Provincial High-alert Medication List

Classes/Categories of Medications Specific Medications

adrenergic agonists: IV (e.g., epiNEPHrine, ePHEDrine, isoproterenol, magnesium sulfate injection PHENYLephrine, norepinephrine, doBUTamine, doPAMine, salbutamol) methotrexate: oral for non-oncologic adrenergic antagonists: IV (e.g., propranolol, metoPROLOL, labetalol, use esmolol) nitroprusside sodium for injection anesthetic agents: general, inhaled and IV (e.g., propofol, ketamine, sevoflurane, isoflurane, desflurane, etomidate) opium tincture antiarrhythmics: IV (e.g., lidocaine, amiodarone, procainamide, oxytocin: IV adenosine, bretylium, ibutilide) potassium chloride for injection: antithrombotic agents: concentrate  anticoagulants (e.g., warfarin, acenocoumarol, tinzaparin, potassium phosphates injection enoxaparin, dalteparin, danaparoid, unfractionated heparin, sodium citrate) promethazine: IV  factor Xa inhibitors (e.g., fondaparinux, rivaroxaban) vasopressin: IV or intraosseous  direct thrombin inhibitors (e.g., apixaban, argatroban, bivalirudin, dabigatran)  thrombolytics (e.g., alteplase, tenecteplase)  glycoprotein IIb/IIIa inhibitors (e.g.,eptifibitide, tirofiban, abciximab) cardioplegic solutions chemotherapeutic agents: parenteral and oral dextrose: 20% or greater (hypertonic) dialysis solutions: peritoneal and hemodialysis The following medications are also epidural or intrathecal medications associated with higher risk and must inotropic medications: IV (e.g., digoxin, milrinone) comply with the segregated storage and labelling requirements for high- insulin: subcutaneous and IV alert medications. Refer to the Management of High-alert liposomal forms of drugs and conventional counterparts (e.g., Medications Policy, Procedure, and amphotericin B, amphotericin B-lipid complex, amphotericin B-liposomal, Electrolytes Guideline for labelling DOXOrubicin HCL, DOXOrubicin-pegylated liposomal, PACLitaxel, specifics: PACLitaxel-nab)  calcium chloride IV moderate sedation agents: IV (e.g., dexmedetomidine, lorazepam  calcium gluconate IV midazolam)  potassium acetate IV  potassium chloride small volume moderate sedation agents: oral, for children (e.g., chloral hydrate) bolus bags narcotics/opioids: IV, transdermal, and oral  sodium phosphate IV  sodium acetate IV neuromuscular blocking agents (e.g., succinylcholine, rocuronium, pancuronium, atracurium, cisatracurium) parenteral nutrition preparations Adapted from Institute for Safe Medication Practice sodium chloride for injection: greater than 0.9% (hypertonic) http://www.ismp.org/Tools/highalert sterile water for injection, inhalation, and irrigation (excluding pour medications.pdf bottles) in containers of 100 mL or more sulfonylureas: oral (e.g., GLICLAzide, glyBURIDE) vasodilating agents: IV (e.g., epoprostenol, iloprost, treprostinil)

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