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1 2552 (High Alert Drug )

2552 High Alert Drug ) - NKHphamacy.nkh.go.th/Doc/HAD.pdf7 Calcium Gluconate Injection High Alert Drug Nongkhai Hospital Generic Name Calcium gluconate 10% calcium gluconate (1 g)

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Page 1: 2552 High Alert Drug ) - NKHphamacy.nkh.go.th/Doc/HAD.pdf7 Calcium Gluconate Injection High Alert Drug Nongkhai Hospital Generic Name Calcium gluconate 10% calcium gluconate (1 g)

1

������������� ����� 2552 (High Alert Drug )

ก�����������ก��� ����������������

���� ����� � ���!���" �

Page 2: 2552 High Alert Drug ) - NKHphamacy.nkh.go.th/Doc/HAD.pdf7 Calcium Gluconate Injection High Alert Drug Nongkhai Hospital Generic Name Calcium gluconate 10% calcium gluconate (1 g)

2

���������� ��������� ���� (High Alert Drug, HAD) ก�%����&'( �

1. ��������� ��������������� �������������ก���������� ��ก������ก�������ก�������������� ��!����"����#��

2. #%���������&����� ��� ��'���� �� �()*�� #���*�� ����+�� ��&��ก������� *"�������"������

3. ���������������#���������(� ������� ��ก�-����� �������%��).�*!��/&���&������#%����*"��01���

ก%�ก���� doctor7s order sheet ;���� 24 ��.

4. ��ก�� Monitoring parameter ��� critical point ����ก������ก*��&E &��ก������� *!��/&���

���F#%��������� ���*"�#��G��� ก�%)*� ��+,ก�%�ก-%�ก.� �

1. �� �ก1��� High Alert Drug ��ก��ก������) ��)L�������'�� ��� *"���#%��&�� M ��#���������(�&���������E� N &E ��ก"����� *"�&E �&EOก�ก��/����!(�������#��� P��#���������(� &���������E�7 ��

�"� ����� ��HAD �Fก��

2. ก�������� High Alert Drug ��������0�� High Alert Drug ���*&�"�&���� !����&E Q"�ก�� High Alert Drug ������+(�)R�� �%���� �ES���� *"����#���������Q"�ก��

3. ก��������#���������(� �;���ก�&���)�����&��*��ก��&E &��ก�������#���������(� *"�&E �&EOก�ก��/����!(�������#��� M��#���������(� &���������E�N ����������Fก#��'�

4. ก�����������������F � &�������Q"�ก 2 #��'� &�����ก��&������0'%� ก�%%/�%�+,�0���ก�%&'( �

1. ��ก�����#%����ก�������#���������(�������������� (&����E�)�����������Fก#��'� 2. �����ก������� HAD ��ก�-��).���Q� ��+��ก���'%��ก"���������Q"�ก�'%��ก"� ���)L������!(

3. ���)�กก���* ���ก������Vก����("�� HAD ��#%����ก������� *������Vกก�������!����"(MAR),

drug profile, )L�� IV fluid *"� Card �� 4. ��ก����E���ก��#%���-��� ��*"�ก��+����&������ 2 �F##" ������������ 2 #��'�

5. &��������� �� *"�#���*����������&�������&��ก��#%����*!��/ก�������� �ก��&������ 2

�F##"���&������ 2 #��'� �����������"�ก��&������ 6. ����&���������1� +(��&����&��������#������������������&����"���Q"�ก�� ���"�"�����&����

�Fก#��'�!�����01���+(��&��������Q"�ก ���

7. ������ก��&������0'%�ก��������+(�)R������

8. ������*!��/��������+(�)R���������-��!�������ก����*� �GV�;���!Ea��กก�������&��

*��b��/�&E &��ก�������#���������(�

9. �� �ก1���#���������(�����+(�)R��*�ก��ก������) *"���)L�������'�� ��� ��#%��&�� M ��#���������(�&��������N

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3

%� ก�% � High Alert Drug %1./�3���

1. Amiodarone injection

2. Calcium Gluconate Injection. 3. Chloral hydrate

4. Digoxin injection

5. Dopamine injection

6. Heparin injection

7. Magnesium sulfate injection.

8. Morphine Sulfate injection. 9. Norepinephrine barbiturate

10. Pethidine Sulfate Injection.

11. Phenytoin Sodium injection. 12. Potassium Chloride injection.

13. Regular insulin injection .

14. Warfarin 15. Doxorubicin injection 16. Fluorouracil injection

17. Metrotrexate injection

18. Cyclophosphamide injection

Page 4: 2552 High Alert Drug ) - NKHphamacy.nkh.go.th/Doc/HAD.pdf7 Calcium Gluconate Injection High Alert Drug Nongkhai Hospital Generic Name Calcium gluconate 10% calcium gluconate (1 g)

4

������� Amiodarone injection High Alert Drug

Nongkhai Hospital Generic Name Amidarone

Strength 150 mg/3 ml (inj.) Category Anti-arrhythmias

1. ���-./01� ��ก��������� �������ก�� , VF , VT 2. �34� Adults

• Breakthrough VF/VT : 150 in D5W 100 ml, over 10 min • Pulseless VF/VT : IV.Push , ��56��� 300 mg in D5W 20-30 ml , if VF/VT recurs ��<=ก 150 mg ��6

���> iv.infusion 1mg/min 6 hr. then 0.5/ min (max.dose 2.1 g/day) • Stable VT/SVT : 24 G6. H�ก : 1050 mg ��6IJ���K��L�=M

Step 1 : 150 mg (100 ml) over first 10 min (3 ml in D5W 100 ml) Step 2 : 360 mg (200 ml) over next 6 hr. (18 ml in D5W 500 ml) 1mg/min Step 3 : 540 mg (300 ml) over next 18 hr.

when swithching from I.V.to oral therapy < 1 wks I.V. infusion < 800-1600 mg/day 1-3 wks I.V. infusion : 800-1600 mg/day

> 3 wks I.V. infusion : 400 mg/day S���>���K��T�����U��VW ��56���> 800-1600 mg/��� ���I 1-2 X��ML ���1-3 Y����Z HI��I�S��� �[� 600-800 mg/��� ���I 1-2 X��ML ���1 �\<� ��6���> Maintenance dose 400 mg/��� 3. Compatible and incompatible

• ก���Y6>�H��J����Y6�� D5W ก� =�� IV infusion > 2 G�5�_6L X���Y6��S��Hก�� �\< polyolefin

• ��6���W�6Y�> IV.ก�K atropine, adrenaline, calcium chloride, magnesium sulfate HI sodium bicarbonate

• ��6���W�6ก��T=5 Y a site ก�K Furosemide ,cefazolin ,Heparin, Aminophylline • >�T=5�Y6HI�� กdKe�� 24 G6. • ก���G��W�6ก�K>�กIfW6 fluoroquinolone � h�56h��S<L>�6�กSiM�

:;<ก<><�>?@A./�

• Digoxin : ก���G� amiodarone �W�6ก�K digoxin � h�56���K>� digoxin Y<L TW� • Warfarin : amiodarone h�56���K>� warfarin TJ����IS<L>� warfarin h�56SiM� • Fentanyl : hK<�ก�� bradycardia, hypotension HI cardiac output I�IL

4. �ก>C�.DE/:>?F/GHIก�

• Hypotension , Bradycardia , Cardiac arrhythmia , hyperthyroidism, abdominal pain ,edema, AST/ALT > 2Xnormal,pulmonary toxicity

• ก���G�>����m 6=�I ก��h���W<��K h���W<�<� �Kก��ก��6<L d�HI�Kก��ก��TJ�L��S<L�W<6eT�<>�Z HI6=<�ก��Hh�HYLH�� (Photosensivity)

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5

ก>J<4J�ก>01��

• Monitoring : o EKG, BP,HR o Liver function tests o ก��6<L d� o Thyroid function tests o Pulmonary function tests

• <�ก��K�6��66\< T�� �MJ���กI� • <�ก��T=5HY�L�W�<��6=���K>��� I\<�YUL e��HกW ��� X�����<ก �>��IJ�K�ก �U�Yiก�W�HS� S� _�

���Y�5� eS�SiM� �dKX< rกsMJ�LW�>�\< I\<�<<กLW�>����ก�� �����L �I=5>�Y= ก��6<L d�����ก��

K3AL/:;<-MJ<��/ก>IM4ก>�GA�NFOP�/F�/03>?--� High Alert Drug

Nongkhai Hospital Generic Name Amidarone

Strength 150 mg/3 ml (inj.) Category Anti-arrhythmias

K3AL/ก>FMP/01�� 1. ��6XJ�>W<��ก��Y�5L�G�>� 2. �KfS���>�T=5Y�5L�G���G�� �� h��<6�Kf�W�>T=5�G� 3. Y�5L>����>����e�� th�ก� =tfก t��HI��<LILK��TiกT��T=T=5TJ�e�� 4. u��X��6 S�6S�� > 2 mg/ml X����T�L central line 5. max dose = 2 g/day, max iv. rate = 30 mg/min

K3AL/ก>I.��K�?ก>NกQ->MกR� 1. กdK��ก��>�_�>H>ก��กIW<LT=5�G�tI�กHY�LG\5<T=5H�ก�W�L��ก>�<\5� HI6=XJ� �\<� w >�X��6 Y=5>LYUL��<L

���L>�5L x ���T=5กIW<L>� 2. ก���W�>>�e6W�W����f��� ��<L<W��tI�ก 2 X��ML ��<L6=ก������Y<KsMJ�

K3AL/ก>NJ>O��� 1. ����Y<K 2 KfXXI �\<<>W�L��<> 2 X��ML ( ��ก� =S��KfXI�ก� ) ��ก��>�K>�ก��XJ���^S���>�HI

ก���Y6>� 2. 6\5< ��=>6>� Y�d� �U� ��=>6��<L S=>�X��6 S�6S��S<L Amidarone T=5 ��=>6ILK�tI�กS��Y��II�>T=5

��=>6TfกX��ML h��<6 sd�G\5<�U� ��=>6>�K�tI�ก���> 3. ก���Y6>�H��J����Y6�� D5W X��6 S�6S��I�L�Y6 X\< 1-6 mg/ml 4. ��6���W�6Y�> IV ก�K Floxacillin, Furosemide, quinidine 5. ��6���W�6ก��T=5 Y-site ก�K Furosemide, cefazolin, Heparin, Aminophylline, sodium bicarbonate

K3AL/ก>-><@>� 1. ����Y<KS���>� HIX��6H�LS<L>�T=5 ��=>6����Lก�KXJ�Y�5LHhT>ZกW<���>� _�>ก������Y<K 2

KfXXI�\<����Y<K 2 X��ML_�> ����> �I�ก������Y<K 2. ��>�_�>><� S��T�LI<� I\<��J�e��T�L �=>� TW���M� HIX����T�L central line h\5<�y<Lก��ก�� ก��

extravasation 3. ก� =�� IV infusion >2 G�5�_6LX���Y6��S��Hก�� �\<polyolefin HIX����<L กdK��h��HYL H�Wu���Y6

�� PVC Y�6��u กdKe����>�� 2 hr

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6

4. ���W�� infusion pump h\5<��e���J����Y��II�>T=5uUก��<L 5. ก��t=� IV u���U��z�>6=<�ก�� Bradycardia, hypotension X��K���� �I���ก����>�<>W�LG��m 6. ก��>f�>�X��XW<>m I�S���>�ILG��m �ก>f�>�T��T=<�� ก�� hypotension

K3AL/ก>J<4J�ก>01�� 1. Monitoring: - BP, HR(EKG) q 15 ��T= x 3 X��ML I�L loading dose - Liver function test, Thyroid function test

- ก��6<L d� 3. <�ก��T=5HY�L�W�<��6=���K>��� I\<�YUL e��HกW ��� X�����<ก �>��IJ�K�ก �U�Yiก�W�HS�S�_� ���Y�5� eS�SiM� �dKX< rกsMJ�LW�> �\< I\<�<<กLW�>����ก�� �����L �I=5>�Y= ก��6<L d�����ก�� <�ก��K�6��66\< T�� �MJ���กI�

�ก> �ก>KF4/ LOPJ��/KI�/KDL�H 1. BP<90/60 mmHg 2. HR< 60 BPM 3. hK EKG: VT, VF, Heart block 4. liver enzyme > 5x normal 5. <�ก��T=5HY�L�W�<��6=���K>��� I\<�YUL

K3AL/ก>Kก�C�SA?D<R Amidarone 1. temporary pacemaker 2. >�Hก�h��S<L Amidarone e��HกW isoproterenol IV 3. ก�� Dialysis e6W6=��_>G�Z

Page 7: 2552 High Alert Drug ) - NKHphamacy.nkh.go.th/Doc/HAD.pdf7 Calcium Gluconate Injection High Alert Drug Nongkhai Hospital Generic Name Calcium gluconate 10% calcium gluconate (1 g)

7

������� Calcium Gluconate Injection

High Alert Drug Nongkhai Hospital

Generic Name Calcium gluconate 10% calcium gluconate (1 g)

Strength Element Ca2+ 90 mg @>X� 4.5 mEq @>X� 2.25 mmol/10 ml

Category Electrolyte,calcium ���-./01�

• �G���ก��HI�y<Lก����� hypocalcemia • ��� hyperkalemia • Hypocalcaemia tetany

�34�

• Cardiac life support �U��VW : Calcium gluconate 500 mg-2 grams IV (10 % solution) over 2-4 mL/min

�dก : Calcium gluconate 60 mg-100/kg (10 % solution) IV injection into central vein is prefered, intraosseous administration is aceptable

• Hypocalcaemia : IV. - Neonates : 200-800 mg/kg/day continue infusion or 4 divided dose (max = 1g/dose) - Infants and children : 200-500 mg/kg/day continue infusion or 4 divided dose (max 2-3

g/dose) - Adults : 2-15 g/24 G6. continue infusion or 4 divided dose

• Hypocalcaemia tetany : IV - Neonates , infant and children : 100-200 mg/kg/dose over 5-10 ��T= ; may repeat q 6-8

G6. or follow infusion 500 mg/kg/day - Adults : 1-3 g ��ก�T�5L<�ก��T�LXI���ก�=SiM�

• Magnesium intoxication , cardiac arrest in the presence of hyperkalemia :IV - Infants and children : 60-100 mg/kg/dose (max 3 g/dose) - Adult : 500-800 mg/dose (max : 3 g/dose)

Compatible &Incompatible

• Y��II�>T=5�G��Y6e�� D5W, NSS H��J� D5W h��?ก���Y6ก�K���> NSS , sodium �TJ��� Ca S�K<<ก �d�SiM�

• >�T=5�Y6HI��6=X��6XL��� 24 G6. T=5<f^�U6��<L • ��6 กdK���U� >d�HI��6�G� 6\5<6=�ก<� • ��6�Y6ก�K sodium bicarbonate h����ก�ก<� • ��6�Y6�W�6ก�K>� amphotericin B,ampicillin, cefazolin, dobutamine ,adrenaline, fat

emulsion ,hydrocortisone, MgSO4, meropenem, potassium phosphate, promethazine HI streptomycin

�ก>C�.DE/:>?F/GHIก�

• hypotension , Arrhythmia , bradycardia , cardiac arrest , hypocalcemia, hypomagnesemia

• XI\5�eY� <� �=>� ���T�<L T�<L�Uก กI��6 �\M<<W<�H�L

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8

• u���U��z�>e����K digoxin <>UW <�� h�56�T���S<L digoxin �� ก��h��e�� �iLX������������K>� digoxin e��กW<� �\<Y�L ก�<�ก��h��S<L digoxin

ก>J<4J�ก>01�� 1. Blood pressure, Heart rate 2. EKG ��W�Lก��K����>� 3. Calcium level ( ��Tfก 4-6 G�5�_6L ), Phosphate , Magnesium level 4. ����Y<K<����ก��>�>� S�� Y��HI����Y<KK�� �^T=5HTL�MJ� กI\<<>W�L��<> ��I 1 X��ML 5. <�ก��T=5HY�L�W�<��6=���KHXI s=>6�� I\<�YUL : XI\5�eY� <� �=>�, bradycardia, Cardiac arrhythmia

, Severe constipation

K3AL/:;<-MJ<��/ก>IM4ก>�GA�NFOP�/F�/03>?--�

High Alert Drug

Nongkhai Hospital

Generic Name Calcium gluconate 10% calcium gluconate (1 g)

Strength Element Ca2+ 90 mg @>X� 4.5 mEq @>X� 2.25 mmol/10 ml

Category Electrolyte,calcium K3AL/ก>FMP/01��

1. ก��Y�5L�G� calcium X��Y�5L �[� gm �\< mg S<L calcium gluconate, �\< �[� ml ก� =T=5�KfX��6 S�6S��G�� �� GW� 10% calcium gluconate 10 ml e6WX��Y�5L>� �[��J���� wampulex HI�Kf<���� �d���ก���� calcium T�LI<� I\<��J�

2. XJ��iLuiL�����>T=56=�I�W<HXI s=>6 ��6uiLr<Y r� HI<�IKU6�� si5L�U��z�>T=56=<�IKU6���5J���<LXJ���^ total corrected calcium

3. <���� �d�S<L IV infusion YULYf�X\< 1.5 mEq/minute HIS��� 1 gm ��<L����� 30 ��T=SiM�e��\< �d�T=5Yf���<L�����ก�W� 10 ��T=

K3AL/ก>I.��K�?ก>NกQ->MกR� 1. �G�tI�กHY�LG\5<>�T=5G�� �� X\< calcium gluconate 2. กdK��ก��>�_�>H>ก��กIW<LT=5tI�กHY�LG\5<T=5H�ก�W�L��ก>�<\5� HI6=XJ� �\<� w >�X��6 Y=5>LYUL ��<L���L>�5L x ���T=5กIW<L>� 3. ก���W�>>�e6W�W����f��� ��<L<W��tI�ก 2 X��ML ��<L6=ก������Y<KsMJ�

K3AL/ก>NJ>O��� 1. ����Y<K 2 KfXXI �\<<>W�L��<> 2 X��ML (��ก� =S��KfXXI�ก�) ��ก��>�K>�ก��XJ���^S���>�HI

ก���Y6>� 2. ก�� ��=>6>���T�L IV infusion

- �Y6 calcium gluconate ���> NSS �\< D5W >� S��I<� I\<��J��� �I� 4-6 G�5�_6L - 6\5< ��=>6>� Y�d� �U� ��=>6��<L S=>�X��6 S�6S��S<L calcium gluconate T=5 ��=>6ILK�tI�ก

S��Y��II�>T=5 ��=>6TfกX��ML h��<6 sd�G\5< �U� ��=>6K�tI�ก>����> - e6W�Y6�W�6ก�K>���L�=M Amphotericin B , Ampicillin , Cefazolin , Adrenaline , Dobutamine ,

Intralipid 10% , Magnesium sulfate , Phenergan HIY��II�>T=56= phosphate - >�T=5�Y6HI��XL���T=5 24 G�5�_6L T=5<f^�U6��<L ��6 กdK���U� >d�HI��6�G� 6\5<6=�ก<�

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9

K3AL/ก>-><@>� 1. ����Y<KS���>� HIX��6H�LS<L>�T=5 ��=>6����Lก�KXJ�Y�5LHhT>ZกW<���>� _�>ก������Y<K 2

KfXXI�\<����Y<K 2 X��ML_�> ����> �I�ก������Y<K 2. ก����>�T�L IV ��t=� S��I<� I\<��J�G��m��>�� �I� 10-20 ��T= ��TfกS�<KWL�G� �\5<L��กก���� �d�

ก��e� <��TJ��� ก�� cardiac arrhythmia T=5�f�H�L6�กe�� K3AL/ก>J<4J�\�ก>01��

1. ����Y<K<����ก��>�>� S�� Y��HI����Y<KK�� �^T=5HTL�MJ� กI\<<>W�L��<> ��I 1 X��ML 2. Heart rate 3. Blood pressure 4. EKG ��W�Lก��K����>� 5. Calcium level ( ��Tfกm 4-6 G�5�_6L h\5<��e����6 �y�6�> : 7-9 mg/dl) 6. Phosphate , Magnesium level 7. <�ก��T=5HY�L�W�<��6=���KHXI s=>6�� I\<�YUL

�ก>LOPKF4/A.�O>?4M-KG�N]O��F�/ J��/ND<P�GA�>?�M4>?AM/ J<4J�\� @>X�KI�/KDL�H 1. XI\5�eY� <� �=>� 2. bradycardia 3. Cardiac arrhythmia 4. Severe constipation

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10

������� Chloral hydrate High Alert Drug

Nongkhai Hospital Generic Name Chloral hydrate

Strength Solution 100 mg/ml Category

1. ���-./01�

• �G� �[�>��L�K��Y�T�� �dก • ��������������� ก"��ก�#$"�%�&�#'�ก"��ก#( )�ก�#*�+ก�#,-*�./0��#� $1��2)��&3ก ��"� CT

scan, MRIs 4&��5-�(��"�+�67+��ก#89�&3ก:9��ก�#/�7� �#'�;:"/+ (Agitation) 2. �34� �dก :

• Sedation or anxiety : oral, rectal ; 5-15 mg/kg/dose Tfก 8 G�5�_6L YULYf�e��e6W ก�� 500 mg/dose • Prior to EEG : oral, rectal ; 20-25 mg/kg/dose , 30-60 ��T= กW<��� EEG <����sMJ�e��Tfก 30 ��T= ,

maximum dose 100 mg/kg �\< 2 g/day • Hypnotic : oral, rectal ; 20-40 mg/kg/dose up to 50 mg/kg/day �\< 1 gm/dose �\< 2 gm/day • Conscious sedation : oral , 50-75 mg/kg/dose , 30-60 ��T= กW<�TJ���ก�� <����sMJ�e��Tfก 30 ��T= ,

maximum dose 120 mg/kg �\< 1 g/day �U��VW : oral , rectal

• Sedation or anxiety : 250 mg ���I 3 �I� • Hypnotic : �� 500-1000 mg กW<��<� H�W��YULYf�e6W ก�� 2 g �W<���

ก�����KS���ก���G�>����U��z�>_�Xe� • u���U��z�>6=Clcr < 50 ml/min e6WX���G�>� • Heanodialysis : Diabyazble (50-100%)

ก�����KS���ก���G�>����U��z�>_�X��K • �U��z�>_�X��KX��I=ก I=5>Lก���G�>�

���GA>>?AM/

• ก��e����K>� ก��S��� : Hypotension, ก�ก���>��, Cardiac arrhythmias • ��6�G����U��z�> :_�X�KKT�L ����>�� _�> th��U��z�>T=56=X��6����ก����Y6<L<>UWHI�� � h�56X��6

e��W<>���ก��ก�Y6<LHIT�L ����>��e�� 4. �ก>C�.DE/:>?F/GHIก�

• GI : Gastric irritation, N/V, diarrhea • CNS : Ataxia, hallucination, drowsines, whangoverxeffect • Dermatologic : Rash, urticaria

5. ก>J<4J�ก>01��

• Vital sign (BP, HR, RR)

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11

K3AL/:;<-MJ<��/ก>IM4ก>�GA�NFOP�/F�/03>?--� High Alert Drug

Nongkhai Hospital Generic Name Chloral hydrate

Strength Solution 100 mg/ml Category

K3AL/ก>FMP/01�� 6. �KfS���>�T=5Y�5L�G���G�� �� h��<6�Kf�W�>T=5�G� �[� mg 7. Y�5L>����>����e�� th�ก� =tfก t��HI��<LILK��TiกT��T=T=5TJ�e��

K3AL/ก>I.��K�?ก>NกQ->MกR� 3. กdK��ก��>�_�>H>ก��กIW<LT=5�G�tI�กHY�LG\5<T=5H�ก�W�L��ก>�<\5� HI6=XJ� �\<� w >�X��6 Y=5>LYUL��<L

���L>�5L x ���T=5กIW<L>� 4. ก���W�>>�e6W�W����f��� ��<L<W��tI�ก 2 X��ML ��<L6=ก������Y<KsMJ�

K3AL/ก>NJ>O��� 6. ����Y<K 2 KfXXI �\<<>W�L��<> 2 X��ML ( ��ก� =S��KfXI�ก� ) ��ก��>�K>�ก��XJ���^S���>�HI

ก���Y6>� K3AL/ก>-><@>�

7. ����Y<KS���>� HIX��6H�LS<L>�T=5 ��=>6����Lก�KXJ�Y�5LHhT>ZกW<���>� _�>ก������Y<K 2 KfXXI�\<����Y<K 2 X��ML_�> ����> �I�ก������Y<K

K3AL/ก>J<4J�ก>01��

• Vital sign (BP, HR, RR) �ก> �ก>KF4/ LOPJ��/KI�/KDL�H

• Hypotension, ก�ก���>��, Cardiac arrhythmias

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12

������� Digoxin (Lanoxin®) High Alert Drug

Nongkhai Hospital Generic Name Digoxin

Strength 0.25 mg , 0.0625 mg (tablets) 0.5 mg/2 ml (inj.)

Category Cardiac glycoside ���-./01�

1. Congestive heart failure 2. Atrill fibrillation

�34�

• S���>�T=5H��J�e�� �[�H��T�Lก���G�>� ��56���YJ���K�U��z�>e��ก�� TW���M� (��6����L) ���KS���>�I�IL���U��z�>YUL<�>fHIe�Kกh�W<L

age Total digitalizing dose1

(mcg/kg) Daily maintenance dose2

(mcg/kg) P.O. I.V. /I.M. P.O. I.V. /I.M.

Preterm infant 20-30 15-25 5-7.5 4-6 Full-term infant 25-35 20-30 6-10 5-8 1 mo-2 y 35-60 30-50 10-15 7.5-12 2-5 y 30-40 25-35 7.5-10 6-9 5-10 y 20-35 15-30 5-10 4-8 >10 y 10-15 8-12 2.5-5 2-3 �U��VW 0.75-1.5 mg 0.5-1 mg 0.125-0.5mg 0.1-0.4 mg

• 1 6�>uiL HKWL��>�X��MLH�ก��6�^X�i5L�i5LS<LS���>�T�ML6� HIHKWL��S���>�T=5 I\< �[�GW�Lm

Tfก 48 G6. • 2 6�>uiL �� infant HI �dก��<>ก�W� 10 �� HKWL��Tfก 12 G6. YW�� �dก6�กก�W� 10 �� HI�U��VW ��

���IX��ML Dosing adjustment / interval in renal impairment - CrCl 10-50 ml/min : 25-75% of dose �\< Tfก 36 G6. - CrCl < 10 ml/min : 10-25% of dose �\< Tfก 48 G6. - Reduce loading dose IL 50% �� ESRD

Compatible &Incompatible

• Y���MJ�T=5 S��ก��e�� e��HกW SWFI, NSS ,D5W�\< LRS • e6WH��J����Y6�W�6ก�K>�<\5� >�t=� กdK��h��HYL • ��6�Y6�W�6ก�K alkaline solution , amphotericin B, calcium chloride, dobutamine • >�T=5 I\<��T�MLe�

�ก>C�.DE/:>?F/GHIก� XI\5�eY� <� �=>� ���T�<L K\5<<��� <W<� hI=> �����=� 6i�LL Y�KY� ���กก�L�I d���hI<� d���he6WG�� d�HYLY= I\<L ,arrhythmias, heart block , tachycardia

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13

ก>J<4J�ก>01�� 1. Mornitor EKG, serum digoxin, electrolyte (K, Ca, Mg), HR, renal function 2. <�ก��T=5HY�L�W�<��6=���K>��� I\<�YUL e��HกW ���� ���G�� XI\5�eY�<� �=>� <�ก��K�6��6<��>�

�W�Lm 6<L d�HYLY= S=>� I\<L����ก����H��LHhT>Z

K3AL/:;<-MJ<��/ก>IM4ก>�GA�NFOP�/F�/03>?--� High Alert Drug

Nongkhai Hospital Generic Name Digoxin

Strength 0.25 mg , 0.0625 mg (tablets) 0.5 mg/2 ml (inj.)

Category Cardiac glycoside K3AL/ก>FMP/01��

1. ��6�G�XJ�>W<��ก��Y�5L�G�>� 2. �KfS���>�T=5Y�5L�G���G�� �� h��<6�Kf�W�>T=5�G� �[� mg(>�ก��) �\< mg/ml (>�t=�) 3. Y�5L>����>����e�� th�ก� =tfก t��HI��<LILK��TiกT��T=T=5TJ�e��

K3AL/ก>I.��K�?ก>NกQ->MกR� 1. �G�tI�กHY�LG\5<>�T=5G�� �� X\< digoxin 2. กdK��ก��>�_�>H>ก��กIW<LT=5�G�tI�กHY�LG\5<T=5H�ก�W�L��ก>�<\5� HI6=XJ� �\<� w >�X��6 Y=5>LYUL��<L

���L>�5L x ���T=5กIW<L>� 3. ก���W�>>�e6W�W����f��� ��<L<W��tI�ก 2 X��ML ��<L6=ก������Y<KsMJ�

K3AL/ก>NJ>O��� 1. ����Y<K 2 KfXXI �\<<>W�L��<> 2 X��ML��ก��>�K>�ก��XJ���^S���>�HIก���Y6>� 2. ก���� IV <����HKKe6W �\<��L �\< �\<��L���>Y���MJ�T=5 S��ก��e�� _�>���>� 1 ml �\<��L���>Y���MJ�

<>W�L��<> 4 TW� h\5<�y<Lก��>��ก�ก<� 3. 6\5< ��=>6>� Y�d� �U� ��=>6��<L S=>�X��6 S�6S��S<L digoxin T=5 ��=>6ILK�tI�กS��Y��II�>T=5

��=>6TfกX��ML h��<6 sd�G\5<�U� ��=>6>�K�tI�ก���> 4. e6W�Y6 digoxin �W�6ก�K Alkaline solution, Amphotericin B, Calcium chloride, Dobutamine 5. >�t=���<L กdK��h��HYL

K3AL/ก>-><@>� 1. ����Y<KS���>� HIX��6H�LS<L>�T=5 ��=>6����Lก�KXJ�Y�5LHhT>ZกW<���>� _�>ก������Y<K 2

KfXXI�\<����Y<K 2 X��ML_�> ����> �I�ก������Y<K 2. �U���K K+ กW<���>� digoxin u�� K+ �5J�ก�W� 3.5 mmole/L H��LHhT>Z h\5<>\�>�� (X��������K K+ 1

X��ML/Y����Z ก� =�U��z�>��) 3. ����G=h��HIILK��TiกกW<���>� H��LHhT>Z h\5<>\�>��กW<���>�u��

a. �dก<�>f��<>ก�W� 1 �� HR �5J�ก�W� 100 X��ML/��T= b. �dก 1 - 6 �� HR �5J�ก�W� 80 X��ML/��T= c. �dก<�>f6�กก�W� 6 �� HR �5J�ก�W� 60 X��ML/��T=

4. ก��t=� S�� IV _�>��L �I���ก��K����>���<Le6W��<>ก�W� 5 ��T= h��ก��t=� �d�m <��TJ��� ก�� systemic and coronary constriction

5. ก��t=� deep IM ���6���>�e6WX�� ก�� 2 ml ��6���>ก�����K�� �^T=5t=� ก��t=� IM <��TJ������K�� �^T=5t=� �\< ก��ก���X�> X\<L�J�H�WL��M�e��

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14

K3AL/ก>J<4J�ก>01�� 1. ก� = Digoxin t=� ����� vital sign Tfก 15 ��T= ����W<ก�� 2 X��ML �W<e� ����W<ก�� 3 X��ML�W<e�Tfก 1 G�5�_6L��X�K 5 G�5�_6L ��H��LHhT>Zu�� - HR ��<>ก�W� 60 bpm - Heart block 2. X�� 6=ก�� mornitor EKG, serum digoxin, electrolyte (K, Ca, Mg), HR, renal function 3. �����U<�ก��S��L X=>Le��HกW ���� ���G�� XI\5�eY�<� �=>� <�ก��K�6��6<��>��W�Lm 6<L d�HYLY= S=>� I\<L����ก����H��LHhT>Z 4. u��YLY�>�W� ก�� digoxin toxicity ��YWL����������K>��� I\<�T��T=

�ก>LOPKF4/A.�O>?4M-�F�/ J��/ND<P�GA�>?AM4>?AM/ J<4J�\� @>X�KI�/KDL�H 1. XI\5�eY� <� �=>� 6<L d�HYLY= S=>� I\<L����ก����H��LHhT>Z 2. ���K_hHTY s=>6�� I\<�YUL 3. ���� ���G�� 4. ����>f� ���

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15

������� Dopamine HCL injection High Alert Drug

Nongkhai Hospital Generic Name Dopamine HCl

Strength 250 mg / 10 mg Category Adrenergic agonist

1. ���-./01�� 1. ��ก����� Shock T=5 ก����กก��T�HT��MJ�e6W h=>Lh< Adjunct in the treatment of shock 2. h�56 cardiac output, h�56X��6���_I��, h�56 renal blood flow 2. �34�

• Neonate : 1-20 mcg/kg/min ���KS���>���6ก���<KY�<LS<L�U��z�> • Children : 1-20 mcg/kg/min ���KS���>���6ก���<KY�<LS<L�U��z�> _�>S���>�YULYf� 50

mcg/kg/min • Adult : 1-5 mcg/kg/min ���KS���>���6ก���<KY�<LS<L�U��z�> _�> h�56X��MLI 1-

4 mcg/kg/min/kg/min Tfก 10-30 ��T= ��ก�T�5L�U��z�>�<KY�<L S���>�YULYf� 20 mcg/kg/min The hemodynamic effects of dopamine are dependent :

• Low a dose (dopaminergic effect): 1-3 mcg/kg/min , increased renal blood flow and urine output • Intermedlate a dose (β-adrenergic effect ) : 3-10 mcg/kg/min , increased renal blood flow heart

rare , cardiac contractility and cardiac output • High a dose (alpha a adrenergic effects) : > 10 mcg/kg/min , alpha a adrenergic effects begin to

predominate , vosoconstwtion , increased blood pressure 3. Compatible and incompatible

• Y���MJ�T=5 S��ก��e�� e��HกW D5W ,NSS, D5S, D5S/2 • ��6�Y6�W�6ก�K Sodium bicarbonate �\<Y��II�>T=5 �[��W�L GW� KCl h���TJ��� Dopamine

6��T��� • S��e6We��ก�K Ampicillin, Amphotericin B, Gentamicin • �G�Y��II�>T=5�Y6HI����>�� 24 G6. H�Wu��Y��II�> �I=5>���กY= I\<L<W<�m �[�Y= S�6SiM� �\<

�I=5>� �[�Y=G6hU��<LT�MLT��T= HI กdK��h��HYL 4. �ก>C�.DE/:>?F/GHIก� ectopic beat, tachycardia, angina pain, palpitation , hypotention, vasoconstriction, headache, nausea, vomiting, dyspnea, tissue necrosis ก>J<4J�ก>01��

• ����Y<KK�� �^T=5HTL�MJ� กI\< • BP, HR, EKG, Urine output • K��Tiก vital sign, BP Tfก 1 G6. S^��>�

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K3AL/:;<-MJ<��/ก>IM4ก>�GA�NFOP�/F�/03>?--� High Alert Drug

Nongkhai Hospital Generic Name Dopamine HCl

Strength 250 mg / 10 mg Category Adrenergic agonist

K3AL/ก>FMP/01�� 1. ��6�G�XJ�>W<��ก��Y�5L�G�>� 2. HhT>Z�U�Y�5L>� กJ���X��6 S�6S�� �[� mg : ml GW� Dopamine 1:1 �\< Dopamine 2:1 HI<���� �d���

ก����>� �[�e6_X���<K�W<��T= �ก>W<S<�� S=>� mcg/min 3. Y�5L>����>����e�� th�ก� =tfก t��HI��<LILK��TiกT��T=T=5TJ�e�� 4. e6WX���G�S���>�YULก�W� 20 mcg/kg/min , S���>�YULYf�e6W ก�� 40 mcg/kg/min 5. e6WX��Y�5L�G�>� dopamine �W�6ก�K phenytoin h���TJ���X��6���_I���5J�HI���� ���G��

K3AL/ก>I.��K�?ก>NกQ->MกR� 1. TJ�tI�ก>�T=5HY�LX��6H�ก�W�L ก�K>� e��G�� �� GW� DOPamine _�> th�ก�K dobutamine 2. กdK��ก��>�_�>H>ก��กIW<LT=5�G�tI�กHY�LG\5<T=5H�ก�W�L��ก>�<\5� HI6=XJ� �\<� w >�X��6 Y=5>LYUL��<L

���L>�5L x ���T=5กIW<L>� 3. ก���W�>>�e6W�W����f��� ��<L<W��tI�ก 2 X��ML ��<L6=ก������Y<KsMJ� 4. �KfS�<X��6 �\<�K�tI�กS<L�I����^�Z w Y��II�> S�6S����<L �\<��LกW<��G� x

K3AL/ก>NJ>O��� 10. ����Y<K 2 KfXXI �\<<>W�L��<> 2 X��ML ( ��ก� =S��KfXI�ก� ) ��ก��>�K>�ก��XJ���^S���>�HI

ก���Y6>� 11. �Y6>���L�=M

- Dopamine 1:1 6�>uiL Dopamine 1 mg �W<Y���MJ� 1 ml TJ�_�>�G�>� Dopamine 10 ml ( 1 amp )+ D5W 250 ml I�L�Y6<>UWe�� 24 hr - Dopamine 2:1 6�>uiL Dopamine 2 mg �W<Y���MJ� 1 ml TJ�_�>�G�>� Dopamine 20 ml ( 2 amp )+ D5W 250 ml I�L�Y6<>UWe�� 24 hr

12. 6\5< ��=>6>� Y�d� �U� ��=>6��<L S=>�X��6 S�6S��S<L Dopamine T=5 ��=>6ILK�tI�กS��Y��II�>T=5 ��=>6TfกX��ML h��<6 sd�G\5<�U� ��=>6>�K�tI�ก���>

13. e6W�Y6 Dopamine ��Y��II�>T=5 �[��W�L GW� Sodium Bicarbonate 14. Y��II�>T=5�Y6HI���G���>�� 24 G6. u��Y��II�> �[�Y=G6hU��<LT�MLT��T=

K3AL/ก>-><@>� 1. ����Y<KS���>� HIX��6H�LS<L>�T=5 ��=>6����Lก�KXJ�Y�5LHhT>ZกW<���>� _�>ก������Y<K 2

KfXXI�\<����Y<K 2 X��ML_�> ����> �I�ก������Y<K 2. ��>�_�>>� S��T�LI<� I\<��J�e��T�L �=>� TW���M� HIX����T�Lcentral line h\5<�y<Lก��ก�� ก��

extravasation 3. ��<L���W�� infusion pump h\5<��e���J����Y��II�>T=5uUก��<L 4. ��56��T�LI<� I\<��J����><���� 1-5 µg/kg/min Y�6��u���K h�56SiM�G��me��e6W ก�� 5 µg/kg/min Tfก

15-30 ��T= 5. �I��>f�>���<LXW<>mI�S��� h\5<e6W��X��6����ก �d� ก��e� ( hypotension )

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K3AL/ก>J<4J�ก>01�� 1. K��Tiก vital sign Tfก 1 G6. S^��>�

- BP �U��VWe6WX�� ก�� 160/90 mmHg - BP �dก<�>f ก�� 1 �� e6WX�� ก�� 120/80 mmHg - BP �dก<�>f�5J�ก�W� 1 �� e6WX�� ก�� 90/60 mmHg - HR �U��VWe6WX�� ก�� 120 X��ML / ��T= - HR �dก<�>f ก�� 1 �� e6WX�� ก�� 180 X��ML / ��T= - HR �dก<�>f�5J�ก�W� 1 �� e6WX�� ก�� 220 X��ML / ��T= - �\<��6HhT>ZY�5L

2. ����Y<K<���� �d���ก����>�S<L infusion pump <>W�L��<> ��IX��ML HI 6\5<��<Lก������\< ��� X�\5<L 3. ����Y<KK�� �^T=5HTL�MJ� กI\<<>W�L��<> ��IX��ML 4. <�ก��T=5HY�L�W�<��6=���K>��� I\<�YUL

�ก>LOPKF4/A.�O>?4M-�F�/ J��/ND<P�GA�>?AM4>?AM/ J<4J�\� @>X�KI�/KDL�H 1. <����ก�� ���S<L���������L� 2. ��� X�����<ก 3. XI\5�eY�<� �=>�

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18

������� Heparin Sodium injection High Alert Drug

Nongkhai Hospital Generic Name Heparin Sodium injection

Strength 5000 unit/ml Category Anticoagulants

���-./01� 1. ��ก��_�XI<� I\<������=K����> t=>KhI�� (Acute coronaru syndrome : ACS) 2. ��ก��_�XY6<LS�� I\<�t=>KhI�� (Acute ischemic strock) 3. �G��y<Lก��HI��ก����� Tromboembolic disorder : Pulmonary embolism Deep vain thrombosis

(DVT) 4. �G��y<Lก��HI��ก�� Peripheal arterial embolism 5. �y<Lก��ก��HSdL���S<L I\<���S^ กdK���<>W�L I\<� 6. �y<Lก��ก�� ก����S<L I\<�HI fibrin ��6S�<�W<HIY�><f�ก� Z

�34� 1. Acute myocardial infraction, Acute coronary syndrome

60-80 unit/kg IV bolus (Maximum : 5000 unit) within 1-2 minute then 12-18 unit/kg/hr (Maximum : 1000 unit/hr)

2. Central venous catheter maintenance : 100 unit/ml 3-5 ml ��6��<f�ก� Z 3. Deep vein thrombosis : 80 unit/kg IV bolus then 18 unit/kg/hr 4. Full dose anticoagulant for adult SC ;10000 -20000 units as initial dose followed by 8000 - 20000 unit every 8-12 hr. Intermittent IV : 10000 unit as initial dose follwed by 5000 - 10000 unit every 4 a 6 hr IV infusion ; 20000 - 40000 unit /day 5. Full dose anticoagulant for children Intermittent IV ; 50 unit/kg as initial dose followed by 100 unit /kg every 4 hr IV infusion ; 50 unit/kg as initial dose followed by 20000 unit/m2/24 hr 6. Low dose prophylaxis SC ; 5000 unit 2 hr before surgery and and 8 -12 hr there after for 7 days or until patient is fully ambulatory Compatible and incompatible

• Y���MJ�T=5 S��ก��e�� e��HกW D5W ,NSS, D5S, D5S/2 • Incompatible ก�K amikacin , amiodarone, ciprofloxacin, gentamicin, amphoterin B , dobutamine ,

netilmicin, atracurium �ก>C�.DE/:>?F/GHIก� ��� I\<�<<กLW�>, ก�d� I\<��5J�, ก��Uกh�f� , T�<L�Uก , <� �=>� �[� I\<�, ��YY�� �[� I\<� ก>J<4J�ก>01��

• CBC กW<�HII�L��>� • PTT, aAPTT, Pletlet count, Hemoglobin , Hematocrit • Sign of bleeding : ��� I\<�<<ก GW� �����L6=�MJ� I\<�, ��YY�� �[� I\<�, <� �=>� �[� I\<�

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19

K3AL/:;<-MJ<��/ก>IM4ก>�GA�NFOP�/F�/03>?--� High Alert Drug

Nongkhai Hospital Generic Name Heparin Sodium injection

Strength 5000 unit/ml Category Anticoagulants

K3AL/ก>FMP/01�� 1. S=>�G\5<Y�6�VT�L>�T=5 �[�XJ� �d6 e6W�G�XJ�>W< 2. �KfS���>� �[� Unit �\< >U��� e6W�G����>W< U 3. �Kf<���� �d���ก����>� Y��YW��>��W<Y���MJ�T=5�G��Y6��X�Ku���

K3AL/ก>I.��K�?NกQ->MกR� 1. �G�tI�กGW�>HY�LG\5<>�T=5G�� �� HI6=XJ� �\<� �>�X��6 Y=5>LYUL��<L���L>�5L� 2. ก�� กdK��ก��_�>H>ก��กIW<LT=5�G�tI�กHY�LG\5<>�T=5H�ก�W�L��ก>�<\5� HI6=XJ� �\<� �>�X��6 Y=5>L

YUL ��<L���L>�5L� 3. ก���W�>>�e6W�W����f��� ��<L<W��tI�ก 2 X��ML ��<L6=ก������Y<KsMJ� 4. ��� กdK>�H>กW�L��ก �G��^�ZT=56=�U�HKKXI��>XIiLก��HIH>กYu��T=5 กdK>� heparin <<ก��ก insulin

K3AL/ก>NJ>O��� 1. ����Y<K 2 KfXXI �\<<>W�L��<> 2 X��ML ��ก��>�K ก��XJ���^S���>� HIก���Y6>� 2. 6\5< ��=>6>� Y�d� �U� ��=>6��<L S=>�X��6 S�6S��S<L heparin T=5 ��=>6ILK�tI�กS��Y��II�> 3. �Y6>����> 0.9 % NSS �\< D5W HIX��hI�กกI�K<>W�L��<> 6 X��ML h\5<��>�ก���>���<>W�LT�5�uiL 4. ��6�G�Y��II�>��M��กI�L�Y6HI��6=Y= �I=5>�e� �\<6=�ก<� 5. ��6�Y6��6ก�K>�กIfW6 Aminoglycosides GW� amikacin , gentacin, netromicin, amphotericin

B,amiodarone, atracurium, ciprofloxacin K3AL/ก>-><@>�

1. ����Y<KS���>� HIX��6H�LS<L>� ��=>6����Lก�KXJ�Y�5LHhT>ZกW<���>� _�>ก������Y<K 2 X� �\<����Y<K 2 X��ML _�> ����>ก������Y<K

2. e6WX����>�T�L IM �\5<L��ก�TJ����X�> X\<L HI ��� K�� �^T=5t=� K3AL/ก>J<4J�\�ก>01��

1. ����Y<K<����ก��>� S�� Y�� I\<� HI ����Y<KK�� �^T=5HTL�MJ� กI\< <>W�L��<> ��IX��ML 2. PTT (Patial Thromboplastin Time) 3. aPTT( activated Patial Thromboplastin Time) ก�^=�G�>��W�6ก�K>����� ก�d� I\<� HI >�II�>

I�56 I\<� h\5<�y<Lก��X��6 Y=5>L�W<��� I\<�<<กe�� 4. platelet count , hemoglobin, hematocrit 5. sing of bleeding

�ก>LOPKF4/A.�O>?4M- Heparin F�/ J��/ND<P�GA�>?�M4>?AM/ J<4J�\� @>X� KI�/KDL�H

• ��� I\<�<<ก (Hemorrhage) GW� �����L6=�MJ� I\<�, ��YY�� �[� I\<�, <� �=>� �[� I\<� ก>Kก�C�SA?D<R��/

• �� IV Protamine sulfate injection 1 mg : 100 units of Heparin ��ก�� neutralizied �T��� Anticoagulant S<L Heparin _�>�Y6 Protamine sulfate 10 mg/ml slow IV injection �� 1-3 ��T= YULYf�e6W ก�� 50 mg HIY�6��usMJ�e��Tfก 10 ��T=

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20

������� Magnesium sulfate injection

High Alert Drug Nongkhai Hospital

Generic Name Magnesium sulfate injection Strength 10% MgSO4 in 10 ml = 8mEq

50% MgSO4 in 2 ml = 8mEq Category Electrolyte , Magnesium

���-./01�

• �y<Lก��<�ก��G�ก �\5<L��ก���X���Z �[�h��( Pre eclampsia �\< eclampsia) • ��ก��������� ��������L� �\5<L��ก���H6ก�= s=>6�� I\<��5J� • Hypomagnesemia

�34� S���>�YULYf�e6W ก�� 30-40 g / ��� ก>hO Pre j eclampsia , Eclampsia

• Iv. 4-6 gm over 15 -20 ��T= ��6���> 2 g/hr ก>hOKก�C� Mg 03N�X�4JPk \��0@l.

• Mild hypomagnesemia : 1 g IM Tfก 6 G6. �J���� 4 dose • Severe hypomagnesemia : 250 mg/kg IM Tfก 4 G6. �\< 5 g �� D5W �\< NSS 1000 ml slow

infusion 6�กก�W� 3 G6. N4Qก

• Neonate , MgSO4 25-50 mg/kg iv. Tfก 8-12 G6. 2-3 dose • Children, MgSO4 25-50 mg/kg iv.Tfก 4-6 G6. 3-4 dose, max single dose 2 g.

ก>hO Torsades de Pointes \��0@l.

• Pulseless arrest , 1-2 g �\<��L�� 10 ml D5W , IV/intraosseous 5-20 ��T= • With pulses , 1-2 g �\<��L�� 50-100 ml D5W , IV. 5-60 ��T= �[� loading dose HI����6���>

continuous iv. Infusion 0.5 a 1 g/hr N4Qก 25-50 mg/kg IV/intraosseous 10-20 ��T= , maximum dose 2 g Compatible& incompatible

• Y��II�>T=5�G��Y6H��J� D5W • �Y6HI�� กdKe����� 24 G6. ��6 กdK���U� >d� • e6WX���Y6ก�K>�T=56= phosphate, alkali carbonate or bicarbonate GW� Sodium bicarbonate, amino

acid �W�Lm HI>�<\5�m GW� Amphotericine B, Ciprofloxacin , clindamycin , dobutamine, hydrocortisone, fat emulsion 10 % h���TJ����ก�ก<�

�ก>C�.DE/:>?F/GHIก�

• T�<L Y=>, hypotension, asystole, deep tendon reflex uUกก�, respiratory depression

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21

ก>J<4J�ก>01��

• Magnesium level ( ��Tfก 12-24 G�5�_6L I�LY�M�Yf�ก����>� ���K�ก�� 1.5-2.5 mg/dl) • Blood pressure, Heart rate , Respiratory rate • Deep tendon reflex • Sign of arrhythmia, respiratory and CNS depression • Urine output X��6�กก�W� 100 ml / 4 hr. • <�ก��T=5HY�L�W�<��6=���KH6ก�= s=>6�� I\<�YUL e��HกW T�<L Y=> XI\5�eY� <� �=>� • ����Y<K<����ก��>�>� S�� Y��HI����Y<KK�� �^T=5HTL�MJ� กI\<<>W�L��<> ��I 1 X��ML

K3AL/:;<-MJ<��/ก>IM4ก>�GA�NFOP�/F�/03>?--�

High Alert Drug

Nongkhai Hospital

Generic Name Magnesium sulfate injection Strength 10% MgSO4 in 10 ml = 8mEq

50% MgSO4 in 2 ml = 8mEq Category Electrolyte , Magnesium

K3AL/ก>FMP/01�� 1. ก��Y�5L�G� Magnesium ��<L S=>�G\5<Y�6�VT�L>� h��<6T�ML S=>�G\5<HhT>Z�U�Y�5L�G�กJ�ก�KTfกX��ML 2. ก��Y�5L�G� magnesium X��Y�5L �[� gm �\< mg S<L Magnesium sulfate, �\< �[� ml ก� =T=5�KfX��6

S�6S��G�� �� GW� 10% Magnesium sulfate 10 ml e6WX��Y�5L>� �[��J���� wampulex HI�Kf<���� �d���ก���� Magnesium T�LI<� I\<��J�

3. ก���� 50% MgSO4 Y�6��u��T�L IM �\< IV slow infusion TW���M� <���� �d�YULYf�S<Lก����>�e6W ก�� 2 ก��6/G�5�_6L

4. ก���� 10% MgSO4 Y�6��u push G��me��e6W ก�� 1 ก��6/��T= K3AL/ก>I.��K�?NกQ->MกR�

1. �G�tI�กGW�>HY�LG\5<>�T=5G�� �� HI6=XJ� �\<� w >�X��6 Y=5>LYUL ��<L���L>�5Lx 2. กdK��ก��>�_�>H>ก��กIW<LT=5tI�กHY�LG\5<T=5H�ก�W�L��ก>�<\5� HI6=XJ� �\<� w >�X��6 Y=5>LYUL ��<L���L>�5L x ���T=5กIW<L>� 3. ก���W�>>�e6W�W����f��� ��<L<W��tI�ก 2 X��ML ��<L6=ก������Y<Ks��

K3AL/ก>NJ>O��� 1. ����Y<K 2 KfXXI �\<<>W�L��<> 2 X��ML (��ก� =S��KfXXI�ก�) ��ก��>�K>�ก��XJ���^S���>�HI

ก���Y6>� 2. ก�� ��=>6>���T�L IV infusion:

- �Y6 MgSO4 ���> D5W ��6=X��6 S�6S�� < 10%>�T=5�Y6HI����X��6 S�6S�� 4 % กdK���U� >d�e��<>W�L��<> 7 ���

- 6\5< ��=>6>� Y�d� �U� ��=>6��<L S=>�X��6 S�6S��S<L MgSO4 T=5 ��=>6ILK�tI�กS��Y��II�>T=5 ��=>6 h��<6 sd�G\5<K�tI�กTfกX��ML

- X�����Lก���Y6>�T=56= phosphate , alkali carbonate or bicarbonate GW� sodium bicarbonate ,amino acid solution �W�Lm �ก�J� �[�����iก�� �Y�Gก�

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K3AL/ก>-><@>� 1. ����Y<KS���>� HIX��6H�LS<L>�T=5 ��=>6����Lก�KXJ�Y�5LHhT>ZกW<���>� _�>ก������Y<K 2

KfXXI�\<����Y<K 2 X��ML_�> ����> �I�ก������Y<K 2. ก����>� IV slow infusion e6W ก�� 1-2 ก��6/G�5�_6L HI IV bolus e6W ก�� 1-2 ก��6/10 ��T=

K3AL/ก>J<4J�\�ก>01�� 1. ����Y<K<����ก��>�>� S�� Y��HI����Y<KK�� �^T=5HTL�MJ� กI\<<>W�L��<> ��I 1 X��ML 2. Heart rate 3. Blood pressure 4. Magnesium level ( ��Tfก 12-24 G�5�_6L I�LY�M�Yf�ก����>� ���K�ก�� 1.5-2.5 mg/dl) 5. <�ก��T=5HY�L�W�<��6=���K Magnesium �� I\<�YUL

�ก>LOPKF4/A.�O>?4M- Magnesium 03N�X�4F�/ J��/ND<P�GA�>?�M4>?AM/ J<4J�\� @>X�KI�/KDL�H 1. Diarrhea 2. CNS depression 3. Depressed neuromuscular transmission and tendon reflexs 4. Flushing 5. Somnolence 6. Complete heart block 7. Respiratory depression

K3AL/ก>Kก�C�SA?D<R��/ Magnesium 1. Antidote : 10 % calcium gluconate �� 10-20 ml IV push e6W ก�� 0.5 ml/min 2. TJ� Dialysis ก� = ก��h���f�H�L

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23

������� Morphine Sulfate

High Alert Drug Nongkhai Hospital

Generic Name Morphine sulphate Strength Injection:10 mg/ml ; IM, IV, Sc

Tablet :MST Continus 10 mg Category Nacrotics Analgesic

���-./01� 1. K�� T�<�ก��������กI�L - �f�H�L 2. K�� T�<�ก�� dyspnea T=5 ก����ก acute left ventricular failure and pulmonary edema 3. Preanesthetic medication

�34� Children (��o�กกA. 6 N4X�3 K�?3pk@3Mก3���กA. 50 กก.) :

• SC,IM 0.1-0.2 mg/kg Tfก 3-4 G6. (single pediatric dose e6W ก�� 15 mg) • IV. 0.05 - 0.1 mg/kg Tfก 3-4 G6. • IV. Infusion 0.01 a 0.03 mg/kg/hr. • Adolescents > 12 �� : Sedation/analgesia for procedures : I.V.3-4 mg HIsMJ�e��<=ก 5 ��T= u���J� �[�

Adult : Acute Pain (moderate - severe)

• SC,IM 5 - 20 mg Tfก 3-4 G6. • IV. 2.5 - 15 mg Tfก 3-4 G6. (ก� =�J� �[�<�� h�56>�X��MLI��<>m GW� 1-4 mg sMJ�e��Tfก 5 ��T= ) • Contiuous IV. Infusion ��56���> 0.8 a 80 mg/hr. • Intrathecal (I.T.) : 0.2 - 0.25 mg/dose repeat dose not recommend • Epidural

- Single dose, ��56��� : 3-5 mg - Infusion ; Bolus dose : 1-6 mg maximum dose : 10 mg/day

• Surgical anesthesia : Epidural, single dose, Lumbar epidural only - Cesarean section : 10 mg - Lower abdominal/plemic surgery : 10-15 mg - Major orthopedic surgery of lower extremity : 15 mg

���KS���>�I�IL���U��z�>e�Kกh�W<LHI�U�YUL<�>f Compatible &Incompatible

• Y���MJ�T=5 S��ก��e�� : D5W / NSS • e6WX���Y6ก�K>��W<e��=M Aminophylline, Fluouracil, Heparin, Pethidine, Amphotericine B,

Furosemide, Phenobarbital, Dilantine(Phenytoin), Sodium bicarbonate • ��6�Y6�� y-site �W�6ก�K acyclovir , furosemide, minocycline • X��6XL���I�L�Y6 >��XL���<>UWe��I�>��� H�We6WH��J����Y6>�T�MLe�����ก�W� 24 G6. • ��6�G�>� 6\5<6=ก���ก�ก<� ก��SiM� �\<6=Y= I\<L S�6SiM�

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�ก>C�.DE/:>?F/GHIก�

• Cardiovascular : hypotension , bradycardia , tachycardia • CNS : dizziness, headache, drowsiness, delilbrium • GI : nausea, vomiting, constipation, xerostomia • Ocular : blurred vision, miosis • Respiratory : respiratory depression, shortness of breath

ก>J<4J�ก>01��

1. Respiratory status , Mental status, Blood pressure , Oxygen saturation , Pain score, Sedation score , urine output

2. ����Y<K<���� �d���ก����>�S<L infusion pump <>W�L��<> ��I 1 X��ML 3. <�ก��h����ก>� �U��z�>�LW�Lsi66�กHI�>��G�� HI6W����� IdกS��� TW��U Sd6 u���>����<>ก�W�

10 X��ML/��T= ( �dก<�>f�5J�ก�W� 1 �� 30 X��ML/��T= �\< �dก<�>f6�กก�W� 1 �� 20 X��ML/��T= ) <��ก�ก���>��e�� ��H��LHhT>Z u��กJ�I�L��>� �[� continuous drip <>UW ��>f�>�T��T=

4. >�Hก�h��S<L Morphine e��HกW Naloxone _�>S���>����U��VWX\< 0.2 a 0.4 mg �� IV, IM, SC �� �dก 0.01 mg/kg ��sMJ�e��Tfก 2-3 ��T= (��6HI��e6W ก�� 10 mg)

K3AL/:;<-MJ<ก>IM4ก>�GA�NFOP�/F�/03>?--�

High Alert Drug

Nongkhai Hospital

Generic Name Morphine sulphate Strength Injection:10 mg/ml ; IM, IV, Sc

Tablet :MST Continus 10 mg Category Nacrotics Analgesic

K3AL/ก>FMP/01�� 1. S=>�G\5<Y�6�VT�L>�T=5 �[�XJ� �d6 e6W�G�XJ�>W< ���>W<T=5�G���_�Lh>�K�I�<LX�> X\< MO TW���M� 2. �G��K >Y.5 ��ก<Kก��Y�5L�G� 3. ก� =�� IV infusion ��<LกJ���X��6 S�6S�� �[� mg/ml <���� �d���ก����>� �[� ml/hr �\< mg/hr �ก

�� ก�� 10 mg/hr X�������6�กI�G�� H�W<���� �d�YULYf�e6W ก�� 80 mg/hr 4. ��ก� =�J� �[���<L��T�L IV ��S��� 4-10 mg _�> �\<��L���> sterile for injection ��<����YW�� 1mg :

1 ml IV G��m �G� �I�6�กก�W� 4-5 ��T= K3AL/ก>I.��K�?ก>NกQ->MกR�

1. �G�tI�กGW�>HY�LG\5<>�HIX��6H�LT=5G�� �� X\< Morphine 2. ก�� กdK��ก��>����U�>� Yh��� HI6=XJ� �\<� w>�X��6 Y=5>LYUL ��<L���L<>W�L>�5Lx ���T=5����U�>� 3. ก���W�>>�e6W�W����f��� ��<L<W��tI�ก 2 X��ML ��<L6=ก������Y<KsMJ�

K3AL/ก>NJ>O��� 1. <W��XJ�Y�5LHItI�ก>���G�� �� �กY�5L���>���>W<X��TKT��X��6uUก��<L HI>\�>��X��6uUก��<LS<L

�U��z�>HIS���>� _�>����Y<K<>W�L��<> 2 KfXXI �\<<>W�L��<> 2 X��ML 2. ����Y<K 2 KfXXI �\<<>W�L��<> 2 X��ML ��ก��>�K ก��XJ���^S���>� HIก���Y6>� - ��=>6 IV push : 4-10 mg _�> �\<��L���> sterile water for injection ��<����YW�� 1 mg : 1 ml - ��=>6 IV infusion : _�> �\<��L���> D5W ��<>UW��X��6 S�6S�� 0.1-1 mg/ml 3. e6WX���Y6ก�K>��W<e��=M aminophylline, fluoracil, heparin, pethidine, amphotericin B, furosemide,

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Phenobarbital, phenytoin, sodium bicarbonate 4. Y�6��u��T�LY�>>�L HIT�L<���e�� 5. ก� = Intrathecal / Epidural �G�ก�K Patient Controlled Analgesia �����K�����6H��T�LT=5กJ���S<L

��Y�VV= K3AL/ก>-><@>�

1. ����Y<KS���>� HIX��6H�LS<L>� ��=>6����Lก�KXJ�Y�5LHhT>ZกW<���>� _�>ก������Y<K 2 X� �\<����Y<K 2 X��ML _�> ����> �I�ก������Y<K

2. Y�6��u��>�T�L IM, IV, IV infusion, Sc 3. ��W�L��>��U��z�>X��<>UW��TW��<� ก����>�T=5 �d� ก��e�<��TJ���6=_<ก�Y ก���IS��L X=>L��ก>�e�� 4. ก����>�HKK IV ��<L �\<��LกW<��G� HI�G� �I���>� 4-5 ��T=SiM�e� 5. ��6�G�>� 6\5<6=ก���ก�ก<� ก��SiM� �\<6=Y= I\<L S�6SiM� 6. ก����>�HKK IV infusion <����ก����>�YULYf�e6W ก�� 80 mg/hr - 6\5< ��=>6>� Y�d� �U� ��=>6>���<L S=>�X��6 S�6S�� Morphine T=5 ��=>6ILK�tI�กS��Y��II�>h��<6

sd�G\5<กJ�ก�KTfกX��ML - X����>��W�� infusion pump 7. 6=6���ก��X�KXf6 �KKK��TiกT=5G�� �� ��6e�uiL��G�K���fT=5�G�HI�� h\5<����Y<Kก���G�>�sMJ�

�ก>LOPKF4/A.�O>?4M- Morphine F�/ J��/ND<P�GA�>?�M4>?AM/ J<4J�\� @>X�KI�/KDL�H

1. Miosis 2. Hypotension (BP<90/60 mmHg) 3. Respiratory depression and apnea (RR <10) 4. Pulmonary edema (oxygen sat <95%) 5. urine output < 600 ml/day

K3AL/ก>Kก�C�SA?D<R Morphine sulphate

1. Support airway 2. >�Hก�h��S<L Morphine e��HกW Naloxone(Narcan) _�>S���>����U��VWX\< 0.2 a 0.4 mg �� IV, IM, SC

�� �dก 0.01 mg/kg ��sMJ�e��Tfก 2-3 ��T= (��6HI��e6W ก�� 10 mg)

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26

������� Norepinephrine injection High Alert Drug

Nongkhai Hospital Generic Name Norepinephrine

Strength 4 mg/2 ml (inj.) Category Alpha/Beta agonist

1. ���-./01� 1. ��ก�����Gd<ก I�L��กT=5��Y���MJ�T�HT�<>W�L h=>Lh<HI�� 2. �G�YJ���KGW�>��H�L���_I��T=5I��5J�IL<>W�L t=>KhI��กI�KYULSiM�YUW���K�ก��

2. �34� Continuous I.V. infusion : N4Qก ( Pediatric )

• ��56��� 0.05-0.1 mcg/kg/min. HI��XW<>m h�56<����ก��>�>�e��uiL 2 mcg/kg/min \��0@l.

• ��56��� 0.5-1 mcg/kg/min and titrate to desired response ; 8-30 mcg/min is usual range ( maximum /day = 68 mg )

3. Compatible and incompatible 1. �\<��L>����> D-5-W , D-5-S e6WH��J����Y6�� NSS �\5<L��กก���Y6>���Y��II�>T=56= Dextrose

�GW�>�y<Lก��ก��YUV Y=>X��6H�L ( loss of potency ) S<L>���ก���ก���>� oxidation 2. ��6����Y�> IV �=>�ก��ก�K I\<�HIhI�Y6� �\<Y��II�>T=5 �[��W�L ( GW� Y��II�>T=56= Sodium

bicarbonate, barbiturates �I� ) 3. Y��II�>T=5 �\<��LHI���6=X��6XL��� 24 G�5�_6L T=5<f^�U6��<L _�> กdK��h��HYL 4. ��6�G�Y��II�>T=5SfW��\< �I=5>� �[�Y=G6hU Y= I\<L S�6 �\<Y=�MJ���I

4. :;<ก<><�>?@A./� 1. Contraindicated : Dihydroergotamine, Isocarboxazid, Phenelzine, Linezolid : ��6�G� linezolid HI

norepinephrine �W�6ก��_�>e6W6=ก�����������6X��6���_I��T=5<�� h�56SiM�e�����U��z�>T=5��ก�����> linezolid , S���>� ��56���X��6=ก�����KI�S���>� HIXW<>m h�56S���>� h\5<��e���Iก����ก��T=5��<Lก������>I�L

2. Major Drug interactions : Amitriptyline, Clomipramine, Desipramine, Dotiepine, Doxepin, Imipramine, Nortriptylin, Protriptyline,Trimipramine,

3. Moderate Drug interaction : Chlorpromazine, Selegiline, 5. �ก>C�.DE/:>?F/GHIก�

• Serious adverse effects : Cardiac arrest, Cardiac dysrhythmia • Adverse effects <\5�m e��HกW Bradycardia, arrhythmias, peripheral ischemia, headache (transient),

anxiety, skin necrosis (with extravasation), dyspnea, respiratory difficulty. 6. ก>J<4J�ก>01��

1. ���Lก����5�si6<<ก�<กI<� I\<� h���TJ��� ก�� �\M<��> HI�ก��<L�G� �[� �I���� X�� �I=5>�H�ILK�� �^T=5HTL Sd6 S��I<� I\<� �[��> h\5<I�ก�� ก�����I<� I\<�������K�� �^T=5HTL Sd6 H�Wu��>���5�<<ก�<กI<� I\<����Y6 phentolamine 5-10 mg ���> NSS ���6��� 10 -15 ml infiltrate ��K�� �^��M�

2. �������X��6��� I\<� HIG=h��Tfก 2 ��T= 6\5< ��56��>�HI���Tfก 5 ��T= 6\5<X��6��� I\<�<>UW�����KXLT=5T=5��<Lก�� ( ��6�^ 80 a 100 mmHg systolic ) I�L��ก��M����Tfก 15 ��T=

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K3AL/:;<-MJ<��/ก>IM4ก>�GA�NFOP�/F�/03>?--�

High Alert Drug Nongkhai Hospital

Generic Name Norepinephrine Strength 4 mg/2 ml (inj.) Category Anti-arrhythmias

K3AL/ก>FMP/01�� 1. �KfS���>�T=5Y�5L�G���G�� �� h��<6�Kf�W�>T=5�G� 2. Y�5L>����>����e�� th�ก� =tfก t��HI��<LILK��TiกT��T=T=5TJ�e��

K3AL/ก>I.��K�?ก>NกQ->MกR� 1. กdK��ก��>�_�>H>ก��กIW<LT=5�G�tI�กHY�LG\5<T=5H�ก�W�L��ก>�<\5� HI6=XJ� �\<� w >�X��6 Y=5>LYUL��<L

���L>�5L x ���T=5กIW<L>� 2. ก���W�>>�e6W�W����f��� ��<L<W��tI�ก 2 X��ML ��<L6=ก������Y<KsMJ�

K3AL/ก>NJ>O��� 1. ����Y<K 2 KfXXI �\<<>W�L��<> 2 X��ML ��ก��>�K>�ก��XJ���^S���>�HIก���Y6>� 2. 6\5< ��=>6>� Y�d� ��<L S=>�X��6 S�6S��S<L>�T=5 ��=>6ILK�tI�กS��Y��II�>T=5 ��=>6TfกX��ML 3. �\<��L>����> D-5-W , D-5-S e6WH��J����Y6�� NSS �\5<L��กก���Y6>���Y��II�>T=56= Dextrose

�GW�>�y<Lก��ก��YUV Y=>X��6H�L ( loss of potency ) S<L>���ก���ก���>� oxidation 4. ��6����Y�> IV �=>�ก��ก�K I\<�HIhI�Y6� �\<Y��II�>T=5 �[��W�L ( GW� Y��II�>T=56= Sodium

bicarbonate, barbiturates �I� ) 5. Y��II�>T=5 �\<��LHI���6=X��6XL��� 24 G�5�_6L T=5<f^�U6��<L _�> กdK��h��HYL 7. ��6�G�Y��II�>T=5SfW��\< �I=5>� �[�Y=G6hU Y= I\<L S�6 �\<Y=�MJ���I

K3AL/ก>-><@>� 1. ��6t=�HKK IV push ��<L �\<��L>�กW<�K���� ( Dilution กW<� IV infusion ). 2. ����Y<KS���>� HIX��6H�LS<L>�T=5 ��=>6����Lก�KXJ�Y�5LHhT>ZกW<���>� _�>ก������Y<K 2

KfXXI�\<����Y<K 2 X��ML_�> ����> �I�ก������Y<K 3. K����>� S��T�LI<� I\<��J� _�>�G� infusion pump h\5<��Y�6��uX�KXf6 ก���G�>�e���= 4. ก��>f�>���<LXW<>m ���KI�IL ��6>f�>�T��T= h\5<�y<Lก�����X��6��� I\<��5J� 5. X����>� ( Infused ) S��I<� I\<��J��VW��L antecubital vein T=5S�<�<ก������ h��_<ก�YT=5� ก��

�����L��> th�YW��6=e6W6�ก��ก �\<��>�T�LI<� I\<��J� femoral T=5���S�กde�� 6. e6WX����>�_�>���= catheter tie-in. h���TJ��� ก�� I\<�X�5L HI6=>�e�X�5L<>UWK�� �^��M�TJ���X��6

S�6S��S<L>�YUL6�ก ก��e� ( si5L<��TJ��� ก�� local necrosis ��ก extravasation ) 8. I=ก I=5>Lก��t=��MJ�>� S��I<� I\<��J�T=5S� (Leg veins) , _�> th�<>W�L>�5L���U�YUL<�>f�\<�U��z�>si5L

�[�_�XI<� I\<�<f���� (Occlusive vascular diseases ), arteriosclerosis, DM 9. X�� �I=5>�T=5t=� �[��>m h\5<I�ก�� ก�����I<� I\<�������K�� �^T=5t=�>�

K3AL/ก>J<4J�ก>01�� 1. �������X��6��� I\<� HIG=h��Tfก 2 ��T= 6\5< ��56��>�HI���Tfก 5 ��T= 6\5<X��6��� I\<�<>UW�����K

XLT=5T=5��<Lก�� I�L��ก��M����Tfก 15 ��T= 2. EKG 3. �����J�H�WL��>�KW<>m h\5<�U�W��MJ�>�eIe�� �[��ก��HIe6W��5�<<ก��ก Y�� I\<� (extravasation )

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�ก> �ก>KF4/ LOPJ��/KI�/KDL�H 6. hK EKG: VT, VF, Heart block 7. ��>L��HhT>Z 6\5< HR > 140 X��ML/��T= 8. Extravasation

K3AL/ก>Kก�C�SA?D<R 1. u��6= Extravasation ก��SiM� ���=K���MJ� กI\< ( NSS ) 10 a 15 ml. si5L6=���>� phentolamine 5 -10 mg.

infiltrated S����K�� �^T=56= extravasation _�> �d�T=5Yf� phentolamine �GW�>�y<Lก��6��� �\M< >\5<K�� �^��M� ก��ก����> th�YW��HIIf� �[�H�I X���G��� Sd6G���t=� S����������LS��� IdกHIX��t=��MJ�>��J����6�กm ��HT�กsi6 S��T�5�T�MLK�� �^T=56=I�ก�^HSdL >d� HIs=�ก�W�K�� �^<\5� HIX���=K�G�phentolamine ��>�� 12 G�5�_6LH�กT=5 ก�� extravasation.

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������� Pethidine Sulfate Injection High Alert Drug

Nongkhai Hospital Generic Name Pethidine

Strength 50 mg/ml (inj.) Category Nacrotic Analgesic

���-./01� 1. K�� T�<�ก��������กI�L a �f�H�L 2. Pre -anesthetic medication

�34� S���>�YULYf�e6WT��KH�W�<� SiM�ก�KY���S<L�U��z�> H�W���U��z�>T=56=e��ก��H��J�S���>�e6WX�� ก�� 600 mg/day HIC�.GA>01�33Nก<3 48 1�. ( American Pain society ,1999 ) Children :

• IV, IM, SC : 1-1.5 mg/kg/dose Tfก 3-4 G6. (single pediatric dose e6W ก�� 15 mg) • >��J�YIK : 1-2 mg/kg single dose ; maximum 100 mg/dose Adult :

• SC,IM : S���>� ��56��� ; opiate-native ; 50-75 mg Tfก 3-4 G6. �U��z�>T=5 X>e����K6�กW<�S���>� ��56���<��YULก�W��=M , preoperative 50-100 mg ��กW<� 30-90 ��T=

• Slow IV. : S���>� ��56��� 5-10 mg Tfก 5 ��T= • Patient a controlled analgesia (PCA) ; usual concentration 10 mg/ml

- S��� ��56��� ; 10 mg - Demand dose ; 1-5 mg (manufacturer recommendation ) ; range 5-25 mg ( American Pain

society ,1999 ) - Lockout interval ; 5-10 ��T=

Elderly :

• IM ; 25 mg Tfก 4 G6. :>M-�34��4�/03\��:rA�CJ-กD>.�/K�?\��F�/��o Compatible &Incompatible

• Y���MJ�T=5 S��ก��e�� : D5W / NSS • e6W�Y6ก�K>��W<e��=M Aminophyline, Morphine, Heparin, cefoperazone, Amphotericin B,

Furosemide, Imipenem, Phenobarital, Phenytoin, Sodium bicarbonate • X��6XL��� I�L�Y6>�X���G���>�� 24 G�5�_6L HIX�� กdK��h��HYL

�ก>C�.DE/:>?F/GHIก�

• Cardiovascular : hypotension ,bradycardia, palpitation • CNS : LW�Lsi6, Y�KY�, �f�H�L-ก���Y�TYW��กI�L, G�ก, ก�ก���>�� • GI : nausea, vomiting, constipation, anorexia, stomach cramp • ��YY��X�5L, ���H�L , L\5<<<ก6�ก

ก>J<4J�ก>01�� 1. Respiratory status , Mental status, Blood pressure , Oxygen saturation , Pain score, Sedation

score , urine output 2. ����Y<K<���� �d���ก����>�S<L infusion pump <>W�L��<> ��I 1 X��ML

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3. <�ก��h����ก>� �U��z�>�LW�Lsi66�กHI�>��G�� HI6W����� IdกS��� TW��U Sd6 u���>����<>ก�W� 10 X��ML/��T= ( �dก<�>f�5J�ก�W� 1 �� 30 X��ML/��T= �\< �dก<�>f6�กก�W� 1 �� 20 X��ML/��T= ) <��ก�ก���>��e�� ��H��LHhT>Z u��กJ�I�L��>� �[� continuous drip <>UW ��>f�>�T��T=

4. >�Hก�h��S<L Morphine e��HกW Naloxone _�>S���>����U��VWX\< 0.2 a 0.4 mg �� IV, IM, SC �� �dก 0.01 mg/kg ��sMJ�e��Tfก 2-3 ��T= (��6HI��e6W ก�� 10 mg)

K3AL/:;<-MJ<��/ก>IM4ก>�GA�NFOP�/F�/03>?--�

High Alert Drug Nongkhai Hospital

Generic Name Pethidine Strength 50 mg/ml (inj.) Category Nacrotic Analgesic K3AL/ก>FMP/01��

1. ��6�G�XJ�>W<��ก��Y�5L�G�>� �KfS���>�T=5Y�5L�G���G�� �� h��<6�Kf�W�>T=5�G� ��6T�ML���=ก����T=5G�� �� 2. �G��K >Y.5 ��ก<Kก��Y�5L�G�>� 3. ก� =�� IV infusion ��<LกJ���X��6 S�6S�� �[� mg/ml <���� �d���ก����>� �[� ml/hr �\< mg/hr �ก

�� ก�� 10 mg/hr X�������6�กI�G�� H�W<���� �d�YULYf�e6W ก�� 80 mg/hr 4. ��ก� =�J� �[���<L��T�L IV ��S��� 4-10 mg _�> �\<��L���> sterile for injection ��<����YW�� 1mg :

1 ml IV G��m �G� �I�6�กก�W� 4-5 ��T= K3AL/ก>I.��K�?ก>NกQ->MกR�

1. �G�tI�กGW�>HY�LG\5<>� HIX��6H�LT=5G�� �� X\< Pethidine 2. ก�� กdK��ก��>����U�>� Yh��� HI6=XJ� �\<� w>�X��6 Y=5>LYUL ��<L���L<>W�L>�5Lx ���T=5����U�>� 3. ก���W�>>�e6W�W����f��� ��<L<W��tI�ก 2 X��ML ��<L6=ก������sMJ� 4. ���U��z�>T=5e��ก�� S���>�YULYf� 600 mg/day HIe6WX���G���� ก�� 48 G�5�_6L

K3AL/ก>NJ>O��� 1. <W��XJ�Y�5LHItI�ก>���G�� �� �กY�5L���>���>W<X��TKT��X��6uUก��<L HI>\�>��X��6uUก��<LS<L

�U��z�>HIS���>� _�>����Y<K<>W�L��<> 2 KfXXI �\<<>W�L��<> 2 X��ML 2. ก��>�K ก��XJ���^S���>� HIก���Y6>� X��6=ก������Y<K<>W�L��<> 2 KfXXI �\<<>W�L��<> 2

X��ML 3. 6\5< ��=>6>� Y�d� �U� ��=>6��<L S=>�X��6 S�6S��S<L Pethidine T=5 ��=>6ILK�tI�กS��Y��II�>T=5

��=>6TfกX��ML h��<6 sd�G\5<�U� ��=>6>�K�tI�ก���> - ��=>6 IV push: �\<��L���> SWFI 5 ml กW<�t=�(10 mg/ml) ��>�G��m<>W�L��<> 5 ��T=

- ��=>6 IV infusion: �\<��L���> D5W ��e��X��6 S�6S�� 1 mg/ml 4. e6WX���Y6ก�K>��W<e��=M Aminophylline, Morphine, heparin, cefoperazone, Amphotericin B,

Furosemide, Phenobarbital, phenytoin, sodium bicarbonate 5. X��6XL��� I�L�Y6>�X���G���>�� 24 G�5�_6L HIX�� กdK��h��HYL

K3AL/ก>-><@>� 1. ����Y<KS���>� HIX��6H�LS<L>� ��=>6����Lก�KXJ�Y�5LHhT>ZกW<���>� _�>����Y<K 2 X� �\<

����Y<K 2 X��ML _�> ����> �I�ก������Y<K 2. Y�6��u��>�T�L IM, IV push, IV infusion, SC - IM ��ก� =�G�กW<��W���� ��t=�>�กW<���>�YIK 30-90 ��T= - Sc ��ก� =�G�กW<��W���� ��t=�>�กW<���>�YIK 30-90 ��T=

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- IV. Infusion �\<��L��6=X��6 S�6S�� 0.1-1 mg/ml ���<>W�L��<> 15-30 ��T= - IV. push �\<��L���> SWFI 5 ml ��6=X��6 S�6S��e6W ก�� 10 mg/ml ���<>W�L��<> 5 ��T= 3. ��W�L��>�t=�X�����U��z�><>UW��TW��<� HI���<�h�ก 30 ��T=I�L��>� 4. ����Y<KS���>� HIX��6H�LS<L>� ��=>6����Lก�KXJ�Y�5LHhT>ZกW<���>� _�>����Y<K 2 X� �\<

����Y<K 2 X��ML _�> ����> �I�ก������Y<K 5. Y�6��u��>�T�L IM, IV push, IV infusion, SC - IM ��ก� =�G�กW<��W���� ��t=�>�กW<���>�YIK 30-90 ��T= - Sc ��ก� =�G�กW<��W���� ��t=�>�กW<���>�YIK 30-90 ��T= - IV. Infusion �\<��L��6=X��6 S�6S�� 1 mg/ml ���<>W�L��<> 15-30 ��T= - IV. push �\<��L���> SWFI 5 ml ��6=X��6 S�6S��e6W ก�� 10 mg/ml ���<>W�L��<> 5 ��T= 6. ��W�L��>�t=�X�����U��z�><>UW��TW��<� HI���<�h�ก 30 ��T=I�L��>� 7. ก����>�HKK IV infusion X����>��W�� infusion pump 8. 6\5< ��=>6>� Y�d� �U� ��=>6>���<L S=>�X��6 S�6S�� pethidine T=5 ��=>6ILK�tI�กS��Y��II�>h��<6

sd�G\5<กJ�ก�KTfกX��ML 9. X��6=6���ก��X�KXf6 �KKK��TiกT=5G�� �� ��6e�uiL��G�K���fT=5�G�HI�� h\5<ก������Y<Kก���G�>�

sMJ� K3AL/ก>J<4J�ก>01��

1. Respiratory status Tfก 15 ��T= �[� �I� 1 G�5�_6LI�L��>� 2. Mental status (CNS depression; 6=�KK�y<Lก���U��z�>hI���กกI�6��ก<�ก��6i�LL) 3. Blood pressure 4. Prolong sedation 5. urine output 6. ����Y<K<���� �d���ก����>�S<L infusion pump <>W�L��<> ��I 1 X��ML

�ก>KF4/A.�O>?4M- Pethidine F�/ J��/ND<P�GA�>?�M4>?AM/ J<4J�\� @>X�KI�/KDL�H 1. 6�Y�� I�K�Ifกe6W�\5� 2. Miosis (6W����� Idก) 3. hypotension (BP<90/60 mmHg) 4. Respiratory depression and apnea (RR< 10/min) 5. Pulmonary edema (oxygen sat <95%)

K3AL/ก>Kก�C�SA?D<R Pethidine hydrochloride 1. support airway 2. >�Hก�h��S<L Morphine e��HกW Naloxone(Narcan) _�>S���>����U��VWX\< 0.2 a 0.4 mg �� IV, IM,

SC �� �dก 0.01 mg/kg ��sMJ�e��Tfก 2-3 ��T= (��6HI��e6W ก�� 10 mg)

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32

������� Phenytoin Sodium

High Alert Drug Nongkhai Hospital

Generic Name Phenytoin Strength Injection:250 mg/5ml

Capsule:100 mg Category Anticonvulsant

���-./01� 1. X�KXf6ก��G�กHKK ก�dL a ก��fกT�ML��� (status epilepticus grand mal ) 2. G�กHKK complex partial ( psychomotor & temperal lobe ) 3. �y<Lก��HI��ก��<�ก��G�กT=5 ก��SiM���W�L�\<I�Lก���W�����KK��Y�T �34�

Status Epilepticus : iv.

• Adult : loading dose slow iv. 15-25 mg/kg , maintenance dose slow iv. 300 mg/day �\< 5-6 mg/kg/day HKWL�����I 3 X��ML

• Infant and Children : loading dose slow iv. 15-20 mg/kg , maintenance dose ��56������> 5 mg/kg/day ���I 2 X��ML _�>�ก������6<�>f��L�=M

- 6 �\<� a 3 �� : 8 a 10 mg/kg/day - 4 a 6 �� : 7.5 a 9 mg/kg/day - 7 a 9 �� : 7 a 8 mg/kg/day - 10 a 16 �� : 6 a 7 mg/kg/day Anticonvulsant : oral

• Children and Adult : loading dose 15-20 mg/kg , maintenance dose . 300 mg/day �\< 5-6 mg/kg/day HKWL�����I 3 X��ML

Neurosurgery prophylaxis slow iv. 100-200 mg/kg Tfก 4 G6. ��W�L�W����HII�L�W���� Compatible and incompatible

• >�6=X��6XL����5J� ก��ก���ก�ก<�ก�KY���MJ� ก\<KTfก��� >ก ��� NSS

• >�T=5�G��W�6e�� Sodium bicarbonate , fluconazole • ��6�Y6�W�6ก�K 10 % fat emulsion, TPN, adrenaline, Amikacin, Aminophylline , clindamycin,

ciprofloxacin (y-site), dobutamine, potassium chloride (y-site), heparin(y-site), insulin, lidocaine, theophyliine (y-site), ondansetron (y-site), methadone, vitamin B complex (y-site), morphine,pethidine,streptomycin, nitroglycerine, pentobarbital HI ranitidine

• Y��II�>T=5�Y6HI�� I�L�Y6 กdKe�� 4 G6. �ก>C�.DE/:>?F/GHIก� gingival hyperplasia , hypotension , bradycardia, cardiac arrythmias, peripheral neuropathy, �\5�HKK lupus erythematosus, hypertrichosis osteomalacia, thrombocytopenia, leucopenia, tremor, nystagmus ก>J<4J�ก>01��

• Respiratory rate , BP , HR • Liver function test • CBC

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• Monitor dose related effect: nystagmus, blurred vision, ataxia, slurred speech, confusion, hypotension

<�ก��T=5HY�L�W�6=���K Phenytoin YUL ��<L h�56X��6�6�����L �\<H��LHhT>Z >20 mcg/ml: far lacteral nystagmus >30 mcg/ml: 45 lateral gaze nystagmus ��� s >40 mcg/ ml: hU��กfก�ก�ก HI<�ก��I�K��

>100 mcg/ml: uiL Y=>G=���

K3AL/:;<-MJ<ก>IM4ก>�GA�NFOP�/F�/03>?--�

High Alert Drug Nongkhai Hospital

Generic Name Phenytoin Strength Injection:250 mg/5ml

Capsule:100 mg Category Anticonvulsant

K3AL/ก>FMP/01�� 1. S=>�G\5<Y�6�VT�L>�T=5 �[�XJ� �d6 e6W�G�XJ�>W< h��<6�Kf�U�HKK>� ��=>6 X��6H�L TfกX��ML 2. ก� = �[�>�t=� กJ������=ก����>� �[� IV intermittent TW���M� HI<���� �d���ก����>�e6W ก�� 50

mg/kg/min ���U��VW HIe6W ก�� 20 mg/kg/min ���U��z�>T=56=��������W�6���> HI<���� �d���ก����>�e6W ก�� 1-3 mg/kg/min �� �dก

3. ก��K����>��U�HKK>� 6d�HKK Loading dose 6=S�<�J�ก��S<Lก���U�si6 ��L��M� ���6�^>�T=5X��e��(50-20 mg/kg) ��HKWL��K��T�� �[� 3 X��ML W�Lก��X���I 2 G�5�_6L

K3AL/ก>I.��K�?ก>NกQ->MกR� 1. �G�tI�กGW�>HY�LG\5<>�HIX��6H�LT=5G�� �� X\< Phenytoin h��<6�KfS�<X��6 wก��K����>��� IV

intermittent TW���M� x HI w>�X��6 Y=5>LYUL ��<L���L<>W�L>�5Lx 2. ก�� กdK��ก��>���กIW<LT=5�G�tI�กHY�LG\5<T=5H�ก�W�L��ก>�<\5�HI6=XJ� �\<� w>�X��6 Y=5>LYUL ��<L���L

<>W�L>�5Lx 3. ก���W�>>�e6W�W����f��� ��<L6=<W��tI�ก 2 X��ML ��<L6=ก������Y<KsMJ�

K3AL/ก>NJ>O��� 1. ������Y<K 2 KfXXI�\< <>W�L��<> 2 X��ML ��ก��>�K ก��XJ���^S���>� HIก���Y6>� 2. ��=>6 IV intermittent : _�> �\<��L���> Narmal Saline(NSS) TW���M� I�L�Y6 กdKe�� 4 G6. 3. e6WX���Y6 Phenytoin ก�K>���m ����W�Lก����>� �\5<L��ก<�� �I=5>�H�IL pH S<L>� HITJ���

Phenytoin �ก�ก<� 4. 6\5< ��=>6>� Y�d� �U� ��=>6��<L S=>�X��6 S�6S��S<L Phenytoin T=5 ��=>6ILK�tI�กY��II�> h��<6

sd�G\5<�U� ��=>6K�tI�กTfกX��ML 5. ����Y<KS���>� HIX��6H�LS<L>� ��=>6����Lก�KXJ�Y�5LHhT>ZกW<���>� _�>ก������Y<K 2 X�

�\<����Y<K 2 X��ML _�> ����> �I�ก������Y<K 6. �� IV intermittent TW���M� e6WX����T�L IM, SC, IV infusion 7. <���� �d���ก����>�e6W ก�� 50 mg/min ���U��VW HIe6W ก�� 20 mg/min ���U��z�>T=56=��������W�6���>

HI<���� �d���ก����>�e6W ก�� 1-2 mg/kg/min �� �dก

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34

K3AL/ก>J<4J�ก>01�� 1. Blood pressure(H��LHhT>Z 6\5< Bp < 90/60 mmHg) 2. Heart rate 3. Respiratory rate 4. Liver function test 5. Monitor dose related effect : nystagmus, blurred vision, ataxia, slurred speech, confusion, hypertension

�ก>LOPKF4/A.�O>?4M- Phenytoin F�/ J��/ND<P�GA�>?�M4>?AM/ J<4J�\� @>X�KI�/KDL�H 1. > 20 mcg/ml : far lateral nystagmus 2. > 30 mcg/ml : 45 lateral gaze nystagmus, ��� s 3. > 40 mcg/ml : hU��กfก�ก�ก HI <�ก��I�K�� 4. > 100 mcg/ml : uiL Y=>G=��� 5. therapeutic range : children & adult ; 10-20 mcg/ml , Infant ; 8-15 mcg/ml

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35

������� Potassium Chloride injection

High Alert Drug Nongkhai Hospital

Generic Name Potassium Chloride Strength 40 mEq/20ml Category Electrolyte, Potassium

���-./01� 1. �G���ก�����_�H�Y s=>6�� I\<��5J��G�YJ���K�y<Lก���\<��ก��<�ก�����S��_�H�Y s=>6

Chypoualmia 2. �G���ก��<�ก��S<L���� ��������L� (cardiac arrthythmia)

�34� 1. Prevention during diuretic therapy : oral

Children : 1-2 mEq/kg/day ; 1-2 divided dose Adults : 20-40 mEq/kg/day ; 1-2 divided dose

2. Treatment of hypokalamia Children : 1-3 mEq/kg/day Adults : - serum K+ > 2.5 mEq/L: Max infusion rate 10 mEq/hr , max conc.40 mEq/L , Max does 200 mEq/day - serum K+ < 2.5 mEq/L : Max infusion rate 10 mEq/hr , max conc.80 mEq/L, Max does 400 mEq/day Compatible & incompatible

• �Y6e��ก�K NSS ,D5W H�WH��J����G� NSS �\5<L��ก dextrose Y�6��uTJ��� ก����� hypokalemia ��ก intracellular shift e��

• ��6�Y6�W�6ก�K>� amikacin ,amphotericin B ,penicilline G ,dobutamine ,fat emulsion ,mannitol ,phenytoin

• Y��II�>T=5�Y6HI�� กdKe����� 24 G6. �ก>C�.DE/:>?F/GHIก� XI\5�eY� T�<L Y=> ���T�<L T�<L<\� H�W�T�<L I<� I\<��J�<�ก YK, Bradycardia, hypotension, chest pain, muscle weakness, extravasation ก>J<4J�ก>01��

• Serum K, BP, Urine output • �����6 EKG u�� infusion rate >0.5 mEq/kg/hr �� �dก HI > 10 mEq/hr ���U��VW • <�ก��T=5HY�L�W�6=���K_�HTY s=>6�� I\<�YUL : XI\5�eY� ��Y�5� ���� ���G�� กI��6 �\M<<W<�H�L H�W�

���<ก T�<L Y=>

K3AL/:;<-MJ<��/ก>IM4ก>�GA�NFOP�/F�/03>?--�

High Alert Drug Nongkhai Hospital

Generic Name Potassium Chloride Strength 40 mEq/20ml Category Electrolyte, Potassium

K3AL/ก>FMP/01�� 1. กJ������6�^>� �[� milliequivalent (mEq) G���HI���6�^S<LY��II�>T=5�G��Y6>� �[� milliliter

(ml) HIX�� �\<��L���> normal saline �\<Y��II�><\5�T=5e6W6= glucose <>W�L��<> 100 6�II�I��� HI

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กJ���<���� �d�S<Lก��K����>� �[�6�I�I����W<G�5�_6L (ml/hr) 2. �G�X��6 S�6S��e6W ก�� 60 mEq/L , <���� �d�e6W ก�� 40 mEq/hr HIS���>�e6W ก�� 400 mEq/day

K3AL/ก>I.��K�?ก>NกQ->MกR 1. �G�tI�กHY�LG\5<>�T=5G�� �� X\< KCl �\< Potassium chloride 2. กdK��ก��>�>�_�>H>ก��กIW<LT=5�G�tI�กHY�LG\5<T=5H�ก�W�L��ก>�<\5� HI6=�y�>KWLG=MT=5G�� �� w >�X��6 Y=5>LYUL��<L���L>�5L x ���T=5กIW<L>� 3. ก���W�>>�e6W�W����f��� ��<L<W��tI�ก 2 X��ML ��<L6=ก������Y<KsMJ� 4. �KfS�<X��6 �\<�K�tI�กS<L�I����^�Z w Y��II�> S�6S�� ��<L �\<��LกW<��G� x

K3AL/ก>NJ>O��� 1. ����Y<K 2 KfXXI �\<<>W�L��<> 2 X��ML (��ก� =S��KfXXI�ก�) ��ก��>�K>� ก��XJ���^S���>�

HIก���Y6>� 2. X��6 S�6S��S<L KCl injection T=56=�� 1 6�II�I���(ml) 6= K+ 2 mEq 3. 6\5< ��=>6>� Y�d� �U� ��=>6��<L S=>�X��6 S�6S��S<L KCl T=5 ��=>6ILK�tI�กS��Y��II�>T=5 ��=>6

TfกX��MLh��<6 sd�G\5<�U� ��=>6>�K�tI�ก���> 4. ���6�^>�Yf�T��>S<Lก�� ��=>6>�t=��Y6T=5���T�LI<� I\<��J�YW���I�> KCl ��<Le6W ก��

60 mEq/L �ก ก��ก�W���M�����iก��HhT>Z 5. X���Y6>����> normal saline �\<Y��II�><\5�T=5e6W6= glucose 6. e6WX���Y6 KCl ��S���\<ufL>�t=�T=56=���6�^6�กT=5HS��<>UW �ก6=X��6�J� �[���<L�Y6 KCl ��<L ��6

G��m S>W� �\< hI�กufL�\<S����6�^ 10 X��ML �� KCl ก���>���MJ� กI\<���=กW<� ��56>�>� 7. ��6�Y6�W�6ก�K>��W<e��=M Amokacin ,Amphotericin B ,Penicillin G ,Dobutamine ,Fat emulsion

10% , Mannitol HI Phenytoin K3AL/ก>J<4J�\�ก>01��

1. ����Y<K<����ก��>� S�� Y�� HI����Y<KK�� �^T=5T�L�MJ� กI\<<>W�L��<> ��IX��ML 2. EKG 6\5<<���� �d���ก����>�6�กก�W� 10 mEq/hr �กhK tall peaked T waves , depression SW

segment , wide QRS complex , absent of P wave , ventricular tachycardia �\< ���กI��6 �\M<<W<�H�L ��<L��6HhT>Z

3. Serum potassium �ก ก�� 5.5 mEq/L ��<L��6HhT>Z 4. <�ก��T=5HY�L�W�6=���K_hHTY s=>6�� I\<�YUL 5. Urine output u�� < 600 ml/day H��LHhT>Z

�ก>LOPKF4/A.�O>?4M-s:KLFN]O��F�/ J��/ND<P�GA�>?�M4>?AM/ J<4J�\� @>X�KI�/KDL�H 1. T�<L Y=> 2. XI\5�eY�<� �=>� 3. T�<L<\� 4. ���� ���G��

ก>Kก�C�SA?D<R��/s:KLFN]O��F�/ 1. �� RI 10 units + 50% glucose 50-100 ml IV stat 2. �� NaHCO3 YJ���K��� acidosis 3. �� 10% calcium gluconate 10 ml T�L IV G��m�� 5 ��T= <����sMJ�e��<=กI�L��>�X��MLH�ก��� 5 ��T=

u�� EKG >�L����ก��

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37

������� Regular insulin injection High Alert Drug

Nongkhai Hospital Generic Name Regular insulin

Strength 100 units/ml Category Diabetic drugs

���-./01� _�X K���� , diabetic ketoacidosis , hyperglycemic-hyperosmolar nonketotic coma , hyperkalemia �34�

1. Hyperkalemia : _�>��t=� calcium gluconate HI sodium bicarbonate กW<� ��ก��M��� 50% dextrose 0.5-1.0 ml/kg HI insulin 1 unit YJ���KTfกm 4-5 g S<L dextrose

2. Diabetic ketoacidosis : IV loading 0.1-0.15 unit/kg : maintenance continuous infusion 0.1 unit/kg/hr �\< 0.05-0.2 unit/kg/hr SiM�<>UWก�K<����ก��I�ILS<L���K glucose ��ก� =T=5���K glucose �� I\<�e6WI�IL 50 mg/dl ��>�� 1 G�5�_6LH�ก S<Lก��ก����>� �����K h�56<����ก����>�SiM� 2 TW� Tfกm G�5�_6L

3. @�4FJ<Iกs>GN-@A3Iก3pkJ�F�/ : initial 0.1 unit/kg IV ��ก��M��� continuous infusion 0.1 unit/kg/hour �����K�MJ���I�� I\<�I�ILuiL 250 mg/dl

Compatible &Incompatible 1. Y��II�>T=5Y�6��u�Y6 S��ก��e�� : D5W , D5S/2, NSS, LR 2. Regular insulin T=5�Y6HI��6=X��6XL��� 24 G6. T=5<f^�U6��<L (250C) HI���U� >d� (2-80C) 3. Insulin T=5 ����G�HI�� กdKe��T=5<f^�U6� 2-80 C �\<<f^�U6��<Le6W ก�� 300 C e����� 28 ��� 4. ก�� กdK��ก�� insulin ��<L กdK���U� >d�<f^�U6� 2 a 80 C HI กdK��h��HYL, 6\5<�J�>�<<ก6��G���6 S>W�

S��>� ���G����=กI�MLS��>�e�6�G��mK��z�6\< 5. e6WX���Y6ก�K>��W<e��=M Aminophyline, dobutamine, Phenobarital Phenytoin

�ก>C�.DE/:>?F/GHIก� 1. ����MJ���I�� I\<��5J� 6=<�ก����L�=M L\5<<<ก ,��Y�5� , �=>��=��, ���6\� �� ��� , s\5<Lsi6 ,�<�e6W

I�K <���f�H�LuiLSiM� shock , coma 2. ก�����ก���>�K�� �^T=5t=�>� �U��z�>K�L��><��Hh� th�T=5 e��HกW K�6 H�LHIX�� si5L6�ก��>e�� <L��

2-3 ��� uiL 2-3 Y����Z �\<G�M�eS6����������L����ก��6=T�ML atrophy HI hypertrophy ก>J<4J�ก>01��

1. fasting blood sugar 2. DTX 3. hypoglycemia ( L\5<<<ก, ���Y�5�, ���� ��� �d�, ��, X�=>�, 6i�LL, �����, ��h�W�, TJ�L��I <=>�

e6We��, G�ก, Y�KY�, 6�Y��) 4. hyperkalemia

ก>Kก�C�D<RIก�

• �ก�U��z�>T=5>�L�U�Yiก����=X����<����J�h�กX��Z_K_� ���T=5�U�si6 �d� GW� �MJ�����\<�MJ��Ie6� 100 a 200 s=s= �\<<���� �[��Ie6��Y��� GW� Y�6 กI��>�MJ���� 1 �I <�ก����=SiM���>�� 5 a10��T= �<ก��ก��M�ก���y<Lก��ก�� ก������MJ���I�5J� T=5X��H��J��U��z�> X\< ก��<������I 3 6\M<����L �I� ��K�L��><���J� �[���<L6=6\M<<����W�LกW<�uiL6\M<I�ก

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K3AL/:;<-MJ<��/ก>IM4ก>�GA�NFOP�/F�/03>?--�

High Alert Drug Nongkhai Hospital

Generic Name Regular insulin Strength 100 units/ml Category Diabetic drugs

K3AL/ก>FMP/01�� 1. ��6�G�XJ�>W<��ก��Y�5L�G�>� 2. ��ก��Y�5L�G�>����G�XJ��W� w units x �\< S=>� �[����eT>�W� w >U��� x HT� U 3. ก��Y�5L IV. Continuous infusion ���Kf�W�> �[� units/hours.

K3AL/ก>I.��K�?ก>NกQ->MกR� 1. �G�tI�กHY�LG\5<>�T=5G�� �� X\< Regular insulin 2. กdK��ก��>�_�>H>ก��กIW<LT=5�G�tI�กHY�LG\5<T=5H�ก�W�L��ก>�<\5� HI6=XJ� �\<� w >�X��6 Y=5>LYUL��<L

���L>�5L x ���T=5กIW<L>� 3. ก���W�>>�e6W�W����f��� ��<L<W��tI�ก 2 X��ML ��<L6=ก������Y<KsMJ�

K3AL/ก>NJ>O��� 1. ����Y<K 2 KfXXI �\<<>W�L��<> 2 X��ML ( ��ก� =S��KfXI�ก� ) ��ก��>�K>�ก��XJ���^S���>�HI

ก���Y6>� 2. ก�� ��=>6 insulin X�� ��=>6��Y���MJ� 100 ml ��L��M� 1 unit/hour = 1ml/hour 3. standard dilution : 100 unit / 100 ml �� 0.9%NSS �\< 0.45 %NSS 4. Y��II�>T=5Y�6��u�Y6 S��ก��e�� : D5W , D5S/2, NSS, LR 5. Regular insulin T=5�Y6HI��6=X��6XL��� 24 G6. T=5<f^�U6��<L (250C) HI���U� >d� (2-80C) 6. �ก��<Lt=� insulin Y<LG����W�6ก�� X���U� insulin G����YกW<� (regular insulin) กW<� HI���iLXW<>�U�

insulin G���SfW� (NPH) h\5<�y<Lก��6����MJ�>�G����YuUก�Y6���>�MJ�>�G���SfW���กX��6���hI��S^�U��MJ�>�

7. ��ก�� ��=>6>�HI��>� ��<L6=h>�K�I<=กX� double check HIILI�>6\<G\5<กJ�ก�K 8. Insulin T=5 ����G�HI�� กdKe��T=5<f^�U6� 2-80 C �\<<f^�U6��<Le6W ก�� 300 C e����� 28 ��� 9. ก�� กdK��ก�� insulin ��<L กdK���U� >d�<f^�U6� 2 a 80 C HI กdK��h��HYL

K3AL/ก>-><@>� 1. ก���� IV ��e�� th� regular insulin TW���M� 2. �G� insulin pump ��ก��X�KXf6<����ก��eIS<L>� 3. ufL�MJ� กI\<Y�6��u�U�s�K>� insulin e�� ��ML��M�X��6 S�6S��S<L>�T=5HT����L��Y��II�> infusion <��

��<>ก�W�X��6 S�6S��S<L insulin T=5X����L ��L��M�ก����>���<L���K infusion rate ��6ก���<KY�<LS<L�U��z�>

4. <����ก����>�<>UW��GW�L 0.05 a 0.2 units/kg/hr ก�����K>�SiM�ก�K<����ก��I�ILS<L serum glucose H�W��<L���L�ก serum glucose I�IL �d� ก��e� <��TJ��� ก�� cerebral edema e�� <����ก��I�ILS<Lserum glucose T=5 6�Y6 X\< 80 a 100 mg/dl/hr

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39

K3AL/ก>J<4J�ก>01�� 1. fasting blood sugar 2. DTX 3. hypoglycemia ( L\5<<<ก, ���Y�5�, ���� ��� �d�, ��, X�=>�, 6i�LL, �����, ��h�W�, TJ�L��I <=>�

e6We��, G�ก, Y�KY�, 6�Y��) 4. hyperkalemia

�ก>LOPKF4/A.�O>?4M-��<3]��<3F�/ J��/ND<P�GA�>?AM4>?AM/ J<4J�\� @>X�KI�/KDL�H 1. ��� hypoglycemia : serum glucose, men < 50 mg/dL ,women < 40 mg/dL 2. ��� hyperkalemia : serum K ≥ 6.5 mEq/L

ก>Kก�C�SA?3pkJ�03N�X�4JPk

1. �ก�U��z�>T=5>�L�U�Yiก����= X����<����J�h�กX��Z_Ke� ���T=5�U�si6 �d� GW� �MJ�����\<�MJ��Ie6� 100 a 200 cc �\<<���� �[��Ie6��Y��� GW� Y�6 กI��>�MJ���� 1 �I <�ก����=SiM���>�� 5 a 10 ��T=

2. ก���y<Lก������MJ���I�� I\<��5J�T=5X��H��J��U��z�> X\< ก��<������I 3 6\M<����L �I���K�L��><���J� �[���<L6=<����W�LกW<�uiL6\M<I�ก

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������� Warfarin tablet High Alert Drug

Nongkhai Hospital Generic Name Warfarin tablet

Strength 3 mg , 5 mg Category Anticoagulants

���-./01� 1. �G��y<Lก��HI��ก�� venous thrombosis, pulmonary embolism HI thrombolic disorders 2. �G��y<Lก��ก�� ก�� thromboembolic complication �� �U��z�>T=5 �[� atrial fibriltion/flutter �U��z�>I�L

�W�����YWI�M����� T=>6HI���U��z�>_�X I\<�K�LG��� GW� protein C pr protein S deficiency 3. secondary prevention �y<Lก�� Y�� I\<�Y6<L<f������กI�56 I\<� 4. �G��W�6ก�K>� aspirin h\5<�y<Lก�� stent thrombosis 5. �G� �[�>� Y��6��ก���y<Lก�� systemic embolism I�L��ก ก�� myocardial infraction

�34� 1. T��กHI �dก : 0.05-0.034 mg/kg/day 2. �U��VW : 2-10 mg/day _�>S���>� ��56��� ; 5-10 mg/day ��� 2 ��� ��ก��M����KS���>���6

XW� INR SiM�ก�K���S<L�U��z�>H�WI��> _�>h����^���ก<�>f ก��TJ�L��S<L��K, ���� �[���� �W�6ก�Kก���<KY�<LS<L>� HI<�ก��T�LXI���ก

ก�����KS���>���6XW� INR SiM�<>UWก�KS�<KWL�G�S<Lก����ก����L�=M • INR 2-3 :atrail fibrillation , biopostatic heart valves �y<Lก��HI��ก�� venous thomboembolism

and pulmonary embolism • INR 2.5a3.5 : post myocardial infraction, mechanical heart valves • INR 2.1-4.8 : PTCA

���@��01� 1. ��6�G����U��z�> infective endocarditis or acute pericarditis and pericardial effusion 2. ��6�G����U��z�> arterial aneurysm 3. ��6�G����U��z�> continuous tube drainage of small intestine, polyarthritis, diverticulitis, emaciation,

malnutrition, blood dyscrasias, I\<�<<ก��Y6<L ���GA>>?AM/

1. e6WX���G��W�6ก�K vitamin K 1 �\5<L��กI� anticoagulant effect 2. e6WX���G��W�6ก�K NSAIDs h���TJ��� ก�� severe GI irritation �<ก��ก��M� salicylates h�56 warfarin

effect _�>ก��HT�T=5>���ก plasma protein binding sites 3. กW<�TJ�ก���W���� X��>f�>��=M��6�^ 3 ���กW<�ก���W���� HIX��6=ก��������K INR , PT �I<�ก��

�W���� :;<ก<><�>?@A./�

Drug Effect Management Amiodarone TJ����IS<L>� warfarin h�56SiM� I�S��� warfarin IL 30-50% ���� PT ,

INR <>W�L�กI�G�� Azole antifungal (fluconazole,Ketoco., )

TJ����IS<L>� warfarin h�56SiM� TJ��� ก�� bleeding

Monitor PT , INR ���KS���>� warfarin �� 6�Y6

Erythromtcin , Clarithromycin

h�56 anticoagulant activity <�� ก�� bleeding e��

I�S���>� warfarin IL , monitor PT , INR

Metronidazole h�56 anticoagulant activity <�� ก�� I=ก I=5>Lก���G�>��W�6ก�� Monitor PT ,

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bleeding e�� INR , ���KS���>� , ��X��6�U��U��z�> �\5<L bleed

Gemfibrozil �IS<L warfarin h�56SiM� TJ��� ก�� bleeding <>W�L�f�H�L

I=ก I=5>Lก���G�>��W�6ก�� Monitor PT , INR

PTU TJ����IS<L>� warfarin I�IL Monitor PT , INR ���KS��� warfarin �� 6�Y6

Thyroids hormone h�56 anticoagulant activity Monitor PT , INR ���KS��� warfarin �� 6�Y6

Sulfamethoxazole/ Trimethoprim

h�56 anticoagulant activity <�� ก�� bleeding e��

Monitor PT , INR ���KS��� warfarin �� 6�Y6

Vitamin E TJ����IS<L>� warfarin h�56SiM� TJ��� ก�� bleedin

Monitor PT , INR ���KS��� warfarin �� 6�Y6

Phenobarbital I� anticoagulant effect ���KS���>� warfarin u��>f�>� phenobarb ��<L�G� warfarin ��<>IL

�ก>C�.DE/:>?F/GHIก� I\<�<<กLW�> ( bleeding ) �\5������L �����L<�ก YK K�6H�L �6�W�L XI\5�eY� <� �=>� K\5<<��� T�<L Y=> ���T�<L ก>J<4J�\�ก>01��

1. INR ( international Normalization Ratio ) 6\5< ��56��>�X�� ��Tfก��� HIX�� ��<>W�L��<> 7 ��� I�Lก�����KS���>� �\5<L��ก�e��XW� INR �กI� X=>L steady state

2. PT (prothrombin time) 3. <�ก��h����ก>� ; I\<�กJ� ��eI, 6=�MJ� I\<���6�W�Lก�> , I\<�<<ก��6e�r�� , I\<�<<ก����YY�� ,

uW�><f���� �[�Y=�J�, ���J� �\<�6�6�กก�W��ก��, I\<�eI>f�>�ก 4. �U<�ก�� clotting : S�K�6 G� ��� 6\5<> e6W6=H�L ��h�W� u��hK��H��LHhT>Z

ก��Hก�eS��� INR YUL��กก���G�>� warfarin INR ก���ก���

INR < 5 >f�>��� dose u��e� HI 6\5< INR <>UW��GW�L �y�6�>S<Lก����ก�� ��56��>�T=5S����5J�ก�W� ��6

INR 5-9 >f�>� 1-2 dose HI 6\5< INR <>UW��GW�L �y�6�>S<Lก����ก�� ��56��>�T=5S����5J�ก�W� ��6 �ก�U��z�>6=X��6 Y=5>L�W<��� I\<�<<ก Y�6��u�� vitamin K1 (Phytonadione) ��K��T�� 1-2.5 6�II�ก��6

INR > 9 >f�>�G�5�X��� �� vitamin K1 ��6�^ 3-5 6�II�ก��6 ������K INR ��>�� 24 G�5�_6L �ก INR >�LYUL<>UW<���� vitamin K1 sMJ�<=กX��ML�i5L

INR >20 6=��� I\<�<<กT=56=��>YJ�X�VT�LXI���ก

�� vitamin K1 _�>ก��t=� S��I<� I\<��J�G��m <���G� fresh frozen plasma �ก�J� �[� HI<���� vitamin K1 <=กX��ML��>�� 1 G�5�_6L �ก�J� �[�

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ก>0@�GkK3?3k\��:rA�

• ก� = OPD ����Y<K�U��z�>�W� S������S���>�HI���=��K��T�� • Y<��U��z�> �\5<L ��6YUKKf�=5 ��6�\56Yf�� e6WX��ก��<��� Y��6 �\<Y6f�eh� GW� _Y6 HI>�Hก����

h�กH<Yeh��� �\<s�I�es I� • H��J��U��z�>��H��LHhT>ZTfกX��ML�W��G�>� Warfarin <>UW u��6= warfarin card ��HY�L���> • H��J��U��z�>���Lก�� ก��K��H�I HIY<����=��6 I\<� GW� �G����Y<��ก�T=5H�I��� 5-10 ��T= u�

� I\<�eIe6W>f����=KhKHhT>Z • H��J��U��z�>e�hKHhT>ZT��T=u��6=<�ก�� I\<�<<กLW�>��� �\<rกsMJ�LW�>����ก�� <f����6=Y=H�L �\<Y=

�J� �\<Y=>�L6�<> ��YY�� �[�Y=H�L�\<�MJ���I S�6 • H��J����U��z�>T��K�W�>�>��TJ�����YY��6=Y=H�LY�6�\<H�L<W<�m �[� �\5<L�ก��e6W��<L�ก�� >ก ���

u����YY�� �[�Y=H�L�\<�MJ���I S�6��e�hKHhT>ZT��T= • H��J��U��z�>T=5T��6�LY�������W�ก��T����ก�K S=>�6�ก ก��e� <��6=�ITJ�����Y�T����h>�I�IL • �y����L�U�YUL<�>f �[�h� �� h�� Y�� I\<� ��������LK�L

K3AL/:;<-MJ<��/ก>IM4ก>�GA�NFOP�/F�/03>?--� High Alert Drug

Nongkhai Hospital Generic Name Warfarin tablet

Strength 3 mg , 5 mg Category Anticoagulants

K3AL/ก>FMP/01�� 1. S=>�G\5<Y�6�VT�L>�T=5 �[�XJ� �d6 e6W�GWXJ�>W< 2. �KfS�<KWL�G� (indication) ���KY�5L>� ก� =�G�>�X��MLH�ก 3. 6=�I�������XW� INR h\5<h����^�ก�����KS���>�TfกX��ML 4. �KfS���>� (mg)h��<6���=��K��T��>� <>W�LG�� ��

K3AL/ก>I.��K�?ก>NกQ->MกR� 1. tI�กGW�>HY�LG\5<>�HIX��6H�LG�� �� 2. ก�� กdK��ก��_�>H>ก��กIW<LT=5�G�tI�กHY�LG\5<>�T=5H�ก�W�L��ก>�<\5� HI6=XJ� �\<� w>�X��6 Y=5>LYUL

��<L���L>�5Lx 3. ��� กdKH>ก>�X��6H�L 3 6�II�ก��6 HI 5 6�II�ก��6 e��X�IYu��T=5T=5e6W���ก�� 4. ก���W�>>�e6W�W����f��� ��<L<W��tI�ก 2 X��ML ��<L6=ก������Y<KsMJ� 5. ����Y<K���ก���>���W�L>�TfกX��MLT=5�W�> 6. X�� กdK>�T=5<f^�U6�e6W ก�� 40 <L�� HI กdK����G�T=5���Y��THITiKHYL �\5<L��ก>�� �I=5>�Y=

6\5<_��HYL K3AL/ก>NJ>O���

1. ก��>�K>���กG�M���L>� ��<L<W��tI�ก 2 X��ML 2. �ก6=ก��XJ���^���6�^>� X��6=�U�����Y<K HI����Y<K 2 X��ML

K3AL/ก>-><@>� 1. ����Y<KS���>� HIX��6H�LS<L>�T=5 ��=>6����Lก�KXJ�Y�5LHhT>ZกW<���>� _�>ก������Y<K 2

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KfXXI�\<����Y<K 2 X��ML_�> ����> �I�ก������Y<K 2. e6WX����K��T��h��<6<��� HI�� �I� �=>�ก����H�WI��� 3. L� ���ก����>�T�L IM S^T=5�U��z�>e����K warfarin

K3AL/ก>J<4J�\�ก>01�� 5. INR ( international Normalization Ratio ) 6\5< ��56��>�X�� ��Tfก��� HIX�� ��<>W�L��<> 7 ���

I�Lก�����KS���>� �\5<L��ก�e��XW� INR �กI� X=>L steady state 6. PT (prothrombin time)

�ก>LOPKF4/A.�O>?4M- warfarin F�/J��/ND<P�GA�>?�M4>?AM/ J<4J�\� @>X� KI�/KDL�H 1. I\<�กJ� ��eI 2. 6=�MJ� I\<���6�W�Lก�> 3. I\<�<<ก��6e�r�� 4. I\<�<<ก����YY�� 5. ���J� �\<�6�6�กก�W��ก�� 6. I\<�eI>f�>�ก

ก>Kก�C�SA? INR F�/Iกก>01�� warfarin INR ก���ก���

INR < 5 >f�>��� dose u��e� HI 6\5< INR <>UW��GW�L �y�6�>S<Lก����ก�� ��56��>�T=5S����5J�ก�W� ��6

INR 5-9 >f�>� 1-2 dose HI 6\5< INR <>UW��GW�L �y�6�>S<Lก����ก�� ��56��>�T=5S����5J�ก�W� ��6 �ก�U��z�>6=X��6 Y=5>L�W<��� I\<�<<ก Y�6��u�� vitamin K1 (Phytonadione) ��K��T�� 1-2.5 6�II�ก��6

INR > 9 >f�>�G�5�X��� �� vitamin K1 ��6�^ 3-5 6�II�ก��6 ������K INR ��>�� 24 G�5�_6L �ก INR >�LYUL<>UW<���� vitamin K1 sMJ�<=กX��ML�i5L

INR >20 6=��� I\<�<<กT=56=��>YJ�X�VT�LXI���ก

�� vitamin K1 _�>ก��t=� S��I<� I\<��J�G��m <���G� fresh frozen plasma �ก�J� �[� HI<���� vitamin K1 <=กX��ML��>�� 1 G�5�_6L �ก�J� �[�

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