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Critical Care Intravenous Infusion Drug Handbook 3rd Edition

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Sources,ix

Abbreviations,xi

DrugCalculationFormulae,xv

SECTIONI:CriticalCareIntravenousInfusionDrugs— QuickMixingGuide,1

QuickReferenceInfusionDrugCompatibilityand IncompatibilityChart,9

SECTIONII:IntravenousInfusionDrugs,53

Abciximab(ReoPro),54

Alteplase(Activase),59

Aminophylline(Theophylline),63

Amiodarone(Cordarone),67

Argatroban(Acova),73

Atracurium(Tracrium),77

Bivalirudin(Angiomax),80

Cisatracurium(Nimbex),85

Conivaptan(Vaprisol),89

Dexmedetomidine(Precedex),92

Diltiazem(Cardizem),95

Dobutamine(Dobutrex),99

Dopamine(Intropin),107

DrotrecoginAlfa(Xigris),115

Epinephrine(Adrenalin)Injection,123

Eptifibatide(Integrilin),128

Esmolol(Brevibloc),133

Fenoldopam(Corlopam),136

Haloperidol(Haldol),139

Heparin,141

Ibutilide(Corvert),148

ImmuneGlobulinIntravenous(Carimune,Gamimune, Gammagard,Gammar-P,Gamunex,Iveegam, Octagam,Panglobulin,Polygam,Sandoglobulin, Venoglobulin-S),150

Inamrinone(Inocor),154

Infliximab(Remicade),161

InsulinDrip,165

Isoproterenol(Isuprel),168

Labetalol(Trandate),173

Lepirudin(Refludan),177

Lidocaine(Xylocaine),181

Lorazepam(Ativan),185

MagnesiumSulfate(MgSO4),189

Midazolam(Versed),193

Milrinone(Primacor),196

Nesiritide(Natrecor),201

Nicardipine(Cardene),204

Nitroglycerin,208

Nitroprusside(Nipride),212

Norepinephrine(Levophed),224

Octreotide(Sandostatin),232

Pantoprazole(Protonix),234

Phenylephrine(Neo-Synephrine),237

PotassiumChloride(KCl),240

Procainamide(Pronestyl),245

Propofol(Diprivan),249

Reteplase(Retavase),253

Tenecteplase(TNKase),255

TirofibanHCl(Aggrastat),258

Vasopressin(Pitressin),262

SECTIONIII:ACLSGuidelinesforAdultEmergency

CardiacCareAlgorithms,267

PulselessVentricularTachycardia(VT)/Ventricular Fibrillation(VF),268

Asystole,271

PulselessElectricalActivity(PEA),274

PulselessElectricalActivity(PEA):ClinicalSignsand Treatment,277

SymptomaticBradycardia,283

NarrowQRSTachycardia,286

AtrialFibrillation/AtrialFlutterAlgorithm,291

Wolff-Parkinson-White(WPW)SyndromeAlgorithm,296

SustainedMonomorphicVentricularTachycardia,300

PolymorphicVentricularTachycardia,304

WideQRSTachycardiaofUnknownOrigin,309

InitialAssessmentandGeneralTreatmentofthePatient withanAcuteCoronarySyndrome(ACS),313

ManagementofST-SegmentElevationMyocardial Infarction(MI),316

ManagementofUnstableAngina/Non–ST-Segment ElevationMyocardialInfarction(MI),319

ManagementofPatientwithaSuspectedAcuteCoronary SyndromeandNondiagnosticorNormalECG,321

ManagementofAcutePulmonaryEdema,322

ManagementofHypotension/Shock:SuspectedPump Problem,326

ManagementofHypotension/Shock:Suspected VolumeProblem,330

ManagementofHypotension/Shock:SuspectedRate Problem,332

Sources

AehlertB: ACLSquickreviewstudyguide,ed3, StLouis,2007,Mosby.

AmericanHeartAssociation: Advancedcardiaclife supportprovidermanual,2006,AmericanHeart AssociationInc.

AmericanHeartAssociationinCollaborationwiththe InternationalLiaisonCommitteeonResuscitation (ILCOR).Part6:Advancedcardiovascularlifesupport; Section7:AlgorithmapproachtoACLSemergencies, Circulation 102(supplI):136-171,2000.

AmericanSocietyofHealthSystemPharmacists: Americanhospitalformularyservice,Bethesda,Md, 2008,TheSociety.

GahartBL,NazarenoAR: 2009intravenous medications,ed25,StLouis,2009,Mosby.

Goldberg,PA,Clinicalresultsofanupdatedinsulin infusionprotocolincriticallyillpatients, Diabetes Spectrum 18:188-191,2005.

HazinskiMF,FieldJM,GilmoreD,editors: Handbook ofemergencycardiovascularcare2008:For healthcareproviders,Dallas,2008,AmericanHeart Association.

LacyCF,ArmstrongLL,GoldmanMP,LanceLL: 2007–2008Druginformationhandbook,ed15, Cleveland,2007,Lexi-CompIncandAmerican PharmaceuticalAssociation.

LesterRM,Dente-CassidyAM: Intravenous medicationsforcriticalcare,ed2,Philadelphia,1996, Saunders.

MedicalEconomicsStaff: Physician’sdeskreference 2008,ed62,Oradell,NJ,2008,MedicalEconomics Company.

TrisselLA: Handbookofinjectabledrugs,ed15, Bethesda,Md,2009,AmericanSocietyofHealth SystemPharmacists.

Abbreviations

ACS acutecoronarysyndrome

ACT activatedclottingtime

ADRs adversedrugreactions

AED automaticexternaldefibrillator

AMI acutemyocardialinfarction

aPTT activatedpartialthromboplastintime

AV atrioventricular

AVNRT atrioventricularnodalreentrytachycardia

AVRT atrioventricularreciprocatingtachycardia

BLS basiclifesupport

BP bloodpressure

CABG coronaryarterybypassgrafting

CAD coronaryarterydisease

CBC completebloodcount

CCU cardiaccareunit

CF calculationfactor

CHF congestiveheartfailure

CLL chroniclymphocyticleukemia

CNS centralnervoussystem

COPD chronicobstructivepulmonarydisease

CPR cardiopulmonaryresuscitation

CrCl creatinineclearance

CSU cardiacsurgeryunit

CVA cerebrovascularaccident,cardiovascular accident

CVP centralvenouspressure

D5W dextrose5%

DBP diastolicbloodpressure

DIC disseminatedintravascularcoagulation

DNAR DoNotAttemptResuscitation

ET endotrachealtube

GGT g-glutamyltransferase

GI gastrointestinal HIT heparin-inducedthrombocytopenia

HR heartrate

ICU intensivecareunit

IgG immunoglobulinG

IHSS idiopathichypertropicsubaorticstenosis

IM intramuscular

INR internationalnormalizedratio

IO intraosseous

ITP idiopathicthrombocytopenicpurpura

IV intravenous

IVP intravenouspyelogram

LBBB leftbundlebranchblock

LMWH lowmolecularweightheparin

MAO monamineoxidase

MAP meanarterialpressure

MAT multifocalatrialtachycardia

NG nasogastric

NPO nothingbymouth

OBS organicbrainsyndrome

PCI percutaneouscoronaryintervention

PCWP pulmonarycapillarywedgepressure

PE pulmonaryembolism

PEA pulselesselectricalactivity

PO bymouth

PRN asneeded

PSVT paroxysmalsupraventriculartachycardia

PT prothrombintime

PTCA percutaneoustransluminalcoronaryangioplasty

PTT partialthromboplastintime

PVC polyvinylchloride

RR respiratoryrate

rTPA recombinanttissueplasminogenactivator

SA sinoatrial

SaO2 saturationlevelofoxygeninhemoglobin

SBP systolicbloodpressure

SC subcutaneous

SGOT serumglutamic-oxaloacetictransaminase

SGPT serumglutamic-pyruvictransaminase

TEE transesophagealechocardiography

TNF-a humantumornecrosisfactoralpha

TPA tissueplasminogenactivator

TPN totalparenteralnutrition

USP UnitedStatesPharmacopeia

VF ventricularfibrillation

VT ventriculartachycardia

WPW Wolff-Parkinson-White

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DrugCalculationFormulae

DrugCalculationFormulae

1.Calculateconcentrationofanydruginabag(orbottle).

Amountofdruginbag ðmgÞ

Totalvolumeofthebag ðmLÞ ¼ Concentrationinmg=mL

Example:

Nitroglycerin25mg D5W250mL ¼ 0:1mg=mL ¼ 100mcg=mL

2.Calculatedoseadministeredforagiveninfusionrate.

Concentrationinbag ðmg=mLÞ infusionrate 60min ¼ Doseperminute

Example: Procainamide4mg/mLisinfusingat30mL/hr.Whatdoseisinfusing(mg/min)?

Procainamide4mg=mL 30mL=hr 60mg ¼ 2mg=min

3.Calculateinfusionrateforagivendoseinmcg/kg/min.

Bodyweight ðkgÞ Dose ðmcg=kg=minÞ

Drugconcentration ðmcg=mLÞ ¼ InfusionrateinmL=min 60min=hr ¼ Rate ðmL=hrÞ

Example: Dobutamine5mcg/kg/minfora60-kgpatient.

60kg 5mcg=kg=min

2000mcg=mLbag ¼ 0:15mL=min 60min=hr ¼ 9mL=hr

4.Calculationfactors(CF).

Dose ðmcg=kg=minÞ

Infusionrate ðmL=hrÞ ¼ CF

Example: Dobutamineat5mcg/kg/minina60-kgpatientisinfusingat9mL/hr.

5mcg=kg=min

9mL=hr ¼ 0:556CF

Calculationfactorscanbeusedtoquicklyconvertaparticulardoseofadrugorinfusiontoaspecificinfusionrate inmL/hrorviceversa.Thiscanbehelpfulwhentitratingvariousdrugstoeffect,andfrequentchangesininfusion ratemayneedtobeconvertedtotheactualdoseofdrugadministered.Forexample,ifweneededtochangethe infusionratefrom9mL/hrofdobutamineto15mL/hrtomaintainbloodpressure,howmanymcg/kg/minwould beinfusing?MultiplytheCFbythenewratetogetthenewdose,or0.556 15=8.34mcg/kg/min.

DrugCalculationFormulae

DrugCalculationFormulae—cont’d

COMMONMETRICCONVERSIONS

1000micrograms(mcg)=1milligram(mg)

1000milligrams(mg)=1gram(g)

1000grams(g)=1kilogram(kg)

1milliliter(mL)=1cubiccentimeter(cc)

1000milliliters(mL)=1liter(L)

CriticalCareIntravenousInfusionDrugs— QuickMixingGuide

CriticalCareIntravenousInfusionDrugs—QuickMixingGuide

ABCIXIMAB(REOPRO)

Bolusdose: GivenIVpush

Maintenancedose: Addrequiredmaintenancedose to 250 mLD5W

ALTEPLASE(ACTIVASE)

Add100mgalteplaseto100mLsterilewateror 50mgalteplaseto50mLsterilewater

Finalconcentration: 1mg/mL

AMINOPHYLLINE(THEOPHYLLINE)

500MGIN500MLD5W

Premadesolution: Theophylline400mg/500mLor 800mg/1000 mL

Finalconcentration: 1mg/mLofaminophylline

AMIODARONE(CORDARONE)

Bolusdose: Add150mgto100mLD5W

Maintenancedose: Add900mgto500mLD5Win glassbottle

Final concentration: 1.8mg/mL

ARGATROBAN(ACOVA)250MGIN 250MLNS

Add250mg(2.5mL)argatrobanto250mLNS

Finalconcentration: 250mg/250mL(1mg/mL)

ATRACURIUM(TRACRIUM)250MG (25ML)IN250MLD5W

Add250mg(25mL)atracuriumto225mLD5W

Finalconcentration: 1mg/mL

BIVALIRUDIN(ANGIOMAX)250MG (5ML)IN50MLD5W

Add250mg(5mL)bivalirudinto50mLD5W

Finalconcentration: 5mg/mL

CISATRACURIUM(NIMBEX)250MG IN250MLD5W

Add250mg(25 5-mLvials)cisatracuriumto125mL D5W

Finalconcentration: 1mg/mL

CONIVAPTAN(VAPRISOL)

20mgIVloadingdose;20-40mg/dayIVcontinuous infusion;maximumdurationis4days

Finalconcentration: 200 mg in100mLD5W (0.2mg/mL)and40mgin250mLD5W(0.16mg/mL)

DEXMEDETOMIDINE(PRECEDEX)2MG IN50MLNS

Add2mLPrecedexto48-mLNSminibag

Finalconcentration: 4mcg/mL

DILTIAZEM(CARDIZEM)125MG IN100MLD5W

Add125mg(5 25-mgvials)diltiazemto100mL D5WorNS

Finalconcentration: 125mg/125mL(1mg/mL)

DOBUTAMINE(DOBUTREX)500MG IN250MLD5W

Premadesolution

Finalconcentration: 500mg/250mL(2mg/mL)

DOPAMINE(INTROPIN)400MG IN250MLD5W

Premadesolution

Finalconcentration: 400mg/250mL(1600mcg/mL)

DROTRECOGINALFA(XIGRIS)(2 3 5MG) 10MGIN100MLNS

Add10mg(2 5mgvials)to100mLNS

Finalconcentration: 10,000mcg/100mL(100mcg/ mL)

EPINEPHRINE(ADRENALIN)1MG IN250MLD5WORNS

Add1mg(1ampule)epinephrineto250mLD5WorNS

Finalconcentration: 1mg/250mL(4mcg/mL)

EPTIFIBATIDE(INTEGRILIN)75MG IN100-MLVIAL

Premadesolution

Bolusdose: from10-mLvial

Maintenancedose: from75-mg/100-mLvial

CriticalCareIntravenousInfusionDrugs—QuickMixingGuide

ESMOLOL(BREVIBLOC)2.5GIN250ML D5WORNS

Add2.5g(10mLof250-mg/mLvial)esmololto250mL D5WorNS

Finalconcentration: 10mg/mL

FENOLDOPAM(CORLOPAM)10MG IN250MLD5WORNS

Add10mg(1mL)fenoldopamto250mLD5WorNS

Finalconcentration: 40mcg/mL

HALOPERIDOL(HALDOL)FORRAPID TRANQUILIZATION

Availableas5-mg/mLvialforIVpush

HEPARIN25,000UNITSIN500MLD5W

Premadesolution

Finalconcentration: 25,000units/500mL(50units/ mL)

IBUTILIDE(CORVERT)1MGIN50ML D5WORNS

Add1mg(10-mLvial)ibutilideto50mLD5WorNS MayalsobegivenIVpushover10minutes

IMMUNEGLOBULINDOSES

Seedosingchart

INAMRINONE(INOCOR)500MG IN100MLNS

Add500mg(5 100-mgampules)inamrinoneto 100mLNS

Finalconcentration: 500mg/200mL(2.5mg/mL)

INFLIXIMAB(REMICADE)100MG TO900MGIN250MLNS

Add100mgto600mg(calculatecorrectdoseby weightindosingcharts)tototalvolumeof250mL NS

Finalconcentration: 0.4to4mg/mL

INSULIN100UNITSIN250MLNS

Add100units(1mL)insulinto250mLNS

Finalconcentration: 100units/250mL(2units/5mL)

For intensive insulinprotocolsadd100(1mL)to 100mLNS

Finalconcentration: 100units/100mL(1unit/mL)

ISOPROTERENOL(ISUPREL)1MG IN250MLD5W

Add1mg(1ampule)isoproterenolto250mLD5W

Finalconcentration: 1mg/250mL(4mcg/mL)

LABETALOL(TRANDATE)200MG IN200MLNS

Add200mg(40mL)labetalolto160mLNS

Finalconcentration: 200mg/200mL(1mg/mL)

LEPIRUDIN(REFLUDAN)100MG IN250MLNS

Add100mg(2mL)lepirudinto250mLNS

Finalconcentration: 0.4mg/mL

LIDOCAINE2GIN500MLD5W

Premadesolution

Finalconcentration: 2g/500mL(4mg/mL)

LORAZEPAM(ATIVAN)40MGIN500ML D5W

Add40mg(10mL)lorazepamto500mLD5Win glassbottle

Finalconcentration: 0.08mg/mL

MAGNESIUMSULFATE(MGSO4)

Add1gmagnesiumsulfateto50mLNSor2gto 100mLNS

Premixeddoses4%solution,4g/100mLor40g/ 1000mL(foreclampsia)

1-2g(2-4mLof50%solution)dilutedin10mLD5W maybegivenIVpushforcardiacarrest

Finalconcentration: 1 g/50 mL(20mg/mL)

CriticalCareIntravenousInfusionDrugs—QuickMixingGuide

MIDAZOLAM(VERSED)125MG IN125MLNS

Add125mg(25mLof5mg/mLvials)midazolamto 100mLNS

Finalconcentration: 1.0mg/mL

MILRINONE(PRIMACOR)20MG IN100MLD5W

Premadesolution

Finalconcentration: 0.2mg/mL

NESIRITIDE(NATRECOR)1.5MG IN250MLD5W

Add1.5mg(5mL)nesiritideto250mLD5W

Finalconcentration: 1.5mg/250mL(6mcg/mL)

NICARDIPINE(CARDENE)

Add1ampule(25mg/10mL)to240mLofDextrose 5%orNSresultingin250mLofsolution

Finalconcentration: 0.1mg/mL

A premixed 200mLsolutionisalsoavailablecontaining20mginNSorD5W

Finalconcentration: 0.1mg/mL

NITROGLYCERIN25MGIN250MLD5W

Premadesolution

Finalconcentration: 25mg/250mL(100mcg/mL)

NITROPRUSSIDE(NIPRIDE)50MG IN500MLD5W

Add50mg(1vial)nitroprussideto500mLD5W

Finalconcentration: 50mg/500mL(100mcg/mL)

NOREPINEPHRINE(LEVOPHED)4MG IN250MLD5WORNSWITHREGITINE 5MG/250ML

Add4mg(1 4-mgampule)norepinephrineto 250mLD5WorNSandadd5mgRegitine (1 5–mgvial)toeach250-mLbag

Finalconcentration: norepinephrine4mg/250mL (16 mcg/mL)

OCTREOTIDE(SANDOSTATIN)

1200MCGIN250MLD5WORNS

Add1200mcg(2.4mL)Sandostatinto250mLD5W orNS

Finalconcentration: Sandostatin4.8mcg/mL

PANTOPRAZOLE(PROTONIX)40–80MG IN100MLD5WORNS

Add10mLNStoeach40-mgvialandaddcontentsto 90mLNS

Finalconcentration: 40mg/100mL(0.4mg/mL)or 80 mg/100 mL(0.8mg/mL)

PHENYLEPHRINE(NEO-SYNEPHRINE)

10MGIN250MLD5W

Add10mg(1ampule)phenylephrineto250mLD5W

Finalconcentration: 10mg/250mL(40mcg/mL)

POTASSIUMCHLORIDE(KCl)

Basedonserumpotassiumlevels:20-60mEq/dayis usual

Typicaldosesbasedonserumlevels:

3.1-3.4mmol/Lgive20mEqevery2hr 2doses

2.5-3mmol/Lgive20mEqevery2hr 3doses

Lessthan2.5mmol/Lgive20mEqevery2hr 4 doses

1.Max:200mEq/dayandrarelyupto400mEq/ daywithextremecaution.

2.Maxinfusionrate:10mEq/hr;inseverehypokalemia(K < 2.0),20-40mEq/hrwith extremecautionandinfusionpump

Finalconcentration: 10 mEq/100 mL(centralline)or 40mEq/500mL(peripheral)

PROCAINAMIDE(PRONESTYL)1G IN250MLD5WORNS

Add1g(1vial)Pronestylto250mLD5WorNS

Finalconcentration: 1g/250mL(4mg/mL)

PROPOFOL(DIPRIVAN)500MG/50ML OR1G/100MLEMULSION

Premadesolution

Finalconcentration: 10mg/mL

CriticalCareIntravenousInfusionDrugs—QuickMixingGuide

RETEPLASE(RETAVASE)20-UNITKIT

Add10mLsterilewaterto10unitsRetavasewithkit provided

Repeatforsecond10-unitdose

TENECTEPLASE(TNKase)

Add10mLsterilewaterto50mgTNKase

Finalconcentration: 5mg/mL

TIROFIBAN(AGGRASTAT)12.5MG

IN250MLD5WORNS

Apremixedsolution100mLor250mLcontainer, Finalconcentration: 50mcg/mLor0.05mg/mL

VASOPRESSIN(PITRESSINSYNTHETIC) 250UNITSIN250ML

Add250units(12.5mLof20units/mL)vasopressinto 250mLD5WorNS

Finalconcentration: 250units/250mL(1unit/mL)

QuickReferenceInfusionDrugCompatibilityandIncompatibilityChart

Drug Compatibility Incompatibility

Abciximab Unknownornoinformation

Alteplase

Dextrose5%

Lidocaine

Aminophylline

Allopurinol

AmphotericinB

Bretylium

Ceftazidime

Cimetidine

Cladribine

Diltiazem

Dopamine

Doxorubicin

Enalaprilat

Esmolol

Etoposide

Famotidine

Filgrastim

Metoprolol

Propranolol

Fluconazole

Foscarnet

Gatifloxacin

Gemcitabine

Granisetron

Heparin

Inamrinone(Inocor)

Labetalol

Lidocaine

Linezolid

Meropenem

Morphine

Nitroglycerin

Paclitaxel

Unknownornoinformation

DobutamineDopamine

Amiodarone

Atracurium

Chlorpromazine (Thorazine)

Ciprofloxacin

Clindamycin

Codeine

Dobutamine

Hydralazine

Hydroxyzine (Vistaril)

Insulin

Isoproterenol

Meperidine (Demerol)

Norepinephrine

Ondansetron (Zofran)

Prochlorperazine (Compazine)

Phenytoin (Dilantin)

Promethazine (Phenergan)

Verapamil

Continued

QuickReferenceInfusionDrugCompatibilityandIncompatibilityChart—

Drug Compatibility Incompatibility

Pancuronium

Piperacillin

Potassiumchloride

Propofol

Ranitidine

Amiodarone Amikacin

Bretylium

Clindamycin

Dobutamine

Doxycycline

Erythromycin

Esmolol

Gentamicin

Insulin

Isoproterenol

Labetalol

Lidocaine

Metaraminol

Remifentanil

Sargramostim

Tacrolimus

Vecuronium

Metronidazole

Midazolam

Morphine

Nitroglycerin

Norepinephrine

PenicillinG

Phentolamine

Phenylephrine

Potassiumchloride

Procainamide

Tobramycin

Vancomycin

Aminophylline

Cefazolin

Heparin

Sodiumbicarbonate

ArgatrobanUnknownornoinformation

Atracurium Bretylium

Cefazolin

Cefuroxime

Cimetidine

Dobutamine

Dopamine

Epinephrine

Esmolol

Etomidate

Fentanyl

Gentamicin

Heparin

Hydrocortisone

Bivalirudin

Dexamethasone

Digoxin

Diphenhydramine

Dobutamine

Dopamine

Isoproterenol

Lidocaine

Lorazepam

Midazolam

Milrinone

Morphine

Nitroglycerin

Procainamide

Ranitidine

Sodium nitroprusside

Trimethoprim/sulfa

Vancomycin

Epinephrine

Eptifibatide

Esmolol

Furosemide

Heparin

Unknownornoinformation

Aminophylline

Diazepam

Propofol

Thiopental

[includingY-site]

Alteplase(tPA)

Amiodarone

hydrochloride

AmphotericinB

Chlorpromazine

hydrochloride

Diazepam

Prochlorperazine

Reteplase(rtPA)

Continued

QuickReferenceInfusionDrugCompatibilityandIncompatibilityChart—

Drug Compatibility Incompatibility

Hydrocortisone

Lidocaine

Meperidine

Methylprednisolone

Midazolam

Morphine

Cisatracurium [viaY-site]

Alfentanil

Amikacin

Aztreonam

Bretylium

Bumetanide

Buprenorphine

Butorphanol

Calciumgluconate

Ceftriaxone

Nitroglycerin

Potassiumchloride

Sodiumbicarbonate

Tirofiban

Verapamil

StreptokinaseVancomycin hydrochloride

Chlorpromazine

Cimetidine

Ciprofloxacin

Clindamycin

Dexamethasone

Digoxin

Diphenhydramine

Dobutamine

Dopamine

Doxycycline

Droperidol

Acyclovir

Aminophylline

AmphotericinB

Ampicillin

Ampicillin/ sulbactam

Cefazolin

Cefotaxime

Cefotetan

Cefoxitin

Ceftazidime

Cefuroxime

Diazepam

Diprivan

Furosemide

Ganciclovir

Heparin

Ketorolac

Methylprednisolone

Nitroprusside

Piperacillin

Thiopental

Enalaprilat

Epinephrine

Esmolol

Famotidine

Fentanyl

Fluconazole

Gatifloxacin

Gentamicin

Haloperidol

Hydrocortisone

Hydromorphone

Hydroxyzine

Imipenem/cilastatin

Inamrinone

Isoproterenol

Ketorolac

Lidocaine

Linezolid

Lorazepam

Magnesiumsulfate

Mannitol

Meperidine

Metoclopramide

Metronidazole

Midazolam

Minocycline

Morphine

Nalbuphine

Nitroglycerin

Norepinephrine

Ofloxacin

Ondansetron

Phenylephrine

Potassiumchloride

Procainamide

Prochlorperazine

Promethazine

Ranitidine

Remifentanil

Sufentanil

Ticarcillin/clavulanate

Trimethoprim/sulfa

Zosyn

QuickReferenceInfusionDrugCompatibilityandIncompatibilityChart—

Drug Compatibility Incompatibility

Theophylline

Ticarcillin

Tobramycin

Vancomycin

Zidovudine

ConivaptanNone LR&NS

DiluteonlywithD5W. Donotmixor administerwithotherIVfluids ormedications.

Dexmedetomidine

Diltiazem

Atracuriumbesylate

Atropinesulfate

Fentanylcitrate

Glycopyrrolate

bromide

Aminophylline

Albumin

Amikacin

20%Mannitol

Midazolam

Mivacuriumchloride

Morphinesulfate

Normalsaline

AmphotericinB

Aztreonam

Bretylium

Blood:serumorplasma

Acetazolamide

Acyclovir

Aminophylline

Ampicillin

Diazepam

Hydrocortisone

Bumetanide

Cefazolin

Cefotaxime

Cefoxitin

Ceftazidime

Ceftriaxone

Cefuroxime

Cimetidine

Ciprofloxacin

Clindamycin

Digoxin

Dobutamine

Dopamine

Doxycycline

Epinephrine

Erythromycin

Esmolol

Fentanyl

Fluconazole

Gentamicin

Heparin

Hetastarch

Hydromorphone

Imipenem/cilastatin

Insulin

Labetalol

Lidocaine

Lorazepam

Meperidine

Metoclopramide

Metronidazole

Midazolam

Milrinone

Morphine

Multivitamins

Nicardipine

Oxacillin

PenicillinG

Pentamidine

Piperacillin

Insulin

Lasix

Methylprednisolone

Phenytoin

Procainamide

Rifampin

Sodium bicarbonate

Thiopental

QuickReferenceInfusionDrugCompatibilityandIncompatibilityChart—

Drug Compatibility Incompatibility

Potassiumchloride

Potassiumphosphate

Ranitidine

Nitroglycerin

Nitroprusside

Norepinephrine

Dobutamine Amiodarone

Atracurium

Aztreonam

Bretylium

Cladribine

Calciumchloride

Calciumgluconate

Ciprofloxacin

Cisatracurium

Diazepam

Theophylline

Ticarcillin/clavulanate

Tobramycin

Trimethoprim/sulfa

Vancomycin

Vecuronium

Diltiazem

Docetaxel

Dopamine

Doxorubicin

Enalaprilat

Epinephrine

Etoposide

Famotidine

Fentanyl

Fluconazole

Acyclovir

Alteplase

Aminophylline

AmphotericinB

Calcium

Cefazolin

Cefepime

Diazepam

Digoxin

Foscarnet

Furosemide

Heparin

Hydrocortisone

Indomethacin

Insulin

Magnesium sulfate

Midazolam

Phenytoin

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