How Do You Administer The Following Meds?

Nurses Medications

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Dilantin 1g IV: This much I know: Administer over 1 hour in atleast 100ml of normal saline, though I've heard people says atleast 250 ml of saline because it vasodilates blood vessels? Also I know that you have to piggy back it on another line as to avoid that horrible burning sensation, and the patient should be on a cardiac monitor?

Cardizem IV: I've noticed that this medication causes rebound hypertension. I mean I've never seen BP fluctuate so drastically in such a small amount of time? Do you also piggy back this on normal saline?

Diprivan IV: Now I've been taught that for Dip you don't have to piggy back it on normal saline?

Magnesium 2G IV: I know that you have to check renal function first. I give this atleast over an hour.

Does this sound right? Also what other medications have special precautions when being administered????

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Anyone lol?

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Specializes in Med-Surg.

Cardizem, rebound htn is something I have never really seen with this, but we do Cardizem gtts all the time now for SVT or UCAFIB. But, we typically see pressures drop with this drug and often have to stop the gtt because of this problem. We will start them on a low dose, and titrate if BP tolerates!

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Also what other medications have special precautions when being administered????

All of them.

It is best to consult a trusted, peer-reviewed drug reference to get the full picture of what you need to look out for as a nurse.

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Specializes in ER trauma, ICU - trauma, neuro surgical.

Dilantin - Causes extreme burning so I give it with 250 NS. It can cause arrhythmias, so yes for the monitor. IT SHOULD BE GIVEN WITH FILTER. A lot of nurses don't do this. Needs in-line filter.

diprivan - better for PICC/central line but can be given peripherally. Diprivan also burns pretty bad. Some doc's mix it with Lido. You can infuse diprivan with TPN (compatible)

cardizem - never seen rebound HTN

Mag - infuse over hour but (in the ER with monitor) you can give mag over 20 minutes to stop bronchospasm for asthma pts. Give it to fast...it can shut down resp drive. Always infuse via pump

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Specializes in ER, progressive care.

Cardizem: never seen it for rebound HTN...only for atrial flutter/atrial fibrillation! The dose range at my facility is 5-15mg/hr. Our concentration is 1mg/mL. I always piggyback it into NS and keep it in it's own dedicated line. BP's and HR's seem to fluctuate a lot while on this medication, which is why you need to titrate per policy or get on the phone with the physician to see what they want.

Magnesium: also needs to be through it's own dedicated line...I piggyback into NS. 2g at my facility is given over 1hr. I will sometimes give 4g, depending on how low their mag level is, and that is given over 2hr. HR & rhythm need to be monitored as well as signs of magnesium toxicity.

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For diprivan (propofol) you also need to be aware of the possibility, although rare, of propofol infusion syndrome. This is characterized by cardiac arrhythmias, metabolic acidosis, circulatory collapse. Early cardiac signs can include brugada like changes to the ECG. It is often fatal, and is currently debated in the literature. High doses, and long term sedation seem to be associated with this, however some episodes have occurred during the first day of sedation. Dr. Jeff Guy's podcast ICU rounds has a good discussion of this phenomenon. Although it is rare if you are ever administering propofol you NEED to be aware of this complication.

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