McGraw-Hill’s I.V. DRUG Handbook Notice Medicine is an ever-changing science.As new research and clinical experience broaden our knowledge,changes in treatment and drug therapy are required.The authors and the publisher ofthis work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time ofpublication.However,in view ofthe possibility ofhuman error or changes in medical sciences,neither the authors nor the publisher nor any other party who has been involved in the preparation or publication ofthis work warrants that the information contained herein is in every respect accurate or complete,and they disclaim all responsibility for any errors or omissions or for the results obtained from use ofthe information contained in this work.Readers are encouraged to confirm the information contained herein with other sources.For example and in particular, readers are advised to check the product information sheet included in the package ofeach drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration.This recommendation is ofparticular importance in connection with new or infrequently used drugs. McGraw-Hill’s I.V. DRUG Handbook Patricia Dwyer Schull, MSN, RN New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. Manufactured in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. 0-07-164279-X The material in this eBook also appears in the print version of this title: 0-07-154863-7. All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark. 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For more information about this title, click here Contents Foreword vii Advisors ix Contributors and reviewers x Preface and user’s guide xi Part 1 Drugs A to Z 3 Safe I.V.drug administration I.V.drug compatibilities S2 Conversions and calculations S6 Drug infusion rates S7 Venipuncture and peripheral venous access S10 Preventing and treating extravasation S16 High-alert drugs S17 Hazardous I.V.drugs S18 Guidelines for administering hazardous drugs S19 Avoiding dangerous abbreviations S23 Common abbreviations S24 I.V.drugs and drug names that look or sound alike S26 Monitoring blood levels S28 Anaphylaxis:Treatment guidelines S30 Adult cardiac arrest:Treatment guidelines S31 Pediatric cardiac arrest:Treatment guidelines S32 Part 2 Less commonly used drugs 661 Part 3 Appendix Common laboratory values 692 Body surface area in adults 695 Body surface area in children 696 v vi Contents I.V.drug and solution compatibilities 697 Effects ofdialysis on drug therapy 700 Identifying life-threatening adverse reactions 703 Selected references 710 Index 712 Foreword N ot so long ago,when I was an ICU nurse,the pharmacy printed pocket cards to serve as handy references for intravenous (I.V.) drugs.The concept ofgiving hospital staffa fast,easy-to-use guide to I.V.drugs is still a good one.In fact,the need for such a guide is greater than ever—considering the number ofI.V.drugs given today,the complexity ofI.V.therapy,increasing patient acuity,and our growing responsibilities surrounding drug administration. Many I.V.drugs are powerful medications.Not only are more patients receiving them today;a significant number receive multiple I.V.drugs at the same time.Frequently, these patients are the sickest—and the most susceptible to life-threatening conse- quences ofa medication error. As you’re undoubtedly aware,patient safety recently has taken center stage—to a de- gree we’ve never seen before.Over the last decade,numerous studies have explored the problem ofmedication errors,including which drugs are most often involved, how the errors come about,and what the consequences are.Ofparticular significance for I.V.drugs,a 2007 study in the Archives ofInternal Medicinefound that from 1998 to 2005,the number ofserious adverse drug events (ADEs) reported to the Food and Drug Administration (FDA) increased 260% and ADE-related deaths rose 270%.Of the nearly 1,500 drugs linked to ADEs,a subset of51 (most ofwhich are adminis- tered I.V.and designated high-alert or hazardous) accounted for 43% oftotal ADEs. In every year studied,the FDA received 500 or more reports on each ofthese 51 drugs. Furthermore,not only are those drugs commonly involved in errors,but they pose an increasedrisk ofcausing significant harm when used in error.Although mistakes may or may not be more common with these drugs,the consequencesofthese mistakes are more devastating.Ofthe drugs deemed high-alert by the Institute for Safe Medication Practices,the majority are given I.V.The same is true ofhazardous drugs (those that can cause cancer,genetic mutations,reproductive or developmental problems,and certain other harmful effects). Studies have found that multiple factors contribute to medication errors.So no matter how hard an individual healthcare provider tries to prevent medication errors,trying harder isn’t the answer—or at least,not the only answer.To meet the challenge ofad- ministering I.V.drugs safely,healthcare providers require reliable,updated,easily ac- cessible information on the drugs they give. TheMcGraw-Hill’s I.V.Drug Handbookis the 21st-century version ofthe old pharma- cy pocket card.It’s compact,so you can carry it with you just about anywhere,includ- ing on your PDA.But don’t let its compact size fool you:this book is comprehensive. You’ll be impressed by the number ofdrugs covered and the depth ofcoverage,as well as the vital supplementary information it contains.The handbook provides full,detailed monographs on more than 300 I.V.drugs. vii Copyright © 2009 by The McGraw-Hill Companies, Inc. Click here for terms of use. viii Foreword Ofcourse,each drug monograph covers the essentials—generic and trade drug names,mechanism ofaction,pharmacokinetics,available forms,approved indica- tions,contraindications,precautions,adverse effects,and patient teaching. Above and beyond these basics,you’ll find additional crucial data: ●the latest FDA boxed warnings ●actions to take before you administer the drug (including supportive therapy to give) ●detailed instructions on preparing admixtures,which solutions to dilute,which to avoid,and correct administration rates ●dosing schedules and critical dosage adjustments ●essential patient monitoring. The book’s benefits don’t stop there.Each high-alert or hazardous drug is specially marked for easy identification,and crucial warnings and instructions are highlighted with “Clinical alert”icons.A special 32-page full color insert includes sanctioned guide- lines on treating cardiac arrestand stroke and administering hazardous I.V.drugs,a step-by-step illustrated procedure for starting an I.V.line,I.V.drug compatibility charts—and more.And you can download the full text to your PDA at no extra cost. Like me,you’ll appreciate the thought and planning that went into creating this impressive book.The writing (concise and jargon-free) and the design (customized for busy healthcare workers) make for easy reading and allow you to instantly find the information you seek.I’m certain that within the pages ofthe McGraw-Hill’sI.V.Drug Handbook,you’ll find all the informationyou need to administer I.V.drugs with confidence. Vicki L.Buchda,MS,RN,CNAA Vice-Chair,Division ofNursing Services Mayo Clinic Phoenix,Arizona