Potentially High Risk Medications

The Institute for Safe Medication Practices (ISMP) has listed a number of medications that are potentially high risk.

Classes or Categories of Drugs	Examples
adrenergic agonists, IV	epinephrine
adrenergic antagonists, IV	propranolol
agents for moderate sedation, IV
agents for moderate sedation, oral for children	chloral hydrate
anesthetic agents for general anesthesia	propofol
anticoagulants	warfarin (Coumadin), low molecular weight hepariun, unfractionated heparin
cardioplegic solutions
chemotherapeutic agent, oral or parenteral
concentrated electrolyte solutions, IV	hypertonic sodium chloride (> 0.9%), concentrated potassium chloride, magnesium sulfate, potassium phosphate
dialysis solutions	peritoneal or hemodialysis
drugs for intrathecal or epidural injection
glycoprotein IIb/IIIa inhibitors	eptifibatide
hypoglycemic agents, injectable	insulin
hypoglycemic agents, oral
inotropic agents	digoxin, milrinone
liposomal drug formulations	amphotericin B
neuromuscular blocking agents	succinylcholine
opiates or narcotics, oral or IV
radiocontrast agents, IV
a thrombolytic or fibrinoytic agent, IV	tenecteplase
total parenteral nutrition (TPN) solutions

Specific drugs that may be high risk:

(1) amiodarone, IV

(2) hypertonic (>= 20%) dextrose, IV

(3) lidocaine, IV

(4) nesiritide

(5) nitroprusside sodium, IV

(6) colchicine

(7) methotrexate, oral

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Purpose: To identify high risk medications that a patient may be receiving.