonate ,
provide 60 min for neonate 3 days when refrigerated .(or
bacteriostatic water.
concentration of  For I.M injection: as recommended by the
 Incompatible with
100 mg/ml, May Give by deep IM manufacture)
Ceftriaxone 1 g calcium-containing
further dilute with injection. Doses >1g  Do not admix with
solutions (eg, LR,
50–100 ml NS or should be distributed aminoglycosides in same
Third generation Hartmann’s solution,
D5W. between two injection bottle/bag.
cephalosporin parenteral nutrition
 I.M ceftriaxone sites.  Do not reconstitute, admix, or
solutions). . Fatalities
1 gm in 3.5 ml of  To minimize co- administer with calcium-
have occurred in
1% lidocaine discomfort, inject deep containing solutions.
neonates and infants
hydrochloride IM slowly. Less painful due to precipitates  intermittent infusion is
(water for if injected into gluteus preferred in doses more than
forming in lungs and
injection not maximus than lateral 1g .
kidneys
preferred because aspect of thigh.  The lidocaine solution must
it's very painful ). never be administered
intravenously.
26
 store the intact vials at CRT.
 Stability after preparation:
 For I.V. injection:
Store for 24 hrs at CRT or 48
Reconstitute
hrs in refrigerator.(depending
750 mg vial in
on formulation).
6-10 ml (8 ml )
Cefuroxime compatible solution  I.V injection.: over  Solution appears light yellow
750 mg  Intermittent I.V. 3-5 min. to amber (may darken, but
 Intermittent IV infusion: color change does not indicate
infusion:
 NS,D5W, loss of potency.
Second Reconstitute over 15-30 min.
D10W, LR  Do not admix with
generation 750 mg vial in  I.M.: Inject deep I.M.
cephalosporin 100 ml compatible aminoglycosides in same
slowly into large muscle
antibiotic solution to obtain bottle/bag, If used in
mass.
7.5 mg/ml solution. combination with an
aminoglycoside), preferably
 I.M.injection:
Reconstitute administer at a different site.
750 mg in 3 mL If this is not possible then
flush the line thoroughly with
SWFI
drugs.
27
 For
I.V.injection:  I.V. injection : over 5 min
Reconstitute at a maximum
each 1g vial concentration of
Chloramphenicol  NS, 1/2NS,  Store the intact vials at CRT
with 100 mg/mL
1g I.V. D5W, D10W,  Reconstituted vials may be
compatible  I.V. intermittent infusion
LR stored at CRT for 24 hrs or
diluents to give over 15-30 min at a final
broad-spectrum  fat emulsion according to the
a solution concentration for
antibiotic 10%, manufacturer.
containing administration ≤20 mg/mL
100mg/mL
28
 Store the ampoule at CRT
 Protect from light Keep covered in carton until
time of use.
 Protect from freezing
 .Monitor BP closely.
 The IV route is very irritating and should be
reserved for severe cases only (intractable
 Ready to use
hiccups-surgery and tetanus.)
for IM  Deep IM
 Parenteral administration: should be limited to
Chlorpromazine injection  IV slowly at
bedfast patient and acute ambulatory situations
50mg IV  For IV rate of
 NS, D5W  Because of possible hypotensive effects
injection: 0.5mg/min for
keep patient lying down for at least 1/2 hr after
Phenothiazine dilute with NS children
injection
antipsychotic to max conc and1mg/min
1mg/mL for adult  Patients who develop irritation with IM
formulations such as abscesses and local
necrosis ,the drug may be diluted with saline
or the addition of 2% procaine.
 Because of the possibility of contact dermatitis,
avoid getting solution on hands or clothing.
 Subcutaneous injection is not advised due to
risk of sever tissue necrosis
 mixing with other agents in the syringe is not
recommended
29
 Store at CRT
 Protect from freezing and
light
 undiluted use immediately
and Discard any unused
undiluted solution
Ciprofloxacin  NS , D5W, LR  Infusion into large vein to
 Ready to use avoid patient discomfort and
200 mg/ 100 ml ,D10W, SWFI
 For infusion  For slow IV (200mg over to reduce risk of venous
 incompatible
injection further 30min, 400mg over 60 min) irritation
Fluoro- quinolone with sodium
diluted to Equivalent
Antibacterial bicarbonate
0.5-2 mg/ml Ciprofloxacin Ciprofloxacin
Oral Dosage injection
Dosage
250mg tablet
200mg IV q12h
q12h
500mg tablet
400mg IV q12h
q12h
750mg tablet
400mg IV q8h
q12h
30
 Store at CRT
 For IV Rate should not  Do not refrigerated
exceed 30 mg/min. the  Stability after preparation
usual infusion dilution and from microbiological point of
rates are as follows: view should be used
Clindamycin Dose Diluents Time immediately however
150 mg/ 1 ml prepared infusion may be
 Dilute 300mg 50ml 10min
(4 ml)  D5W,D10 W, stored at REF and infused
300-600 mg 600mg 50ml 20min
NS, LR with 24 hrs
with 50 ml of 900mg 50-100ml 30min
Lincosamide,
suitable diluents  Because its use has been
1200mg 100ml 40 min
antibiotic associated with sever colitis it
 administration of more than
should be used only when
1200 mg in a single 1-hr
absolutely necessary and
infusion is not
when an alternate drug is not
recommended
acceptable
 Sever hypotension and cardiac
arrest can occur with too rapid
injection
31
 For IM
Reconstitute 500 mg
with 2 ml SWFI
 For IV:
Reconstitute 500 mg
with 5 ml SWFI,
(100mg/ml ) or
with10ml SWFI  IM  Store the vial at CRT
Cloxacillin 500 mg (50mg/ml )  IV injection Over  Reconstituted solution used
 For IV infusion: 2 - 4 min immediately unless there is
 NS ,SWFI, D5W
Antibiotic, Reconstitute 500 mg  IV infusion over 30 any recommendation from
Penicillin with 5 ml SWFI, min the manufacturer
Withdraw required
dose and further dilute
with suitable diluents.
(Dose ≤ 500 mg to
250 ml
Dose >500 mg to 500
ml)
32
 For IV infusion:
Reconstitute
500 mg with 5ml
SWFI then  Store the intact vials at CRT
further dilute  Protect from light
with150 ml NS  Do not refrigerate may cause
 For SC precipitation
infusion(for  IV infusion: rate of  Prepared infusion should be
ambulant patient infusion is 15mg/hr not to used immediately
Desferrioxamine to use with exceed 125mg/hr.  Incompatible with heparin
mesylate. 500gm pump):  SC infusion: administer sodium and Iron dextran
 NS ,SWFI,
Reconstitute into abdominal tissue via
D5W,1/2NS  Rapid IV infusion may cause
Chelating agent 500 mg with 5ml pump over 8-12 hrs hypotension and edema
Antidote SWFI then  IM injection: inject deeply  Discard turbid solution
further dilute into large muscle mass  Although reconstituted
with NS,  intraperitonial solution may be stored for 24
withdraw dose hrs at CRT, the manufacturer
into syringe recommends using within 3
pump hrs of reconstitution due to
 IM: the lack of preservatives.
Reconstitute
500 mg with 2ml
SWFI
33
Dexamethasone  Protect from light and
4mg/ 1 ml  Ready to use freezing
 IV infusion:  IV slowly: over 1-5min  Protect from heat
Anti- dilute dose in  IV infusion:  Store in cartoon until time of
 D5W, NS
inflammatory 50-100 ml over 15-30 min use
Corticosteroid, D5W or NS  IM  Use diluted solution within
Systemic 24 hrs from time of
preparation
34
 Widely incompatible, do not
mix with other drug solution
 No dilution necessary it may
cause precipitation
 Absorption following IM
administration is slow and
 For slow IV injection: erratic
Diazepam - Infants and Children not  Continuous IV infusion and
10mg/ 2ml more than 1-2 mg/min IV bolus not recommended
 Ready for use Adult max infusion rate  D5W, NS,LR due to precipitation in IV
Benzodiazepine 5mg/min fluid and absorption of
 IM injection diazepam by tubing and
 Rectal route infusion bags
 Diazepam administered
rectally is well absorbed
with an absolute
bioavailiability of about 90%
relative to diazepam
injection
 Antidote : Flumazenil
35
 Ready to use
 For IV infusion  Store the ampoule at CRT
must be diluted  Protect from light and heat
with 100-500
 the infusion solution should
ml NS or D5W  Deep IM 75mg once daily
Diclofenac not be used if crystals or
this solution  For IV :
sodium 75mg/ 3ml precipitates are observed
should be 25mg- 50mg over15-60 mins  NS, D5W
 Do not infuse with other
buffered with 75mg over 30-120 mins
NSAID medicines
sodium
bicarbonate  Check the drug if its use by
solution IM only or both IM and IV
(0.5ml 8.4%or1
ml 4.2%)
36
 Immediate use of the diluted
product is recommended
 The use of less than 4-fold volume
of diluents could lead to
precipitation of the digoxin.
 Slow infusion of Digoxin Injection
 It can be is preferable to bolus
Digoxin administered administration. Rapid infusion of
0.5mg /2ml undiluted or digitalis glycosides has been shown
 IV administer to cause systemic and coronary
diluted with a
over at least  NS, D5W,D10W arteriolar constriction, which may
Cardiac glycoside 4-fold or
5 min be clinically undesirable
antiarrhythmic greater
volume of  Mixing of Digoxin Injection with
diluents other drugs in the same container
or simultaneous administration in
the same intravenous line is not
recommended
 Avoid Intramuscular injection can
lead to severe pain at the injection
site( if it must be given by this
route, it should be injected deep
into the muscle followed by
massage)
37
DRUG RECONSTITUTION
AND RATE
COMPATIBILITY
INCLUDED STABILITY
 Store intact vial in REF.
 Don’t freeze , product which has been exposed to freezing should
not be used
 Inspect visually for any particulate or discoloration
 Shake vial well before use
 Once opened multidose vial from which one or more doses of
vaccine have been removed during an immunization session may
 Should not be used in subsequent immunization session for up to a maximum
Diphtheria and be of 4 weeks with the guide of the following instruction
 IM
Tetanus toxoid No combined Inner square lighter than outer circle
 Not for
vaccine reconstitution with any If the expiry date has not been passed,
or dilution IV or SC Use the vaccine.
vaccine in
injection At a later time, inner square still lighter
the same
than outer circle.
syringe If the expiry date has not been passed.
Use the vaccine.
Discard point:
Inner square matches color of outer circle
Don’t use the vaccine
Inform your supervisor
Beyond the discard point:
Inner square darker than outer circle.
Don’t use the vaccine
Inform your supervisor
38
 Store intact vial at CRT
 prepared infusions may be
stored at REF. and infused
within 24 hrs.
 D5W, D10W,  The solution should be clear
LR, NS and no more than faintly pink
 250-mg
 Continuous IV infusion via  Incompatible in color. Pink coloring of
DobutamineHcl (20-mL) vial
using syringe pump at rate with Sodium solution does not affect
250mg I.V. 20ml must be diluted
2.5 mic /kg /min. (Prepare bicarbonate or potency;
in suitable
Adrenergic
fresh syringe every 24hr) any other  don’t freeze , freezing cause
diluents to max.
 Administer into central or strongly crystallization
Agonist conc. Of
5mg/ml
large peripheral vein alkaline  When diluted in D5W may
solution exhibit a pink color, will
increase with time. This color
change caused by a slight
oxidation of the drug, but
there is no significant loss of
potency.
39
 Continuous IV infusion only.  Store the intact vials at

 The concentration used is CRT.
dependent on the patient  Protect from excessive heat
dosage and fluid requirement.  NS, D5W, and from freezing.
 Concentration greater than D10W ,D5NS,  Stability of diluted
3.2mg/ml must be given via LR . solutions 24 hrs at CRT .
central line.  Dopamine is  The drug is inactivated in
 Dopamine is administered by stated to be alkaline solution.
Dopamine WARNING:
200mg/5ml This is a potent
intravenous infusion into a incompatible  Phenytoin when given
large vein using an infusion with iron salts, together with Dopamine
drug: It must be oxidizing
pump or other infusion may cause severe
Adrenergic diluted before agents, sodium
control device. hypotension and
Agonist administration to
patient.  Adjust the rate of infusion bicarbonate, bradycardia.
every 30 mins to desired and other  ANTIDOTE:
response. alkaline Phentolamine, an alpha-
 Do not bolus other drugs via solutions (e.g. adrenergic blocker, may be
Dopamine infusion. Aminophylline, useful in an overdose
 If no central IV access is phenobarbital) situation that does not
available the maximum respond to discontinuation
concentration for infusion of dopamine
through a peripheral vein is
1.6mg/ml.
40
 Store at CRT
 To avoid the loss of drug
from 30 mg and 40 mg
syringes , don’t expel the
Enoxaparin 40  Pre-filled
 Administered by deep SC bubbles from syringe prior to
mg,60mg,80mg syringes
injection the injection.
prefilled syringes  Ready to use
 Enoxaparin sodium is not  In order to minimize bruising
without
intended for IM don’t rub injection site.
Low Molecular dilution.
Weight Heparin  ANTIDOTE
Protamine sulfate.
The recommended dose of
protamine sulfate is 1 mg for
100 U of LMWH given
within 4 hrs.
41
Ephedrine Hcl
 Dilute with  Store intact ampoule at
50mg
suitable diluents  Give by IV injection CRT
 NS , D5W, DW10
to max. conc. over 3- 4min  Use the prepared
Alpha/Beta
5mglml  IM , SC dilutions immediately.
Agonist
 Used diluted or
 Store at CRT.
undiluted
according to the  SC, IM, IV injection ,IV  Protect from light
route of infusion and Inhalation  Solution for injection is
administration  SC: 1mg/ml ampoule stable for 24 hrs in CRT or
REF.
 for IV injection preferred .(undiluted)
 Epinephrine deteriorates
dilute each 1 mg  IM : 1mg/ml ampoule but not
Epinephrine rapidly on exposure to air or
of 1:1000 into the buttocks .(undiluted)  D5W , NS , RL
1 mg/ ml light, turning to pink from
solution with 10  IV injection over 1 min or and D5NS . oxidation.
ml NS to more(may be given more
Adrenergic
provide 1:10000  Solutions which show
agonist rapidly in cardiac evidence of discoloration
solution resuscitation) should be replaced .
 For IV infusion,  IV infusion ( central line  Do not refrigerate.
further dilution only) with ( infusion pump )  IM route is preferred in
with 250-500 ml as a diluted solutions . shock and allergy because
of D5W  inhalation by neublization absorption from this route is
 For inhalation, more reliable than SC
dilute in 3 ml NS
42
 Store intact syringe at REF
Erythropoietin in original packaging. Do not
2000 I.U. freeze
Recombinant  Protect from light
 Ready to use  SC
human  Don’t shake during
 IV over at least 1 min
erythropoietin preparation will render it
biologically inactive
Antianemic agent  Single dose syringe
contain no preservative .
43
 Reconstitute  Store vial, single-use prefilled
vial powder syringe, and prefilled auto-
with 1 ml injector in the REF, do not freeze;
 Subcutaneous
Bacteriostatic protect from light.
injection:
Water for  Store multiple-use vial in the
Etanercept  Rotate injection sites.
Injection.  Bacteriostatic REF. , do not freeze;
 New injections
 To avoid Water for  reconstituted solution prepared
TNF inhibitor should be given at
excessive Injection. with bacteriostatic water for
Antirheumatic least one inch from
foaming, gently  No other injection is stable for 14 days if
an old site and never
swirl contents medications refrigerated; do not shake or
into areas where the
until powder is should be agitate vigorously; do not use if
 25-mg dry skin is tender,
dissolved. added to discolored or cloudy or if
powder bruised, red, or hard.
resulting solutions particulate matter is present; do
vials with
concentration is  The maximum
containing not filter reconstituted solution;
solvent amount injected at
25mg/ml etanercept do not add or mix with other
 25-mg and any single site should
 Do not shake and not medications.
50-mg pre- not exceed 25 mg.
 Withdraw all of reconstitute  The contents of one vial of
filled  Solution for with other
the solution etanercept solution should not be
syringes injection: May be
into syringe. diluents mixed with or transferred into ,the
 50-mg pre- allowed to reach
Final volume contents of another vial of
filled pens room temperature
should be etanercept.
prior to injection.
approximately  Diluent for multidose vial
1 ml. contains benzyl alcohol as
preservative
44
NOTES
ADMINISTRATION
DRUG RECONSTITUTION
AND RATE
COMPATIBILITY INCLUDED
STABILITY
 Compatiblewith
 Fat emulsion may be
Solutions of amino acid
administered IV via a
and dextrose solutions.  Store at CRT
peripheral vein or by central
 Do not add medication to  protect from light.
venous infusion.
fat emulsion syringes  Don’t freeze.
 Avoid rapid infusion
because the  Should be used
 It has been recommended that
bioavailability of a drug Immediately after
Fat emulsion administration sets used to
from an emulsion system opening.
(intralipid) 10% administer lipid emulsions be
500ml changed within 24 hrs of
is uncertain.  Use within 24hrs
 Only heparin at a when Dispensed in
 ready to use initiating infusion because of
concentration of 1-2 syringes.
without the potential for bacterial and
Caloric Agent dilution fungal contamination.
unit/ml may be added to  The remaining
fat emulsion. contents of partly
 Continuous infusion over 24
 Careful considerations used bottle must
hrs is preferred (but can be
should be given to be discarded, and
administered ≥20 hrs).
addition of divalent should not be
 Fat emulsion intravenous,may
cations (Calcium and stored for later
also be administered
Magnesium) which have use.
intravenously in total nutrient
been shown to cause
admixtures(TNA,3-in-1)
emulsion instability.
45
 Store the intact vial

 D5W, NS at CRT
 Fentanyl citrate is
 may be diluted or  Fentanyl  Protect from light.
administered by IM or
undiluted. citrate is stated  Stability of premixed
IV injection.
Fentanyl  Small volumes to be solution
 Slow IV injection over
0.1mg/2ml may be given physically 1 day at CRT,
1-2 min for adults and
undiluted (usually incompatible 2 days at REF.
over 3-5 mins for
by the with  Too-rapid bolus
pediatrics.
Analgesic, Opioid anesthesiologist). Phenytoin, administration may result in
 Continuous infusion.
pentobarbital, apnea or chest wall rigidity
and thiopental. and respiratory paralysis.
 Antidote:
Effects can be reversed by
Naloxone (10mcg/kg).
46
ADMINISTRATION
DRUG RECONSTITUTION COMPATIBILITY NOTES
AND RATE
INCLUDED STABILITY
 The first infusion must include
the test dose; facilities for
cardiopulmonary resuscitation  NS
should be available (due to  Iron sucrose
Adverse events). injection
 IV injection or injection into the should not be
 Used diluted venous limb of the dialyzer (not mixed with
Ferrous sucrose or undiluted more than 10ml/injection). other drugs or  Store the vial at CRT.
complex 100mg/5  Intermittent  Give 1ml as a test dose over 1- added to  Don’t freeze.
ml IV IV injection: 2mins, and observe the patient for parenteral  Contains no preservatives;
Dilute the at least 15mins, If there is no nutrition use immediately after
Venofer® dose with NS side effects, give the reminder of solutions for opening vials.
to produce a the injection over 1-2mins. IV infusion.  The diluted solutions are
solution of not  Intermittent IV infusion: The  Avoid dilution stable for 48hrs at CRT or
less than initial test dose : give 25mg by in dextrose REF.
1mg/ml. IV infusion over 15min then due to increase
observe the patient ,if there is the incidence
NO side effects , give the of local pain
reminder of the infusion .(100mg and phlebitis.
infusion over 15mins)(200mg
infusion over 30mins)
47
 Store intact vial at CRT.

 If drawn undiluted into
Flumazenil syringe or mixed with D5W
 IV injection into large
0.5mg/ 5ml or NS, discard solution after
vein: 0.2mg over 15 to 30
 Ready to use. 24 hrs after removal from
seconds.
Antidote  D5W, NS, LR its original vial.
 May repeat every 1min for
(benzodiazepine  Rapid injection may cause
a total of 1 mg,
antagonist) withdrawal symptoms in
patients with long-term
exposure to
benzodiazepines.
48
 IM: Undiluted  Store intact vial at CRT

 Slow IV injection:  Do not freeze.
over 1-2 min  NS, D10W,  Protect from light.
 IV infusion at a rate not D5W, D5NS,  Stability of premixed or
exceeding 4 mg/min. Mannitol 20%, diluted solution 24 hrs at
Furosemide  may be used
 Intermittent Infusion LR. CRT.
20mg/2ml undiluted and
 Continuous infusion  (NS and SWFI  Furosemide is unstable in
diluted in
Loop Diuretic compatible  in children can be used for direct IV acidic solutions including
undiluted by direct IV at a injection while medications (e.g.
solution.
maximum rate: D5W for ciprofloxacin, labetalol,
0.5 mg/kg/min for doses continuous IV milrinone), while it is very
less than 120 mg , and at infusion) stable in basic media.
rate 4mg/min for doses  Rapid injection may cause
more than 120 mg. tinnitus and deafness.
49
 Store the intact ampoule at

CRT
 not for intrathecal use and
nephrogenic systemic fibrosis
(NSF)
 Inadvertent intrathecal use of
Gadodiamide has caused
 For IV use only as bolus
injection convulsions, coma, sensory
and motor neurologic deficits
Gadodiamide  Must be flushed with 5ml
287mg/ ml 20 ml  Do not use the solution if it is
NS to ensure complete
 Ready to use discolored or particulate mater
injection of the media
is present.
Contrast agent  Imaging should be
 Protect Gadodiamide from
completed within 60 mins of
strong daylight and direct
injection
exposure to sunlight.
 Do not freeze. Freezing can
cause small cracks in the
vials, which would
compromise the sterility of
the product. Do not use if the
product is inadvertently
frozen.
50

CRT
 Prefer to  IV injection/ IM  prepared infusion stable for
dilute it in  IV injection  D5W, D10W ,NS. LR 24 hrs at CRT and REF.
neonates: over 15 min. Mannitol 20%,  Nephrotoxicity and
final  Slow  Do not physically premix ototoxicity are more
concentration Intermittent with other drugs; pronounced with additional
Gentamycin
for IV should Infusion over 30 administer separately. other nephrotoxic
80mg/2ml
not exceed 10 to 60 min  The incompatibility of agents as furosemide and
Antibiotic,
mg/mL  For neonatal heparin sodium with vancomycin.
 For dosing, gentamicin is due to the  Administration of
Aminoglycoside
intermittent 4 mg/kg/day IV co-precipitation which gentamycin with other
infusion /24hrs or may result from the antibiotics such as
dilute the 2.5 mg/kg/dose administration of (Cephalosporins, penicillins)
dose in /8hrs. gentamicin through a should not be
50-200 ml Administer over heparinized IV cannula. simultaneously , if not
NS or D5W. at least 5 min possible flush the line or
cannula thoroughly with
compatible solution between
the drugs.
51
ADMINISTRATION OTES
Dilute powder  Store glucagon (rDNA
with diluents origin) for injection
supplied(1000  SC,IM (GlucaGen®) below 25°C
mcg/ml.)  IV over 3-5min,  Use immediately after
Glucagon
Dilute 1 unit Dose more than 1 mg over reconstitution. Discard any
1mg/ml  D 5W,SWFI
(1 mg) with 1 10 min. unused portion.
 Incompatible
mL SWFI (may  Continuous infusion may be  Do not freeze.
Antidote, with saline.
Diagnostic Agent
be supplied). used in the treatment of  Form precipitate when
Shake vial calcium -channel blocker or mixed with chloride
gently until beta-blocker overdose, solutions.
completely  Don’t use Normal Saline
dissolved. ,dilute with SWFI or D5W
Haloperidol
 Store at CRT in original
5mg/1ml
 Ready to use  IM injection only packaging.
antipsychotic
52
 Heparin intact vial should be stored at

CRT,
 Protect from freezing and heat
 Don’t rub the injection site after SC
administration.
 IM injection should not be used because of
pain and hematoma formation
 Deep SC Stability:
injection  Vial content should be used within 28 days
 intermittent IV of the first use, after this period any
Heparin sodium
injection  NS, 1/2NS, unused material should be discarded.
5000 I.U/ml 5ml
 May be given undiluted or D5W, D10W,  Prepared bag: 24-72 hrs at CRT, REF.
Anticoagulant
undiluted or diluted in 50 to D5NS D51/2NS,  Do not administer heparin preparations
diluted. 100 mL of fat emulsion preserved with benzyl alcohol to neonates,
D5W or NS 10% ,LR infants, pregnant women, or breast-feeding
 continuous IV mothers
infusion Antidote:
 Protamine sulfate is a heparin antagonist
and specifically indicated in overdose or
desired heparin reversal .
 Each milligram of protamine neutralizes
approximately 100 units heparin. No more
than 50 mg should be administered, very
slowly, in any 10-minute period.
53
 Store at CRT
 Do not refrigerate
 For IM  Protect from light
injection:  Changes color after contact
used undiluted  It given deep IM with a metal filter discard any
 For IV  For IV injection discolored hydralazine
Hydralazine
infusion: Administer over at least 1  NS ,LR,SWFI solution
Reconstitute min in adult and 3-5 mins in  Incompatible  dihydralazine has very similar
20mg\2ml
20 mg ampoule pediatrics with D5w effect of hydralazine(same
Vasodilator
with1ml SWFI Max rate 5mg/min preparation)
then further or 0.2 mg/kg/min  Do not add hydralazine to any
diluted with IV solutions.
500 ml NS  It should not use D5W for
dilution
 use immediately after dilution
54
 For IV injection
dilute with
suitable diluents
to conc.  Store the intact vials
Hydrocortisone  Intravenous injection
of 50 mg/ ml and solutions at CRT
sodium succinate Give by IV injection over
 For intermittent  Protect solution from
100mg 3-10 min.
IV dilute to 1mg /  NS,D5W, LR light.
 IV infusion over 20-30
Corticosteroid,
ml  prepared infusions may
min.
 IM injection: be stored at REF. and
Systemic  IM injection
reconstitute each infused within 24 hrs.
100 mg vial up to
2 ml SWFI
55
Hydroxyethyl  Iv infusion
 Store at CRT
starch 500ml 500 ml are infused over
 Do not freeze.
(Hemacil) 30 min.
 Discard any unused content
 Ready to use  The first 20 – 30ml solution
of the opened container
Plasma volume should be infused slowly in
substitute  After admixture of an
order to detect
additive start administration
anaphylactoid reaction
immediately
Hyoscine N-  For IM:

butylbromide ready to use
 Give by IV injection  Store the intact ampoule at
20mg  For IV  NS , D5W
slowly over 3-5 min CRT
injection:
 IM injection  Protect from light
Antimuscarinic, dilute to
antispasmodic 10 mL with
NS or D5W.
56
 Store in REF. before use.
 Discard unused product in
syringe
 DON'T freeze
 keep in original carton to
protect from light.
 use only one syringe for one
patient
Immunoglobulin,
 don't mixed  Check manufacture
anti D, Human  Ready to use in  IM recommendation for each
with other
300mcg prefilled  slow IV injection over generic drug
medical
syringe 3 to 5 min
products  Rophylac® should be brought
(Rophylac) ® to room or body temperature
before use
 WinRho® SDF and
Rhophylac®are the only
Rho(D) IMMUNE
GLOBULIN products
available administered both
IM and IV
 For ITP must administered by
IV
57
 Store intact vial in REF.
 Don’t freeze
 Warm to RT before use
 Ready to use  Don’t shake
Immunoglobulin  May be diluted  By IV infusion only over  Don’t administer live virus
 D5W,NS
G human 2.5% only with 2-24 hrs vaccine from 2 weeks before
(See each product
100ml diluents  Infusion rate varies by and 3 months after
recommendation)
recommended product intravenous immunoglobulin
by manufacture G (IVIG) due to passive
transfer of antibody that
interfere with the response of
vaccine
 Discard unused portion
58
 Store the intact vial in the
REF.
 Don’t freeze
Insulin human  during use, should not be
30/70 100U/ ml refrigerated but should be
10ml kept in a place as cool as
 For subcutaneous possible (below 30)
 Ready to use
Long acting administration only  can be used for up to 28
Insulin days from the first day of
use
 keep the needle under the
skin for at least 6 second to
make sure the full dose
have been delivered
59
REF.
Insulin NPH HM
 Don’t freeze
100U/ml 10ml  Don’t mix
 during use, should not be
 Ready to use  For subcutaneous use only. with other
refrigerated but should be
Intermediate insulin
kept in a place as cool as
acting insulin formulation
possible (below 30°C)
 can be used for up to 28 days
from the first day of use
60
REF.
 Don’t freeze
 during use, should not be
refrigerated but should be
kept in a place as cool as
possible (below 30°C)
 can be used for up to 28 days
from the first day of use
Insulin regular  Ready to use  For subcutaneous  diluted solution stable for 48
HM 100U/ml  May be dilute
administration hrs in refrigerator
10ml each 1 ml
 IV infusion  D5W, NS.  When mixing regular insulin
(100 units)with
short acting  IM (in selected clinical with other preparations of
100 ml NS to
insulin situations) insulin, regular insulin
yield 1 U/ml
should be drawn into syringe
first.
 If possible, avoid I.V. bolus
administration in pediatric
patients with DKA; may
increase risk of cerebral
edema. Do not administer
mixtures of insulin
formulations intravenously
61
 Store at CRT
Isosorbide  may be
 All ampoules/vials are single
dinitrate1mg/ml given
use only discard any unused
10ml undiluted or
 Give by IV infusion only portion
diluted  NS, D5W
Antianginal Agent
using a syringe pump.  prepared infusions may be
(50 ml up to
a vasodilator stored at REF. and infused at
500ml NS
CRT within 24 hrs
or D5W)
 use of PVC containers is
avoided.
62
 store the intact vials at CRT
 Shelf life after opening 28
 I.V injection: Administer days below 25°C ( unless
bolus doses over 1 min; there is other
more rapid administration recommendation from the
may result in respiratory manufacturer)
depression  Shelf life after
Ketamine HCL  pediatric I.V Administer reconstitution in NS or
50mg.10ml slowly, do not exceed 0.5 D5W up to 72 hrs. (unless
 Ready to use there is other
mg/kg/min; do not
 May be recommendation from the
General administer faster than 60
diluted  D5W, NS. manufacturer
Anesthetic seconds
 . intermittent or  Can be used orally …Mix
continuous infusion the appropriate dose (using
 IM injection the 100 mg/mL injectable
Laryngospasm was more solution) in cola or other
common with IM beverage; administer
immediately after
compared to IV ketamine
preparation.
 Don’t give 100mg/ml
preparation undiluted
63
 Bolus dose
may be given
undiluted.  For IV :Use only lidocaine
 Store the intact vials at CRT.
 For IV without preservative,
clearly marked for IV use.  avoid excessive heat and
infusion: protect from freezing.
prepare Label must state, ―for IV
use‖ and be preservative  Discard diluted solution after
solution by
Lidocaine HCL free. 24 hrs.
adding 2 g to
10mg/mL (1%)  IV injection :  Products containing
250–500 ml
20mg/mL (2%) adrenaline or preservatives
D5W or NS to - use 1% (10 mg/ml) or 2%  NS, D5W, LR
(20 mg/ml). must not be given by IV
provide
local anesthetic - Administer at rate of 25– injection.
concentration
antiarrhythmic
of 8 mg/ml or 50 mg/mins.  Some products contain
4 mg/ml,  IV infusion : preservatives. not be used for
spinal, epidural, caudal or IV
respectively.  Administer at rate of 1–4
 Max regional anesthesia
mg/mins (1–4 ml).
concentration:  SC or epidural
4 g/250 ml (16
mg/ml)
64
 Store at CRT
 Used immediately after
 Must be opening the ampoule or after
Magnesium diluted to  For IV injection: (diluted): dilution
sulphate 50% maximum Give no faster than 150  Too rapid administration
 D5W, LR, NS;
10ml concentration mg/min. may cause hypotension and
 not stable in
of 20% for IV  For IV infusion systole
fat emulsion
Magnesium Salt infusion, IV .(must be diluted to ≤ 20%  IM injection is painful and
10%
Anticonvulsant, push, or and maximum rate should be mixed with
continuous of infusion is 2 g/hr) lidocaine
infusion.  Antidot: slow intravenous
injection (10-20 ml) of 10%
Calcium gluconate.
65
 Store intact vials at CRT
 Regarding stability …according to
 Reconstitute manufacturer instruction where
each 500 mg variable stability for reconstituted
with 10 ml solution according to the
SWFI, NS, or manufacturer recommendation and
D5W to type of diluents
provid
 meropenem reconstituted with
concentration
Meropenem 1gm SWFI is stable for up to 2 hrs at
of 50 mg/ml.  IV push 50 mg/mL
 D5W, D10W, CRT temperature or for up to 12 hrs
(Reconstitute over 3 – 5 mins.
Antibiotic, NS, at REF.
1 gm with 20  Intermittent infusion
Carbapenem 1/2NS,LR.  when reconstituted with NS, the
ml diluents) over 15 – 30 mins.
solution is stable for up to 2 hrs at
 May further
CRT temperature or 18 hrs at REF;
dilute with
NS or D5W  when reconstituted with D5W, the
to a solution is stable for up to 1 hr at
concentration CRT or 8 hrs when refrigerated.
of 1–20  IV infusion: with NS stable for 4 hrs
mg/ml. at room temperature or 24 hrs if
refrigerated (with D5W, 1 hr at room
temperature or 4 hrs if refrigerated).
66
 May be administrated by  Available in preservative-free
IM,IV(Bolus injection or solution.
 Can be given infusion), intraventricular, or  Store the intact vial at CRT;
undiluted for IM intra-arterial , intrathecal. protect from light.
injection  IV injection:  Diluted solutions with D5W
 Can be given  Each 10 mg or fraction over 1 or NS stable for 24hrs. at
diluted: min, CRT.
 D5W ,NS
Reconstitution  A concentration of 25 mg/mL is  Discard solution if a
 Do not use
of each 5 mg the maximum concentration that precipitate forms
Methotrexate formulations
sodium 50mg/
with 2 mL of can be given IV.  Antidote:
or diluents
preservative-free  Infusion: Leucovorin calcium (folinic
2ml with
D5W or  A single dose equally distributed acid) may be given PO, IM,
preservatives
NS(Each over 30 min to 4 hrs or as or IV promptly to counteract
Antineoplastic for high-dose
milliliter equals prescribed by protocol in advertent overdose.
therapy or
2.5 mg of  large doses (more than 100mg) intrathecal  Do not administer NSAIDs
methotrexate). are usually administrated by IV before or concomitantly with
injection.
 When infusion over periods not high doses of methotrexate
administrated by exceeding 24hr. (e.g., treatment of
infusion should  For intrathecal administration osteosarcoma); deaths have
only be diluted Methotrexate can be given as been reported.
with NS 1mg/ml using appropriate sterile  Vitamins with folic acid may
preservative-free medium such inhibit the antifolate effects
as NS. of methotrexate.
67
 IV
Reconstitute each vial  Store the intact vials at CRT
with the diluents
 Diluted solution is stable for 48 hrs
provided.(1 gm vial with  I.V. injection
at CRT or REF. or according to
15.6 ml bacteriostatic over one to
manufacturer instruction
water for injection) several min
 Do not give acetate form I.V.
 Intermittent intravenous (High doses ≥
15 mg/kg; ≥  Too rapid administration of doses
Methyl Reconstitute each vial
500 mg/dose greater than 500mg given over less
prednisolone with the diluents
should be than 10 min associated with
sodium succinate provided then
infused  D5W, NS, cardiac arrhythmia, hypotension
1g Withdraw the required
Over and sudden death
dose and add to a D5 ½ NS, LR,
suitable volume of ≥ 30 min)  In I.M injection Avoid injection
Corticosteroid,
compatible infusion  Intermittent into the deltoid muscle due to a
Systemic
solution (usually infusion Over high incidence of subcutaneous
100—250 mL NS 20 – 60 min atrophy. Avoid injection or leakage
 Continuous into the dermis; dermal and/or
 IM
sodium succinate should infusion subdermal, skin depression may
occur at the site of injection. Do
be reconstituted  I.M injection.
not inject into areas that have
with the diluents
evidence of acute local infection
provided. (Bacteriostatic
Water for Injection)
68
 I.V.: Administer undiluted  Store the intact ampoule at

by direct I.V. injection CRT
over 5-10 min  Protect from light
Methylene blue
1%
 when administered for the  Diluted solution used
 Ready to use treatment of ifosfamide- immediately after
5 ml
 May be induced encephalopathy, preparation
 D5W, NS
Antidote
diluted may be administered  Antidote for cyanide
either undiluted as a slow poisoning and drug-induced
I.V. push over at least 5 methemoglobinemia and
min or diluted in 50 mL indicator dye
NS or D5W and infused
over 5-15 min
69
 Store in REF.
 May be  Can be given IM,IV  protect from light
given  The recommended route  Mothers should not
undiluted. of administration is IM. breastfeed during treated
Methylergometrine
0.2mg /1ml
 Some  IV administration is for with and for at least 12 hrs
clinicians emergency use only,  NS after the final dose.
Ergot derivative
recommend should be given slowly  IV use may induce
dilution with over a period of no less hypertension Give slowly
5 mL than 60sec. with careful and monitor BP.
volume of monitoring of BP.  Too-rapid injection may
NS. cause severe nausea and
vomiting.
 Store the intact vials at
 direct I.V. injection for CRT
lower doses (≤10 mg)  After dilution, IV infusion
undiluted over 3 mins is stable for 24 hrs.
Metoclopramide
 May be given  higher doses (>10 mg) to  D5 1/2NS,  Protect from light
10mg/ 2ml
diluted or be diluted in 50 mL of D5W, LR,  Rapid I.V. administration
undiluted compatible solution NS. may be associated with a
Antiemetic
(preferably NS) and given transient (but intense)
over at least 15 mins feeling of anxiety and
 May be given I.M. restlessness, followed by
drowsiness.
70
 IV infusion slowly over  Store the intact vial at CRT

Metronidazole
 Pre-diluted 20-60 min, (don’t give by  Do not refrigerate; a
500mg 100ml
and ready to IV bolus). precipitate will result.
 NS, D5W
Antibacterial
use  May be given as slow  Protect from light
(5 mg/mL) intermittent or continuous when storing
Antiprotozoal
IV infusion,  Avoid contact of the drug
with equipment containing
Aluminum.
ADMINISTRATION OTES
 I.M.:  Store the intact ampoule at
Administer deep I.M. into CRT
large muscle.  Midazolam, at a
 I.V.: concentration of 0.5
Administer by slow I.V. mg/mL, is compatible with
injection over at least D5W and NS for up to 24
Midazolam 5mg/  Ready to use
2-5 min at a concentration  D5W,NS hrs
1ml  May be
of 1-5 mg/mL or by I.V.  incompatible  arrest have occurred when
diluted infusion. with LR doses were given too
Benzodiazpem
 For induction of rapidly.
anesthesia, administer I.V.  Any rapid injection may
bolus over 5-30 seconds. cause severe hypotension or
 Continuous infusions saziure in infant, the
should be administered via incidence increase when
an infusion pump. used with fentanyl
71
 May be given
diluted or
undiluted
 loading dose
may be given  Loading dose by IV
as undiluted injection:
solution, but Administer slow I.V.
may dilute to injection over 15 min for
Milrinon 10mg/
10-20 mL (in pediatric patients and over
ml
adults) for ease 10 min in adults;  Store at CRT
 D5W, LR,
of  Continuous I.V. infusion:  avoid freezing
Phosphodiesterase 1/2NS, NS
administration via infusion pump or  Diluted solutions stable for
Enzyme Inhibitor
 Continuous I.V. syringe pump 72 hrs at CRT
infusion: Dilute  Some pediatric centers use
with suitable a concentration of 500
diluents, usual mcg/mL but only if infused
concentration: via a central line.
≤200 mcg/mL;
250 mcg/mL in
NS has been
used
72
DRUG RECONSTITUTION
AND RATE
COMPATIBILITY
INCLUDED STABILITY
 For IV It may be given  Store at CRT
undiluted or diluted the
 Protect from light..
method is to dilute 10mg
 The preferred route for
into a total of 10ml of
Morphine 10mg/  SC ,IV administration is IV (IM rout
compatible IV fluid to
ml  For IV not recommended ,its painful)
obtain concentration of  NS , D5W
2mg/min  Monitor for respiratory
1mg/ml
opiate analgesic depression
 For continuous infusion
 Prepared infusions may be
dilute 100 mg in 100 ml of
stored at REF. for 24 hrs
compatible fluid to obtain
conc. of 1mg\ml  Antidote: Naloxone
73
 For IV It may  Store at CRT
be given  Discard any solution not used
undiluted or within 24 hrs of preparation
diluted the
 Continuous infusion used for
method is
long-acting opioid overdose
dilute 0.4 mg
 if the patient takes opiates
to a total of
 . Give by IV regularly Administer the
4 ml of
minimum dose required to
compatible IV injection into a large
Naloxone 0.4mg/ produce improvement because
fluid to obtain vein. 0.4 mg-2 mg
ml 1ml rapid reversal of opiates may
concentration each 0.4 mg over
 NS , D5W ,SWFI be associated with seizures
of 0.1mg/ml 15 sec
narcotic ,hypertension ,pulmonary
 For  continuous infusion
antagonist odema,or sever agitation
continuous  IM, SC if unable to
 If the IV route is unavailable,
infusion, add obtain IV access
may be given by IM or SC
2 mg to 500
injection but onset is slower
ml of
compatible IV  do not use with alkaline
fluid to give a solution
solution with a  only preservative free product
concentration are given via epidural or
of 4 mcg/ml. intratrachial
74
 Store the ampoule at CRT .
 Keep injection in carton until
ready to use .
 Protect from light .
 Stability of the injection cannot
be guaranteed once it has been
Neostigmine Methyl  IM, S.C
 ready to use diluted.
sulfate  Very slowly IV route  SWFI, NS. D5W
 Neostigmine  -Discard any unused portion
2.5 mg / ml .
can be diluted  Neostigmine Methylsulfate
with SWFI. should not be given during
Acetylcholinesterase
inhibitor cyclopropane or halothane
anaesthesia; although it may be
used after withdrawal of these
agents.
 Antidot: Atropin sulphate
75
 Nitroglycerin
for injection
must be  Store the ampoule at C.R.T .
diluted prior to
 Discard unused portion.
its infusion .
 Protect from freezing and
 Dilute the
light.
Nitroglycerin ampoule in
 Premixed nitroglycerin with
50mg/50ml 500 mL of  NS,D5W
 For infusion only. dextrose : Store at room
either D5W or
Vasodilator temperature ; however, brief
NS. This yields
exposure up to 40°C does not
a final conc. of
adversely affect the product.
100 mcg/mL
 Need glass container to avoid
 max
adsorption of the drug to
concentration of
container wall
0.4 mg/ml
 use glass bottle
76
 Store the intact vial at C.R.T.
 The freshly reconstituted and
diluted solution is stable for 24 hrs
 must be diluted
if protected from light.
 Dissolve the
 Protection from light by promptly
contents of a 50
wrapping with the supplied opaque
mg vial in 5 ml
sleeve, aluminum foil, or other
SWFI or D5W
Nitroprusside opaque material.
 The initially
sodium, dihydrate
 Use only an infusion  It is not necessary to cover the
50mg/ml reconstituted
pump and infusion  D5W infusion drip chamber or the
solution
rate chart provided tubing.
containing 50
Vasodilator
mg must be by manufacturer or  The blood pressure must be
further diluted protocol continuously monitored .
 solution should appear very faint
in
250 to 1000 mL brown so if any deterioration
of D5W evidence by color change from
brown to blue, green or dark red
,Don’t use discolored solutions, or
solutions with particulate matter
visible
77
 Store at CRT
 For continuous  Protect from light
 It must be
intravenous use.  Store in tight, light-resistant
diluted for
 The infusion should be at containers as
Norepinephrine Continuous
a controlled rate using  D5 W norepinephrine is readily
1mg/ ml intravenous
either a syringe pump or  Incompatible oxidized
infusion via
an infusion pump with alkaline  IV Push / IM / SC not
Alpha/Beta syringe pump
 For Adult: solution recommended
Agonist  (Dilute 4mg
0.01-3 mcg/kg/min  Discard infusion if brown
in 250-1000
 Pediatric : 0.05- colour develops
ml D5W )
2mcg/kg/min.  Not stable in NS so dilution
in NS is not recommended
78
DRUG RECONSTITUTION
AND RATE
COMPATIBILITY
INCLUDED STABILITY
 Store the intact vials at
 Initial dose in adult 1 CRT
ampoule (250 mg) and in  protect from light.
child 4 – 8 mg/kg BW
 Do not freeze.
 Ready to given by slow IV injection
 Diluted solution with NS or
use , then followed by
Obidoxime chloride D5W is stable for 24 hrs.
 may be Continuous I.V. infusion :
0.25mg/ml
in adult at a dose of 750  Specific antidote treated
diluted
 NS,D5W. with Obidoxime is initiated
with NS mg/24 hrs and in children
Organophosphorous after the first dose of
for IV at a dose of 10 mg/kg BW
poisoning antidote atropine.
injection daily as long as
. reactivation of  Maintain oxygenation by
acetylcholinesterase is airway management,
reached. administration of high
 I.M. concentration oxygen and
ventilation as necessary.
79
 Refrigerate vials for
prolonged storage;
 may be stored at CRT for up
 For IV and SC 2 weeks
It may be give
undiluted
 Diluted solution stable for 24
 For  SC undiluted solution
Octreotide acetate hrs at CRT( NS is preferred)
continuous
0.1mg/ml 1ml (preferred rout)  Allow solution to come to
infusion
 For slow IV Over 3 min  NS , D5W room temperature to
0.5 mg
somatostatin  Iv infusion minimize pain at the
(500 mic)
Analog injection site.
diluted with
(50-200 ml)of  Do not freeze.
compatible  For Multidose vial do not
fluid puncture vials more than 10
times, to reduce
contamination and discard
after 14days of the opening
80
 For IV
Reconstitute vial
with 10ml
compatible fluid
 Store at CRT
to provide
concentration
 Prepare immediately before
4mg/ml  IV over 3-5 min
Omeprazol 40mg use
 For intermittent  IV infusion over
 Reconstituted solution is
infusion 40mg 20—30 min
a proton pump  NS , D5W stable at CRT for 4 hrs.
make up with at a rate of 8 mg/hr
inhibitor (PPI).
NS or D5W to  The reconstituted Solution
100 ml for infusion in 100ml D5W is
(0.4 mg/ml) stable for 6hrs while in
 for continuous 100ml NS is stable for 12hrs
infusion
Preparation of
200 mg/ 500 mL
solution
81
 Given only as slow IV

infusion.
 Dilute each
 Use IV drip infusion or
10 IU of
preferably by a variable-
oxytocin in
1000 ml. speed infusion pump or
other accurate control  Store at REF.
 Rotate the
Oxytocin 10 I.U. device.  Don’t freeze.
bottle or the
1ml In all situations, use the  D5W, NS  Each 10 IU/ml
bag gently
minimum effective rate ,LR, D5NS equal 16.66 mcg/ml.
several times
Oxytocic Agent and monitor strength,  Any portion remaining
before use to
frequency, and duration of should be discarded.
distribute
contractions; resting
medication
uterine tone, fetal HR (in
through
induction of labor), and
solution
maternal BP at least every
15 min or more often if
indicated.
82
 Storage in REF.
 By rapid IV injection. A  After opening , discard any
Pancuronium
single dose over  D5W, remaining amount.
bromide 4mg/2ml  May be given
60 to 90 sec. D51/2 NS,  Antidote:
undiluted or
 May be given slowly with D5NS, NS, or Pyridostigmine or
Neuromuscular diluted
ongoing infusion or as LR neostigmine given with
blocking agent
continuous infusion. Atropine will probably
reverse the muscle
relaxation.
ADMINISTRATION COMPATI NOTES

DRUG RECONSTITUTION
AND RATE BILITY INCLUDED STABILITY
Pethidine  store at CRT

 Can be given diluted or
50mg/ml  Protect from light.
undiluted.  slow IV injection over 5
1ml  Once the ampoule has been
 For slow IV injection min.
 NS. opened or their content
should be diluted with  IM, SC
Opioid analgesic diluted ,they must be
NS solution to a
administered immediately.
concentration 10mg/ml
 Antidote: Naloxone
83
 Store the contact ampoule

 Diluted or at CRT.
undiluted  The preparation must be
Phenobarbitone  IM: inject deeply into the
 For IV administrated within 30min
200mg/1ml muscle.  D5W, NS, or
administration of diluting it.
 slowly IV (diluted) D10, but
: dilute  Avoid SC injection.
Barbiturate  The rate of administration SWFI is
(0.25ml- 1ml)
preferred.  Titrate slowly to desired
should be no more than
of effect.
30mg/min (children) or
Phenobarbital  Rapid injection rate may
60mg/min(adults).
in 10 ml of cause symptoms of
SWFI overdose (e.g., serious
respiratory depression).
84
 For IV injection
dilute 1 mL  Store the intact vial at CRT
Phenylphrine phenylephrine injection  protect from light.
HCL 1% 1ml 1% with 9 mL of SWFI  SC, IM,  Keep covered in carton until
(10mg/ml) to yield 1mg/1ml  slowly IV  SWFI, NS , time of use.
 For IV infusion:  continuous IV D5W  For single use only, discard
Alpha-Adrenergic
Add 10 mg of the drug infusion. unused portion.
Agonist
(1 mL of 1% solution)  don’t use if the solution turn
to brown
500 mL of D5W or NS
85
DRUG RECONSTITUTION
AND RATE
COMPATIBILITY
INCLUDED STABILITY
 NS  Store the intact vial at CRT
 Incompatible with  Do not freeze.
D5NS, D5W, fat  Keep covered in carton until
 IV injection
emulsion 10%, LR, time of use.
Do not exceed 50 mg per
 For single use only, discard
1
min in adults or 1 to 3 /2NS
mg/kg/min in neonates.  Phenytoin should be unused portion.
 Inject phenytoin slowly and
diluted with saline  Upon refrigeration or
and shouldn’t be freezing, a precipitate might
directly into a large vein
 may be used added to dextrose or form; this will dissolve again
Phenytoin through a large-gauge
diluted or dextrose containing after the solution is allowed to
sodium. needle.
undiluted . solution due to the stand at CRT
250mg/5ml  Each injection of IV
 Dilution potential for  Only a clear solution should
phenytoin should be
with SWFI, precipitation of be used. A faint yellow
Anticonvulsant followed by an injection of
NS only phenytoin acid coloration may develop;
sterile saline through the
 The addition of however, this has no effect on
same needle to avoid local
phenytoin injection the potency of the solution.
venous irritation due to the
solution to IV fluids  There is a relatively small
alkalinity of the solution.
is not recommended margin between full
 Continuous infusion should
because of the lack therapeutic effect and
be avoided.
of solubility and minimally toxic doses of this
likelihood of drug
precipitation.
86
ADMINISTRATION
 Whenever possible, give
 May be used phytomenadione by the S.C  Store the intact vial at CRT
undiluted or route.  D5W ,NS  Protect from light.
Phytomenadione
diluted  When IV administration is  Solution should  Do not use if the solution is
10mg/ml
minimum with considered unavoidable, not be mixed turbid.
Vitamin K
50 ml D5W or inject the drug slowly not with other  The preferred route is SC,
NS(don’t used exceeding 1 mg per min. injectables . while IM route should be
other diluents)  when diluted given over restricted to occasions where
20 mins the SC route cant be used
 Administered IM
 Reconstitute each  Store the intact vial at
with limitation.
gram of  SWFI, NS, D5W, CR.T .
 Intermittent I.V
piperacillin for D5NS.  Do not freeze.
infusion :
injection with at  Do not mix  The reconstituted vial
Infuse diluted
least 5 mL. ( 10 ml piperacillin with should be used
solution over a
Piperacillin 2g, 4g for 2 GM and 20 an immediately if not
period of
ml for 4 GM ) . aminoglycoside in refrigerated .
approximately 30
Antibiotic,  Reconstituted a syringe or  The reconstituted vial is
min.
Penicillin solution may be infusion bottle stable for up to 12 hrs
 I.V injection (bolus) :
further diluted to since this can when stored in REF or
Inject reconstituted
the desired volume result in according to
solution slowly over a
(eg, 50 to 150 ml ) inactivation of the recommendation of the
3 to 5 min period to
with suitable aminoglycoside. manufacture
help avoid vein
diluents .
irritation.
87
 Store the intact vial at
CRT..
 don’t administer by IV  The vial should be used
push immediately .
Potassium  should be
 I.V infusion only  The diluted solution should
chloride 15%. diluted with  SWFI, NS,
 Use infusion pump . be used immediately after
10ml suitable D5W,
diluents  To avoid vein irritation the D10W,LR
preparing.
Electrolyte conc. shouldn't exceed  Unused solution should be
before I.V
supplement 40 mEq/ L . discarded.
infusion
 each 1 ml potassium
chloride contain 2 mmol
potassium and 2 mmol
chloride
88
 Store intact vials at CRT and
protect from light.
 Prior to dilution, Solutions in
NS or D5 W are stable for 24
 I.M. injection hrs at CRT.
is the  I.M. injection :  The solution should be clear
preferred route Inject deep IM and colorless. Slightly
of  I.V injection : yellow color does not alter
administration. Administer slowly potency. Discard if greatly
(undiluted) over 10–15 min. at a discolored.
Promethazine
 I.V injection max rate of  Too-rapid rate of infusion
50mg/ 2ml
(not the 25mg/min. (more  NS, D5 W, D10W, RL may result in transient fall in
preferred diluted solutions are B/P, producing orthostatic
Phenothiazine,
route) recommended). hypotension, reflex
Antihistamine
Dilute with  Use large vein or tachycardia, serious tissue
10–20 ml central venous site injury.
suitable (no hand or wrist  Take care to avoid
diluents veins). extravasation or inadvertent
The conc. intra-arterial injection (can
<25mg/ml. cause necrosis and peripheral
gangrene).
 May cause drowsiness; if
affected do not drive or
operate machinery.
89
 Store intact vials at CRT;
 Propofol should be  NS, D 5W, RL protect from light.
administered intravenously  Manufacturers  Do not freeze.
as injection or as recommend  Discard unused portions.
 For IV
continuous infusion , either that propofol  Prepare immediately before
injection
diluted or undiluted with an not be mixed each use.
 May give
infusion solution with D5W with any other  Do not use if emulsion
Propofol 10mg/ undiluted, or
or NS therapeutic separates.
ml. 20ml diluted
 Use of a syringe pump or agents prior to  Shake well before using
 Do not dilute
Rapid acting volumetric pump administration  More stable in glass than in
to
general anesthetic recommended to provide  Compatibility plastic.
concentration
less than
controlled infusion rates. with  Strict aseptic technique must
2 mg/ml  Do not give through same blood/serum/pl be maintained in handling
IV line with blood or asma has not  Flush IV line at end of every
plasma.. been 6 hrs in extended procedures
established. to remove residual propofol.
 Avoid Too-rapid IV
administration
90
 Store intact vials at CRT
 IV injection: Do not exceed  protect from freezing or
 IV injection:
1 mg/min injection rate. excessive heat
Give
Propranolol 1mg/ (Pediatric rate: Extend rate  protect from light.
undiluted.  NS, D5W, RL
1ml of administration of a  The solution should be clear
 IV infusion: ,  incompatible
single dose by injection to and colorless.
may dilute with
non-selective
each 1 mg in
a minimum of  Significant differences exist
beta- blocker 5 mins) bicarbonate
10 ml suitable between oral and I.V.
 IV infusion: give over dosing. Use caution when
diluents.
15- 30 mins converting from one route of
administration to another.
91
 Store intact vials at
 For IV use only CRT.
 Intravenous injection  Do not refrigerate.
 over about 10 min at  Stability after
a maximum rate of 5 mg/min. Preparation: Use
(50 mg in any 10-min period) prepared infusions
Protamine Sulfate  Intermittent or continuous  NS, D5W immediately
10mg/ml  May be given undiluted intravenous infusion:  Incompatible  Must be administered
)50mg/5ml ) or  Give by IV infusion via a with some in a facility equipped to
 May be further diluted volumetric infusion device. antibiotics, monitor the patient and
Heparin with NS or D5W. Rate depends on indication., including respond to any medical
antagonist, may be given over 2 to 3 hrs several emergency
antidote with dosage titrated according cephalosporins  Too-rapid IV
to coagulation studies. and penicillins. administration may
Increase duration of infusion produce
to 8 to 16 hrs for treatment of acute hypotension,
SC heparin overdose. bradycardia, pulmonary
hypertension, dyspnea,
transient flushing,
feeling of warmth.
92
 IM injection :
 IM injection :
Give by deep IM injection
Give undiluted
into a large muscle such as
 IV injection:  Store the intact
the gluteus or lateral aspect of
dilute each 50 mg with ampoule at CRT.
the thigh.
20 ml suitable diluents.  protected from light.
 IV injection: over minimum
 For IV infusion, dilute  after preparation
of 5 min (prevents
with suitable diluents should be used
arrhythmias, hypotension).
Ranitidine to a maximum immediately; however,
 Intermittent IV infusion:
50gm/2ml concentration of 2.5 prepared infusions
over 15-20 mins.  NS, D5 W,
mg/ml may be stored at REF.
 Continuous IV infusion: D10W, LR,
histamine H2-  Intermittent IV and infused (at room
receptor total daily dose equally
infusion: dilute each temperature) within 24
antagonist distributed over 24 hrs.
50 mg with suitable hrs. .
Should not exceed a rate of
diluents to a max  IV solutions appear
6.25 mg/hr (10.7 mL/hr if
concentration of 0.5 clear, colorless to
150 mg [6 mL ranitidine] is
mg/ml. yellow (slight
diluted in 250 mL).
 Continuous IV darkening does not
 Use of infusion pump
infusion: Total daily affect potency)
preferred to avoid
dose may be diluted in
complications of overdose or
250 mL of compatible
too-rapid
solution.
administration.
93
 May be given
 For I.V. administration:
undiluted
Give by slow IV injection.
 May be diluted
Concentrations >1.26%
(dilute the 1  Store the intact vials at CRT
should be given via a
mEq/mL central line except in  protect from light.
solution 1:1 emergency situations.  Do not freeze.
Sodium with SWFI
 For IV infusion in  NS,D5 W, D10,W  Discard unused portion.
bicarbonate 8.4%  I.V. emergencies:  incompatible  Rapid or excessive
50ml administration administer slowly infuse with acids, administration may produce
1meq/1ml to infants: use over 2 hrs (maximum rate acidic salts, alkalosis, hypernatremia,
the 0.5
of administration: alkaloid salts, hypokalemia, and
Electrolyte mEq/mL
1 mEq/kg/hr) calcium salts, hypocalcemia. Cardiac
supplement, solution.
 For children younger than catecholamines, arrhythmias may result from
Alkalizing agent  for IV 2 years, premature infants, and atropine. an intracellular shift of
infusion: neonates, administer by potassium.
dilute to a
slow infusion, up to 10  Each I ml contain 1 mEq of
maximum
mEq/min. Sodium bicarbonate.
concentration
 Flush IV line thoroughly
of 0.5 mEq/mL
before and after
in dextrose
administration.
solution.
94
Sodium chloride  Concentrated must be

diluted before use.  Store intact vials at CRT
23.4% 30ml 
 The dose is diluted to  By slow IV : over 4  NS,D5W,RL protect from light.
4meq/1ml
the required hrs  Do not freeze.
concentration by (Not exceed 100ml  preservative free ,so Discard
Electrolyte over 1hr)
addition to an unused portion.
replenisher
appropriate
intravenous solution
such as D5.W
95
 The contents
should be
dissolved in  D5W, NS, RL,
4-5 ml of SWFI
compatible
 Single dose of  plasma
fluid. expanders such  The freeze-dried powder
1.5 million IU streptokinase
 Roll or swirl the as dextran’s should be stored below 25°C
Streptokinase 1.5 should be infused over 1hr.
vial gently, interfere with and should not be frozen
mill. I.U.  IV infusion in 50-200ml of
avoid foaming. coagulation and  Don’t freeze the product
compatible fluid given as
 Once the are therefore  protect from light
Fibrinolytic soon as possible after onset
powder is not suitable for  The reconstituted solution
of symptoms.
completely use as vehicles should not be stored for more
dissolved , with than 12 hrs in REF.
transfer the streptokinase.
content of the
vial into 45ml
of compatible
fluid
96
 NS, D5W, RL
 may be used  Store the intact ampoule at
 incompatible
undiluted REF.
with alkaline
(I.M. injection  I.M. injections use only
solutions  Protect from light.
Suxamethonium and rapid I.V. when I.V. access is not
 Suxamethonim  Do not freeze.
chloride 50mg/ ml injection) available.
 I.V. : rapid I.V. should not be  Only freshly prepared
 diluted in
Neuromuscular mixed with solutions should be used ,
continuous injection(10-30 sec)
any other agent  non-used solution and
Blocker Agent infusion up to  continuous IV infusion:
in the same opened ampoules should be
1-2 mg/ml (range : 0.5-10 mg/min)
syringe discarded.
(particularly
thiopentone/
thiopental).
97
 Reconstitute
vials with the
content of the  For IV injection:  store the intact vial at CRT
solvent to give over 3-5 min.  store reconstituted vial at
200mg|3ml or  For IV infusion : REF. for 24 hrs
Teicoplanin 400mg|3ml Withdraw the required dose  during reconstitution if the
200mg  Rotate the vial and mix with suitable solution becomes foamy
gently volume usually 100ml NS  NS, D5W, LR leave it to stand for 15 min
Antibiotic between the or D5W and given over 30 ,D/S to settle
hands until the mins.  Teicoplanin and
powder is  For IM: given after aminoglycoside solution are
completely reconstitution with solvent incompatible when mixed
dissolved to 400mg|3ml or 200mg|3ml directly and should not be
avoid  intraperitoneal mixed before injection
formation of
foam
98
 500 mg vial
reconstituted in
 Extravasation may cause
Thiopental at least 20ml
necrosis
sodium (25mg|ml)
 Slow injection is
 May be further  IV injection for anesthesia  NS , D5W ,
recommended to minimize
General diluted each over 1 min. SWFI
respiratory depression and
Anesthetic, 500mg in
possibility of overdose
Barbiturate 125-250 ml NS
 Conc. less than 2% are not
or D5W
used they cause hemolysis
99
 For IM :
Inject undiluted into large
 Can be diluted muscle
Tramadol 100mg
(2ml in 10 ml  For IV :  NS , D5W,
 Store intact ampoule at CRT
SWFI) Undiluted or diluted SWFI
Analgesic, Opioid
Or undiluted in compatible IV fluid and
administer over
2-3 min
 IV infusion
 Ready to use
diluted or CRT
Tranexamic acid undiluted  NS , D5W ,LR
 Strictly limited to slow IV  Store diluted solution for 24
500gm/ 5ml  For  incompatible
injection at rate of hrs at CRT.
continuous with solutions
1 ml \ min(100mg\ min.)  increased risk of hypotension
antifibrinolytic infusion containing
 For continuous infusion with rapid injections
diluted in penicillin
 should not be administered
10 ml of NS
by IM route
then 500 ml
100
 Store at REF.
 Do not freeze.
 For prophylaxis of infant
born to positive mothers
given IM after physiologic
Vaccine, hepatitis stabilization of infant within
B Infant 24hrs, preferably within 12
In preservative-  Ready to use  For IM administration hrs. of birth.
free and latex-free  Do not shake (for exposure of infants  Bring to room temperature
vials; avoid born to HBsAg-positive before administrate.
Immunizing agent foaming mothers)  Use within 6 hrs of opening
(passive) the vial, and discard partially
used vials
 Vaccination with live virus
vaccines should be deferred
until approximately 3months
after administration of
hepatitis B IGIV
101
 store the intact vial at CRT
 reconstituted vials stored at
REF.for 96hrs
 incompatible with beta-
 reconstitute lactam antibiotic the
500mg vial in likelihood of precipitate
10 ml SWFI increases with higher conc.
Vancomycin
(use 20 ml for  Give by IV infusion only of vancomycin, flush the IV
500mg
1gm vial) to over a minimum of line between administration
 NS , D5W, LR
give a solution 60 min. at max rate 10 mg| of these antibiotics
antibiotic
of 50mg|ml min  to reduce the risk of red man
then dilute syndrome 1gm dose is
with minimum usually given over 2 hrs
of 100 ml  rapid bolus administration
over several minutes may be
associated with exaggerated
hypotension , rarely cardiac
arrest
102
 store intact ampoule at CRT
Verapamil Hcl
 Give undiluted slowly over  NS, D5W  protect from light
5mg/ 2ml
 Given at least 2 min.(3 min. in  Incompatible  discard immediately after
undiluted or elderly) with continuous with sodium opening ampoule
Ca- channel
blocker,
diluted with ECG and blood pressure bicarbonate  after dilution store for 24 hrs
NS , D5W monitoring can repeat if and alkaline at CRT.
antiarrythmic
necessary after 5-10 min solution  inject slowly because of the
risk of hypotension
CRT
 Don’t store unused portion
Water for after opening
 It is diluents
injection 10ml  For single use only
for
 Should be inspected
reconstitution
diluents visually for particulate
of drugs
matter and discoloration
 Without added solute is
contraindicated as it cause
hemolysis
103
References
1. Drug facts and comparisons 2010.
2. Drug information handbook 17th edition.
3. EMC medicine website.
4. Injectable drug guide 2011.
5. Medscape.
6. Neofax 2011.
7. Nursing drug hand book 2016.
8. Uptodates 21.6
9. www.medicines.org.uk/emc.
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دليل اعطاء الادوية الوريدية في المستشفيات 5 PDF

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دليل اعطاء الادوية الوريدية في المستشفيات 5 PDF

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State of Palestine

Amal Ahmed El Shorbassy Pharmacist at El Nassr Hospital

‫األخوة األكارم‪ ،‬األخوات الفُضميات‪،،‬‬

‫د‪ .‬عبد المطيف الحاج‬

 For rapid bolus I.V.

 Store the intact vial at REF.

 Continuous IV infusion only.  Store the intact vials at

 Store the intact vial

 Store intact vial at CRT.

 IM: Undiluted  Store intact vial at CRT

 Store the intact ampoule at

 Store the intact ampoule at

 Heparin intact vial should be stored at

Hyoscine N-  For IM:

 I.V.: Administer undiluted  Store the intact ampoule at

 IV infusion slowly over  Store the intact vial at CRT

 Given only as slow IV

ADMINISTRATION COMPATI NOTES

Pethidine  store at CRT

 Store the contact ampoule

Sodium chloride  Concentrated must be

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