คู่มือระบบยาโรงพยาบาลศรีสงคราม ปี 2565

48

6. Spinal/ Epidural anesthesia catheter 10
Warfarin ,
12 . bleed

7. : Amikacin Inj , Amiodarone Inj , Ciprofloxacin inj /

8. *** Enoxaparin

Aspirin , NSAIDs, Clopidogrel , steroids ( )

9.

High Alert Drug

10.

11.

:

: 0.3 1

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

(Monitoring)

signs of bleeding ***

hemoglobin, hematocrit, Plt - skin necrosis

Fentanyl Injection

: 0.05 mg/ml
: 1.
2.

(Supply):
1.
2.

(Storage):

(Prescribing): nitrous oxide 150 mcg/kg
/
1. :

Stat dose 20-50 mcg IV
2.

49

IM 50-100 mcg 30-60 1-2
- 0.5-1 microgram/kg/hr

3

microgram/kg/hr GFR

- GFR 10-50 ml/min 75%

- GFR 10 ml/min 50%

(Administration):

: IM IV 3-5 ( )

- SWFI, NSS, D5W 5 ml 10 microgram/ml

24 .

- Diazepam , Lidocaine Antidote Naloxone

respiratory depression hypoxia

(Monitoring)

- dose Sedation score 30

- Sedation score 4 .

- 3 microgram/kg/hr sedation Vital

sign Sedation score 1

- Respiratory rate < 15 /min ( ) <12 /min ( )

- Sedation score > 1

- O2 saturation < 92 % BP < 90/60 mmHg

Heparin Injection

5,000 unit/ml in 5 ml (25,000 unit/vial)

: Anticoagulant: thromboembolic disorders

Myocardial Infarction (MI), Acute ischemic stroke, Deep Vein Thrombosis (DVT), Pulmonary Embolism (PE)

: (Supply):

1.

2.

(Storage): 2-8 prefilled syringe
14 100,000/mm3 keep arterial line central line

24
(Prescribing):

1. (platelet)

50

2. neonates infants 10 kg 12 100 units/ml
systemic anticoagulation enoxaparin heparin 10-11

3. 60
4. enoxaparin

enoxaparin dose
:

- : SC 5,000 unit 8 - 12

- Intermittent IV 10,000 unit, 50 100 unit/kg 4

- unfractionated heparin

50 unit/kg loading dose 800-1500 unit/hr IV infusion weight-

based dosing regimen

- MI: IV bolus 60 70 unit/kg (maximum continuous IV infusion 12 - 25 unit/kg/hr

- DVT, PE: IV bolus 80 unit/kg continuous IV infusion 18 unit/kg/hr

aPTT(second)

< 35 (<1.2xcontrol) 80 U/kg bolus rate 4 U/kg/hr

35-45 (1.2-1.5xcontrol) 40 U/kg bolus rate 2 U/kg/hr

46-70 (1.5-2.3xcontrol)

71-90 (2.5-3.0xcontrol) rate 2 U/kg/hr

>90 (>3.0xcontrol) 1 . rate 3U/kg/hr

: Intermittent IV 50 100 unit/kg 50 100 unit/kg 4

IV infusion 50 unit/kg 15 - 25 unit/kg/hr 2 4 unit/kg/hr 6 -8

: SC, IV push, IV infusion IM SC IV bolus

- IV infusion infusion pump

- heparin line flushing 10 .

10 unit/ml 100 unit/ml

: /
Heparin-induced thrombocytopenia
:- CBC, PT, aPTT baseline

51

- aPTT continuous IV infusion 6

intermittent IV infusion aPTT 3.5 4

- Aptt 1( 1.5 - 2.5 x control

- CBC, PT

- guaiac test, U/A, BP (< 90/60 mmHg), HR

(>120 / )

in 10 ml) antidote Protamine sulfate (Sterile solution for injection 10 mg/ml

heparin ( ) Protamine
< 30 1 mg/100 U heparin
30-60
60-120 0.5-0.75 mg/100 U heparin
>120 0.375-0.5 mg/100U heparin
0.25-0.375 mg/100 u heparin

52

Heparin

Morphine inj

: Morphine inj. 10mg/ml
:

(Supply):
1.
2.

(Storage): syrup
3-5
: 5( .5)
: IM, SC : 5-15 mg 4

- IV push 1 mg/ml
- IV Infusion
0.1-1 mg/ml

53

Naloxone IV push 5-10
: double check IV infusion: 1 mg/ml 24
NSS D5W

Usual infusion concentration:

()

RR -IV push ( 5 x4 30 X 2 ) (Critical point)
RR<12 /
BP -SC,IM ( 15 x 4 30 X2 ) BP<90/60 mmHg
HR<60 /
HR -IV infusion ,Oral( 1 .x4 4 Sedative score 2
Pain score 4
2 Saturation O2 Saturation<94%

( ):

Hypoxia overdose

10 ( 1 30 / 1 20 /

continuous drip

Naloxone

Opioid intoxication: Naloxone 0.4-2 mg 2-3 (

10 mg)

10 naloxone (Duration 45 )

Morphine morphine

Nicardipine chronic stable angina

: Nicardipine inj. 10mg/10 ml
: hypertension, Postoperative Hypertension

(Supply):
1.
2.

(Storage):

54

1. 2.5 mg/hr 5 ( rapid titration)
2. 15mg/hr 3

: IV: Acute hypertension nicardipine infusion
- 5 mg/hr (3-5 mg/hr)

15 ( gradual titration)

mg/hr
- hypotension tachycardia

:

Double check sodium bicarbonate lactated ringer

solution 0.1-0.2 mg/ml infusion pump D5W, D5S/2, D5S/2

D5S Sodium 0.45% NSS 24

venous thrombosis phleblitis vascular impairment small veins dorsum

peripheral vein infusion site 12

24

:

- (angina)

- hypotension

tachycardia

- serum potassium ( hypokalemia arrhythmia)

-

Nitroglycerine injection (5 mg/ml) in 5 ml

(5 mg/ml) in 5 ml
- (Onset)
- (Peak)
- (Duration) 5-10

- sublingual nitroglycerin beta blocker
- angina / complication
- acute angina pectoris/

phosphodiesterase type -5 (PDE-5) inhibitors sildenafil
:

55

:continuous I.V infusion : 0.25-0.5 mcg/kg/min

Usual dose :

- 1-3 mcg/kg/min 0.5-1 mcg/kg/min 3-5 minutes

- : 5 mcg/kg/min

- : continuous I.V infusion : 5 mcg/min

- 5 mcg/min 3-5 20 mcg/min

- 10-20 mcg/min 3-5 200mcg/min

IV infusion infusion pump

- NTG 1:5 4 ml (20 mg) NSS 5%D/W 100 cc
NSS 5%D/W 100 cc
- NTG 1:10 2 ml (10 mg)
15 2
Monitor : HR >100 /

- BP HR EKG

- BP 5 2 1

- BP <90/60 mmhg HR < 60 /

-

Nitroglycerine injection (5 mg/ml) in 5 ml

: continuous I.V infusion : 5 mcg/min

5 mcg/min 3-5 20 mcg/min

10-20 mcg/min 3-5

200mcg/min

: :continuous I.V infusion :

0.25-0.5mcg/kg/min Usual dose : 1-3 mcg/kg/min

0.5-1 mcg/kg/min 3-5 minutes

IV infusion infusion pump

- NTG 1:5 4 ml (20 mg) NSS 5%D/W 100 cc

- NTG 1:10 2 ml (10 mg) NSS 5%D/W 100 cc

Monitor : BP HR EKG

- BP 5 2 15 2

1 BP <90/60 mmhg HR < 60 / HR >100

/

-

56

Pethidine injection 50 mg/ml

(5 mg/ml) in 5 ml
- (Onset) 10-45
- (Peak) 0.5-1
- (Duration) 2-4
:
-
- Pre-anesthetic medication
:

- Pain : IM, SC: 50-150 mg 3-4

- : IM, SC: 50-150 mg 30-90

- : IM, SC: 50-100 mg 1-3 .

- Pain: IM,SC:1.1-1.8 mg/kg/dose 3-4 (Maximum: 50-150 mg/dose)

- : IM,SC:1.1-2.2 mg/kg 30-90

:

Asthma Shock

:

- Clcr 10-50 ml/min 75%

- Clcr<10 ml/min 50%

/:

- IV push ( 45 ) SWFI 5 ml

- 10 mg/ml iv infusion D5W 0.1-1 mg/ml

:

Furosemide, Heparin, morphine, phenytoin, sodium bicarbonate

:

- IM,SC ( , 5) 30-90

- IV infusion 1 mg/ml 15-30

- IV push 5

:

hypotension bradycardia

palpitation

Monitor :

RR,HR,BP pupil 15 1

12

:

57

- RR 6 < 14 /min- 1-6 <20 /min

- < 30 /min - < 40 /min

- BP < 90/60 mmHg ( ) , HR<60 Sedative score > 3
0.01 mg/kg)
:

naloxone inj. 0.4 - 2 mg IV 3 max 10 mg (

58

- NSS, D5W / Neonate: 2-20 mcg/kg/min
Dopamine inj. : alkaline solution Children: 1-20 mcg/kg/min
250 mg./10ml.
Dopamine 1:1, 2:1 KCl, NaHCO3, Iron salt 50 mcg/kg/min

5-8 mcg/kg/min = inotropic+HR acceleration
>8 mcg/kg/min = HR acceleration
> 10 mcg/kg/min = HR acceleration+Vasoconstriction
15-20 mcg/kg/min = Vasoconstriction

Adrenaline inj. NSS, D5W, RLS NaHCO3 Anaphylaxis
1 mg./ml. IM; 0.01 mg/ kg/dose (1:1,000) lateral
IV push NSS (

1 amp NSS 9 ml thigh repeat 5-15

10 ml) 1:10000 (max dose 0.3 mg)

(0.1mg/ml) CPR Pulseless VT/VF ;asystolic
/pulseless electrical activity
IV/IO; 0.1 mg/kg/dose (1:10,000)

3-5

Atropine inj. - - Bradycardia : 0.1 mg
0.6 mg./ml. - IV/IO: 0.02 mg/kg
-
Dexamethasone - 0.5 mg
inj. 4 mg./ml.
CPM inj. IV: 0.1-0.2mg/kg/dose
10mg/ml.
- Anaphylaxis:
Noradrenaline D5W, D5S IV: 0.25 mg/kg/dose
(Levophed) : IV plasma Max. 2-6 =6mg/kg/day
1 mg/ml in 4ml NaHCO3 6-11 = 12 mg/kg/day
Levophed: 1:62.5, [dose 0.35 mg/kg/day IV,SC,PO q
1:31.25 6-8 hr]
Start : 0.05-0.1 mcg/kg/min
Max : 2 mcg/kg/min

Amiodarone D5W NSS, Heparin,Cefazolin, Furosemide Tachycardia with Pulse:
injection 150mg ( Loading dose 5 mg/kg over 20-60 min

in 3 ml <2 )

59

Maintenance dose 5 mcg/kg/min by
continuous infusion, titrate dose to
desired effect , Max 15 mcg/kg/min

- - / Terminal of seizure/Epilepsy :
Diazepam inj. -
5 mg./ml.
: 30 -5

IV 0.2 0.3mg/kg/dose slowly push

Rectal suppo. 0.5 mg/kg/dose q 15-30

min

Max dose 5 mg.

> 5 : IV 0.2-0.3

mg/kg/dose slowly push

Max dose 10 mg.

Adenosine Pediatric tachycardia with pulse

(SVT/VT)

First dose: 0.1 mg/kg/dose rapid bolus

(Max 6 mg)

Second dose: 0.2 mg/kg/dose rapid

bolus (Max second dose 12 mg)

Phenytoin (50 NSS - Status epilepticus
mg/ml; 5
ml/amp) ( Diazepam )

Loading dose: 20 mg/kg/dose PO/IV

infusion over 15 min, repeat dose with 5

mg/kg/dose IV q 2 hr, Max 30 mg/kg/day

Maintenance: 5-7 mg/kg/day PO/IV q 12

hr

Step Anaphylaxis
1. Adrenaline (1:1,000) 0.01 mg/ kg/dose IM lateral thigh
2. CPM IV: 0.25 mg/kg/dose

Max. 2-6 = 6mg/kg/day
6-11 = 12 mg/kg/day
3. Hydrocortisone (5 mg/kg/dose) IV, Max 100 mg
4. Ranitidine 1 mg/kg/dose IV

60

CPM, Dimenhydrinate
Aspirin, Ibuprofen

,
Antacid tab.

61

1. 2

1.
2.

(
)

3.

>

2.

62

3.

4.

63

5.

6.

64

7.

8.

65

9.

:,

66

67

68

69

70

.. ..................................
. ..................................

...18 . . 2565...
.....Chlorpheniramine 4 mg (20 tab.)......

... ...
.... .....

... 1... ...3...
30

... ...

71

1.

2.

3.

a. --- OPD card

b. ---

4.

5. OPD card Hosxp

--- Doctor order sheet drug profile

6. APR

.

--- OPD card
----

Hosxp Hosxp
OPD card Hosxp OPD card

Refer

( 72

) OPD card )

( -
00.30 .
- 16.30 .- 00.30 .
- 08.30 .- 00.30 .

Consult ( )

Consult . OPD card
( + /

) ()
-
+
+
Com

OPD card

OPD
Card

73

1. (serious) ADR
- Type A ADR

Type A ADR F

- Arrhythmia ( ) Aminophylline, Salbutamol

- Anemia AZT

- Ataxia ( ), Gingivitis ( ) Phenytoin, Carbamazepine
Methotrexate
- Thrombocytopenia, Granulocytopenia

- Myalgia, Myopathy/Rhabdomyolysis ( )

Statin

- GI bleeding Steroid, NSAIDs, Aspirin

- Jaundice Cimetidine, Fluconazole

- Nephropathy toxicity Aminoglycosides, Amphotericin B

- Ototoxicity ( ) Aminoglycosides Amikacin

- Hypokalemia Acetazolamide, HCTZ
- Hypotension Hyoscine, Tramadol

- Type B ADR (Drug Allergy)
Skin reactions

Angioedema, Fix-drug Eruption, Urticaria, Pruritus, Rash, Angioedema, Eczema, Skin discoloration

Anaphylactic shock, Anaphylactoid reactions

2.
1. HN
2. generic name ( trade name® )

3. ( ADR ) 1-3
ADR

1 (Certain): (Dechallenge)
ADR 90-100 % (Rechallenge)

74

2 (Probable):
(Dechallenge)

ADR 70-90 %
3 (Possible):

ADR 60-70 % / ADR
4.
5.

6.

7.

8.

- OPD Card
- OPD Card
-

-
/ADR

- OPD Sticker
ADR

()
1)

,-
2)

OPD card

()
1)

75

2)
Chart
OPD Card

....................................HN..............................
................................................................
.................................................................

1) ( ADR )
2) skin

rash, renal failure, hepatitis / notify Pharmacist
ADR
3)
OPD Card
1) / Drug Cross

/ADR 2) Severe Certain
Reaction 3) HN

- generic name ( trade name® )
( ADR )
-
/ ADR
4)
1.
2.

3.
4.

5.

76

6. ADE
7.
8. 2

Type A (Augmented ADR)
Type B (Bizarre ADR)

Type A (Augmented ADR)

Type A (Augmented ADR) Type A (Augmented ADR)

o ADE Hypokalemia HCTZ
o Hyponatemia Digoxin, Beta-blocker (Atenolol, Metoprolol, Propanolol),

Amiodarone Bradycardia
o
o Hyperkalemia ACEI (Enalapril), ARB (Losartan)
o
Metabolic acidosis metformin
ADE
ADE Glibenclamide, Glipizide

ADE LAB
LAB

77

ADE
Consult

ACE: Enalapril K+> 5 (hyperkalemia)
ARB:Losartan
HCTZ (Enalapril SCr > 3 30% baseline )

Metformin K+< 3.5 Na+< 130

Glibenclamide (Hypokalemia, Hyponatremia)
Glipizide
Digoxin, Atenolol , Metoprolol, SCr > 1.5 ( ) >1.4 ( )
Amiodarone, Propranolol
GFR<30 ml/min (metabolic acidosis)

GFR < 30 ml/min

GFR < 10ml/min

HR < 60 (Bradycardia)

Consult

Consult

./

K+> 5 (Hyperkalemia) K+< 3.5 (Hypokalemia)
Na +< 130 (Hyponatremia) HR < 60 (Bradycardia)

2

)
Off

)

78

Intradermal skin test Intradermal skin test
-
- dermis
-
sensitive hypotension, angioedema, airway obstruction
systemic reaction

30

- false positive

skin test

1. Insulin Tuberculin syringe 3/8 5/8 26-30 gauge needle)

syringe leak syringe

0.01 - 0.02 ml Penicillin G 10,000 u/ml

(small bleb)

2. Negative control 1.5 ( 5

.)

3. 15

- 0.1 mg/ml false
- bleb 0.01 0.02 ml

negative
- positive control morphine sulfate

positive control

(Positive reaction)

(wheal) 6x6 mm (erythema) negative
)
control 3-5 . (

(Negative reaction)

negative control

/ 10,000 u/ml cephalosporin)
- Penicillin G 3 mg/ml (
- -lactam drugs

(control)

79

Negative control 0.9 % NaCl (saline control)

1. Penicillin G 10,000 u/ml

1. Penicillin G Sodium 1 mu/vial 0.9% NaCl 10 ml (

100,000 u/ml)

2. syringe insulin 1 ml 10 units syringe insulin (10 units

syringe insulin 0.1 ml)

3. syringe insulin 100 units syringe insulin (100 units

syringe insulin 1 ml) 10,000 u/ml

2. -lactam drugs 3 mg/ml cephalosporin

1. cloxacillin cephalosporin ceftriaxone 1 gm/vial

10 ml ( 100 mg/ml)

2. 1 ml 10 ml (

10 mg/ml)

3. syringe insulin 1 ml 30 units syringe insulin (30 units

syringe insulin 0.3 ml)

4. syringe insulin 100 units syringe insulin (100 units

syringe insulin 1 ml) 3 mg/ml

skin test

- skin test immediate

1 anaphylaxis,

hypotension, laryngeal edema, wheezing, urticaria angioedema

- skin test immediate

- skin test hemolytic anemia, Stevens-Johnson

syndrome (SJS), Toxic epidermal necrolysis (TEN), Erythema multiforme (EM)

- skin test anaphylaxis

- skin test

- allergic symptom

- skin test

- skin test

- skin test antihistamine corticosteroid false

negative

- , Human immunodeficiency virus (HIV), Systemic

lupus erythematosus (SLE)

-

80

- penicillin cephalosporins 5 first generation

cephalosporins cephalexin, cefazolin third generation cephalosporins

5 (side chain) first generation

cephalosporins (third generation cephalosporins ceftriaxone, cefotaxime, ceftazidime)

- (Positive reaction)

- (Negative reaction)

2/2551

14 . .2551
- ERIG Skin test

- Penicillin G

81

Look-Alike Sound-Alike (LASA) Medication

1.

ALDOmet SINEmet alPRAZOLAM alLOPURINOL
amIODARONE
(Methyldopa) (Carbidopa+Levodopa) diMENHYDRINATE
cefTAZIDIME D/5/N/5
aldOMET aldATONE HISTA-oph
ROXITHEOmycin fluPHENAZINE
(Methyldopa) (Spironolactone) dicYCLOMINE Metoprolol
D/5/N/2
amITRIPTHYLINE amLODIPINE fluCONAZOLE
AMItripthyline NORtripthyline
AMOXYcillin DICLOXAcillin hydrALAZINE
ChlorPHENIRAMINE metFORMIN
ChlorAMPHENICOL cefAZOLIN
cefTRIAZONE CIPROfloxacin (500)
CPM CPZ
DEX-oph POLY-oph sineMET
CLINDAmycin CLARITHROmycin traZODONE
dicloFENAC dicloXACILLIN Vitamin B complex
D/5/N/2 D/5/N/3
fluOXETIN fluNARIZINE
FLUconazole KETOconazole
ELTRoxin DIGoxin
hydrOXYzine hyDERgine

metoCLOPAMIDE (Co-dergocrine)
metiMAZOLE
norFLOXACIN metroNIDAZOLE
metFORMIN
NORfloxacin (100) norTRIPTYLINE
0.45%NSS Ofloxacin (100)
loraTADINE 0.9%NSS
loraZEPAM
pheNOBARBITAL pheNYTOIN
simVASTATIN simeTICONE
traMADOL traNXENE
Vitamin B1 Vitamin B6

2. 82

Vial Allopurinol PTU RI
Vial Co-trimoxazole fort Nevirapine (NVP)

Ampoule Amlodipine Simvastatin
3. Dextromethorphan Diclofenac
Fluphenazine dec inj Haloperidol dec inj
Omeprazole
Gemfibrozil
MIXtard NPH
Sterile water
Sodium chloride for irrigation
for irrigation Vitamin B complex
Vitamin B1

Dry syrup Alprazolam (0.25) Alprazolam (0.5) Ampicillin 1 g
Vial Amitripthyline (10) Amitripthyline (25) CPZ (100)
Amoxycillin (250) Amoxycillin (500) Haloperidol (5)
Ampule/Vial
Amoxycillin Amoxycillin

(125 mg/5 ml) (250 mg/5 ml)

Ampicillin 250 mg Ampicillin 500 mg
Artrane (2) Artrane (5)
ASA (81) ASA (300)

Clonazepam (0.5) Clonazepam (2)
Clozapine (25) Clozapine (100)
Co-trimaxazole Co-trimaxazole forte

CPZ (25) CPZ (50)
Diazepam (2) Diazepam (5)
Dicloxacillin (250) Dicloxacillin (500)
Furosemide (40) Furosemide (500)
Furosemide (20) inj Furosemide (250) inj
Haloperidol (0.5) Haloperidol (2)
Ibuprofen (200) Ibuprofen (400)

83

Ampule 10% Magnesium 50% Magnesium
sulfate sulfate

Isordil (5) Isordil (10)
Lamivudine (150) Lamivudine (300)
Lorazepam (0.5) Lorazepam (1)

MOM 60 ml MOM 240 ml Oseltamivir (75)
Norfloxacin (100) Norfloxacin (400)
Nortripthyline (10) Nortripthyline (25) Seretide Evo 25/125
Oseltamivir (30) Oseltamivir (45) Warfarin (5)
Paracetamol (325) Paracetamol (500)
Perphenazine (4) Perphenazine (8)
Phenobarbital (30) Phenobarbital (60)
Plumicort (100) Plumicort (200)
Rifampicin (300) Rifampicin (450)
Risperidone (1) Risperidone (2)
Seretide accuhaler Seretide Evo 25/50

TA 0.02% TA 0.1%
Thioridazine (50) Thioridazine (100)

Warfarin (2) Warfarin (3)
Zidovudine (100) Zidovudine (300)

84

Warfarin bioavailability Warfarin

therapeutic index

(onset)

warfarin

Warfarin

1.

- Hypermetabolic states: , Hyperthyroidism, Infection clotting factors

Warfarin Warfarin
Warfarin
- clotting factors
Warfarin
- Malnutrition: albumin Warfarin
Warfarin
- (Heart Failure)

Warfarin

- Hypothyroidism clotting factors

2. CYP450 2C9 Warfarin
Warfarin

3. Drug interaction (DI)
3.1 warfarin
Antiseizure
- Carbamazepine
- Phenytion, Phenobarbital
Antibiotic
- Rifampicin, Dicloxacillin
- Griseofulvin
Antithyroid agents
- PTU
3.2 warfarin
Cardiovascular Drugs
- Amiodarone, propafenone
- Fluvastatin, rosuvastatin, Simvastatin
- Propranolol
Antibiotics
- Erythromycin, clarithromycin, Roxithromycin

85

- cotrimoxazole, ciprofloxacin, cefoperazone, Quinine

- metronidazole , Amoxycillin, Isoniazid, Norfloxacin

- Doxycycline

Antifungals

- Ketoconazole, itraconazole, fluconazole

Acid suppression therapy

- Cimetidine, Ranitidine, Omeprazole

Anticoagulant / Anti-platelets

- Heparin, Clopidogrel, Aspirin

Antilipid

- Gemfibrozil, Simvastatin

NSAIDs Coxibs

4.

- Vitamin E, Fish oil
warfarin
- (Gingko biloba)
warfarin
-K
-K

-E

5.
Warfarin

Warfarin

86

Target INR

INR 10-20% INR
< 1.5 5-10% 1
1.5-1.9 Continue same does 2
2.0-3.0 5-10% 1
3.1-3.9 Hold for 1 day then 10% 2
4.0-4.9 Omit 1-2 doses, Vit K1 1
5.0-8.9 no bleeding 1 mg orally
Vit K1 5-10 mg orally Admit
9.0 no bleeding Vit K1 10 mg iv plus FFP 12
Major bleeding with any I Repeat Vit K1
every 12 hours if needed
NR

Adverse drug interaction (ADR) warfarin 2.0 3.0 INR
INR
INR < 1.5 INR
1.
INR > 6 Warfarin

(Thromboembolism event) INR

1.1 Minor thromboembolism event

(mild superficial thrombophlebitis)

1.2 Major thromboembolism event

- (TIA) (stroke)

- (recurrent deep venous thrombosis)

- (Pulmonary embolism)

- (neurologic deficit)

-

2. (Bleeding complication) INR

2.1 Minor bleeding

-

-

-

2.2 Major/life threatening bleeding

87

-
-

-2

-

Warfarin

Warfarin FDA Pregnancy Category X

nasal hypoplasia stippled epiphyseal

calcification Warfarin Vitamin K

()

Warfarin 23

heparin

1. Warfarin
2.
3. (ADR)
4. (DI)
5. Warfarin
6. INR
7.
8.
9.
10.
11.

88

(Medication error)

(Medication error)

1. (Prescription error) ( order)
2. (Transcribing error)
3.
4. (Dispensing Error)
1. (Administration Error)

(Prescription error)

2. (Transcribing error)
- /
- /
3. (Dispensing Error)

/ (Administration error)
4.

89

(Medication error)

-
-
- - HN

-

- (Apothecary System)

- 50 mg 0.5 g 0

0.5 mg .5 mg

-
Units U, IU
mcg µg
mL cc

- Route P.O., IM
O.D., QD, QID, QOD

-

-

-
-

-
-

90

-

-

- ()

-
-
-
-

91

(Rational Drug Use: RDU)

1.

92

93

94

3.

95

(US FDA) 5 Pregnancy Category A, B, C, D X
Pregnancy Category A

2 3
Pregnancy Category B

Pregnancy Category C

Pregnancy Category D

Pregnancy Category X

96

Pregnancy Category D X

Pregnancy Category D
1. Alcohol

2. Carbamazepine, Phenobarbital, Phenytoin , Valproic acid

3. Propylthiouracil

4. Co-trimoxazole ( ), Neomycin, Amikacin, Streptomycin,

Tetracycline, Doxycycline

5. ( 2 3) Losartan, Enalapril, Atenolol, Metoprolol,

Propranolol

6. HCTZ, Amiloride, Furosemide, Spironolactone

7. Amiodarone

8. ( ) Codeine, Morphine, Pethidine

9. ( 3 ) Aspirin (

), Diclofenac, Ibuprofen, Mefenamic acid

10. Amitriptyline, Nortriptyline, Imipramine

11. Alprazolam, Clonazepam, Clorazepate, Diazepam,

Lorazepam

12. Lithium

13. ( 1) Dexamethasone, Hydrocortisone, Prednisolone,

Triamcinolone

14. Efavirenz

15. Colchicine, Iodine

Pregnancy Category X
1. Ergotamine tartrate
2. Simvastatin
3.
4. Oxytocin
5. Methotrexate
6. Warfarin

97

1. Trihexyphenidyl (Artane®) 11. Levodopa+Carbidopa
2. Bisacodyl 12. Mebendazole
3. Cafergot (Ergotamine tartrate) 13. Norfloxacin
4. Cyproheptadine 14. Ofloxacin
5. Cytotec (Misoprostol) 15. Perphenazine
6. Dimenhydrinate 16. Praziquantel
7. Efavirenz 17. Simvastatin
8. Glipizide 18. Methotrexate
9. HCTZ (hydrochlorothiazide)
10. Hydroxyzine 19. Tramadol
20. Lithium
21. Methimazole

NSAIDs

NSAIDs 50%
NSAIDs
Clinard F.
10 2.2
4.8 Rodriguez LA. NSAIDs
5

Ref. 75/2558; http://www.lpnh.go.th/newlp/wp-content /uploads/
2013/10/DIS-news-75-2558.pdf