Kingdom of Saudi Arabia ‫المملكة العربية السعودية‬

Ministry of Health ‫وزارة الصحة‬

Jazan General Directorate of Health Affairs ‫المديرية العامة للشئون الصحية بمنطقة جازان‬
‫ى‬
‫مستشف ضمد العام‬
Damad General Hospital
Pharmacy Department ‫قسم الصيدلية‬

Revised 03 JUL 2022

(ICU Protocols for drug)

(Preparations and Calculations)

PREPARED BY: APPROVED BY: APPROVED BY:

PREPARED
MR. MOTAENBY: FAGEH APPROVED
PH. MUATHBY:NUBAYRI APPROVED
DR. YuneskaBY:
Rodriguez DR. RAID SULIMAN Mr. SABRI RYANI
MR. MOTAEN FAGEH
Quality Coordinator PH. MUATH NUBAYRI
Pharmacy Director DR. Yuneska
Medical Rodriguez
Department DR. Medical
MOHD AHMED
Director Mr. SABRIDirector
Hospital RYANI
Quality Coordinator Pharmacy Director
P&TC co-chairman ICU Director Medical
P&TC Director
chairman Hospital Director
P&TC co-chairman P&TC chairman

References / Saudi-MOH Protocol www.moh.gov.sa

 Kingdom of Saudi Arabia ‫المملكة العربية السعودية‬
Ministry of Health ‫وزارة الصحة‬
Jazan General Directorate of Health Affairs ‫المديرية العامة للشئون الصحية بمنطقة جازان‬
Damad General Hospital ‫ى‬
‫مستشف ضمد العام‬
Pharmacy Department ‫قسم الصيدلية‬

Revised 03 JUL 2022

Protocols for Dopamine

(Preparations)

1 Ampule = 200 mg Dose: from 1 20 mcg/kg/min

Single dose Double dose

800 mg 1600 mg
4 ampules in 500 cc NS or D5% 8 ampules in 500 cc NS or D5%
• Abbreviations: (D5%) dextrose 5%, (NS) normal saline .

(Calculations)

Volume in ml X Dr. order X wt X 60 (minutes)

Stock x 1000

500 ml X Dr. order X wt X 60 (minutes)

800 or 1600 mg X 1000

PREPARED BY: APPROVED BY: APPROVED BY:

MR. MOTAEN
PREPARED BY: FAGEH PH. MUATH
APPROVED BY: NUBAYRI DR. Yuneska
APPROVED BY: Rodriguez DR. RAID SULIMAN Mr. SABRI RYANI
Quality Coordinator
MR. MOTAEN FAGEH PH. MUATH Director
Pharmacy NUBAYRI DR. YuneskaDepartment
Medical Rodriguez DR. Medical Director
MOHD AHMED Hospital
Mr. SABRI Director
RYANI
Quality Coordinator P&TC co-chairman
Pharmacy Director ICU Director P&TC
Medical chairman
Director Hospital Director
P&TC co-chairman P&TC chairman

References / Saudi-MOH Protocol www.moh.gov.sa

 Kingdom of Saudi Arabia ‫المملكة العربية السعودية‬
Ministry of Health ‫وزارة الصحة‬
Jazan General Directorate of Health Affairs ‫المديرية العامة للشئون الصحية بمنطقة جازان‬
Damad General Hospital ‫ى‬
‫مستشف ضمد العام‬
Pharmacy Department ‫قسم الصيدلية‬

Revised 03 JUL 2022

Protocols for Dobutamine

(Preparations)

1 ampule = 250 mg Dose: from 1 20 mcg\kg\min

Single dose Double dose

500 mg 1000 mg
2 ampules in 500 cc NS or D5% 4 ampules in 500 cc NS or D5%
• Abbreviations: (D5%) dextrose 5%, (NS) normal saline .

(Calculations)

Volume in ml X Dr. order X wt X 60 (minutes)

Stock x 1000

500 ml X Dr. order X wt X 60 (minutes)

500 or 1000 mg X 1000

PREPARED BY: APPROVED BY: APPROVED BY:

MR. MOTAEN FAGEH PH. MUATH NUBAYRI DR. Yuneska Rodriguez DR. RAID SULIMAN Mr. SABRI RYANI
PREPARED BY: APPROVED BY: APPROVED BY:
Quality Coordinator Pharmacy Director Medical Department Medical Director Hospital Director
MR. MOTAEN FAGEH PH. MUATH NUBAYRI DR. Yuneska Rodriguez DR. MOHD AHMED Mr. SABRI RYANI
Quality Coordinator
P&TC co-chairman
Pharmacy Director ICU Director
P&TC chairman
Medical Director Hospital Director
P&TC co-chairman P&TC chairman

References / Saudi-MOH Protocol www.moh.gov.sa

 Kingdom of Saudi Arabia ‫المملكة العربية السعودية‬
Ministry of Health ‫وزارة الصحة‬
Jazan General Directorate of Health Affairs ‫المديرية العامة للشئون الصحية بمنطقة جازان‬
Damad General Hospital ‫ى‬
‫مستشف ضمد العام‬
Pharmacy Department ‫قسم الصيدلية‬

Revised 03 JUL 2022

Protocols for Norepinephrine

(Noradrenaline, levophed)

(Preparations)
1 ampule = 4 mg Dose: from 0.01 2 mcg\kg\min

Single dose Double dose

16 mg 32 mg
4 ampules = 16 ml. in 34 cc D5% 8 ampules = 32 ml. in 18 cc D5%
• Abbreviations: (D5%) dextrose 5% .

(Calculations)

Volume in ml X Dr. order X wt X 60 (minutes)

Stock x 1000

50 cc X Dr. order X wt X 60 (minutes)

16 or 32 mg X 1000

PREPARED BY: APPROVED BY: APPROVED BY:

MR. MOTAEN
PREPARED BY: FAGEH PH. MUATH
APPROVED BY:NUBAYRI DR. Yuneska
APPROVED BY:Rodriguez DR. RAID SULIMAN Mr. SABRI RYANI
Quality Coordinator
MR. MOTAEN FAGEH PH. MUATH Director
Pharmacy NUBAYRI DR. YuneskaDepartment
Medical Rodriguez DR.Medical Director
MOHD AHMED HospitalDirector
Hospital Director
Quality Coordinator P&TC co-chairman
Pharmacy Director ICU Director P&TCDirector
Medical chairman
P&TC co-chairman P&TC chairman

References / Saudi-MOH Protocol www.moh.gov.sa

 Kingdom of Saudi Arabia ‫المملكة العربية السعودية‬
Ministry of Health ‫وزارة الصحة‬
Jazan General Directorate of Health Affairs ‫المديرية العامة للشئون الصحية بمنطقة جازان‬
Damad General Hospital ‫ى‬
‫مستشف ضمد العام‬
Pharmacy Department ‫قسم الصيدلية‬

Revised 03 JUL 2022

Protocols for Nitroglycerin

(Preparations)
References / Saudi-MOH Protocol
www.moh.gov.sa
1 ampule = 50 mg

Drug concentration is: 50 mg / 50 cc NS

So 1 mg = 1ml

To transfer from mg to mcg: 1 mg x 1000 =1000 mcg/ml

desired dose X 60 min

Rate of infusion =
Drug concentration

5 mcg X 60 min
= 0.3 ml/hr
1000 mcg

•
PREPARED BY:
Abbreviations: (NS) normal saline
APPROVED BY:
. APPROVED BY:
MR. MOTAEN
PREPARED BY: FAGEH PH. MUATH
APPROVED BY:NUBAYRI DR. Yuneska
APPROVED BY:Rodriguez DR. RAID SULIMAN Mr. SABRIRYANI
Mr. SABRI RYANI
Quality Coordinator
MR. MOTAEN FAGEH PH. MUATH Director
Pharmacy NUBAYRI DR. YuneskaDepartment
Medical Rodriguez DR.Medical Director
MOHD AHMED Hospital Director
Hospital Director
Quality Coordinator P&TC co-chairman
Pharmacy Director ICU Director P&TCDirector
Medical chairman
P&TC co-chairman P&TC chairman

References / Saudi-MOH Protocol www.moh.gov.sa

 Kingdom of Saudi Arabia ‫المملكة العربية السعودية‬
Ministry of Health ‫وزارة الصحة‬
Jazan General Directorate of Health Affairs ‫المديرية العامة للشئون الصحية بمنطقة جازان‬
Damad General Hospital ‫ى‬
‫مستشف ضمد العام‬
Pharmacy Department ‫قسم الصيدلية‬

Revised 03 JUL 2022

Narcotic preparation
(Fentanyl infusion)
1 ampule = 500 mcg

Single dose
500 mcg = 10 ml So 10 mcg = 1 ml
10 cc of fentanyl in 40 cc NS 20 mcg = 2 ml

Example: Dr order is 50 mcg.?

So, we will start with 5 ml of fentanyl infusion.

Double dose
1000 mcg = 20 ml So 10 mcg = 0.5 ml
20 cc of fentanyl in 30 cc NS 20 mcg = 1 ml

Dr order is 100 mcg.?

Example:
So, we will start with 5 ml of fentanyl infusion.

• Abbreviations: (NS) normal saline .

PREPARED BY: APPROVED BY: APPROVED BY:
MR. MOTAEN
PREPARED BY: FAGEH PH. MUATH
APPROVED BY:NUBAYRI DR. Yuneska
APPROVED BY:Rodriguez DR. RAID SULIMAN Mr. SABRI RYANI
Quality
MR. Coordinator
MOTAEN FAGEH Pharmacy
PH. MUATH Director
NUBAYRI DR.Medical
YuneskaDepartment
Rodriguez DR.Medical Director
MOHD AHMED Hospital
Mr. SABRIDirector
RYANI
Quality Coordinator P&TC co-chairman
Pharmacy Director ICU Director P&TCDirector
Medical chairman Hospital Director
P&TC co-chairman P&TC chairman

References / Saudi-MOH Protocol www.moh.gov.sa

 Kingdom of Saudi Arabia ‫المملكة العربية السعودية‬
Ministry of Health ‫وزارة الصحة‬
Jazan General Directorate of Health Affairs ‫المديرية العامة للشئون الصحية بمنطقة جازان‬
Damad General Hospital ‫ى‬
‫مستشف ضمد العام‬
Pharmacy Department ‫قسم الصيدلية‬

Revised 03 JUL 2022

Narcotic preparation
(Midazolam infusion)

1 ampule = 15 mg = 3 cc

Dose
3 ampules of Midazolam = 45 mg = 9 cc

9 cc Midazolam + 36 cc pf NS

45 mg 45 cc
1 mg 1 cc

Dr’s order to start 3 mg/hr. of inj.Midazolam.?

Example:
So we will start with 3 ml/hr.

PREPARED BY: APPROVED BY: APPROVED BY:

MR. MOTAEN
PREPARED BY: FAGEH PH. MUATH
APPROVED BY:NUBAYRI DR. Yuneska
APPROVED BY:Rodriguez DR. RAID SULIMAN Mr. SABRI RYANI
Quality Coordinator
MR. MOTAEN FAGEH PH. MUATH Director
Pharmacy NUBAYRI DR. YuneskaDepartment
Medical Rodriguez DR. Medical Director
MOHD AHMED Hospital
Mr. SABRI Director
RYANI
Quality Coordinator P&TC co-chairman
Pharmacy Director ICU Director P&TCDirector
Medical chairman Hospital Director
P&TC co-chairman P&TC chairman

References / Saudi-MOH Protocol www.moh.gov.sa

 Kingdom of Saudi Arabia ‫المملكة العربية السعودية‬
Ministry of Health ‫وزارة الصحة‬
Jazan General Directorate of Health Affairs ‫المديرية العامة للشئون الصحية بمنطقة جازان‬
Damad General Hospital ‫ى‬
‫مستشف ضمد العام‬
Pharmacy Department ‫قسم الصيدلية‬

Revised 03 JUL 2022

Narcotic preparation
(Atracurium Besylate)

❖ (Given without dilution)

❖ (1 ampule = 25mg = 2.5 cc)

Preparation
20 ampules in 50 cc syringe
Every 10 mg = 1 ml of Atracurium infusion

PREPARED BY: APPROVED BY: APPROVED BY:

MR. MOTAEN
PREPARED BY: FAGEH PH. MUATH
APPROVED BY:NUBAYRI DR. Yuneska
APPROVED BY:Rodriguez DR. RAID SULIMAN Mr. SABRI RYANI
Quality Coordinator
MR. MOTAEN FAGEH PH. MUATH Director
Pharmacy NUBAYRI DR. YuneskaDepartment
Medical Rodriguez DR.Medical Director
MOHD AHMED Hospital
Mr. SABRIDirector
RYANI
Quality Coordinator P&TC co-chairman
Pharmacy Director ICU Director P&TCDirector
Medical chairman Hospital Director
P&TC co-chairman P&TC chairman

References / Saudi-MOH Protocol www.moh.gov.sa

 Kingdom of Saudi Arabia ‫المملكة العربية السعودية‬
Ministry of Health ‫وزارة الصحة‬
Jazan General Directorate of Health Affairs ‫المديرية العامة للشئون الصحية بمنطقة جازان‬
Damad General Hospital ‫ى‬
‫مستشف ضمد العام‬
Pharmacy Department ‫قسم الصيدلية‬

Revised 03 JUL 2022

Narcotic preparation
(Rocuronium bromide)
(ESMERON)

❖ (Given without dilution)

❖ 50 mg = 5 cc
10 mg = 1 cc

Preparation
10 ampules = 50 ml
Withdraw in 50 cc syringe

PREPARED BY: APPROVED BY: APPROVED BY:

PREPARED BY: APPROVED BY: APPROVED BY:
MR. MOTAEN FAGEH PH. MUATH NUBAYRI DR. Yuneska Rodriguez DR. RAID SULIMAN Mr. SABRI RYANI
MR. MOTAEN FAGEH PH. MUATH NUBAYRI DR. Yuneska Rodriguez DR. MOHD AHMED Mr. SABRI RYANI
Quality Coordinator Pharmacy Director Medical Department Medical Director Hospital Director
Quality Coordinator Pharmacy Director ICU Director Medical Director Hospital Director
P&TCco-chairman
P&TC co-chairman P&TC
P&TC chairman
chairman

References / Saudi-MOH Protocol www.moh.gov.sa

 Kingdom of Saudi Arabia ‫المملكة العربية السعودية‬
Ministry of Health ‫وزارة الصحة‬
Jazan General Directorate of Health Affairs ‫المديرية العامة للشئون الصحية بمنطقة جازان‬
Damad General Hospital ‫ى‬
‫مستشف ضمد العام‬
Pharmacy Department ‫قسم الصيدلية‬

Revised 03 JUL 2022

Narcotic preparation
(Propofol)

❖ (Given without dilution)

❖ 1 ampul = 200 mg = 20 cc
10 mg = 1 cc

(Preparations)

3 ampules = 600 mg in 60 cc syringe

Dr’s order to start 30 mg/hr.?

Example:
So, we will start with 3 ml/hr.

PREPAREDBY:
PREPARED BY: APPROVED
APPROVED BY:BY: APPROVED
APPROVED BY: BY:
MR. MOTAEN
MR. MOTAEN FAGEH
FAGEH PH.MUATH
PH. MUATHNUBAYRI
NUBAYRI DR. Yuneska Rodriguez
DR. Yuneska Rodriguez DR.MOHD
DR. RAID SULIMAN
AHMED Mr.
Mr. SABRI RYANI
SABRI RYANI
Quality Coordinator
Quality Coordinator Pharmacy Director
Pharmacy Director Medical Department
ICU Director Medical Director
Medical Director Hospital Director
Hospital Director
P&TCco-chairman
P&TC co-chairman P&TC
P&TC chairman
chairman

References / Saudi-MOH Protocol www.moh.gov.sa

 Kingdom of Saudi Arabia ‫المملكة العربية السعودية‬
Ministry of Health ‫وزارة الصحة‬
Jazan General Directorate of Health Affairs ‫المديرية العامة للشئون الصحية بمنطقة جازان‬
Damad General Hospital ‫ى‬
‫مستشف ضمد العام‬
Pharmacy Department ‫قسم الصيدلية‬

Revised 03 JUL 2022

Dexmedetomidine preparation
(Precedex®)

❖ 1 ampule = 200 mcg

❖ Dose from 0.2 – 0.7 mcg/kg/hr

Volume X Dr’s order X wt

Stock

Example: 40 cc X 0.2 - 0.7 mcg X wt

= ......ml / hr
2 amp ( 400 mcg )

PREPARED BY: APPROVED BY: APPROVED BY:

MR. MOTAEN
PREPARED BY: FAGEH PH. MUATH
APPROVED BY:NUBAYRI DR. Yuneska
APPROVED BY:Rodriguez DR. RAID SULIMAN Mr. SABRI RYANI
Quality
MR. Coordinator
MOTAEN FAGEH Pharmacy
PH. MUATHDirector
NUBAYRI DR.Medical
YuneskaDepartment
Rodriguez DR.Medical Director
MOHD AHMED Hospital
Mr. SABRIDirector
RYANI
Quality Coordinator P&TC co-chairman
Pharmacy Director ICU Director P&TCDirector
Medical chairman Hospital Director
P&TC co-chairman P&TC chairman

References / Saudi-MOH Protocol www.moh.gov.sa

 Kingdom of Saudi Arabia ‫المملكة العربية السعودية‬
Ministry of Health ‫وزارة الصحة‬
Jazan General Directorate of Health Affairs ‫المديرية العامة للشئون الصحية بمنطقة جازان‬
Damad General Hospital ‫ى‬
‫مستشف ضمد العام‬
Pharmacy Department ‫قسم الصيدلية‬

Revised 03 JUL 2022

Omeprazole Infusion Preparation

(Omecure®)

❖ 1 ampule = 40 mg

❖ 2 ampule = 80 mg

Preparation

80 mg of omeprazole in 40 cc NS

Example: Dr’s order to start 8 mg.?

So, we will start with 4 ml/hr.

PREPARED BY: APPROVED BY: APPROVED BY:

MR. MOTAEN FAGEH PH. MUATH NUBAYRI DR. Yuneska Rodriguez DR. RAID SULIMAN Mr. SABRI RYANI
PREPARED BY: APPROVED BY: APPROVED BY:
Quality Coordinator Pharmacy Director Medical Department Medical Director Hospital Director
MR. MOTAEN FAGEH PH. MUATH NUBAYRI DR. Yuneska Rodriguez DR. RAID SULIMAN Mr. SABRI RYANI
Quality Coordinator
P&TC co-chairman
Pharmacy Director ICU Director
P&TCDirector
Medical chairman Hospital Director
P&TC co-chairman P&TC chairman

References / Saudi-MOH Protocol www.moh.gov.sa

 Kingdom of Saudi Arabia ‫المملكة العربية السعودية‬
Ministry of Health ‫وزارة الصحة‬
Jazan General Directorate of Health Affairs ‫المديرية العامة للشئون الصحية بمنطقة جازان‬
‫ى‬
‫مستشف ضمد العام‬
Damad General Hospital
Pharmacy Department ‫قسم الصيدلية‬
Revised 03 JUL 2022
Magnesium sulfate infusion protocol in pre-Eclampsia
/Eclampsia patients

Drug of choice to prevent

Eclampsia:
Indication: severe pre-eclampsia with symptoms/ bp 160/110 > or less with sign of severity.
Contraindications: myasthenia gravis.
Caution: renal insufficiency, pulmonary eodema.
Timing: start at the time of diagnosis of severe preeclampsia.

Dose:
Loading dose Maintenance dose
4 – 6 gm of 10% solution over 15 -20 min 1 – 2 gm per hour for 24 hrs. after delivery or last fit
which is last happen
2 ampules (4 gm) = 20ml in 40ml NS = 3ml/min 80 ml per hour of fluid Normal saline used.
Put 3 ampule of 10% magnesium sulphate
60 ml + 420 ml = 480ml
80 ml of this solution of mg sulphate per hour
by infusion pump
Repeated every 6hrs for 24 hrs.

Dose in renal disease

Creatinine > 1.1 < 2.5 mg /dl (110-221 micmol/L) 1 gm /hr.

Creatinine >= 2.5 mg /dl no maintenance.

Follow up:
Hourly: Pulse rate/ Bp/ urine output/ Respiratory rate/ Reflexes

PREPARED BY: APPROVED BY: APPROVED BY:

MR. MOTAEN FAGEH PH. MUATH NUBAYRI DR. DR. RAID SULIMAN Mr. SABRI RYANI
Quality Coordinator Pharmacy Director Medical Director Hospital Director
P&TC co-chairman P&TC chairman

References / Saudi-MOH Protocol www.moh.gov.sa

 Kingdom of Saudi Arabia ‫المملكة العربية السعودية‬
Ministry of Health ‫وزارة الصحة‬
Jazan General Directorate of Health Affairs ‫المديرية العامة للشئون الصحية بمنطقة جازان‬
‫ى‬
‫مستشف ضمد العام‬
Damad General Hospital
Pharmacy Department ‫قسم الصيدلية‬

Revised 03 JUL 2022

Magnesium sulfate infusion protocol in pre-Eclampsia
/Eclampsia patients

Sign of toxicity:

Loss of reflexes / RR > 12 per min/ uop < 30 ml /hr action stop magnesium sulphate immediately and
call SOD.
Magnesium sulphate measure 6-8hrly

Sign/level Meq Mg/dl Mmol/L

Loss of deep reflexes 7-10 8.5 – 12 3.5 – 5
Respiratory paralysis 10 – 13 12 – 16 5 – 6.5
Cardiac conduction altered >15 >18 >7.5
Cardiac Arrest >25 >30 >12.5

Antidote
Calcium gluconate 15- 30 ml of 10 % solution (1500-3000mg) over 2 – 5min
Start 10 ml of 10 % solution over 2 -5 min in less severe toxicity.
Frusemide as directed by Doctor.

PREPARED BY: APPROVED BY: APPROVED BY:

MR. MOTAEN FAGEH PH. MUATH NUBAYRI DR. DR. RAID SULIMAN Mr. SABRI RYANI
Quality Coordinator Pharmacy Director Medical Director Hospital Director
P&TC co-chairman P&TC chairman

References / Saudi-MOH Protocol www.moh.gov.sa

 Kingdom of Saudi Arabia ‫المملكة العربية السعودية‬
Ministry of Health ‫وزارة الصحة‬
Jazan General Directorate of Health Affairs ‫المديرية العامة للشئون الصحية بمنطقة جازان‬
‫ى‬
‫مستشف ضمد العام‬
Damad General Hospital
Pharmacy Department ‫قسم الصيدلية‬

Revised 03 JUL 2022

Electrolyte's Replacement Recommendation

Magnesium Replacement:

Serum Magnesium Replacement With Magnesium Sulfate

0.61 – 0.8 mmol/L 3 gm in 100 ml NS over 2 hr

0.5 – 0.6 mmol/L 4 gm in 100 ml NS over 3 hr
<0.5 mmol/L 4 gm in 100 ml NS over 3 hr & Call MD

• Maximum Magnesium Replacement in 8 gm / 24 hr.

• NB:
1 Ampule of Magnesium Sulfate 10 % (0.8 Meq/ml) = 2 gm Mgso4

PREPARED BY: APPROVED BY: APPROVED BY:

MR. MOTAEN FAGEH PH. MUATH NUBAYRI DR. Riyadh Shalabi DR. RAID SULIMAN Mr. SABRI RYANI
Quality Coordinator Pharmacy Director Medical Department Medical Director Hospital Director
P&TC co-chairman P&TC chairman

References / Saudi-MOH Protocol www.moh.gov.sa