1. ( HIGH ALERT DRUGS ) . 15-Aug-14 1

2. High alert drug (high alert drug) 15-Aug-14 2 3. ( Narrow Therapeutic Index ) 15-Aug-14 3 4. 15-Aug-14 4 5. / 15-Aug-14 5 6. () mg/kg mg 15-Aug-14 6 7. 15-Aug-14 7 8. 2 15-Aug-14 8 9. 6 R 15-Aug-14 9 10. sticker 15-Aug-14 10 11. High alert drug dormicum, diazepam, ketalar ephedrine morphine, kapanol, pethidine, fentanyl Taxotere, campto, 5-FU, xeloda, oxalip, lipodox, MTX 15-Aug-14 11 12. High alert drug Insulatard (NPH), actrapid (RI), lantus (insulin glagine) Heparin, clexane, warfarin KCl, MgSO4, 3%NaCl, calcium gluconate 15-Aug-14 12 13. High alert drug Tracium, nimbex, esmoron, succinyl, siccum, thiopental, etomidate therapeutic index Theophylline, phenytoin, digoxin cardiovascular drug Adenocor, adrenaline, atropine, cardipine, cordarone, dopamine, dobutex, levophed, nitrocine, sodium nitroprusside, streptokinase 15-Aug-14 13 14. 2 1 15-Aug-14 14 15. 15-Aug-14 15 16. 1. Adrenaline 1 mg/ml Inj 2. Calcium Gluconate inj. 3. Digoxin Inj 4. Dopamine Inj 5. Potassium Chloride Inj 6. Magnesium 10% Inj,50% Inj 15-Aug-14 16 17. () 7. Morphine Inj. 8. Pethidine Inj. 9. Amiodarone Inj 10. Diltiazem Inj 11. Terbutaline Inj 15-Aug-14 17 18. Adrenaline : Adrenaline Injection (1mg/1ml) = (1:1000) 15-Aug-14 18 19. Adrenaline 0.05 1 mcg/kg/min , Maximum dose 1-2 mcg/kg/min 4 mcg/kg/min Cardiac arrest 1 mg IV 3-5 Anaphylaxi 0.3 0.5 mg IM/SC 15 -20 Bronchospasm 0.1 0.5 mg IM/SC 10 -15 4 . 0.1-1 % solution nebulizer 15 4 . 15-Aug-14 19 20. Adrenaline (Indication) Cardiopulmonary resuscitation (CPR) Anaphylaxis Hypotension (peripheral vascular disease) 15-Aug-14 20 21. Adrenaline Double check IV drip Infusion pump 15-Aug-14 21 22. Adrenaline (Monitoring) CPR Vital signs Anaphylaxis Vital signs 10 30 Hypotension IV drip Vital 1 . BP>160/90 mmHg, HR > 120 / BP > 120/80 mmHg, HR > 180 / IV site 1 15-Aug-14 22 23. Adrenaline BP>160/90 mmHg, HR > 120 / BP > 120/80 mmHg, HR > 180 / IV site 15-Aug-14 23 24. Calcium Gluconate : Calcium gluconate Injection 1 gm/10 mL (0.45 mEq/mL) 15-Aug-14 24 25. Calcium Gluconate Hypocalcemia: Neonates I.V. 200 800 mg/kg/day continuous infusion 4 (maximum : 1 gm /dose) Infants & children I.V. 200 500 mg/kg/day continuous infusion 4 (maximum : 2-3 gm/dose) Adults I.V. 2 15 gm/24 hour continuous infusion 15-Aug-14 25 26. Calcium Gluconate () Hypocalcemic tetany: Neonates, Infants & children I.V. 100 200 mg/kg/dose 5-10 6-8 . I.V. infusion 500 mg/kg/day Adults 1 3 gm (4.5 16 mEq) Hyperkalemia (Serum K > 7 mEq/L ) Ca glucanate 0.5 1 g (5-10 ml) IV push (2-5 ) monitor EKG 15-Aug-14 26 27. Calcium Gluconate (Indication) 1. hypocalcemia 2. K+ digoxin digoxin 15-Aug-14 27 28. Calcium Gluconate Ca ++ 15-Aug-14 28 29. Calcium Gluconate Double check IV phosphate 15 1 mg/mL 15-Aug-14 29 30. Calcium Gluconate (Monitoring) Hyper K+ Ca++ monitor EKG IV push Hypocalcemia Ca++ Ca++ IV site 1 . 15-Aug-14 30 31. Calcium Gluconate Calcium Calcium Calcium Normal saline IV 200-300 ml/hr IV site 15-Aug-14 31 32. Digoxin (Lanoxin) :Digoxin injection (0.5mg/2ml) 1. Lanoxin 0.25 mg tablet 2. Lanoxin PG 0.0625 mg tablet 3. Lanoxin elixir 0.05mg/mL (60 mL) 4. Lanoxin injection 0.25 mg/mL (2 mL) 15-Aug-14 32 33. Digoxin (Lanoxin) 15-Aug-14 33 34. Digoxin (Lanoxin) (Indication) 1. Congestive Heart Failure 2. Reduce ventricular rate K+ ( 3.5 mEq/L) 15-Aug-14 34 35. Digoxin (Lanoxin) Digitalis Intoxication 15-Aug-14 35 36. Digoxin (Lanoxin) Double check K+ Digoxin K+ 3.5 mEq/L 60 / < 1 HR 100 / 1-6 HR 80 / > 6 HR 60 / 15-Aug-14 36 37. Digoxin (Lanoxin) () IV 5 1 2 12 . 15-Aug-14 37 38. Digoxin (Lanoxin) (Monitoring) () Digoxin monitor EKG 1 . Digoxin HR 15 2 30 3 1 . 5 . 15-Aug-14 38 39. Digoxin (Lanoxin) (Monitoring) Digitalis Intoxication K+ Digitalis Intoxication (therapeutic level 0.8-2 ng/mL) 2 ng/mL 15-Aug-14 39 40. Digoxin (Lanoxin) Digitalis Intoxication monitor EKG 6-8 Activated charcoal 1 mg/kg 15-Aug-14 40 41. Dobutamine : Dobutamine injection 250 mg/20 mL (12.5 mg/mL) 15-Aug-14 41 42. Dobutamine (Indication) hypovolemia idiopathic hypertrophic subaortic stenosis myocardial infarction, severe coronary artery disease, cardiac arrhythmia 15-Aug-14 42 43. Dobutamine 15-Aug-14 43 44. Dobutamine Double check Dopamine Infusion pump (Monitoring) BP, HR 1 BP>160/90 mmHg HR > 120 / BP > 120/80 mmHg HR > 180 / infusion pump 1 . IV site 1 15-Aug-14 44 45. Dobutamine HR BP IV site 15-Aug-14 45 46. Dopamine 1. Dopmin injection 200 mg/ 5mL (40 mg/mL) 2. Inopin (Dopamine) injection 250 mg/ 10mL (25 mg/mL) 15-Aug-14 46 47. Dopamine (Indication) 1. Low cardiac output 2. Hypotension 3. Poor perfusion of vital organs Dobutamine acidosis, hypercapnia, hypovolemia, hypoxia () Dilantin (Phenytoin) 15-Aug-14 47 48. Dopamine 15-Aug-14 48 49. Dopamine Double check Dobutamine central vein central line peripheral line Infusion pump (Max rate) 20 mcg/Kg/min IV rate of infusion 15-Aug-14 49 50. Dopamine (Monitoring) BP, HR 1 BP>160/90 mmHg , HR > 120 / BP > 120/80 mmHg, HR > 180 / infusion pump 1 . IV site 1. 15-Aug-14 50 51. Dopamine HR BP IV site 15-Aug-14 51 52. 15-Aug-14 52 53. 15-Aug-14 53 54. Heparin : Heparin 5000 Unit/mL (5 mL) 15-Aug-14 54 55. Heparin (Indication) (platelet) 100,000/mm3 keep arterial line central line insulin 15-Aug-14 55 56. Heparin Double check infusion pump heparin ampicillin, ciprofloxacin, vancomycin, cephalosporins, aminoglycosides, steroids, antiemetics NSS 15-Aug-14 56 57. Heparin (Monitoring) infusion pump 2 . aPTT 6 . 24 . aPTT 6 . CBC 7 NG tube, 15-Aug-14 57 58. Heparin heparin CBC aPTT heparin aPTT heparin aPTT 15-Aug-14 58 59. Heparin () heparin protamine sulphate heparin continuous infusion protamine sulphate 1 mg 100 unit heparin 2 . 15-Aug-14 59 60. Insulin 1. Novorapid 2. Humalog 3. Actrapid HM 4. Humulin R 5. Gensulin R 6. Humulin N 7. Gensulin N 15-Aug-14 60 61. Insulin 8. Insulatard HM 9. Lantus 10. Novomix 30 11. Humalog Mix 25 12. Humulin 70/30 13. Mixtard 30 HM 14. Gensulin M 15-Aug-14 61 62. Insulin 15-Aug-14 62 63. Insulin 15-Aug-14 63 64. Insulin (Indication) 1 2 15-Aug-14 64 65. Insulin Double check Insulin Heparin IV drip infusion pump 15-Aug-14 65 66. Insulin (Monitoring) baseline 60 Hypoglycemia infusion pump 2 . 15-Aug-14 66 67. Insulin Hypoglycemia capillary blood glucose capillary blood glucose 60 mg/dL insulin insulin capillary blood glucose 30 capillary blood glucose 15-Aug-14 67 68. Insulin capillary blood glucose 60 mg/dL insulin insulin () 50% glucose 40-50 ml IV push 10% dextrose 80-100 ml/hr capillary blood glucose 30 capillary blood glucose 15-Aug-14 68 69. Potassium (K+) : 1. KCl inj. 10 mL ( K+ 2 mEq/mL) 2. K2HPO4 Inj. 20 mL ( K+ 1 mEq/mL) 15-Aug-14 69 70. Potassium (K+) (Indication) Hypokalemia K+ K+ 2.5 mEq/L IV push bolus K2HPO4 Hypophosphatemia K+ 15-Aug-14 70 71. Potassium (K+) K+ Double check IV push bolus IV K+ loading Infusion pump 15-Aug-14 71 72. Potassium (K+) (Monitoring) 10-20 mEq/hr HR , BP 1 . EKG 40-60 mEq/L 8-12 . HR BP 4-6 . BP 160/110 90/60 mmHg HR 60-100 / 15-Aug-14 72 73. Potassium (K+) (Monitoring) K+ K+ K+ infusion pump 4 . 15-Aug-14 73 74. Potassium (K+) K+ K+ K+ K+ 15-Aug-14 74 75. Potassium (K+) hyperkalemia 1-3 10% calcium gluconate 10 ml IV push K+ monitor EKG 10% calcium gluconate 10-30 potassium 50% glucose 40-50 ml+ regular insulin (RI) 5-10 unit IV push Capillary blood glucose 15-Aug-14 75 76. Potassium (K+) hyperkalemia () Cation exchange resin kayexalate kalimate 30-60 g 30 2 . kayexalate sorbitol hyperkalemia HD K+ 4-6 . IV site 15-Aug-14 76 77. Magnesium sulfate Injection 1. 50% MgSO4 inj. 2 mL 2. 20% MgSO4 inj. 20 mL 3. 50% MgSO4 inj. 20 mL 4. 4% MgSO4 in D5W 1000 mL 15-Aug-14 77 78. Magnesium sulfate Injection 15-Aug-14 78 79. Magnesium sulfate Injection (Indication) pre-eclampsia , eclampsia hypomagnesemia Torsades de Pointes Magnesium sulfate 15-Aug-14 79 80. Magnesium sulfate Injection heart block 15-Aug-14 80 81. Magnesium sulfate Injection Double check IV drip infusion pump syringe pump (Monitoring) magnesium loading dose 1.9-2.9 mg/dL preeclampsia therapeutic level 4-8 mg/dL 15-Aug-14 81 82. Magnesium sulfate Injection (Monitoring) () Pre-eclampsia, eclampsia 1 gm/hr HR RR 15 2 1 . 4 . RR 14 / 60 / Urine output > 100 mL/ 4 hr ( 600 mL) 15-Aug-14 82 83. Magnesium sulfate Injection (Monitoring) () Deep tendon reflex knee jerk reflex 4 . negative bicep jerk reflex negative Magnesium infusion pump 1 . 15-Aug-14 83 84. Magnesium sulfate Injection Magnesium Magnesium Magnesium Magnesium (dialysis) 15-Aug-14 84 85. Morphine Morphine syrup 2 mg/mL Morphine inj. 1 mg/mL, 10 mg/mL MST tablet 10, 30, 60 mg Kapanol cap 20, 50, 100 mg 15-Aug-14 85 86. Morphine 15-Aug-14 86 87. Morphine 15-Aug-14 87 88. Morphine (Indication) 600 15-Aug-14 88 89. Morphine overdose Double check IV push 5-10 IV drip infusion pump syringe pump 15-Aug-14 89 90. Morphine (Monitoring) IV push monitor Heart rate respiratory rate pain score sedation score 5 4 30 2 monitor 15-Aug-14 90 91. Morphine (Monitoring) () IV continuous drip monitor 1 4 monitor 4 SC or IM monitor 15 4 30 2 RR < 10/min , HR< 60/min 15-Aug-14 91 92. Morphine > 10 / ( 1 30 / 1 20 / ) continuous drip Morphine 15-Aug-14 92 93. Morphine Naloxone 0.2-0.4 mg IV , IM, SC 0.01 mg/Kg 2-3 10 Naloxone (-1 ) Morphine 15-Aug-14 93 94. Warfarin (Orfarin) 1. Orfarin 3 mg tablet 2. Orfarin 5 mg tablet 15-Aug-14 94 95. Warfarin (Orfarin) (Indication) 15-Aug-14 95 96. Warfarin (Orfarin) - Double check OPD 15-Aug-14 96 97. Warfarin (Orfarin) () Warfarin / Warfarin bleeding, clotting 15-Aug-14 97 98. Warfarin (Orfarin) (Monitoring) INR Warfarin bleeding clotting 15-Aug-14 98 99. Warfarin (Orfarin) bleeding clotting INR INR Vitamin K1 10 mg IV push Fresh Frozen Plasma (FFP) Prothrombin complex concentration 15-Aug-14 99 100. INR 15-Aug-14 100 101. Pethidine : Pethidine Injection (50 mg/ml) : - (Preanesthetic medication) 15-Aug-14 101 102. Pethidine : : 25-100 . 3-4 . 10-30 . 10 . /. 4-5 : 0.5-2 ./. 1 . 3-4 . 100 ./ 15-Aug-14 102 103. Pethidine (Monitoring) vital sign 30 RR < 14 / BP < 90/60 mmHg (orthostatic hypotension) 15-Aug-14 103 104. Pethidine overdose < 10 / ( 1 30 / 1 20 /) naloxone 0.2-0.4 mg IV, IM SC 0.01 mg/kg 2-3 > 10 / 15-Aug-14 104 105. Amiodarone : Amiodarone injection 150 mg/3 ml 15-Aug-14 105 106. Amiodarone : Atrial Ventricular tachyarrythymia Rapid atrial arrythymia (AF with RVR) impair LV function Digoxin : Cardiac arrest IV push 20 ml. 10-20 : wide complex tachycardia (stable) IV infusion 15-Aug-14 106 107. Amiodarone : hypersensitivity amiodarone iodine severe sinus-node dysfunction,bradycardia cause syncope cardiogenic shock 15-Aug-14 107 108. Amiodarone 15-Aug-14 108 109. Diazepam Valium ,panic disorder, , , , status epilepticus, alcohol, Injection: 10 mg/ 2 ml 15-Aug-14 109 110. Diazepam : Oral IM/IV 0.12-0.8 mg/kg/day 6-8 . 0.04-0.3 mg/kg/day 2-4 . 8 . 0.6 mg/kg 2-10 mg 2-4 2-10 mg 3-4 . 1-2 mg 1-2 10 mg/day 2-5 mg 2-4 15-Aug-14 110 111. Diazepam 50% albumin 15-Aug-14 111 112. Diazepam 15-Aug-14 112 113. Diazepam 1. ( systolic < 90 mmHg ) 2. AV block 2 3 sick sinus syndrome (sinus bradycardia 50 /), sinus arrest SA block 3. 4. cardiomyopathy 5. 6. 15-Aug-14 113 114. Terbutaline : Terbutaline injection 0.5 mg/ml 15-Aug-14 114 115. Terbutaline : (preterm labour) : IV infusion 12 . : Cardiac arrhythmia associate with tachycardia Tachycardia from digitalis intoxication 15-Aug-14 115 116. Terbutaline 15-Aug-14 116 117. 15-Aug-14 117 118. 15-Aug-14 118 119. 15-Aug-14 119