快樂小藥師 Im pharmacist nichts glücklich

其實本來是要查phytonadione在IM與SC的差別，不過查過很多文獻幾乎都沒有講到這件事情，所以只好給大家不建議打IV的理由了。

資料是從AHFS裡面取得的（因為handbook on injectable drugs也是參考這邊，我們就不用多繞一圈了，直接給大家看一下2010年版的）

Adverse Effects 

Phytonadione is relatively nontoxic; however, severe reactions have occurred rarely during or immediately following IV administration.

These severe reactions, which may occur in patients receiving phytonadione for the first time, resemble hypersensitivity or anaphylaxis.

Symptoms include cramp-like pains, convulsive movements, cardiac irregularities, chest pains, cyanosis, dulled consciousness, flushing of the face, a sense of chest constriction, circulatory collapse, bronchospasm, hyperhidrosis, dyspnea, alteration of taste, dizziness, rapid and weak pulse, brief hypotension, shock, cardiac and/or respiratory arrest, and death.（直接靜脈給予的副作用極多，自己參考看看）

It is not known whether these adverse reactions are caused by the drug or the injection vehicle.

Dilution and slow infusion may not prevent severe reactions; therefore, IV administration of the drug should be restricted to emergency use.

（而且就算你打慢一點或是稀釋，也不見得可以減少副作用，所以IV給藥僅限於急救時候使用）

The possibility of allergic reactions, including anaphylaxis, should also be considered when phytonadione injection is given IM or subcutaneously.

Erythematous, indurated, pruritic plaques have occurred infrequently, usually after repeated injection; rarely, these have progressed to scleroderma-like lesions that have persisted for long periods of time.

In other cases, these lesions have resembled erythema perstans.

Pain, swelling, and tenderness at the injection site occur rarely after parenteral administration of phytonadione.

要是真的不得以，一定要從靜脈給藥呢？

其實書上也有寫：

The route of administration of phytonadione depends on the severity of the prothrombin deficiency and the risks associated with administration by each route. Parenteral administration is indicated in patients who are unable to retain or absorb the drug from the GI tract. Subcutaneous or IM administration may be contraindicated in hypoprothrombinemia because of the possibility of inducing hemorrhage or hematoma at the site of injection. Because of the possibility of severe adverse reactions, IV administration is indicated only when other routes of administration are not feasible.

注射速度及配製溶液的參考：

When AquaMEPHYTON^® is administered IV, it should be injected at a rate not exceeding 1 mg/minute. The drug may be diluted for infusion with preservative-free 5% dextrose, 0.9% sodium chloride, or 5% dextrose in 0.9% sodium chloride injection; other diluents should not be used. The drug should be administered immediately after dilution, and any unused portion of the dilution and the unused contents of the ampul should be discarded. The infusion bottle must be protected from light at all times. （輸注時請避光）

另外，如果IM給予之後，是要揉一下的。

最後，你知道建議病人揉一下注射部位的英文怎麼說嗎？

Advise patient to Knead injection sites