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Approved Formulary
Medications Requiring Cardiac and/or Special Monitoring
| Per policy, these medications require cardiac and/or special monitoring.(KEY: "Y" = indicates the medication may be given on a particular unit with applicable monitoring as specified. "N" = may NOT be given except in Rapid Response/Code Blue situations or as otherwise described in Exceptions section of Policy. | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| A | generic (Brand) / Notes | CCU, OR, PACU, CCL, ED | PCU | 2N (Tele) | 1N (Tele), 3N (Tele) | Med/Surg (1N w/o Tele, 3N w/o Tele, 4N, 5N) | BirthPlace | SNF | ICS | OPS |
| acetylcysteine (Acetadote) IV Key: order set |
Y | Y | N | N | N | N | N | N | N | |
| Activase - see alteplase | ||||||||||
| adenosine (Adenocard) IV Push Key: monitoring |
Y | Y | Y MD present, with RESP standby |
N | N | Y MD present, with RESP standby |
N | N | N | |
| Adrenalin - see EPINEPHrine | ||||||||||
| Aggrastat - see tirofiban | ||||||||||
| alteplase (Activase) IV Infusion as a thrombolytic agent Key: PE,CVA |
Y | N | N | N | N | N | N | N | N | |
| alteplase (Cathflo) IV Push to declot a catheter Key: designated staff |
Y | Y | Y | Y | Y | Y | Y | Y | Y | |
| aminocaproic acid (Amicar) IV Infusion |
Y | N | N | N | N | N | N | N | N | |
| amiodarone (Cordarone) IV Push, IV Infusion |
Y | Y | Y | N | N | N | N | N | N | |
| Anectine - see succinylcholine | ||||||||||
| Angiomax - see bivalirudin | ||||||||||
| Apresoline - see hydrALAZINE | ||||||||||
| argatroban IV Infusion |
Y | Y | Y | Y | Y | Y | N | N | N | |
| Ativan - see LORazepam | ||||||||||
| atropine IV Key: designated staff |
Y | Y | Y | N | Y 1N only for side effects of chemo |
N | N | Y only for side effects of chemo |
N | |
| B | generic (Brand) / Notes | CCU, OR, PACU, CCL, ED | PCU | 2N (Tele) | 1N (Tele), 3N (Tele) | Med/Surg (1N w/o Tele, 3N w/o Tele, 4N, 5N) | BirthPlace | SNF | ICS | OPS |
| Betapace - see sotalol | ||||||||||
| bivalirudin (Angiomax) IV |
Y | Y | Y | N | N | N | N | N | N | |
| Brevibloc - see esmolol | ||||||||||
| bumetanide (Bumex) Key: IV Infusion |
Y | Y | Y | Y | Y | Y | Y | Y | Y | |
| bupivacaine (Marcaine) Epidural Key: management only |
Y | Y | Y | Y | Y | Y | Y | Y | N | |
| C | generic (Brand) / Notes | CCU, OR, PACU, CCL, ED | PCU | 2N (Tele) | 1N (Tele), 3N (Tele) | Med/Surg (1N w/o Tele, 3N w/o Tele, 4N, 5N) | BirthPlace | SNF | ICS | OPS |
| Calan - see verapamil | ||||||||||
| calcium gluconate IV Infusion Key: If > 2 gm monitoring |
Y | Y | Y | Y (≤ 2 gm) |
Y (≤ 2 gm) |
Y (≤ 2 gm) |
Y (≤ 2 gm) |
Y (≤ 2 gm) |
Y (≤ 2 gm) |
|
| Cardene - see niCARdipine | ||||||||||
| Cardizem - see diltaZEM | ||||||||||
| Cathflo - see alteplase | ||||||||||
| CISatracurium (Nimbex) IV Push, IV Infusion Key: order set, vent |
Y | N | N | N | N | N | N | N | N | |
| Cordarone - see amiodarone | ||||||||||
| Corlopam - see fenoldopam | ||||||||||
| Corvert - see ibutilide | ||||||||||
| cytotoxic agents (chemotherapy) IV Push, IV Infusion (chemotherapy) Key: certified RN and 1N designated staff only |
Y (CCU only) |
N | N | Y (1N only) |
Y (1N only) |
N | N | Y | N | |
| D | generic (Brand) / Notes | CCU, OR, PACU, CCL, ED | PCU | 2N (Tele) | 1N (Tele), 3N (Tele) | Med/Surg (1N w/o Tele, 3N w/o Tele, 4N, 5N) | BirthPlace | SNF | ICS | OPS |
| Demerol - see meperidine | ||||||||||
| Depacon - see valproic acid | ||||||||||
| dexmedetomidine (Precedex) IV infusion |
Y | Y | N | N | N | N | N | N | N | |
| diazePAM (Valium) IV Push not for sedation |
Y | Y | Y | Y | Y | Y | Y | Y | Y | |
| diazePAM (Valium) IV Push sedation / analgesia by non-ANES personnel Key: designated staff |
Y | N | N | N | N | N | N | N | N | |
| digoxin (Lanoxin) IV Push |
Y | Y | Y | Y | N | N | N | N | N | |
| digoxin immune FAB (Digibind, DigiFab) IV |
Y | Y | Y | N | N | N | N | N | N | |
| Dilantin - see phenytoin | ||||||||||
| Dilaudid - see HYDROmorphone | ||||||||||
| diltaZEM (Cardizem) IV Push, IV Infusion |
Y | Y | Y | N | N | N | N | N | N | |
| Diprivan - see propofol | ||||||||||
| DOBUTamine (Dobutrex) IV Infusion Key: designated staff |
Y | Y | Y | N | N | N | N | N | N | |
| dofetilide (Tikosyn) Oral for continuation of home medication Key: policy, order set |
Y | Y | Y | Y | Y | N | Y | N/A | N/A | |
| dofetilide (Tikosyn) Oral for initiation and/or titration for atrial fib / flutter ONLY Key: policy, order set |
Y | Y | Y | N | N | N | N | N/A | N/A | |
| DOPamine (Intropin) IV |
Y | Y if not being titrated |
Y if not being titrated |
N | N | N | N | N | N | |
| droperidol (Inapsine) IV/IM Key: If max dose (10 mg), monitoring |
ED/ANES only (≤ 10 mg) | N | N | N | N | N | N | N | N | |
| E | generic (Brand) / Notes | CCU, OR, PACU, CCL, ED | PCU | 2N (Tele) | 1N (Tele), 3N (Tele) | Med/Surg (1N w/o Tele, 3N w/o Tele, 4N, 5N) | BirthPlace | SNF | ICS | OPS |
| enalapril (Vasotec) IV Push |
Y | Y | Y | Y | Y | Y | Y | Y | Y | |
| EPINEPHrine (Adrenalin) IV Infusion vasopressor |
Y | N | N | N | N | N | N | N | N | |
| esmolol (Brevibloc) IV Infusion |
Y | N | N | N | N | N | N | N | N | |
| F | generic (Brand) / Notes | CCU, OR, PACU, CCL, ED | PCU | 2N (Tele) | 1N (Tele), 3N (Tele) | Med/Surg (1N w/o Tele, 3N w/o Tele, 4N, 5N) | BirthPlace | SNF | ICS | OPS |
| fenoldopam (Corlopam) IV Infusion |
Y | N | N | N | N | N | N | N | N | |
| fentaNYL (Sublimaze) Epidural Key: management only |
Y | Y | Y | Y | Y | Y | N | Y | N | |
| fentaNYL (Sublimaze) IV Push, IV Infusion for pain management |
Y | PCA only | PCA only | PCA only | PCA only | Y (IV Push only w/ANES staff) |
N | N | N | |
| fentaNYL (Sublimaze) IV Push sedation / analgesia by non-ANES personnel Key: designated staff |
Y | N | N | N | N | N | N | N | N | |
| fentaNYL (Sublimaze) PCA for End of Life Care |
Y | N | N | 1N only | 1N only | N | N | N | N | |
| furosemide (Lasix) IV Push, IV Infusion |
Y | Y | Y | Y | Y | Y | Y | Y | Y | |
| H | generic (Brand) / Notes | CCU, OR, PACU, CCL, ED | PCU | 2N (Tele) | 1N (Tele), 3N (Tele) | Med/Surg (1N w/o Tele, 3N w/o Tele, 4N, 5N) | BirthPlace | SNF | ICS | OPS |
| haloperidol (Haldol) IV Push Key: See footnote for dose restrictions |
Y | Y | Y | Y | Y | Y | Y | Y | Y | |
| Patients receiving Haldol must be on cardiac monitoring if: a) bolus or one time IV doses exceed 5mg, b) maintenance IV doses exceed 1-2mg every 2-4hours as needed, or c) cumulative doses exceed 35mg in a 24-hour period. | ||||||||||
| haloperidol (Haldol) IV Infusion |
Y | N | N | N | N | N | N | N | N | |
| heparin IV Infusion Key: policy, order set |
Y | Y | Y | Y | Y | Y | N | N | N | |
| HumuLIN R - see insulin regular | ||||||||||
| hydrALAZINE (Apresoline) IV Push |
Y | Y | Y | Y | Y | Y | Y | Y | Y | |
| HYDROmorphone (Dilaudid) Epidural Key: management only |
Y | Y | Y | Y | Y | Y | Y | Y | N | |
| HYDROmorphone (Dilaudid) IV Push, IV Infusion PCA for pain management |
Y | Y | Y | Y | Y | Y | IV Push only | IV Push only | IV Push only | |
| HYDROmorphone (Dilaudid) IV Push, IV Infusion Sedation / Analgesia by Non-ANES Personnel |
Y | N | N | N | N | N | N | N | N | |
| I | generic (Brand) / Notes | CCU, OR, PACU, CCL, ED | PCU | 2N (Tele) | 1N (Tele), 3N (Tele) | Med/Surg (1N w/o Tele, 3N w/o Tele, 4N, 5N) | BirthPlace | SNF | ICS | OPS |
| ibutilide (Corvert) IVPB Key: Order set |
Y | Y | Y | N | N | N | N | N | N | |
| Inapsine - see droperidol | ||||||||||
| Inderal - see propranolol | ||||||||||
| insulin regular (HumuLIN R) IV Infusion for DKA (NOT IV push) |
Y | Y | N | N | N | Y | N | N | N | |
| insulin regular (HumuLIN R) IVPB for Hyperkalemia Key: Order set |
Y | Y | Y | Y | N | N | N | N | N | |
| Integrelin - see eptifibatide | ||||||||||
| Intropin - see DOPamine | ||||||||||
| isoproterenol (Isuprel) IV Infusion |
Y | N | N | N | N | N | N | N | N | |
| Isoptin - see verapamil | ||||||||||
| Isuprel - see isoproterenol | ||||||||||
| IV Immune Globulin (IVIG) policy |
Y | Y | Y | Y | Y | N | Y | Y | N | |
| K | generic (Brand) / Notes | CCU, OR, PACU, CCL, ED | PCU | 2N (Tele) | 1N (Tele), 3N (Tele) | Med/Surg (1N w/o Tele, 3N w/o Tele, 4N, 5N) | BirthPlace | SNF | ICS | OPS |
| ketamine (Ketalar) IV Push |
under direct physician supervision | N | N | N | N | N | N | N | N | |
| L | generic (Brand) / Notes | CCU, OR, PACU, CCL, ED | PCU | 2N (Tele) | 1N (Tele), 3N (Tele) | Med/Surg (1N w/o Tele, 3N w/o Tele, 4N, 5N) | BirthPlace | SNF | ICS | OPS |
| labetalol (Normodyne, Trandate) IV Push, IV infusion |
Y | Y (IV push only) |
Y (IV push only) |
Y (IV push only) |
N | Y (IV push only) |
N | N | N | |
| Lanoxin - see digoxin | ||||||||||
| Lasix - see furosemide | ||||||||||
| Levophed - see norEPINEPHrine | ||||||||||
| lidocaine (Xylocaine) IV Push, IV Infusion |
Y | N | N | N | N | N | N | N | N | |
| Lopressor - see metoprolol | ||||||||||
| LORazepam (Ativan) IV Push not for sedation |
Y | Y | Y | Y | Y | Y | Y | Y | Y | |
| LORazepam (Ativan) IV Push sedation / analgesia by non-ANES personnel Key: designated staff |
Y | N | N | N | N | N | N | N | N | |
| LORazepam (Ativan) IV Infusion |
Y | N | N | N | N | N | N | N | N | |
| M | generic (Brand) / Notes | CCU, OR, PACU, CCL, ED | PCU | 2N (Tele) | 1N (Tele), 3N (Tele) | Med/Surg (1N w/o Tele, 3N w/o Tele, 4N, 5N) | BirthPlace | SNF | ICS | OPS |
| magnesium sulfate IVPB, IV infusion |
Y (≤ 4 gm) |
Y (≤ 4 gm, ≤ 2 gm/hr) |
Y (≤ 4 gm, ≤ 2 gm/hr) |
Y (≤ 4 gm, ≤ 2 gm/hr) |
Y (≤ 4 gm, ≤ 2 gm/hr) |
Y (IVPB ≤ 6 gm) |
Y (IVPB ≤ 1 gm) |
Y (≤ 4 gm, ≤ 2 gm/hr) |
Y (≤ 4 gm, ≤ 2 gm/hr) |
|
| mannitol | Y | Y | Y | Y | Y | Y | Y | Y | Y | |
| Marcaine - see bupivacaine | ||||||||||
| meperidine (Demerol) Epidural Key: management only |
Y | Y | Y | Y | Y | Y | Y | Y | Y | |
| meperidine (Demerol) IV Push, IV Infusion for pain management |
Y | Y | Y | Y | Y | Y | IV Push only | IV Push only | IV Push only | |
| meperidine (Demerol) IV Push sedation / analgesia by non-ANES personnel Key: designated staff |
Y | N | N | N | N | N | N | N | N | |
| metoprolol (Lopressor) IV Push |
Y | Y | Y | Y | N | Y | N | N | N | |
| midazolam (Versed) IV Push, IV Infusion Key: designated staff |
Y | N | N | N | N | N | N | N | N | |
| milrinone (Primacor) IV |
Y | Y not being titrated |
Y not being titrated |
N | N | N | N | N | N | |
| morphine Epidural management only |
Y | Y | Y | Y | Y | Y | Y | Y | N | |
| morphine IV Push,IV Infusion PCA for pain management |
Y | Y | Y | Y | Y | Y | IV Push only | IV Push only | IV Push only | |
| morphine IV Push sedation / analgesia by non-ANES personnel Key: designated staff |
Y | N | N | N | N | N | N | N | N | |
| morphine (Roxanol oral concentrate 20 mg/ml) Oral |
Y | Y | Y | Y | Y | N | Y | Y | Y | |
| N | generic (Brand) / Notes | CCU, OR, PACU, CCL, ED | PCU | 2N (Tele) | 1N (Tele), 3N (Tele) | Med/Surg (1N w/o Tele, 3N w/o Tele, 4N, 5N) | BirthPlace | SNF | ICS | OPS |
| Natrecor - see nesiritide | ||||||||||
| neostigmine (Prostigmin) IV |
Y | N | N | N | N | N | N | N | N | |
| Neo-Synephrine - see phenylephrine | ||||||||||
| nesiritide (Natrecor) IV Push,IV Infusion (NO LONGER STOCKED) Key: order set |
Y | Y | Y | N | N | N | N | N | N | |
| niCARdipine (Cardene) IV Infusion |
Y | Y | N | N | N | N | N | N | N | |
| Nimbex - see CISatracurium | ||||||||||
| Nipride - see nitroprusside | ||||||||||
| nitroglycerin (Tridil) IV Infusion |
Y | Y | N | N | N | N | N | N | N | |
| nitroprusside (Nipride) IV Infusion |
Y | N | N | N | N | N | N | N | N | |
| Norcuron - see vecuronium | ||||||||||
| norEPINEPHrine (Levophed) IV Infusion vasopressor |
Y | N | N | N | N | N | N | N | N | |
| Normodyne - see labetalol | ||||||||||
| O | generic (Brand) / Notes | CCU, OR, PACU, CCL, ED | PCU | 2N (Tele) | 1N (Tele), 3N (Tele) | Med/Surg (1N w/o Tele, 3N w/o Tele, 4N, 5N) | BirthPlace | SNF | ICS | OPS |
| octreotide (SandoSTATIN) IV Infusion |
Y | Y | Y | Y | Y | Y | Y | Y | N | |
| P | generic (Brand) / Notes | CCU, OR, PACU, CCL, ED | PCU | 2N (Tele) | 1N (Tele), 3N (Tele) | Med/Surg (1N w/o Tele, 3N w/o Tele, 4N, 5N) | BirthPlace | SNF | ICS | OPS |
| phenylephrine (Neo-Synephrine) IV Infusion vasopressor |
Y | N | N | N | N | Y (IV Push by ANES) |
N | N | N | |
| phenytoin (Dilantin) IV Push,IV infusion |
Y | Y | Y | Y | N | N | N | N | N | |
| Pitressin - see vasopressin | ||||||||||
| potassium chloride IVPB 10 mEq / hr |
Y | Y | Y | Y | Y | Y | Y | Y | Y | |
| potassium chloride IVPB NTE 20 mEq / hr Key: monitored, Central Line |
Y | Y | Y | Y | N | N | N | N | N | |
| potassium phosphate IV Infusion Key: to be infused over at least 4 hours |
Y | Y | Y | Y (≤ K+ 10 mEq/hr) |
Y (≤ K+ 10 mEq/hr) |
Y (≤ K+ 10 mEq/hr) |
Y (≤ K+ 10 mEq/hr) |
Y (≤ K+ 10 mEq/hr) |
Y (≤ K+ 10 mEq/hr) |
|
| Precedex - see dexmedetomidine | ||||||||||
| Primacor - see milrinone | ||||||||||
| procainamide (Pronestyl) IV Infusion |
Y | N | N | N | N | N | N | N | N | |
| propofol (Diprivan) IV Push,IV Infusion Key: order set |
Y | N | N | N | N | N | N | N | N | |
| propranolol (Inderal) IV Push |
Y | Y | Y | Y | N | N | N | N | N | |
| Prostigmin - see neostigmine | ||||||||||
| protamine sulfate IV Push |
Y | Y | Y | Y | Y | N | Y | Y | N | |
| Q | generic (Brand) / Notes | CCU, OR, PACU, CCL, ED | PCU | 2N (Tele) | 1N (Tele), 3N (Tele) | Med/Surg (1N w/o Tele, 3N w/o Tele, 4N, 5N) | BirthPlace | SNF | ICS | OPS |
| Quelicin - see succinylcholine | ||||||||||
| quiNIDine gluconate IV (NO LONGER STOCKED) |
Y | N | N | N | N | N | N | N | N | |
| R | generic (Brand) / Notes | CCU, OR, PACU, CCL, ED | PCU | 2N (Tele) | 1N (Tele), 3N (Tele) | Med/Surg (1N w/o Tele, 3N w/o Tele, 4N, 5N) | BirthPlace | SNF | ICS | OPS |
| Reopro - see abciximab | ||||||||||
| rocuronium (Zemuron) IV Push, IV Infusion Key: order set, vent |
Y | N | N | N | N | N | N | N | N | |
| Roxanol - see morphine | ||||||||||
| S | generic (Brand) / Notes | CCU, OR, PACU, CCL, ED | PCU | 2N (Tele) | 1N (Tele), 3N (Tele) | Med/Surg (1N w/o Tele, 3N w/o Tele, 4N, 5N) | BirthPlace | SNF | ICS | OPS |
| SandoSTATIN - see octreotide | ||||||||||
| sodium chloride 3% IV infusion IV Infusion Key: policy, order set |
Y | Y (if asympto-matic) |
Y (if asympto-matic) |
Y (if asympto-matic) |
Y (if asympto-matic) |
Y (if asympto-matic) |
N | Y (if asympto-matic) |
N | |
| sodium phosphate IV Infusion Key: to be infused over at least 4 hours |
Y | Y | Y | Y | Y | Y | Y | Y | Y | |
| sotalol (Betapace) IV Load Key: order set, Policy |
Y (CCU only) |
Y | Y | N | N | N | N | N/A | N/A | |
| sotalol (Betapace) PO Load Key: order set, Policy |
Y (CCU only) |
Y | Y | N | N | N | N | N/A | N/A | |
| sotalol (Betapace) PO Continuation of Maintenance Key: order set, Policy |
Y (CCU only) |
Y | Y | Y | Y | N | Y | N/A | N/A | |
| Sublimaze - see fentaNYL | ||||||||||
| succinylcholine (Anectine, Quelicin) IV Push, IV Infusion Key: order set, vent |
Y | N | N | N | N | N | N | N | N | |
| T | generic (Brand) / Notes | CCU, OR, PACU, CCL, ED | PCU | 2N (Tele) | 1N (Tele), 3N (Tele) | Med/Surg (1N w/o Tele, 3N w/o Tele, 4N, 5N) | BirthPlace | SNF | ICS | OPS |
| tenecteplase (TNKase) As a thrombolytic agent Key: order set |
Y | N | N | N | N | N | N | N | N | |
| Tikosyn - see dofetilide | ||||||||||
| tirofiban (Aggrastat) IV Infusion Key: order set |
Y | Y | Y | N | N | N | N | N | N | |
| TNKase - see tenecteplase | ||||||||||
| Trandate - see labetalol | ||||||||||
| Tridil - see nitroglycerin | ||||||||||
| V | generic (Brand) / Notes | CCU, OR, PACU, CCL, ED | PCU | 2N (Tele) | 1N (Tele), 3N (Tele) | Med/Surg (1N w/o Tele, 3N w/o Tele, 4N, 5N) | BirthPlace | SNF | ICS | OPS |
| Valium - see diazePAM | ||||||||||
| valproic acid (Depacon) IV Push,IV Infusion |
Y | Y | Y | Y | Y | Y | Y | Y | Y | |
| vasopressin (Pitressin) IV Push,IV Infusion |
Y | N | N | N | N | N | N | N | N | |
| Vasotec - see enalapril | ||||||||||
| vecuronium (Norcuron) IV Push, IV Infusion Key: order set, vent |
Y | N | N | N | N | N | N | N | N | |
| verapamil (Calan, Isoptin) IV Push |
Y | N | N | N | N | Y with RESP standby |
N | N | N | |
| Versed - see midazolam | ||||||||||
| X | generic (Brand) / Notes | CCU, OR, PACU, CCL, ED | PCU | 2N (Tele) | 1N (Tele), 3N (Tele) | Med/Surg (1N w/o Tele, 3N w/o Tele, 4N, 5N) | BirthPlace | SNF | ICS | OPS |
| Xylocaine - see lidocaine | ||||||||||
| Z | generic (Brand) / Notes | CCU, OR, PACU, CCL, ED | PCU | 2N (Tele) | 1N (Tele), 3N (Tele) | Med/Surg (1N w/o Tele, 3N w/o Tele, 4N, 5N) | BirthPlace | SNF | ICS | OPS |
| Zemuron - see rocuronium | ||||||||||
| last updated: 04/21/2025 | ||||||||||