Inotropes

• Increase contractility through beta-adrenergic stimulation or inhibition of PDErase, increase cardiac output
• SE: tachyarrhythmias
• Drugs
  • Dobutamine(Dobutrex)
  • Milrinone(Primacor) selective PDErase inhibitor, not used anymore due to TCP

 

Vasopressor

• Press down on vasculature causing vasoconstriction, increase BP
• Dopamine - a precursor of epinephrine
  • SE: tachyarrhythmias, hypoperfusion, tissue necrosis (extravasation)
• Epinephrine (Adrenalin): B-agonist at low dose; High dose: more a-agonist effect
• Norepinephrine (Levophed): Stimulate b and alpha receptors, causing increased contractility, HR, vasoconstriction
• Phenylephrine (Neo-Synephrine): Pure a-agonist

·         Extravasation

• Treat w/ phentolamine (Regitine), a-adrenergic blocker that antagonize effect of vasopressor. Dilute in NS and give SC.

 

Vasodilator

• CI: concurrent PDE5 inhibitor
• SE: hypoTN, cyanide toxicity (nitroprusside)
• Drugs
  • Nitroglycerin: in glass bottle
  • Sodium nitroprusside (Nipride): light sensitive, wrap w/ foil to protect from light. Blue color sol’n indicates degradation, do not use

 

Adenosine (Adenocard)	Slows down AV conduction, treat PSVT. SE: flushing, palpitation
Amiodarone	Light sensitive
Amphotericin B	Antifungal dilute w/ D5W only
Dexmedetomidine (Precedex)	Alpha adrenergic agonist used for sedation, mix with NS
Drotrecogin alfa(Xigris)	Activated protein C for severe sepsis SE: bleeding
Furosemide	Store at room temp. refrigeration may result in ppt or crystalization. Light sensitive. IV:PO = 1:2
Levothyroxine IV	IV to PO= 1:2
Metronidazole	Protect from light. Store R.T. IV:PO = 1:1
Phenytoin	Sodium neuronal membrane stabilizer decrease SZ max infusion rate: 50mg/min IV: Po = 1:1
Propofol (Diprivan)	SE: hypoTN, increase lipids (Formulated in lipid emulsion), green urine, propofol-related infusion syndrome. Shake well before use.
Bactrim	Dilute w/ D5W only. Do not refrigerate. IV:PO = 1:1

 

Light sensitive IV drugs

• ABX (10) - amphotericin, Bactrim, cipro/levo, CTX, CFP, Doxy, Flagyl, linezolid, pentamidine-Nebupent (treat PCP)
• CV (2) - amiodarone, furosemide
• Pressors/vasodilator (4) - nitroprusside, dopamine, epi, norepi, metoprolol
• Steroids (2) - hydrocortisone, methylprednisolone
• Opioids (2) - fentanyl, hydromorphone
• Anti-nausea: Ondansetron, Granisetron, prochlorperazine
• PPI: esomeprazole
• Phytonadione(V-K)
• Levothyroxine

 

Do not refrigerate

• ABX (3) - Bactrim, Flagyl, moxifloxacin (Avelox)
• CV - phenylephrine (neosynephrine), hydralazine
• GI (2) - Esomeprazole, lansoprazole
• APAP (Ofirmev)
• Furosemide

 

Refrigerate

• ABX (3): ambisome, gentamicin, synercid
• Octreotide(Sandostatin) - lower levels of excess growth hormone (acromegaly). It can also treat diarrhea associated with certain types of tumors.
• Filgrastim (Neupogen)

 

IV drugs in D5W

• Ampho, ampicillin, bactrim, synercid
• Amio
• Filgrastim

 

IV drugs in NS

• Ampicillin, levothyroxine, phenytoin, cladribine

 

Filter of 0.22 micron filter required for

• TPN, lipids, albumin, mannitol, ampho B, Phenytoin, propofol (don't use <5 micron filter), amiodarone
• Abciximab, infliximab
• Diazepam, lorazepam
• Digifab
• Lansoprazole

 

IV drug < 6h stability

• Ampicillin, bactrim, penems (except erta)
• Levothyroxine
• Phenytoin
• Phytonadione

 

Lipid IV doesn't need a filter

• Liposyn

 

Compatibilities

• Reference: Trissel's handbook on injectable drugs

 

Common IV admixtures that are not compatible

• AMG and beta-lactams
• Ca/phosphorous to TPN

 

Drugs w/ frequent incompatibilities

• Ampicillin: do not freeze
• Furosemide
• Phenytoin
• Heparin
• Midazolam, diazepam
• Lansoprazole
• Sodium bicarb

 

Smart pump

• Can provide a check of calculations and ensure correct dosing.
• Alerts and stops allow clinicians to recognize miscalculated dose and programming errors.
• To reduce potential errors, possess bar code feature.

 

Promethazine inj.

• IM only, due to risk of tissue irritation and damage
• C/I if <2 y/o D/C risk of fatal respiratory depression

 

 

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