No mixing = No mix‑ups.
EMERPHED’s 3 simple steps:
Aligns with standardization recommendations of patient safety and professional organizations: APSF,1 ASHP.2
DELAYS and DRAWBACKS of TVSP (traditional vial and syringe process):
Risk for error if using concentrated ampule
Risk for error if using concentrated vial
FDA warns of risk with the use of products that require compounding.
Nearly half of errors with IV medications occur during preparation or administration³
At-risk practices include number of steps required, syringe-to-syringe transfer, unnecessary dilution, and use of saline flush syringes to dilute IV medications³,⁴
Ready-to-use, manufacturer-prepared products are viewed as the drug delivery of choice.
References: 1. Recommendations for improving medication safety. Consensus from four work groups at the 2018 APSF Stoelting Conference on Medication Safety. Anesthesia Patient Safety Foundation. https://www.apsf.org/medication-safety-recommendations/. Accessed November 19, 2019. 2. American Society of Health-System Pharmacists. ASHP guidelines on preventing medication errors in hospitals. Am J Health-Syst Pharm. 2018;75:1493–1517. 3. Hertig J, Degnan D, Scott C, et al. A comparison of error rates between intravenous push methods: a prospective, multisite, observational study. J Patient Saf. 2018;14(1):60-65. 4. Burger M, Degnan D. Comparative Safety, Efficiency, and Nursing Preference Among 3 Methods for Intravenous Push Medication Preparation: A Randomized Crossover Simulation Study. J Patient Saf. 2019;15(3):238-245.
What important safety information should I know?
WARNINGS AND PRECAUTIONS
EMERPHED can cause pressor effects with concomitant use with oxytocic drugs. Can also cause tachyphylaxis with repeated administration of ephedrine.
Most common adverse reactions during treatment: nausea, vomiting, and tachycardia.
Interactions that Augment Pressor Effect: clonidine, oxytocin and oxytocic drugs, propofol, monoamine oxidase inhibitors (MAOIs), and atropine. Monitor blood pressure.
Interactions that Antagonize the Pressor Effect: Antagonistic effects with α-adrenergic antagonists, β-adrenergic antagonists, reserpine, quinidine, mephentermine. Monitor blood pressure.
Guanethidine: Ephedrine may inhibit the neuron blockage produced by guanethidine, resulting in loss of antihypertensive effectiveness. Monitor blood pressure and adjust the dosage of pressor accordingly.
Rocuronium: Ephedrine may reduce the onset time of neuromuscular blockade when used for intubation with rocuronium if administered simultaneously with anesthetic induction. Be aware of this potential interaction. No treatment or other interventions are needed.
Epidural anesthesia: Ephedrine may decrease the efficacy of epidural blockade by hastening the regression of sensory analgesia. Monitor and treat the patient according to clinical practice.
Theophylline: Concomitant use of ephedrine may increase the frequency of nausea, nervousness, and insomnia. Monitor patient for worsening symptoms and manage symptoms according to clinical practice.
Cardiac glycosides: Giving ephedrine with a cardiac glycoside, such as digitalis, may increase the possibility of arrhythmias. Carefully monitor patients on cardiac glycosides who are also administered ephedrine.
Overdose of EMERPHED can cause a rapid rise in blood pressure. In the case of an overdose, careful monitoring of blood pressure is recommended. If blood pressure continues to rise to an unacceptable level, parenteral antihypertensive agents can be administered at the discretion of the clinician.
INDICATIONS AND USAGE
Ephedrine Sulfate injection is an alpha- and beta- adrenergic agonist and a norepinephrine-releasing agent that is indicated for the treatment of clinically important hypotension occurring in the setting of anesthesia.