HFH-78-HFH-78-0116MR-0509

LUNG TRANSPLANT POST-OPERATIVE

MEDICATION ORDER (Page 1 of 3)

Weight (Actual Standing): ________ kg.

� Primary IV 0.9% NaCl at �minimal carrier rate �OR _________ ml/ hour

� Intensive Care Unit (ICU) Glycemic Control Protocol

� ICU Electrolyte replacement protocols for Potassium, Magnesium, Phosphorous.

� Pantoprazole 40 mg IV push every _______ hours

� Venous Thromboembolism Prophylaxis (Complete Venous Thromboembolism Prophylaxis

in Surgery Patients order form)

� chlorhexidine 0.12% oral swab 15 ml every 12 hours (for intubated patients only)

Cardiovascular IV:

Note typical dose ranges and Lung Transplant Specific Ranges for Cardiovascular drips,

if doses required outside of these ranges, contact surgeon for orders

Concentrate all IV medications as able, at all times.

� Esmolol (2500 mg/250 mL D5W) _____mcg/kg/minute IV. [Range 50-300 mcg/kg/minute]

Titrate:

� Nitro GLYCERIN (50 mg/250 mL NS) ____mcg/minute IV [Range 10-200 mcg/minute]

Titrate:

� nitroPRUSSIDE (100 mg/250 mL D5W) ____ mcg/kg/minute IV [Range 0.25-10 mcg/kg/minute]

Titrate:

� DOPAmine (800 mg/250 mL D5W) ____mcg/kg/minute IV [Range 2 – 20 mcg/kg/minute]

Titrate:

� DOBUTamine (1000 mg/250 mL D5W) ____mcg/kg/minute IV [Range 2 – 20 mcg/kg/minute]

Titrate:

� EPINEPHrine (16 mg/250 mL NS) ____mcg/minute IV [Lung Transplant Specific

Titrate: Range 2-10 mcg/minute]

� NOREPInephrine (32 mg/250 mL D5W) ____mcg/minute IV [Lung Transplant Specific

Titrate: Range 2-10 mcg/minute]

� Milrinone (40 mg/200 mL D5W) ____mcg/kg/minute IV [Range 0.375 – 0.75 mcg/kg/minute]

Titrate:

� Vasopressin (250 units/250 mL NS) ____units/hour IV [Lung Transplant Specific

Titrate: � to a Mean Arterial Pressure of 65-75 mmHg. Range 1 – 10 units/hour]

� to __________________.

Sedation

� Propofol 10 mg/ml at ____ mcg/kg/minute IV [Lung transplant Specific

OR Range 5- 20 mcg/kg/minute]

� Propofol 10 mg/ml Titrate per protocol to a Motor Activity Assessment Score (MAAS) of 3

Immunosuppressants

� Azathioprine (Imuran) 1 mg/kg intravenous (round to the nearest 25 mg) = __________ mg

every day at 0900

� Basiliximab (Simulect) 20 mg intravenous for 1 dose, Post-Operative Day (POD) #4, ______ (Specify date)� Methylprednisolone (Solu-Medrol)

125 mg intravenous every 8 hours for 3 doses, starting _______________, then

75 mg intravenous every 8 hours for 3 doses, starting _______________, then

50 mg intravenous every 8 hours, for 3 doses starting _______________, then

SAMPLE

HFH-78-HFH-78-0116MR-0509

LUNG TRANSPLANT POST-OPERATIVE

MEDICATION ORDER (Page 2 of 3)

Immunosuppressants (continued)------FOLLOWED BY ORAL TAPER------

� Prednisone Oral Taper

Prednisone 40 mg by mouth twice daily at 0900 and1700 for 5 days, starting_______, then

Prednisone 40 mg by mouth daily at 0900, for 5 days, starting ________, then

Prednisone 20 mg by mouth daily at 0900, starting _________, and continuing indefinitely

� Tacrolimus (Prograf) 1 mg �by mouth OR �per tube (please specify) every 0900 and 2100,

starting on POD #3, ________ (Specify date)

Antibacterials

� Please see Antimicrobial Order form for pathogen-directed antibiotics.

� Cefepime 2 gm IVPB every 8 hours. Infuse over 30 minutes.

Stop Date: POD #5, ________ (Specify date)OR

� For severe penicillin allergy, Aztreonam 2 gm IVPB every 8 hours. Infuse over 30 minutes.

Stop Date: POD #5, ________ (Specify date)

� Vancomycin 15 mg/kg (rounded to nearest 250 mg) = ________mg IVPB every 12 hours. Infuse over 1 hour.

Pharmacy to dose subsequently.

Stop Date: POD #5, ________ (Specify date)

� Sulfamethoxazole/trimethoprim (Bactrim DS) 800 mg/160 mg by mouth OR per tube (please specify) every Monday,

Wednesday and Friday. Start on post op day # 5, ________ (Specify date). Stop Date: None

Antiviral

Select one:

� Ganciclovir _______mg (round to nearest 25 mg) IVPB every _____hours (5 mg/kg intravenous every 12 hours with

renal adjustment) Infuse over 1 hour. Stop Date: None

OR

(For NEGATIVE CYTOMEGALOVIRUS (CMV) IGG and IGM serostatus in BOTH donor and recipient.)

� Acyclovir ______mg intravenous every _____ hours (5 mg/kg every 8 hours with renal adjustment) Infuse over 1 hour.

Stop Date: None

Antifungal:

� Liposomal amphotericin B (AmBisome) 50 mg nebulized per endotracheal tube three times weekly. First dose NOW

post-operatively. When extubated, obtain order to convert to Liposomal amphotericin B (AmBisome) 25 mg nebulized,

thrice weekly.

Stop Date: None.

AND

Select one:

� Fluconazole (Diflucan) 400 mg IVPB daily, first dose NOW post-operatively. obtain order to convert to fluconazole 400 mg oral

when taking PO medications. Stop Date: Day of Hospital Discharge.

OR

� Voriconazole 200 mg IVPB every 0900 and 2100.

Pathogen-directed therapy. Stop Date: 90 days.

Respiratory:

� Albuterol 2.5 mg per 3 ml nebulized every 4 hours.

SAMPLE

HFH-78-HFH-78-0116MR-0509

LUNG TRANSPLANT POST-OPERATIVE

MEDICATION ORDER (Page 3 of 3)

Cardiovascular Oral Medications

� Aspirin 81 mg by mouth daily, starting POD#1, ________ (Specify date), if no coagulopathy

suspected.

� _______________ (Statin) __________ mg by mouth at bedtime starting POD # 7,

________ (Specify date).

Pain medication: (check all that apply)

NO Non-steroidal anti-inflammatory drugs(NSAIDS) TO BE GIVEN

� Discontinue bupivacaine (Marcaine) 0.25% “Pain Pumps” after 96 hours or when empty, which

ever occurs first.

� Epidural Anesthesia: Per Pain Management, see Acute Pain Service Order form.

� Epidural contains narcotics, and no other narcotic should be given.

� Epidural DOES NOT contain narcotics, and other narcotic MAY BE given.

� Morphine Sulfate ____ to ____ mg intravenous every ____ hours as needed for moderate to severe pain

� Acetaminophen 650mg by mouth or by rectum every 4 hours as needed for pain or temperature greater than 38.5 degrees

Celsius

� Oxycodone 5 mg ____ to ____ tabs by mouth every ____hours as needed for pain.

� Robaxin 750 mg □ by mouth OR □ per tube (please specify) every 8 hours as needed for muscle spasm/pain

� Senna 8.6 mg/Docusate 50 mg (Senekot-S) 1 capsule � by mouth OR � per tube (please specify) every 12 hours as needed

for constipation.

� Bisacodyl 10 mg suppository per rectum every 12 hours as needed for constipation.

SAMPLE