See also: Typical St. Clare's admission & post-op orders
Pain
Atasol 30 1-2 tabs po q4h prn
Morphine 2-5 mg sc q3h prn
Percocet 1-2 tabs po q4h prn
Dilaudid 0.2-0.5 mg iv q4h prn
Dilaudid 1-2 sc q4h prn
Dilaudid 2.0-4.0 mg PO q4h PRN
Nausea/vomiting
dimenhydrinate (gravol) 25-50 mg po/iv q4h prn
ondansetron (zofran) 4-8mg iv/im q8h PRN
Constipation
colace 100 mg po bid (weak effect)
milk of magnesia 30cc po bid
peg 3350 17 g dissolved in 4-8 oz of beverage daily
lactulose 30 cc po bid
ducolax supp 1 pr od prn (stimulant)
domperidone 10mg bid-tid ac meals
sennosides (senokot) 1-2 tabs po 8.6 mg qhs prn (stimulant)
fleet enema 1 PR daily PRN
Antibiotics
cefazolin (ancef) 1g iv q8h
cephalexin (keflex) 250-500 mg po qid
ceftriaxone 1g iv q24h
flagyl 500mg po/iv tid
cipro 400 mg iv q12h
cipro 500 mg po q12h (excellent absorption, preferred over IV)
ampicillin 1g iv q6h
clindamycin 600mg iv q8h
gentamicin 80mg iv q8h [may need renal dosing]
vancomycin 1g iv q12h [monitor levels q3days]
ca-pna
ceftriaxone 1g iv q24h
azithromycin 500mg po/iv then 250mg po daily x4/7
ha-pna
piperacillin/tazobactam x g q6h x 7/7 then r/a
Anticoagulation
heparin 5000u sc bid/tid*
tid if high risk (e.g. cancer)
enoxaparin 40 mg sc q24h
Vitamin k, to lower inr
vitamin k 5 mg po x 1
recheck inr in 4 h
Sedation
ativan 0.5-1mg sl/po qhs prn
haldol 1-2 mg IV q4h prn
Anti-tussive
benadryl 25-50mg PO/IV q4-8h
codeine 30-60mg q4h
dilaudid 1mg qhs
Miscellaneous
benadryl 25-50 mg po/iv q4h prn
zopiclone (imovane) 3.75-7.5mg po qhs prn [start low with older pt]
pariet 20 mg po daily bid
nicotine patch transdermal 7, 14 or 21 mg
pantaloc 40 mg iv bid
if new NG tube
40 mg pantoloc IV bolus then
pantoloc 8mg/hr iv infusion x24 hours then
pantoloc 40mg iv bid
Insulin sliding scale, ok even if NPO
increase doses per bin if patient is insulin-resistant
accucheck qid
if bg<4.0 then 0 units, give juice or 1 amp D50 and call MD
if bg 4.1-8.0 then 0 units
if bg 8.1-12.0 then 2 units humulin r
if bg 12.1-16.0 then 4 units humulin r
if bg 16.1-20 then 8 units humulin r
if bg >20.1 then 10 units humulin r and call MD
Insulin regimen with long acting dose
Accucheck qid
20 units lantus sc qhs
8 units humulin r sc ac meals tid
Anti-inflammatory
100* mg hydrocortisone IV q8h
*depends on indication/home dose
Post-epidural transition medications
Ondansetron 4mg IV/PO q6h PRN
Dimenhydrinate 25-50 mg PO/IV q4h PRN
Toradol 10 mg PO q8h PRN
Acetaminophen 325-650 mg PO q4h NB<4g/24h
Atasol 30 1-2 tabs PO q4h PRN
Potassium 10mEq minibags IV x 3 over 1 hour each
Ferramax 150 mg po daily-BID
Topical
Viaderm KC Ointment
