Aspirin Desensitization Orders

PLACE LABEL HERE ASPIRIN DESENSITIZATION ORDERS for Aspirin Related Urticaria / Angioedema

The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked. Initial all handwritten order modifications and the bottom of each page when indicated (multipage).

1. Unit: Transfer patient to ICU setting and must remain for 2 hrs post completion of this protocol 2. Assessment/Monitoring: Obtain baseline and document assessment with each new dose  Observe for hypersensitivity reactions and document if the patient has the following: itching, rash, wheezing, dyspnea, rhinorrhea  Blood pressure and pulse  Oxygen Saturation

3. Hold beta-blocker dose prior to desensitization to avoid blunting reaction response 4. Pharmacy Preparation: Aspirin Suspension Bottle A: (Aspirin 1 mg/ml)  Crush and dissolve two (2) Aspirin 81 mg chewable tablets into 162 ml tap water  Label bottle A Aspirin Suspension Bottle B: (Aspirin 0.1 mg/ml)  Remove 1 ml from Aspirin suspension Bottle A and add to 9 ml tap water  Label bottle B Pharmacy to dispense each dose in a labeled oral syringe 5. Aspirin Desensitization Dosing: Goal Aspirin Oral dose  81 mg  162 mg  325 mg (see dose chart below to achieve aspirin dose goal) Goal dose depends on Aspirin dose that patient is expected to take long term.

Dose 1 Dose 2 Dose 3 Dose 4 Dose 5 Dose 6 Dose 7 Dose 8 **Dose 9 **Dose 10

0 minutes 20 min 40 min 60 min 80 min 100 min 120 min 140 min 160 min 180 min

0.1 mg 0.3 mg 1 mg 3 mg 10 mg 30 mg 40 mg 81 mg 162 mg 325 mg Give 2 x Give 4 x Give 1 ml Give 3 ml Give 1 ml Give 3 ml Give 10 ml Give 30 ml Give 40 ml Give 81 mg 81 mg 81 mg po of po of po of po of po of po of po of chewable chewable chewable Bottle B Bottle B Bottle A Bottle A Bottle A Bottle A Bottle A tablet po tablets po tablets po ** Optional doses that may be administered, depends on goal Aspirin dose PRN MEDICATIONS: 6. Anaphylaxis: Epinephrine 0.3-0.5 ml, 1:1000 (1 mg/ml) solution IM q 5 min prn in absence of clinical improvement ADDITIONAL ORDERS: 7. Notify physician if patient develops signs of allergic reaction

______Date Time Physician Signature PID Number

*1-38389* FORM 1-38389 REV. 03/2016 Page 1 of 1 PLACE LABEL HERE ASPIRIN DESENSITIZATION ORDERS for Aspirin Related Urticaria / Angioedema

*1-38389* FORM 1-38389 REV. 03/2016 Page 1 of 1