Neurology Only - MIgraine Infusions		version 9/5/2024		

Appointment Requests 	

	
	Interval	Defer Until	Duration	
	☑	Referral to IV Infusion Room	Once	S	1 treatment	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine		
	☑	Nursing communication	Every visit	S	Until discont'd	
		Please continue to schedule subsequent infusion appointments manually as appropriate.		

Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☐	Nursing communication	Every visit	S	Until discont'd	
		Repeat regimen daily for *** days		
	☐	Insert Peripheral IV or Access Portacath	Every visit	S	Until discont'd	
		No details available for preview		
	☐	sodium chloride 0.9% flush 10 mL	Every visit	S	Until discont'd	
		10 mL, intravenous, PRN, line care, Starting when released, Until Discontinued		
	☐	sodium chloride 0.9% infusion 250 mL	Every visit	S	Until discont'd	
		250 mL, intravenous, at 30 mL/hr, PRN, Flush bag, Starting when released, Until Discontinued		
	☐	Discontinue IV	Every visit	S	Until discont'd	
		No details available for preview		
	☐	Nursing communication	Every visit	S	Until discont'd	
		DHE Infusion:
	o Monitor patient for side effects. Decrease the infusion rate and/or temporarily stop the infusion.  If symptoms improve, continue infusion as best tolerated rate and dose.
	o Need recent NEGATIVE pregnancy test
	o Need recent EKG on file		

Steroids 	

	
	Interval	Defer Until	Duration	
	☐	methylPREDNISolone sodium succinate (Solu-MEDROL) IVPB 1,000 mg	Every visit	S	Until discont'd	
		1,000 mg, intravenous, Administer over: 60 Minutes, once, Starting when released		
	☐	dexAMETHasone (DECADRON) IV 4 mg	Every visit	S	 treatments	
		4 mg, intravenous, once, Starting when released		

Antiepileptic 	

	
	Interval	Defer Until	Duration	
	☐	valproate sodium (DEPACON) 1,000 mg	Every visit	S	Until discont'd	
		1,000 mg, intravenous, Administer over: 60 Minutes, once, Starting at treatment start time		
	☐	levETIRAcetam (KEPPRA) IV 1,000 mg	Every visit	S	Until discont'd	
		1,000 mg, intravenous, once, Starting at treatment start time		

Miscellaneous 	

	
	Interval	Defer Until	Duration	
	☐	hydrOXYzine HCL (ATARAX) tablet 25 mg	Every visit	S	Until discont'd	
		25 mg, oral, once, Starting at treatment start time		
	☐	LORAZepam (ATIVAN) injection 1 mg	Every visit	S	Until discont'd	
		1 mg, intravenous, once, Starting when released		
	☐	diphenhydrAMINE (BENADRYL) injection 25 mg	Every visit	S	Until discont'd	
		25 mg, intravenous, once, Starting when released		
	☐	ketorolac (TORADOL) injection 30 mg	Every visit	S	Until discont'd	
		30 mg, intravenous, once, Starting when released		
	☐	magnesium sulfate IVPB 1 g	Every visit	S	Until discont'd	
		1 g, intravenous, once, Starting when released		
	☐	sodium chloride 0.9 % bolus 1,000 mL	Once	S	1 treatment	
		1,000 mL, intravenous, Administer over: 60 Minutes, once, Starting when released
	For DAY 1 only		

Vasoconstrictive Agents 	

	
	Interval	Defer Until	Duration	
	☐	SUMAtriptan succinate (IMITREX) injection 6 mg	Every visit	S	Until discont'd	
		6 mg, subcutaneous, once, Starting when released
	Do not give within 24 hours of DHE or other ergotamine use.  Do not use with other triptan medications.
	For subcutaneous administation only.
	For subcutaneous administration only. Max dose per 24 hrs is 12 mg.		

Dopamine Antagonists 	

	
	Interval	Defer Until	Duration	
	☐	promethazine (PHENERGAN) injection 12.5 mg	Every visit	S	Until discont'd	
		12.5 mg, injection, once, Starting when released		
	☐	metoclopramide (REGLAN) injection 10 mg	Every visit	S	Until discont'd	
		10 mg, intravenous, once, Starting when released		
	☐	chlorproMAZINE (THORAZINE) 12.5 mg in sodium chloride 0.9% 50 mL IVPB	Every visit	S	Until discont'd	
		12.5 mg, intravenous, Administer over: 60 Minutes, once, Starting when released
	May cause QTc prolongation.		
	☐	prochlorperazine (COMPAZINE) injection 10 mg	Every visit	S	Until discont'd	
		10 mg, intravenous, once, Starting when released		

DHE Infusion 	

	
	Interval	Defer Until	Duration	
	☐	diphenhydrAMINE (BENADRYL) injection 25 mg	Every visit	S	Until discont'd	
		25 mg, intravenous, once, Starting when released
	Pre-med for DHE. Administer 30 minutes prior to start of DHE infusion.		
	☐	ondansetron (ZOFRAN) IV 4 mg	Every visit	S	Until discont'd	
		4 mg, intravenous, once, Starting when released
	Pre-med for DHE. Administer 30 minutes prior to start of DHE infusion.
	May cause QTc prolongation.		
	☐	dihydroergotamine (DHE) 1 mg in sodium chloride 0.9% 250 mL IVPB	Every visit	S	Until discont'd	
		1 mg, intravenous, Administer over: 60 Minutes, once, Starting when released
	If patient experiences side effects, decrease the infusion rate and/or temporarily stop the infusion. If symptoms improve, continue infusion as best tolerated rate and dose. Do not give within 24 hours of triptan use.		

PRN Medications 	

	
	Interval	Defer Until	Duration	
	☐	ondansetron (ZOFRAN) IV 4 mg	Every visit	S	Until discont'd	
		4 mg, intravenous, once, Starting when released
	May cause QTc prolongation.