S.D. Admin. R. tit. 20, art. 20:86, ch. 20:86:03, app A

Current through Register Vol. 51, page 67, December 16, 2024

Appendix A - Drug formulary

Drug	Indication	Dose	Route of Administration	Duration of Treatment
Phylloquinone (Vitamin K₁)	Prophylaxis for Vitamin K deficiency bleeding	1 mg	Intramuscularly	1 dose
Oxytocin (Pitocin)	Postpartum hemorrhage only	10 Units/ml	Intramuscularly only	1-2 doses. Transport to hospital required if more than two (2) doses are administered.
Misoprostol Note: This is an appropriate off label use of this drug.	Postpartum hemorrhage only	200 microgram tabs, at 800 micrograms per dose (4 tabs)	Rectal or sublingual, or may be used as 1/2 rectally and 1/2 sublingually	1-2 doses. Transport to hospital required if more than 2 doses are administered. Not to exceed 800 micrograms.
Methylergonovine (Methergine)	Postpartum hemorrhage only	0.2mg	Intramuscular or orally	Single dose. Every six hours, may repeat 3 times. Contraindicated in hypertension and Raynaud's Disease.
Lidocaine HCL 1% or 2%	Local anesthetic for use during postpartum repair of lacerations or episiotomy	Maximum 50 ml (1%) Maximum 15 ml (2%)	Precutaneous infiltration only	Completion of repair
Penicillin G (Recommended)	Group B Strep Prophylaxis	5 million units initial dose, then 2.5 million units every 4 hours until birth	IV in >=100 ml LR, NS or D₅LR	Until birth of baby
Ampicillin Sodium (Alternative)	Group B Strep Prophylaxis	2 grams initial dose, then 1 gram every 4 hours until birth	IV in >=100ml NS	Until birth of baby
Cefazolin Sodium	Group B Strep Prophylaxis	2 grams initial dose, then 1 gram every 8 hours	IV in >=100 ml LR, NS or D5LR	Until birth of baby
Clindamycin Phosphate	Group B Strep Prophylaxis	900 mg every 8 hours	IV in >=100 ml NS or LR	Until birth of baby
Lactated Ringers (LR)	To administer group B Strep Prophylaxis	Intravenous catheter
5% Dextrose in Lactated Ringer's solution (D5LR)	To administer group B Strep Prophylaxis	Intravenous catheter
0.9% Sodium Chloride (NS)	To administer group B Strep Prophylaxis	Intravenous catheter
Oxygen	Maternal/Fetal Distress, or Neonatal Resuscitation	10-12 L/min 10 L/min	Mask or bag and mask	Until stabilization is achieved or transfer to a hospital is complete
0.5% Erythromycin Ophthalmic Ointment	Prophylaxis of Neonatal Opthalmia	1 cm ribbon in each eye	Topical	1 dose
Rh(D) Immune Globulin	Prevention of RH(D) sensitization in Rh(D) negative women	300 mcg	Intramuscularly	Single dose at any gestation for Rh(D) negative, antibody negative women within 72 hours of spontaneous bleeding or abdominal trauma. Single dose at 2628 weeks gestation for Rh(D) negative, antibody negative women. Single dose for Rh(D) negative, antibody negative women within 72 hours of delivery of Rh(D) positive infant, or infant with unknown blood type,.
Epinephrine HCL	Post-exposure treatment of severe allergic reaction to approved medication	0.3 to 0.5 in a concentration of 1:1000	Intramuscular injection into anterolateral aspect of the thigh or via metered dose auto-injector	Seek medical attention immediately after administration of first injection. Can be given every 5-15 minutes as needed for 3 to 4 doses.
Tranexamic Acid (TXA) To be used when initial anti-hemorrhagic therapies fail and with notification of local medical support	Control of Postpartum Hemorrhage	100mg/ml (1 g)	IV at 1 ml per minute	2nd dose if bleeding continues past 30 minutes or restarts with 24 hours.
IV Fluids * Lactate Ringers (LR) * .45% Saline * .9% Normal Saline	To treat maternal hemorrhage	Infuse 1 liter in wide-open rate	IV line with 16 18 gauge needle	After first liter, a second liter may be titrated to client's condition.

Recodified from appendix a 45 SDR 035, effective 9/19/2018; 48 SDR 115, effective 5/23/2022

General Authority: SDCL 36-9C-32(2)

Law Implemented: SDCL 36-9C-13(7)