Last updated: 6 Aug 2024 | 68743 Views |
Adenosine inj (6 mg / 2 ml)
Indication
Treatment of Paroxysmal Supraventricular Tachycardia (PSVT)
Not infective in atrial flutter , Atrial Fibrillation or ventricular tachycardia
Dosage form/strength
Injection solution 6 mg /2 ml
Dosage and Administration
Double syring technique : (Open the IV line near the heart) followed by NSS Flush.
drug administration
1. To ensure absolute systemic circulation of the drug, administer either directly into the rapid intravenous bolus (repid intraveneous bolus) within 1 to 2 s or intravenously (IV line) if: injected into the line connected to the vein It should be injected as close to the venous line as possible, followed by a rapid intravenous NSS to allow the drug to enter the central department.
2. NSS Flush For pediatric use >= 5 ml, in adults approximately 20 ml.
Instructions for administering the drug
-Before giving the drug, place the patient in the supine position. (no pillow)
-Administer the drug by injecting IV repid push within 1-3 seconds.
-Do not allow Lower arm, hand, lower leg , or foot
-After the injection, raise the arm in which the injection was given. in order for the drug to work on the heart fully
Mixing and Stabilization
Do not mix drugs / After opening the drug should not be stored.
Adult dose
Initiate 6 mg Repid iv bolus in 1-2s, followed by NSS Flush.
If unresponsive to treatment within 1-2 minutes, a second dose should be given with an increase of 12 mg.
If a second dose
Contraindication (Contraindications)
1. hypersensitivity to Adenosine
2. Seconds or third AV block
3. Sinus node dysfunction,such as sick sinus syndrome or symptomatic bradycardia
4. Asthma , COPD
Adverse drug Reaction
CVS : facial flushing, hypotention, AV block, chest pain, ST segment depresstion
CNS : headache , Dizziness
GI : Nuasea
Respiratory : Dyspnea , Hyperventilation
Monitering
- EKG monitering during dosing
- Heart Rate , BP immediately after drug administration and every 2 minutes for 3 cycles
-Clitical point : Heart rate < 60 /min BP<90/60 mmHg
** In the event that the drug is repeated and does not respond, try to review the reasons as follows. Incorrect injection method (injecting or flushing saline following is not fast enough, open the forearm line at the forearm).
Precaution and warning (Caution/Warning )
1.Avoid concomitant use with dipyridamole and methylxanthines (eg Theophylline / aminophylline).
2 Because of the possibility of transient atrial fibrillation during supraventricular tachycardia, normal sinus rhythm administration should be in the hospital. The ECG is always monitored.
3 Patients with atrial fibrillation / flutter and an accessory bypass tract may develop an abnormal ECG conduction through an abnormal pathway.
4 Because of the potential risk of torsade de pointes, adenosine should be used with caution in patients with prolonged QT interval, regardless of congenital etiology. drug induction or from burning for energy
ADRENALINE INJECTION (EPINEPHRINE)
Available dosage form: Adrenaline injection 1 mg in 1 ml , ampoule [concentration 1:1000].
Major Risks 1. A rapid IV infusion may occur. cerebrovascular hemorrhage or cardiac
Arrhythmias should be adjusted with caution.
2. With immediate discontinuation of the drug, rebound hypotension may occur, and the dose should be gradually reduced.
3. Injection of IM in the hip area can cause atherosclerosis, leading to muscle death.
4. adrenaline overdose : arrhythmia, palpitations, dilated pupils high blood pressure
Selection/Procurement - Selection of drugs with a protective container form.
- Drugs taken into the treasury The remaining term is from 1 year or more.
- As an emergency drug, there must be sufficient quantity and quality always available.
STORAGE/STABILITY - The drug has not been opened. Stored at a temperature not exceeding 25 ° C, shelf life 2 years (according to the company)
- The drug has not been activated. Stored at a temperature of 26 – 40 °C, shelf life is 1 year (from the date of
out of storage at a temperature not exceeding 25 °C)
- Drugs that have been mixed or diluted have a shelf life of 24 hours.
- Drugs that are brown or precipitate should not be used as they have deteriorated.
prescription
Indications / How to use / Dosage
1.Anaphylaxis
pediatric IV/SC ; 0.01 mg/kg/dose (diluted to a concentration of 1:10,000 then 0.1 ml/kg/dose) every 15 minutes, 2 doses, then every 4 hours (max dose 0.5 mg).
Adult IV/SC ; 0.1 – 0.5 mg every 10-15 minutes until improvement (max dose 1 mg)
2. CPR in Pulse less VT/VF ;asystolic/pulseless electrical activity
Children IV ;0.01 mg/kg/dose every 3-5 minutes ; To dilute 1:10,000
then inject 0.1 ml/ kg/dose
ET tube ; 0.1 mg/kg (of 1:1000) mixed in NSS 10 ml
Adult IV ; 0.5-1 mg and repeat every 3-5 minutes until symptoms improve.
3. Bronchospasm
Children SC ; 0.01 mg/kg/dose (diluted to a concentration of 1:10,000 then 0.1 ml/kg/dose) every 15-20 minutes, no more than 3 times (max dose 0.5 mg).
Adult IM/SC ; 0.1 – 0.5 mg every 20 minutes – 4 hours until symptoms improve, not more than 3 times.
Contraindications Cardiac arrhythmias , Angle-closure glaucoma
Major adverse reactions: increased blood pressure. fast/irregular heartbeat
drug preparation
Compatible substances : DSW , NSS, Sterile water for injection
Dilution to a concentration of 1: 10,000 use 1 ml of the drug mixed with 9 ml of NSS or Sterile water for injection.
Do not mix with : Sodium bicarbonate ,Ampicillin, Calcium gluconate, Furosemide, Lidocaine.
In case of IV infusion, mix 1 mg (1 ml) in D5W or 250 ml and 500 ml of NSS (according to the table).
The mixed or diluted drug has a shelf life of 24 hours at room temperature and refrigeration.
Brown or precipitated drug should not be used as it has deteriorated.
drug administration
SC/IM in adults does not require dilution. ,In children dilute the drug to a concentration of 1:10,000
IV push Dilute the drug to a concentration of 1:10,000, inject in 5-10 minutes.
Mix ET tube with 10 ml of NSS before administration.
IV Infusion - Mix 1 mg of the drug into 250 - 500 ml of 0.9% NSS Solution or D5W.
- Administer the drug using an infusion pump at a rate of 1- 10 mcg/min.
follow-up
Monitor : Continuously record Heart rate, BP, every 5 minutes until 30 minutes.
Critical point to report to doctor : Child Heart rate > 180/min BP >120/80 mmHg
Adult Heart rate > 120/min BP >140/90 mmHg
Preventing/Troubleshooting Drug Inaccuracies
1. Rapid IV Infusion may occur. cerebrovascular hemorrhage or cardiac arrhythmias, therefore, when IV infusion, an infusion pump should be used.
2. Avoid injecting IM in the hip area, as it can cause atherosclerosis, leading to muscle death.
3. adrenaline overdose : arrhythmia dilated pupils high blood pressure palpitations
Child Heart rate > 180/min BP >120/80 mmHg , Adult Heart rate > 120/min BP >140/90 mmHg, consider dose reduction or discontinuation. no antidote treat according to symptoms
AMIODARONE INJECTION
Available dosage form: Amiodarone injection 150 mg in 3 ml, ampoule.
Major risks 1. IV push injections are at risk of severe hypotension. circulatory system failure
2. Symptoms of poisoning ; sinus bradycardia, and/or heart block , hypotension and QT prolongation
Selection/procurement of emergency drugs must always be of sufficient quantity and quality available.
Storage/Stability
- Unopened medicines are stored at a temperature not exceeding 25 ° C and protected from light.
- The solution is diluted ; Packed in PVC plastic containers, stable for 2 hours.
Packaged in a glass bottle container. 24 hours stable
prescription
Indications / Dosage / How to use :
1. Ventricular arrhythmias QRS narrow : Adult ; IV infusion
The mean dose is 5 mg/kg (total dose in the first 24 hours not to exceed 1,050 mg) as follows:
- Start with a dose of 150 mg (mix 3 ml in 100 ml of D5W ) over 10 minutes (rate 15 mg/min).
- Followed by a 360 mg dose (mix 7.2 ml in 200 ml of D5W ) over 6 hours (rate 1 mg/min).
Followed by a dose of 540 mg (mixed 10.8 ml in 300 ml of D5W ) over 18 hours (rate 0.5 mg/min).
2. Cardiac arrest (CPR) : Adult ; IV push 300 mg mixed in D 5 W 20-30 ml slowly administered 1-2 minutes
Repeat the drug within 5 minutes at a dose of 150 mg mixed with D 5 W 20-30 ml.
Major Adverse Reactions : Hypotension, Heart block, Bradycardia.
drug preparation
Dilution : - Dilute with 5% Dextrose (D 5 W) solution.
; In the case of infusion, the concentration is 1- 6 mg/ml.
; In case of IV push, mix in D 5 W 20-30 ml.
- Diluent solution contained in PVC plastic containers, stable for 2 hours.
Packaged in a glass bottle, stable for 24 hours, protected from light.
Do not mix with : NSS, solutions containing Sodium bicarbonate, Cefazolin, Furosemide.
drug administration
IV infusion : -Use the infusion pump every time.
IV push : For urgent/emergency use, mix in D 5 W 20-30 ml, slowly administered for 1-2 minutes.
sticking
as a result
Monitor : Heart rate, BP after dosing every 15 minutes for 3 cycles and monitor EKG during dosing.
Critical point report to doctor : Heart rate < 60 /min , BP < 90/60 mmHg, heart block
Preventing/Troubleshooting Drug Inaccuracies
- drug interaction ;
amiodarone increases serum digoxin levels, requires a 50% dose reduction of digoxin
amiodarone increases serum aminophylline levels need to adjust the dose Aminophylline 33%
- Symptoms of poisoning, symptomatic treatment
ATROPINE INJECTION
Available dosage form: Atropine sulfate injection 0.6 mg in 1 ml, ampoule.
Significant risks Symptoms of poisoning: blurred vision, dilated pupils, dry mouth, urinary retention, rapid heartbeat. high blood pressure
increased body temperature
Selection/procurement of emergency drugs must always be of sufficient quantity and quality available.
Storage/Stability Unopened medicines should be stored at < 25 °C , opened medicines should be used within 24 hours.
prescription
Indications / Dosage / How to use :
For adults ; IV push
1. Symptomatic sinus bradycardia : 0.5-1 mg repeated every 3-5 minutes, total dose not to exceed 3 mg or not to exceed 0.04 mg/kg.
2. Asytolic or Slow PEA(Pulseless Electrical Activity) : 1 mg, repeated every 3-5 minutes, total dose not more than 0.04 mg/kg.
3. Anticholinesterase overdose (Antidote of organophosphate or carbamate poisoning ) : 1-2 mg repeated every 10 – 20 min until muscarinic symptoms are controlled or when atropine effect occurs, after which every 1-4 hours the total dose in 24 The first hour does not exceed 50 mg.
For child : IV push ; 0.02 mg/kg or minimum dose 0.1 mg , maximum dose 0.5 mg
ET tube ; 0.03 mg/kg or 2-3 mg mixed in 10 ml NSS
Contraindications : myasthenia gravis , narrow –angle glaucoma
Major adverse reactions: dry mouth, blurred vision, dilated pupils and visual impairment, urinary congestion, rapid pulse.
drug preparation
Dilution agent : Do not dilute.
Do not mix with : Adrenaline, Ampicillin, Chloramphenicol, Heparin, Warfarin.
Drug administration : IV push ; The infusion rate is 0.6 mg in 1 minute.
follow-up
Monitor: Every 5 minutes until clinical symptoms are controlled by monitoring Heart rate, BP, Mental status.
Critical point (report doctor) : Heart rate > 60/ min bradycardia , asystolic Heart rate > 120/ min Antidote
Preventing/Troubleshooting Drug Inaccuracies
Overdose symptoms: blurred vision, dilated pupils, dry mouth, urinary retention, rapid heartbeat
high blood pressure increased body temperature
Correction: Physostigmine 1-2 mg SC or Slow IV (0.5 mg or 0.02 mg/kg for children)
DOPAMINE INJECTION
Available dosage form: Dopamine hydrochloride injection 250 mg in 10 ml, ampoule.
Major risk
1. Overdose: hypertension, arrhythmia , tachycardia, acute renal failure
2. Abrupt discontinuation of the drug may cause severe hypotension, the dose should be reduced gradually.
Selection/procurement of emergency drugs must always be of sufficient quantity and quality available.
Storage/Stability unopened medicine Store at a temperature not exceeding 25 °C and protected from light.
The diluted solution is stable for 24 hours at room temperature. and prevent light from the solution that turns darker or brown. Do not use because it has deteriorated.
prescription
Indications / dosage / method of use
Shock with increased cardiac output, blood pressure, urine flow after adequate hydration.
Adult : IV infusion using an infusion pump ; 1-5 mcg/kg/min gradually increase the dose 1-4 mcg/kg/min every 10-30 minutes until desired response is achieved. In the event that the patient has severe symptoms may increase dose by 5-10 mcg/kg/min every 10-30 minutes ; Maximum dose 20 -50 mcg/kg/min. Discontinuation should be reduced gradually, as abrupt discontinuation may result in hypotension.
-The following conditions should be corrected prior to drug administration: hypovolemia, acidosis, hypercapnia, hypoxia.
- The effect of the drug on the blood system
Low : 1-3 mcg/kg/min renal blood flow , urine out put
: 3-10 mcg/kg/min renal blood flow , heart rate, cardiac contraction, cardiac output
High dose : > 10 mcg/kg/min causes vasoconstriction to increase blood pressure.
Contraindications to Phaeochromocytoma, Tacchyarrhythmia, Ventricular fibrillation.
Major adverse reactions hypertension, chest pain, palpitation, tachycardia, olicurea
drug preparation
Diluent : D 5 W, D5 N/2 , D 5 S , NSS, LRS
- dilution 1 : 1 means the concentration is 1 mg/ml ;4 ml of the drug is mixed with the IV solution to obtain 100 ml
- dilution 2 : 1 means the concentration is 2 mg/ml ; 8 ml of the drug is mixed with the IV solution to obtain 100 ml
The diluted solution is stable for 24 hours at room temperature. and light protection
Solution that has turned darker or brown. Do not use as it has deteriorated.
Do not mix with : alkaline solutions such as Amphotericin B, Ampicillin, Irons salts.
Gentamicin, Potassium chloride, Sodium bicarbonate
drug administration
IV infusion using an infusion pump
To stop the drug, reduce the dose gradually. Due to abrupt discontinuation of the drug, severe hypotension may occur.
DOPAMIN
follow-up
Monitor :
- BP, Heart rate , EKG, Urine output before and during administration
- During drug administration, record vital sign, EKG every 15 minutes, 3 cycles, if stable, measure every 2-4 hours.
- Check the infusion pump every 1 hour.
- Check the IV site every 1 hour throughout the period of drug administration.
Critical point (report to physician) : Adult ; BP > 140/ 90 mmHg or BP < 90/ 60 mmHg Heart rate > 120 beats/min.
Preventing/Troubleshooting Drug Inaccuracies
- Overdose symptoms: including high blood pressure, arrhythmia, acute renal failure.
Decrease the rate or stop the medication.
- If redness, swelling, dark circles are found in the IV site, change the position of the drug.
- When stopping the drug, gradually reduce the rate of drug administration to prevent severe hypotension
MAGNESIUM SULFATE INJECTION
Magnasium sulfate10% in 10 ml, ampule (MgSO4 = 1 g, Mg 98 mg = 8.12 mEq/ml= 4 .06 mmol).
Magnasium sulfate50% in 2 ml, ampule (contains MgSO4 = 1 g, Mg 98mg = 8.12 mEq/ml= 4 .06 mmol).
major risk Too rapid administration of the drug may cause hypotension , asystolic.
Toxic symptoms: Nausea, vomiting, diarrhea, CNS depression, respiratory depression, flushing.
Selection/procurement of emergency drugs must always be of sufficient quantity and quality available.
Storage/Stability unopened medicine Store at a temperature not exceeding 25 ° C.
The diluted solution is stable for 24 hours at room temperature. (Do not refrigerate)
prescription
Indications / dosage / method of use
Adults:
1. Hypomanesemia : IM or IV slowly push ; 1 g every 6 hours 4 dose , 8-12 g/day in severe cases
2. Pre-eclampsia, Eclampsia
IVslowly push ; 10 % MgSO4 2 - 4 g given in 5-10 min ,then
IV infusion ; 50 % MgSO4 20 ml (10 g) in D5W or NSS 1000 ml ; rate 1-2 g/hr
Max ; 30-40 g/day
3. Torsades VT / VF : IV slowly push 1-2 minutes
; 50% MgSO4 1-2 g diluted in D 5 W ; 50-100 ml every 10 – 15 min.
(child : 25-50 mg/kg IV ; max 2 g )
Contraindications heart block, hepatitis
Major adverse reactions: diarrhea, CNS depression, respiratory depression, hypotension, asystolic.
drug preparation
Diluent : NSS, D5W, RLS
drug administration
IM concentration 25% or not more than 50 %
IV slowly push 10 % concentration ; 10 ml 1 minute ; rate < 150 mg/min
IV infusion diluted to a concentration of not more than 10% (maximum concentration 100 mg/ml) ; rate < 150 mg/min
follow-up
Monitor : BP , Respiratory rate , serum Mg, serum Cr. , knee jerks reflex, urine output,toxic symptoms
Critical point (doctor report) :
in adults ; BP < 90/ 60 mmHg or > 140/100,
Respiratory rate < 14 / min , Loss of reflex
Heart rate < 60 /min , urine output < 100 ml / 4 hours
Serum Mg > 2.5 mg/ml
Preventing/Troubleshooting Drug Inaccuracies
- Do not give the drug at a rate that is too fast. due to hypotension
- Toxic symptoms: diarrhea, CNS depression, respiratory depression, flushing, discontinue the drug.
Symptomatic and antidote ;calcium gluconate 10% inj. 10 20 ml IV 1-3 min.
Normal serum Mg = 1.7 – 2.3 mg/dL (1.2 – 2.0 mEq/L)
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