Note: Half-life is shortened in children vs adults. Time to steady state: 5-7 days (average) ESRD: 15-20 days. Description. Cumulative dose. Mr Smith is to receive 800 mL of an antibiotic via an IV infusion over 15 hours. EKG. All microdrip tubing delivers 60 gtt/mL and is used to deliver a small or very precise amount of fluid. the Dose Factors (DFs) that we need to convert disintegrations in. 3. PO. To determine the dose conversion IV to PO, the ratio of PO to IV needs to be determined, this is 7.5 / 1.5 which is 5. Where volume is the amount of fluid in the IV bag, time is total number of minutes the fluid is to infuse over, and the drop factor (or drip factor) is related to the size of the IV tubing you are using; the number of drops per mL delivered for a particular drip chamber. PO amiodarone 25.7 mg/kg vs. IV amiodarone 35 mg/kg bolus then 1015 mg/kg over 24 h No difference in conversion to SR between PO and IV (64% vs. 68%, respectively; p=NS) 223 patients with symptomatic atrial fibrillation on digoxin PO amiodarone 600 mg in3 divided doses vs. IV amiodarone 5mg/kg over Calculate the 24 hour current dose: 90 Q12 x 2 = 180 mg PO Morphine/24 hrs. VT with pulse unstable: 1st dose 150mg IVP/IOP under 2 minutes - 2nd dose 150mg IV/IO in 50ml D5W/NS over 10 min. Typical amiodarone dosages in the ACLS setting are provided in Table 1. Methods. Warfarin The medication is supplied in 1 g/250 mL of D 5 W. Calculate the flow Considerations for IV-to-PO Conversions. No matter which strategy you follow with amiodarone, the goal is to transition to PO within 24 hours. Determine the new opioid analgesic to convert to and using equianalgesic dosing data (taking into consideration the limitations) convert to new opioid dose. For example, patients are frequently prescribed intravenous glucose 5%. What is the simpliest method to calculate this into ml/hr. 0.22 micron filter preferred . Calculate total daily oral dose 2. Monitor BUN and serum creatinine q2days (qd if unstable). Drug Usual IV Dose* Approximate PO Dose* PO to IV Considerations/Comments Reference digoxin 0.1 -0.4 mg IV Q 24 H 0.125 -0.5 mg PO Q 24 H Oral bioavailability about 80% for tablets and liquid 1,2 dimenhyDRINATE 25-50 mg IV 25-50 mg PO Conversion of Adjust to the lowest possible dose to limit side effects. Common IV to PO Drug Conversions 1) Metoprolol 1:2.5 2) Diltiazem Oral Dose (mg/day) = [ rate (mg/hr) x 3 + 3 ] x 10 3) Digoxin 0.75:1 4) Levothyroxine 0.75:1 5) Aminophylline to Theophylline 1:0.8 6) Ciprofloxacin 1:1.25 #IVtoPO #Drug #Conversion #Pharmacology #Common #Intravenous #Oral. Alternatively, it is NOT necessary to dilute amiodarone for IV push administration and a filter is not necessary. followed by 20 ml saline flush Amiodarone 50 mg/ml vial Pulseless VT or VF: 300 mg IVP. Round dose to a 30 mg increment, divide this daily dose by 4 to give Q6H dosing 3. However, after withdrawal of long term amiodarone treatment the half-life is as long as 100 days. After IVP, Flush with 20 ml of D5W or NS. 2, 10 In patients who require long-term treatment, intravenous dosing should be switched to oral dosing. Loading dose: 8001,600 mg/day PO in divided doses, for 13 wk; reduce dose to 600800 mg/day in divided doses for 1 mo; if rhythm is stable, reduce dose to 400 mg/day in one to two divided doses for maintenance dose. Monitor apical pulse daily. Restated: Duration of IV infusion < 1 week: 800-1600mg/day po initially x 1-2 weeks or complete current week; 1-3 weeks: 600-800mg/day po initially - total therapy ~ 1 month counting IV infusion ; >3 weeks: 400mg po qd initially. At 23 hours after each subsequent dose of Tikosyn, determine the QTc or QT (if heart rate is less than 60 beats per minute) (for in-hospital doses 25). The plasma half-life of amiodarone after single-dose administration has been reported to be in the range of 3.2 to 79.7 hours. The patient was in Afib and the MD ordered a bolus of Ami followed by a continious drip. Use the equianalgesic ratio: 30 mg PO Morphine = 7.5 mg PO Hydromorphone. Give first PO dose 1 hour prior to Amiodarone PO dosing in hospital After converts to NSR or after 24 hrs, 400mg PO BID up to 10g load (includes IV), then 200mg daily. Calculate the number of units required to deliver the initial bolus dose. 12 mg IV x1 dose. Store at 20 to 25C (68 to 77F) Protect from light. It works in two ways (1) prolongation of the myocardial cell-action potential duration and refractory period and (2) non-competitive alpha- and beta-adrenergic inhibition. Maintenance = (Cl) (Cp) (t) Dose (F) Cp = (F) (dose/ t) Cl Cl equations for digoxin Dexamethasone 0.6 mg/kg IV/IO/ IM/PO Maximum daily dose 16 mg Methylprednisolone sodium succinate 12 mg/kg IV/IO/IM Maximum single dose 60 mg Do not give with amiodarone Sodium Bicarbonate 1 mEq/kg IV/IO Give as a slow bolus Use 4.2% concentration in infants less than 1 month of age Seizures Drug Dose Comment Steps to covert from diltiazem IV to PO 1. Oct 27, 2007. 1) IV metoprolol has immediate action, PO has slow and graded release over hours. Chronic use of amiodarone causes a host of side effects. Articles describing intravenous to oral conversion protocols for any therapeutic category were identified in an English-language MEDLINE search (1990-April 2010) using a 1 yr. ago. Intravenous to Oral Conversion for Antimicrobials 1-20-6-1-010 Author(s): Antimicrobial Stewardship Program Coordinator Page 6 of 6 Issuing Authority: Vice President Medicine and Clinical Programs; Regional Director, Pharmacy Services 2. 290.914.916.010. The objective of this study was to assess the impact of IV and PO amiodarone overlap on short-term tachyarrhythmia recurrence and adverse hemodynamic outcomes in the intensive care unit. Amiodarone: Single dose: 58 days (range: 15 to 142 days) Oral chronic therapy: Mean range: 40 to 55 days (range: 26 to 107 days) IV single dose: Mean range: 9 to 36 days. Amiodarone was discontinued and IV sotalol was initiated at 42 mg/m2/day, divided to 3 doses, and administered every 8 h, which completely suppressed the arrhythmia. Note: This is for converting oral opioids only, and should not be used for IV to oral conversions. 15 mg/hr to 480 mg/day. IV loading should only be performed when a rapid response is required. Dose titration every 3 days monitored or 7 days in chronic use. 1) 5) 1) 5) IV regimen: Bolus 0.15 mg/kg IV over 10 minutes, then 3-5 mg IV Q6hr. The pharmacist leaving the sticky not will open and IV to po i-Vent, leave this i-Vent open until the medication is changed. Half-life: 38-48 hrs. Dogs were given amiodarone at 8:00 AM and 8:00 PM daily for the loading dose and at 8:00 AM daily for the maintenance. Critical Care Intravenous Flow Rates Example 1: The order is to infuse nitroglycerin at 5 mcg/min; 50 mg of Study Resources Percocet = acetaminophen + oxyCODONE), enter only the dose of the opioid component (e.g. IV amiodarone must be administered via a central line. Oral loading dose. An infusion is to run for 30 minutes and is to deliver 200 mL. IV. The drip has been infusing for almost 24 hours and the patient had not yet converted. <2400mg. This medicine half life calculator estimates the action of any medicine and the way concentration decreases in percentage in plasma according to half life and dosage. IV/PO: 4-8 hrs initially; increases to 22-48 hrs with repeated doses. Amiodarone. 125 mcg twice daily. If the patient achieves ROSC, a continuous infusion is started at 1 mg/min for 6 hours, followed by 0.5 mg/min. 5. If intravenous amiodarone is administered during pregnancy, the patient should be apprised of the potential hazard to the fetus. Reduce dose 50% for cross-tolerance: 45 x 0.5 = 22 mg/24 hours = 4 mg q4h. Digoxin loading oral: 500-750mcg 2 doses 6 hours apart (max 1500mcg in 24 hours) Maintenance dose. Stable VT: 150 mg IV over 10 min May repeat with 150 mg IVP if needed. Asymptomatic blue-grey discolouration of exposed areas can also occur. Amiodarone Intravenous should only be used in a special care unit under continuous monitoring (ECG and blood pressure). For oral dosage form (tablets): For ventricular arrhythmias: AdultsAt first, 800 to 1600 milligrams (mg) per day taken in divided doses. Although amiodarone exerts its antiarrhythmic effect by an interplay of different actions on cardiac cells, it has been regarded to be the prototype class III drug due to its prolongation of action potential duration. 1)The physician orders amiodarone IV drip at 0.5 mg/min for ventricular dysrhythmias. Amiodarone is widely prescribed, largely due to its efficacy in the management of both supraventricular and ventricular arrhythmias. Atrial Fib 150 mg IV/IO in 50 ml D5W/NS over 10 minutes. (anephric: 4-6 days). Flush with 20 ml of D5W/NS. New! #23. If rounding is required, round to the nearest tenth.) Calculate the total daily opioid dosage (long acting and break through) and convert to morphine equivalents (either IV or PO) using an equianalgesic dosing table. The physician orders amiodarone IV drip at 0.5 mg/min for ventricular dysrhythmias. 4. Includes dosages for Arrhythmias; plus renal, liver and dialysis adjustments. RxAdvanced: Guide to Cannabis training for pharmacists that offers 16 hours of ACPE-accredited training based on the latest, science-based cannabis research. 100 unit / 100 ml (1 unit/ml). This has to do with the very high volume of distribution (part of why you give the 150mg load). amiodarone pediatric dosing. Infuse 150 mg over 10 minutes (15 mg/min). Alternative regimen of amiodarone: 600 mg/day for 7 days prior to surgery, followed by 200 mg/day until hospital discharge, has also been shown to decrease the risk of postoperative atrial fibrillation. [onset time < 20min] EP or general cardiology consult should be requested if long-term amiodarone use is contemplated. 62.5mcg 250mcg daily. Prepare solution with 150 mg amiodarone in 100-mL D5W bag. Calculate the oral loading dose for a 70 yo, 70 kg adult male with a serum creatinine of 3.0, if the desired Cp is 1.0 ng/ml. 154/ 2.2 = 70 kg 70 x 80 = 5,600. Amiodarone [SVT with pulses] 150mg Rapid infusion over 10 minutes 15mg/minute, may repeat q10 minutes as needed Stable in D5W, NS Incompatible with heparin Maximum cumulative dose 2.2g over 24 hours Ativan (lorazepam) 0.1mg/kg Max dose 4mg Dilute 1:1 with NS Max rate 2mg/minute Stable in D5W, LR, NS Monitor IV site avoid extravasation Faebinder said: Our floor policy (as in the floor where I admit 90% of my patients) frigging wont give lopressor IV even if the person was on lopressor PO prior to admission. Patient had also received 3 doses of PO Amio in addition to the drip in the 24 hours. Amiodarone is an iodinated benzofuran derivative that was synthesized and tested as an antianginal agent in the 1960s but was later discovered to have antiarrhythmic properties. IV. IV: 30 mg/kg over 15 min, followed in 45 min by a continuous infusion of 5.4 mg/kg per h for 23 h. Administration within 8 h of injury is optimal.