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) Pharmacy Services-Medication Quality and Safety 2019/Jun/11 v6 Page 1 of 1 FOR ALBERTA HEALTH SERVICES USE ONLY. Unauthorized distribution, copying or disclosure is PROHIBITED. .