คู่มือระบบยาโรงพยาบาลศรีสงคราม ปี 2565

10 1
2
HIV 3
4
ADE 6
12
warfarin NSAIDs 19
Medication error 23
58
(Rational Drug Use: RDU) 60
- 71
- 76
-
- 100
- NSAIDs 101
-3
- long-acting benzodiazepine 101
- NCD 103
- Asthma
- non-sedating 113
115
() 115
Medication reconciliation 116

116
117
118
119
119

1

10

1.
2.

3.
4.
5.
6.
7.
8. /
9.
10. 18

2

1.
2.
3.
4.
5.
6.
7.

7.1
7.2
7.3
7.4

7.5
7.6

7.7
7.8
7.9

3

OD 06.00 . 18.00 . 22.00 . 24.00 . 22.00 . 02.00 .
q 12 hr 06.00 . 14.00 . 18.00 . 18.00 .
q 8 hr 06.00 . 12.00 . 14.00 . 3rd dose
q 6 hr 06.00 . 10.00 . 30 06.00 .
q 4 hr 06.00 . 06.00 .
06.00 .
: dose stat dose
- admit

- dose

- dose

Gentamycin 2nd dose
Stat dose 06.00 .
06.00 . - 21.00 . 12.00 .
21.01 . - 03.00 . 18.00 .
03.01 . - 05.59 .

07.00 . 11.00 . 16.00 . 20.00 .
08.00 . 12.00 . 17.00 . 20.00 .

: stat dose 30 ( )
- admit dose
- dose
- dose

-

4

P = (%)
V = (ml)

P1V1 + P2V2 ( ) = P3(V1+ V2) ( )

1. 25%DW 100 ml

Glucose 50% = 100 ml Dextrose 50 g = 50%

D5W = 100 ml Dextrose 5 g = 5%

1 D5W 100 ml Glucose 50% 50 ml 1

P1V1 + P2V2 = P3(V1+ V2)
5% x V1 + 50% x 50 ml = 25% x (V1 + 50 ml)

5 V1 + 2500 = 25 V1 + 1250
1250 = 20 V1
V1 = 62.5 ml

D5W 62.5 ml ( D5W 37.5 ml) + Glucose 50% 50 ml 1

25%DW 112.5 ml

2 D5W 100 ml Glucose 50% 50 ml ( 1)

P1V1 + P2V2 = P3(V1+ V2)
5% x V1 + 50% x (100 - V1) = 25% x [ V1 + (100 - V1) ]

5 V1 + 5000 - 50 V1 = 25 V1 + 2500 - 25V1
2500 = 45 V1
V1 = 55.56 ml

D5W 55.56 ml ( D5W 44.44 ml) + Glucose 50% 44.44 ml

25%DW 100 ml

2. 10%DW 100 ml

Glucose 50% = 100 ml Dextrose 50 g = 50%

D5W = 100 ml Dextrose 5 g = 5%

1

P1V1 + P2V2 = P3(V1+ V2)
5% x V1 + 50% x (100 - V1) = 10% x [ V1 + (100 - V1) ]

5 V1 + 5000 - 50 V1 = 10 V1 + 1000 - 10 V1

5

5000 = 1000 + 45 V1
4000 = 45 V1

V1 = 88.88 ml
V2 = 100 - V1 = 100 - 88.88 = 11.12 ml
D5W 88.88 ml ( D5W 11.12 ml) + Glucose 50% 11.12 ml

2 D5W Glucose 50% ( 1)

P1V1 + P2V2 = P3(V1+ V2)
5% x 100 + 50% x V2 = 10% x (100 + V2)

500 + 50 V2 = 1000 + 10 V2
40 V2 = 500 ml
V2 = 12.5 ml

D5W 100 ml + Glucose 50% 12.5 ml

3. D51/4S 1000 ml 100 ml NaCl 0.45 g
D51/2S 1000 ml = 100 ml NaCl
D5W 500 ml =

P1V1 + P2V2 = P3(V1+ V2)
0.45% x V1 + 0% x (1000 - V1) = 0.225% x [ V1 + (1000 - V1) ]

0.45 V1 + 0 = 0.225 V1 + 225 0.225 V1
0.45 V1 = 225
V1 = 500 ml
V2 = 1000 - V1 = 500 ml

D51/2S 500 ml ( D51/2S 500 ml) + D5W 500 ml

6

Paracetamol syrup (120 mg/5 ml)

2 kg 0.8 - 1.2 cc 14 kg 5.8 - 8.8 cc

3 kg 1.3 - 1.9 cc 15 kg 6.2 - 9.4 cc

4 kg 1.7 - 2.5 cc 16 kg 6.7 - 10 cc

5 kg 2.1 - 3.1 cc 17 kg 7.1 - 10.6 cc

6 kg 2.5 - 3.8 cc 18 kg 7.5 - 11.2 cc

7 kg 3 - 4.4 cc 19 kg 8 - 11.9 cc

8 kg 3.3 - 5 cc 20 kg 8.3 - 12.5 cc

9 kg 3.8 - 5.6 cc 21 kg 8.8 - 13.1 cc

10 kg 4.2 - 6.2 cc 22 kg 9.2 - 13.8 cc

11 kg 4.6 - 6.9 cc 23 kg 9.6 - 14.4 cc

12 kg 5 - 7.5 cc 24 kg 10 - 15 cc

13 kg 5.4 - 8.1 cc 25 kg 10.4 - 15.6 cc

Dicloxacillin suspension (62.5 mg/ 5 ml)

Newborns Not recommended
Children < 40 kg
1) 25 - 50 mg/kg/day 6
Children > 40 kg and Adults
Max Dose 2) 50 - 100 mg/kg/day 6

osteomyelitis Osteoarticular infection

125 - 500 mg every 6 3-4

2/

Penicillin V Suspension (125 mg/5 ml)

Adult 5000 unit - 50000 unit/kg/day
Children < 12
Max Dose ( 0.6 ml-1.25 ml/kg/day) 4

25-50 mg/kg/day 4-8

( 1-2 ml/kg/day)

3/

7

Amoxicillin suspension 125 mg/5 ml, 250 mg/5 ml 20-50 mg/kg/day 8
Children
( 0.8 ml-2 ml/kg/day)
Subacute bacterial endocarditis prophylaxis
Max Dose 50 mg/kg 1

2/

Erythromycin Estolate Suspension (125 mg/ 5ml)

Children 30-50 mg/kg/day 6-12 (1.2 ml - 2 ml/kg/day)
Max Dose 2/

Ibuprofen syrup (100 mg/5 ml) 5-10 mg/kg/dose (0.5 ml-0.75ml/kg/dose) 4-6
5-10 mg/kg/dose (0.5 ml-0.75ml/kg/dose) 4-6
Antipyretic 4-10 mg/kg/dose (0.2-0.5 ml/kg/dose) 6-8
Anti-inflammatory Antipyretic 40 mg/kg/day
Analgesic Anti-inflammatory 2.4
Max dose

Salbutamol syrup (2 mg/5ml) 0.1 mg/kg/dose (0.25mL/kg/dose) 6
2-6 : 12 mg (30 ml)
Children 6-12 : 24 mg (60 mL)/
Max dose

Chlorpheniramine Syrup (2 mg/5 ml)

Children 0.35 mg/kg/day (0.9 ml/kg/day) 3-4

Domperidone Suspension (5mg/5 ml)

Children 0.2-0.4 mg/kg/dose 4-8 (0.2 ml-0.4 ml/kg/dose)

1.25 ml 5 kg

8

Cotrimoxazole (Bactrim) Suspension (TMP 40 mg + Sulfamethoxazole 200 mg 5 ml)
TMP
Children 6-12 mg/kg/day TMP
(0.75 ml-1.5 ml/kg/day
)

Pneunocystiscarinili 15-20 mg/kg/day (1.88 ml-2.5 ml/kg/day

Alum milk : 5-15 ml/dose
Peptic ulcer 1-2 /dose

MOM < 2 0.5 ml/kg/day
Children 2-5 5-15 ml/day
6-12 15-30 ml/day

EUROFER-iron (Eurodrug) Fe complex

Children Oral : 6-24 1.3 ml 1

2.5 ml 1

6-12 ml 1

: 4-6 mg of elemental iron/kg/day 30

Zithromax (Azithromycin) Oral : 10 mg/kg/day OD
Children

MTV syrup -1 ½ 1
Children 11 1

Cough syrup 1-3 ½ 3-4
Children 3-6 1 3-4
6-12 2 3-4

9

Carbocysteine syr. Oral :
Children <

Berclomine Syr (Dicyclomine+Simeticone)

Children Oral : 5-10 mg/Dose tid-qid (Base on Dicyclomine)

Simeticone drops Oral : < 2 yr 20 mg tid or qid
Children > 2 - 12 yr 40 mg tid or qid

Sodium bicarbonate mixture pediatric

Children 1-5 23
1 13

Mebendazole syrup

2
- 123
-1

Amoxicillin and Clavulanate Potassium (228.5 mg/ 5 ml) 2
2
25/3.6 mg/kg/day
- 2

()
-

45/6.4 mg/kg
-

()
-

( ) ***
-

10

11

12

1. (new patient regimen)

2HRZE/4HR

1

2. (MDR regimen)
4-6 Bdq(6 Lfx(Mfx)-Pto(Eto)-Cfz-Z-E-Hhigh-dose/ 5 Lfx(Mfx)-Cfz-Z-E

Bdq,Lfx(Mfx),Pto(Eto),Cfz,E,Z,H (high dose)

Bdq Lfx(Mfx),Pto(Eto),Cfz,E,Z,H(high dose)

sputum smear conversion sputum smear

conversion

Lfx(Mfx),Cfz,E,Z

( 1) ( 14 )
( 2)

1

: S 500-750 ./ 10 ./
S 50 . S 500-750 ./
> 60

./

13

2

: 35 > 70 ( 1)
*

**

***

fixed dose combination; FDC) HR, HRZE

2

1. major side effect
2. minor side effect

14

3

3

15

prednisolone systemic steroid
prednisolone 40-60 . 2-3

HR EZ
1/3 1/2

/

H, R Z bilirubin aspartate

transaminase (AST) serum glutamic - oxaloacetic transaminase (SGOT) / alanine transaminase (ALT)

serum glutamic- pyruvate transaminase (SGPT) R

> 60

AST/ALT total bilirubin

AST/ALT total bilirubin 1-2 16

1

AST/ALT > 3 H, R Z E, Lfx Am
liver enzyme re-challenge H, R
AST/ALT 3
3

total bilirubin > 3 ./ AST/ALT 3R
AST/ALT < 5 H, R Z 1
AST/ALT > 5
< 1.5 /
re-challenge

fulminant hepatitis

AST/ALT <2 total bilirubin

H, R Z

AST/ALT total bilirubin 1

re-challenge AST/ALT total bilirubin

(optic neuritis, retrobulbar neuritis) H
E
-)
(dyschromatopsia, -
(central scotoma)

50 20 ./ ./
E

(visual acuity)
E

E 15 ./ ./

17

HH
4

: Quinolone (Q)

Ofloxacin 600-800 ./ ) Rifampicin

ofloxacin effux pump

H 6 (pyridoxine) 50-100 ./

aminoglycosides (ototoxic)
fluoroquinolone (Ofloxacin, norfloxacin)

(haemodialysis) SE haemodialysis
H, R Z /
creatinine clearance (CrCl) ()
(increase the dosing interval) CrCl (too low
peak serum concentration)

18

5

ALT > 3 22

(1) 2
o 2HRE/7HR
o 6-9 RZE

(2) 1
o 2 AmHE/16 HE
o 12-18 HE + Lfx
1 2-3

: 2564,

19

HIV

Didanosine ddI < 3 50 mg/m2/dose q 12 hr
3 13 90-120 mg/m2/ dose q 12 hr 240 mg/day
Efavirenz EFV 13 60 kg : 200 mg/m2/dose q 12 hr 400
mg/day
Lamivudine 3TC
10 - 15 kg : 200 mg q 24 hr
Lopinavir/ritonavir LPV/r 15 - <20 kg : 250 mg q 24 hr
20 - <25 kg : 300 mg q 24 hr
Nevirapine NVP 25 <33 kg : 350 mg q 24 hr
Stavudine d4T 33 <40 kg : 400 mg q 24 hr
Tenofovir TDF > 40 kg : 600 mg q 24 hr
< 30 2 mg/kg/ dose q 12 hr
Zidovudine AZT > 30 < 60 kg : 4 mg/kg/ dose q 12 hr

150 mg q 12 hr
> 6 13 LPV 225 mg/m2/ dose RTV 57.5 mg/m2/ dose q
12 hr

7- 15 kg : LPV 12 mg/kg/ dose RTV 3 mg/kg/ dose q 12 hr
15- 40 kg : LPV 10 mg/kg/ dose RTV 5 mg/kg/ dose q 12 hr
> 40 kg : LPV 400 mg/ dose RTV 100 mg/ dose q 12 hr
160-200 mg/m2/ dose q 12 hr
< 30 kg : 1 mg/kg/ dose q 12 hr
> 30 kg : 30 mg/ dose q 12 hr
300 mg/day
< 6 wk : 4 mg/kg/ dose q 12 hr 2 mg/kg/ dose q 6 hr
> 6 wk : 180-240 mg/m2/ dose q 12 hr

240-300 mg/m2/ dose q 12 hr

20

NRTI backbone

TDF TAF + FTC DTG
TDF TAF + 3TC +

ABC + 3TC EFV RPV
AZT + 3TC

CD4 : 100 < CD4< 200 : Bactrim forte 1x1 pc
CD4< 100 : Bactrim forte 1x1 pc , Fluconazole (200) 2 tab q wk

Tuberculosis) < 50 CD4 (cells/mm3)
2 > 50
Cryptococcosis
PCP / MAC / 2 28
CMV / PML / Cryptoporidium 46
24

12 72 28
NRTI backbone

TDF TAF + FTC DTG 50
TDF TAF + 3TC

+

TDF TAF + FTC RPV 25
TDF TAF + 3TC ATV/r 300/100
DRV/r 800/100

BIC 50

CrCl < 60 ml/min ) AZT TDF

21

1.

Emergency Contraceptive pill (Postinor®) 1
72 24

12

72 21 28
4
4
24

4 12

15
2

2-3

Postinor 4

22

2.

12 72
28

NRTI backbone

TDF TAF + FTC DTG 50
TDF TAF + 3TC +

TDF TAF + FTC RPV 25
TDF TAF + 3TC ATV/r 300/100
DRV/r 800/100

BIC 50

CrCl < 60 ml/min ) AZT TDF

23

(High Alert Drugs)

(high-alert drugs)

Ward 1 Ward 2 ER OR/LR
1. Adrenaline (Epinephrine) inj.1 mg/ml (1:1000)
2. Amiodarone inj. 150 mg/3 ml
3. Calcium gluconate inj. 100 mg/ml x 10 ml
4. Digoxin inj. 0.5 mg/2 ml
5. Magnesium sulfate inj. 8.1 mEq10% (10 ml), (50%) 2 ml
6. Potassium Chloride inj. 20 mEq/10 ml
7. Dopamine HCl inj. 250 mg/10 ml
8. Enoxaparine sodium 6000 anti-Xa IU/0.6 ml
9. Insulin (RI 100 unit/ml 10 ml, Mixtard 70/30 insulin 100
unit/ml 10 ml,3 ml(penfill), NPH insulin 100
unit/ml,3ml(penfill)
10. Norepinephrine(Levophed) injection 4 mg/4 ml
11. Warfarin tablet 2 mg,3 mg,5mg
12. Streptokinase injection 1.5 mu
13. Heparin injection 5,0000unit/ml in 5 ml (25,000 unit/vial)
14. Nicardipine inj . 10 mg/10 ml
15. Fentanyl inj 0.05 mg/ml
16. Morphine inj 10 mg/ml
17. Hypertonic sodium chloride (3%Nacl)
18. Pethidine inj 50 mg/ml
19. Nitroglycerine inj 5 mg/ml

-
-

24

1. / /
1)
2) 1
3) Morphine Pethidine

2.
1)
2)

3)
4)

3. mg. g. 24
1) (contraindication)
2) /

3) (drug interaction)
4)
5)

6)
7)
8)
4.
1)

2)

3)
2

4)
5)

25

5. 2
1)
/
2)

3)

4)
6.

1)

2)
3)

7.

1)
2)

-
-
-
- Lab/Parameter
-
- Contraindication Drug interaction

- Dependent double check Drug interaction
- Contraindication
-
-
-
-

26

- Dependent double check
- Lab/Parameter
-
-
-
-

monitor

Monitor

chart, OPD card

(IPD1, IPD2, ER, OR-LR)

27

Adrenaline Injection

Injection : 1 mg in 1 ml (1: 1,000)
: shock, anaphylaxis

(Supply) : 1 1 mg in 1 ml (1: 1,000) injection

(Storage):

1.

2.

3. ampoule

(Prescribing):

1.

-

- 1: 1,000 1: 10,000

-

Infant and children

Asystolic or pulseless arrest : 1 mg (1 amp) NSS 10 ml (1:10000)

0.01 mg/kg (0.1 ml /kg) 1 35

Adults

Cardiac arrest1. IV 1 mg 1 mg (1 amp) NSS 10 ml 1
10 ml
3 5 push 10 20

Endotracheal 2 2.5 amp 1:1,000 NSS 10 ml

2. ADENOSINE

3. CPR

(Preparation):

1. Adrenaline 1: 1,000 Adrenaline 1 amp

2. Adrenaline 1: 10,000

2.1 Adrenaline 10 amp (10 ml) NSS 90 ml (NSS 100 ml)

2.2 Adrenaline 1 amp (1 ml) NSS 9 ml

(Administration):

1. sc , im Adrenaline 1: 1,000 5 mg
NSS 20 ml
2. Direct iv 1: 10,000

3. iv infusion 0.1 mcg/kg/min infusion pump NSS, SWFI 10 ml
4. endotracheal tube 2 - 2.5 IV

28

(Monitoring):

1. EKG monitor CPR

2. BP, HR 15 1 30 stable
/min >120 /min
BP < 90/60 mmHg >160/100 mmHg HR < 60 tissue necrosis

3. iv infusion IV site

4. GCS

5. -

1. BP 140/90 mmHg
2. HR 140 /
3. Tissue necrosis

1. PROPRANOLOL
2.

- HYPOTENSION
- AGITATION HALOPERIDOL 2 5 MG IM
- DIAZEPAM IV
- CARDIAC ARRYTHMIAS BETA BLOCKERS
- HYPERTHERMIA
-

Amiodarone injection

Injection : 150 mg/3 ml

: Atrial Ventricular tachyarrythymia

: Rapid atrial arrythymia (AF with RVR) impair LV function Digoxin

(Supply):
1.
2.
3.

(Storage): High Alert Drug
1.
2.
3.

29

(Prescribing):

1. Cardiac arrest (VF/pulseless VT) : 300 mg dilute D-5-W 30 ml IV push 3 5 ( 150 mg IV)

2.1 g / 24 hrs IV push 20 ml

10 20

2. wide complex tachycardia (stable) : 24 1050 mg 3 phase

Rapid phase 150 mg / 3 ml(1 amp) ( 3 ml D-5-W 100 ml) 30 mg/min

10 900 mg ( 6 amp = 18 ml D-5-W 500 ml) 2

Slow phase 360 mg (200 ml) IV drip 6 . ( 33 ml/hr) Maintenance

phase 540 mg (300 ml) IV drip 18 ( 17 ml/hr) 24 .

Maintenance

(Preparation) (Administration): D-5-W

- NSS, Heparin, Cefazolin, Furosemide

- Plastic PVC 2

- 24

-

(Monitoring):

1. EKG VT, VF, Heart block

2. BP, RR 5 ( BP, RR

24 ) BP < 90/60 mmHg HR < 60 BMP

3. Serum electrolytes: K, Mg

:

- Hypersensitivity Amiodarone

- Severe sinus-node dysfunction, Bradycardia

- Cause syncope

- Cardiogenic shock

-

Calcium gluconate injection

: Injection : 10% Calcium gluconate in 10 ml (1 g/amp = 4.65 mEq/amp)
: , severe hyperkalemia

(Supply):
1.
2.

30

3. 1 10% 10 mL ( Calcium gluconate 1 g/amp

Elemental Calcium 93 mg/amp = 4.65 mEq/amp)

4.

(Prescribing):

neonatal tetany
MgSO4

- (Corrected serum calcium > 10.5 mmol/L)
- Digitalis
- Ventricular fibrillation

- Digitalis

- Phosphorus ( Corrected serum calcium Serum

Phosphorus) 55 mg/dL2

-

1. IM SC amp mL drip
2. mg g

(Preparation):

1. D-5-W , D-5-S , D-10-W NSS

1- 2 g/100 mL ( Calcium D-5-W NSS sodium
CPR
calcium Bicarbonate )

2. 24

3.

(Administration):

1. IM SC

2. IV 1.5 mL 10% Calcium gluconate

3. Bactrim, Ceftriaxone sodium, Cefazolin sodium, Dexamethasone,
Diazepam, Phenytoin sodium, Sodium bicarbonate

4. Digoxin Calcium gluconate IV push

10% Calcium gluconate 10 mL 100 mL 1

31

(Monitoring): 15
1. On monitor EKG HR < 60 / BP

< 90/60mmHg 8.1 - 10.4 mg/dL 11mg/dL
2.

- Calcium
- Calcium
3.
4.

1
5. Lab: Ca

1.

2. overdose sodium chloride iv infusion normovolumia
Calcium
Furosemide 80 100 mg iv 2 4 Sodium Chloride Calcium

reabsorption Furosemide

Digoxin injection

Injection : 0.5 mg in 2 ml
: Heart failure, atrial fibrillation

(Supply): 0.5 mg/2 ml
1. Digoxin injection

2.

(Storage):

(Prescribing):

:

Load dose: 0.25 0.5 mg (1 2 ml) 46

0.25 0.5 mg (1 2 ml) Heart rate 60 -100 /

Maintenance dose: 0.125 0.25 mg /

:

32

(Dispensing): /
1. 5
2.

3. K
4. 60 /

(Preparation): Digoxin injection :
1 ml steriled water ,NSS , D5W 4 ml

(Administration):
1 ml steriled water ,NSS , D5W 4 ml

(Monitoring):

hyperkalemia ( digoxin overdose)

1. monitor EKG 1

2. vital sign 15 4 4 BP

90/60 mmHg

3. 60 / 14 /

4. EKG : Prolong interval , ST depression ,S-A arrest ,A-V block , AF with slow

5. 3.5 mEq/L

1.

2. atropine 0.6 1.2 mg (1 2 amp) IV bolus bradycardia
(10-20 J)
: cardiovasion digoxin

: Dopamine injection Cardiac output symptomatic
bradycardia ( hypovolemia)
Injection : 250 mg in 10 ml
1. shock renal blood flow
2.
atropine
:
(Supply):

3.

33

(Storage):

(Prescribing):

- Hypotension, shock

- shock cardiac output, blood pressure,

urine flow

- cardiopulmonary resuscitation cardiac output, blood pressure

:

1. Dopamine bisulfites pheochromocytoma,

ventricular fibrillation Phenytoin (

bradycardia) cardiac arrythythmias occlusive vascular

disease

2. 20 microgram/kg/min

:1 20 mcg/kg/min

:1 20 mcg/kg/min 50 mcg/kg/min

:3 10 mcg/kg/min 1 4 mcg/kg/min 10 30

50 mcg/kg/min 20 30

mcg/kg/min epinephrine (adrenaline)

3.

-

-

- ml/hr ( infusion pump microdrop2min)

- scale

- BP

4.

(Dispensing):

iv line flush

(Preparation):

1. Dopamine iv

2. :

24

3.

Dopamine 1:1 2 amp +D5W 500 ml ( 1 mg = 1,000 mcg = 1 ml = 60 microdrop)

Dopamine 2:1 4 amp + D5W 500 ml ( 2 mg = 2,000 mcg = 1 ml = 60 microdrop)

34

ER Dopamine 100 mg (4 ml) + D5W 100 ml NSS

4. Dilantin injection

NAHCO3, ( Fe3+ salt)

1. IV infusion : 20 mcg/kg/min
24

infusion pump

(extravasation)

2. 1 5 microdrop 10 30

20

microgram/kg/min

3. hypotension

4. 24 24

(Monitoring):

1.

2. vital signs 15 4 30 2 1 stable (BP >90/60 mmHg

2 ) HR > 140 / BP > 140/90 mmHg

(15 mcq/kg/min ) BP < 90/60 mmHg

3. urine output : 0.5 cc/kg/hr 4 ( ) urine output

< 100 cc./hr.

4. EKG Prolong QT interval

5.

6. Lab : BUN , Cr

1.

severe hypotension

2.

(peripheral ischemias) (necrosis)

35

Dopamine injection

dopamine injection

Insulin injection 3 mL (penfill) 10 mL (vial)

: RI insulin 100 unit/ml 10 ml
Mixtard 70/30 insulin 100 unit/ml 10 ml, 3 ml (penfill)
NPH insulin 100 unit/ml 10 ml, 3 ml (penfill)
: hyperglycemia, DM

(Supply):
1.
2.

3. 1 100 unit/mL 2

36

4.

(Storage) : 28
1.

42
2.

(Prescribing) : 3 (sc x-x-x ) stat
1. prn
2.
3. sc u0

3

(Dispensing) :
1.

2.
3.

4. /

5. /

(Preparation) (Administration):

1. ( Regular Insulin : RI ) ( IV infusion)

NSS 1 unit/mL rate 0.01-0.1 unit/kg/hr D-

5-W 24

2. Infusion pump/ Syringe pump

(Monitoring): DTX 1

- DTX BG < 80 > 350 mg/dl v

- hypoglycemia hyperglycemia

hypoglycemia: CPG hypoglycemia

37

Magnesium sulfate (MgSO4) injection

Injection : 50% in 2 ml (Mg2+ 1 gm = 8.1 mEq), 10%

: (pre-eclampsia eclampsia)

: (Supply)
1.

2.

(Storage):

1.

2.

(Prescribing):

1.

50

2.

3. 30 40

4. digoxin heart block

5. heart block myocardial damage, pre-eclampsia

2,

(Dispensing):

50% Magnesium sulfate iv push

flush

(Preparation):

1. Sodium bicarbonate ( )

2. iv dilute ( D5W NSS) 20%

(Administration):

1. iv push 20% D5W NSS 1.5 /

10%

2. im 25 50 % 20%

3. iv infusion infusion pump

(Monitoring):

1. Hypermagnesemia ,,

Deep tendon Reflex

2. 15 2 30 2 1
,
off BP < 90/60 mmHg 160/110 mmHg , RR <14 /

HR <60 ,120 /

38

3. Observe FHS < 120 160 /

4. Lab : Mg 12-24

5. -4 < 30 cc./hr

hypomagnesemia

- 130 ideal body weight ideal body weight

- bolus (1 2 g

10 )

hypermagnesia 1.9 2.5 mg/dl : normal level

> 3 mg/dl : CNS depression, diarrhea, depressed neuromuscular transmission and deep tendon reflexs

> 5 mg/dl : flushing, somnolence

> 12.5 mg/dl : complete heart block, respiratory depression

- hypotension asystole

10% Calcium gluconate 10 20 ml iv push 20 10 ml (1 amp)

respiratory depression heart block refer for dialysis

Norepinephrine (Levophed) injection

Injection: Bitartrate 8 mg

Norepinephrine 4 mg 4 ml (1 mg/ml)

: (Supply):
:

:
1.
2.
3.

(Storage):
1.

39

2. High Alert Drug
3.

(Prescribing):

continuous IV infusion NSS (Maximum dose 1 2
- : 0.05 0.1 mcg/kg/min
2 mcg/kg/min
mcg/kg/min) Nasogastric tube
- : 0.5 1.0 mcg/min

8 30 mcg/min
Hypotension, shock and cardiopulmonary resuscitation

- : 0.1 mcg/kg/min
- :8 12 mcg/min
Upper GI Hemorrhage
- 8 mg NSS 250 ml Intraperitoneal 8 mg

68 2 46
-

(Preparation) (Administration): D-5-W D-5-S 100 ml
NSS oxidation
24

infusion pump

-

cardiovascular parameter

-

- antecubital vein

femoral

(Monitoring):

- Anaphylaxis Vital signs (Heart rate, BP) 10 30

- Hypotension IV drip Vital signs (Heart rate, BP) 1

- IV site 1

- : BP > 120/80 mmHg HR > 180 /

40

- :BP > 160/90 mmHg HR > 120 /
:

Potassium Chloride injection

Injection : 20 mEq in 20 ml (1.5 g)
: (hypokalemia)

:
(Supply);
1.
2.

3.

(Storage): KCl injection
1.

2.

(Prescribing): Serum K+ (ml/hr)
1. (mEq/L)

2.

3. im, iv push (bolus)

4. 40 mEq/L

5. 20 mEq/hr 10 mEq/hr

EKG

6. 40 mEq/L peripheral line phlebitis

7. K+

8. 10 mEqKCl in NSS 100ml (isotonic solution)

9.

41

(Preparation and Dispensing) :
1.

2.

3. NSS 24
4. 10
5. HN
6.
7.

8. ( Amikacin, Amoxicillin, Mannitol, Fat

emulsion)

9. Y-site Diazepam

:

- dextrose NSS 40 mEq/L

- (critical state:severe hypokalemia:serum K+ < 2 mEq/L) NSS

dextrose

- KCl 10

(Administration) :

MAR

double check

Peripheral line

- 40 mEq/L 10 mEq/hr

- 500 ml 1000 ml

- < 20 mEq/L infusion pump

- > 20 mEq/L infusion pump

- Isotonic solution 10 mEq/100 ml solution infusion

pump

Central line

- 40 mEq/L infusion pump EKG

- 10 mEq/100 ml solution

Heart block

(Monitoring) :

1. Moderate Severe deficit vital sign 2

Serum K+ 4 6 ( )

42

2. EKG

- Serum K+ < 2.5 mEq/L arrhythmias

KCl > 10 mEq/L

3. peaked T wave , prolong QRS complex Oliguria

4

4.

1. Serum K+ > 5.5 mEq/L
2. EKG
3. Urine output < 200 ml/8 hr
4. Heart Rate > 120 < 60
5. Cr > 2.0

Hyperkalemia
1. 8 mEq/L
2. severe hyperkalemia (K > 6.5 mEq/L)

43

- acidosis sodium bicarbonate 40 160 mEqiv infusion 5 10

15

- ECG 50% dextrose 50 ml. IV D10W Regular insulin (RI) 10-

20 U/L 300-500 ml

-

- ECG P wave calcium gluconate 0.5 1 g. 2

() digitalis

- sodium polystyrene sulfonate (Kayexalate) rectum

- hemodialysis peritoneal dialysis digitalis
- digitalis

toxicity

Warfarin tablet venous thrombosis,
systemic embolism
Tablet 2 mg, 3 mg, 5 mg
:

pulmonary embolism, atrial fibrillation with risk of embolism
myocardial infarction

(Supply):
1.
2.

3.

(Storage):
1.
2

(Prescribing):
:
Usual initial dose : 2 5 mg
Maintenance dose : 2 10 mg /
:

(Dispensing):
1.

44

2. 1
1 mg
2 mg
3.

4. 10 mg/day INR > 3

5.
6. 5 10
7. Warfarin Gemfibrozil, Paracetamol, NSAIDS,

(Administration):
(Monitoring):

(hematuria) (melena) 24

Prothombin time (PT), INR, HCT

- Serious bleeding Warfarin Vitamin K1 10 mg slow I.V. infusion
Fresh plasma transfusion

- Vitamin K1 12

Streptokinase injection 1.5 mu

: 1.5 mu

: Thrombolytic agent severe deep vein thrombosis, pulmonary emboli, myocardial

infarction

(Supply):
1.
2.

(Storage):

1.

2. , reconstituted solution (4 CC) 24

(25 CC) 8

(Prescribing):

: 3000-4000 U/kg over 30 min 1000-1500 U/kg/hr

45

: intradermal skin test streptokinase 100 U 15-20

Acute MI : IV 1.5mU 60

Acute pulmonary embolism : IV 3mU 24

/

- Normal saline 5 ml

NSS/D5W 500 ml 1.5 mu/50 ml.

24

- IV Infusion pump D5W, 0.9% sodium chloride, Ringer's

Lactate iv infusion 60 24 8

25Cc

(Administration):

- continuous IV infusion pulmonary embolism, deep vein thrombosis, arterial

embolism thrombosis

- loading dose pulmonary embolism , deep vein thrombosis, arterial embolism thrombosis

peripheral IV line infusion pump 250,000 IU 30

- maintenance dose infusion pump 100,000 IU/hour pulmonary
arterial embolism thrombosis
embolism continuous IV infusion 24
deep vein thrombosis 72
continuous IV infusion 24 72

- coronary artery thrombi peripheral IV line infusion pump
maintenance dose
1.5 mU 1

-

:

: 0.3 1

: Fever, Bruising, rash, anemia, muscle pain, anaphylactic

(Monitoring)

1. thrombin time, APTT, PT, hematocrit platelet count

heparin

2. vital signs 5-10

hypotension 90/60 mmHg .

.

46

3. 2-3
Anaphylaxis
25 mmHg

4. Monitor EKG defibrillator cardiac arrhythmia

heart block, ventricular tachycardia , ventricular fibrillation

5. 15 1 . .

whole blood

1. local pressure

whole blood, packed RBCs, cryoprecipitate, fresh frozen plasma, platelet (

dextran)

2. bradycardia atropine

3. arrhythmias lidocaine hypotension

dopamine plasma expander albumin

4. Adrenaline

5. heparin streptokinase

streptokinase thrombosis pulmonary emboli heparin
6. 100
7. 3-4 PTT

lower extremities

8.

Enoxaparin injection

: 60 mg/ml
:
1. Unstable angina high risk Non- ST elevated myocardial infarction ( NSTEMI)
2. Venous Thromboembolic Disease
3. Prophylaxis of Venous Thrombosis
4. Prophylaxis of Venous Thromboembolism
5. Prevention of Extra-Corporeal Thrombus During Haemodialysis

47

(Supply):
1.
2.

(Storage):

(Prescribing):

Unstable angina high risk Non- ST elevated myocardial infarction ( NSTEMI)

1 mg/kg SC q 12 hrs ASA 100-325 mg OD

Venous Thromboembolic Disease

1.5 mg/kg SC OD 1 mg/kg SC BID

(High risk patients: obese, iliac vein thrombosis, cancer 1 mg/kg SC BID )

Prophylaxis of Venous Thrombosis

- High Risk Patients: 40 mg SC OD (0.4 ml; anti-Xa: 4000 iu)

- Moderate Risk Patients: 20 mg SC OD (0.2 ml; anti-Xa: 2000 IU)

- Prolonged Thromboprophylaxis: 40 mg OD for 30 post-operative days

Prophylaxis of Venous Thromboembolism

- 40 mg SC OD

Prevention of Extra-Corporeal Thrombus During Haemodialysis

- 1 mg/kg

(Administration): :

- Enoxaparin, heparin heparin
-
- heparin induce thrombocytopenias

1. Double check IM *
2. SC, IV
3.

4. SC left & right anterolateral & left or right posterolateral abdominal wall:
5. (Brushing)