Drugs Commonly Available in the Critical Care Unit
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Transcript of Drugs Commonly Available in the Critical Care Unit
8/8/2019 Drugs Commonly Available in the Critical Care Unit
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DRUGS COMMONLY AVAILABLE IN THE CRITICAL CARE UNIT
Adenosine (Adenocard)Classification:
AntidysrhytmicEffects
Restores normal sinus rhythm by slowing conducting time through theatrioventricular node
Indications
Narrow complex supraventricular tachycardiaCI
Hypersensitivity, second or third degree AV block, asthma,
Not recommended in the tx of atrial fibrillation, atrial flutter, and VTDose and Route
6 mg IV bolus over 1 to 2 secsNursing Considerations
Evaluate heart rate and rhythm
Measure PR interval for the development of AV block Observe for adverse effects: non-myocardial chest discomfort, hypotension,
dyspnea
Amiodarone (Cordarone)Classification
AntidysrhytmicEffects
Decreases cardiac workload and myocardial consumption through itsvasodilatory effects
Indications
Atrial and ventricular tachydysrhytmias
CI Severe sinus bradycardia, 2nd or 3rd degree AV block (unless pacemaker is
functioning), cardiogenic shockDose and Route
300 mg IV pushNursing Considerations
Monitor HR, rhythm, and BP
Observe for adverse effects: hypotension, dysrhytmias, hepatotoxicity, cardiacarrest
Atenolol (Tenormin)Classification
B-Adrenergic blocking agentEffects
Reduces HR, CO, BP, and myocardial oxygen consumption
Promotes redistribution of blood flow from adequately supplied areas of the heartto ischemic areas
Indications
SVTCI
Sinus bradycardia, 2nd and 3rd degree heart block
Cardiogenic shockDose and Route
5 mg IVNursing Considerations
Monitor cardiac rhythm, HR, BP; notify physician if bradycardia (<60bpm) or hypotension (SBP ,100 mm Hg) develops
Observe for adverse effects: breathing difficulties, bradycardia, heart block,hypotension, and cardiac failure
Atropine
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Classification
AnticholinegicEffects
Increases conduction through the AV node and increases the HRIndications
Symptomatic sinus bradycardia, asystoleCI
Asthma, narrow angled glaucoma, obstructive disease of the GI and urinarytracts, MG, and paralytic ileus
Dose and Route
For bradycardia: 0.5 mg IV bolus
For asystole: 1 mg IVNursing Considerations
Monitor HR for response to therapy (>60 bpm is desirable); be alert for development of ventricular fibrillation or VT
Excessive doses can result to tachycardia, flushed hot skin, delirium, coma, or death
Calcium ChlorideClassification
Electrolyte replenisher Effects
Replaces and maintains calcium in body fluidsIndications
Hypocalcemia, hyperkalemia, calcium channel blocker overdoseCI
VF, hypercalcemia, renal calculi, digitalis toxicityDose and Route
8 to 16 mg/kg IV
Nursing Considerations Monitor BP (peripheral vasodilation will occur)
Monitor serial serum calcium levels
Monitor ECG
Monitor electrolye imbalances
Observe adverse effects: bradycardia, cardiac arrest, constipation, fatigue,depression, loss of appetite
Digoxin (Lanoxin)Classification
Cardiac glycoside, inotropic, antidysrhytmicEffects
Increases myocardial contractility, decreases HR, and enhances CO, whichimproves renal blod flow and increases urinary output.
Indications
Patients with heart failure, cardiogenic shock, atrial dysrhytmias such as atrialfibrillation, and atrial flutter
CI
Patients who demonstrates s/sx of digitalis toxicity, 2nd and 3rd degree heartblock
Dose and Route
Doses must be individualized
Usual loading dose is 10-15 mcg/kg
Usual maintenance dose is 0.125 to 0.5 mg per dayNursing Considerations
Check potassium and magnesium levels before administration (hypokalemia andhypomagnesia are associated with increased risk of digitalis toxicity)
Check calcium levels (hypercalcemia can increase risk of digitalis toxicity)
Take apical pulse before administration (if <60 bpm, consult with physician)
Be prepared to treat overdose with IV mgSO4 or digoxin immune Fab (Digibind)
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Observe for digitalis toxicity: nausea and vomiting, anorexia, epigastric pain,unusaul fatigue, diarrhea, dysrhythmias,
Excessive slowing of HR, irritability, or confusion
Diltiazem (Cardizem)Classification
Calcium channel blocker, antidysrhythmicEffects
Dilates coronary arteries and arteriolesIndications
Control of rapid ventricular response in atrial fibrillation and flutter, conversion of PSVT
CI
2nd or 3rd degree heart block, severe hypotension, cardiogenic shockDose and Route
Initially, administer 0.25 mg/kg intravenously over 2 minutes
If an infusion is required, rate is 5 mg/hr; maximum dose is 15 mg/hr
Nursing Considerations: Evaluate dysrhythmia control
Monitor HR, rhythm, and BP
Observe for adverse effetcts: dysrhythmias, hypotension, flushing, chest pain,heart failure, dyspnea and edema
Dobutamine (Dobutrex)Classification:
Inotrope, B1 – agonistEffects
Increases myocardial contractility, and increases CO without significant changein BP
Increases coronary blood flow and myocardial oxygen consumptionIndications
Heart failure, cardiac decompensationCI
Shock without adequate fluid replacementDose and Route
IV infusion of 2 to 20 mcg/kg/min titrated to desired patient responseNursing Considerations:
Infusion pump should be used to regulate flow rate
Check BP and HR every 2 to 5 minutes during initial administration of the drug
Observe for adverse effects: tachycardia, hypertension, chest pain, shortness of
breath, and cardiac dysrhytmias
Dopamine (Intropin)Classification
Sympathomimetic, vasopressor, inotropicEffects
In low doses (1-2 mcg/kg/min): increaes blood flow to the kidneys, therebyincreasing glomerular filtration rate, urine flow, and Na excretion
In low to moderate doses (2-10 mcg/kg/min): increases myocardial contractility,and CO
In high doses (10-20 mcg.kg/min): it increases peripheral resistance and renalvasoconstriction
Indications Shock state, symptomatic bradycardia
CI
Uncorrected tachydysrythmias, VFDose and Route
Initially 2 to 10 mcg/kg
Increase infusion by 5 to 10 mcg/kg/min every 1 to 30 until desired effectNursing Considerations
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Monitor BP and HR every 2 to 5 mins initially during titration of the drug
Measure urine output hourly to evaluate renal function. ( Doses greater than 20mcg/kg/min decreases renal perfusion)
Determine pulse pressure because a decrease indicates excessivevasoconstriction
Observe for adverse effects: tachycardia, headache, dysrryhtmias, nausea andvomiting, hypotension, chest pain, shortness of breath, and vasoconstriction(numbness, tingling, pallor, cold skin, decreased pulses, decreased cerebralperfusion, and decrease urine output)
Epinephrine (Adrenalin)Classification
Bronchodilator, vasopressor, cardiac stimulantEffects
Increases myocardial contractility, HR, SBP, and CO
Relaxes bronchial smooth muscle
Indications Cardiac arrest, hypersensitivity reactions, acute asthma attacks, symptomatic
bradycardia, severe hypotensionCI
Acute narrow angle glaucoma and coronary insufficiencyDose and Route
For patients in cardiac arrest: Give 1 mg IV every 3 to 5 minutesNursing Considerations
Monitor continuous ECG
Monitor BP and HR
Observe for adverse effects: chest pain, dysrhytmias, headache, restlessness,dizziness, nausea and vomiting, weakness, hypertensive crisis, and decreased
perfusion to fingers and toes.
Furosemide (Lasix)Classification
Diuretic, antihypertensiveEffects
Promotes the excretion of fluid of fluid and electrolytes and reduces plasmavolume.
Indications
Edematous state: heart failure, pulmonary edema, hepatic and renal disease,and hypertension
Contraindications
Sensitivity to furosemide and sulfonamidesDose and Route
0.5 to 1 mg/kg over 1 to mins; if no response 2 mg/kg over 1 to 2 minsNursing Considerations
Check potassium levels before administration
Assess lungs to evaluate pt response to therapy
Monitor urine output to evaluate drug effectiveness
Monitor serial BUN and creatinine levels to assess renal function
Monitor BP, I&O, and assess serial weights
Advise pt to report ringing in ears, severe abdominal pain, or sore throat andfever (these may indicate furosemide toxicity?
Observe for adverse effects: orthostatic hypotension, electrolyte imbalance, andhepatic dysfunction
HeparinClassification
Anticoagulant, antithromboticEffects
Prevents conversion of fibrinogen to fibrin and prothrombin to thrombin
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Indications
Treatment of thrombosis and emboli; adjunct therapy in AMICI
Hypersensitivity, active bleeding, hemophilia, recent intracranial, intraspinal or eye surgery, severe thrombcytopenia, severe hypertension, or bleeding disorders
Dose and Route
Adjunct treatment in AMI: bolus with 60 IU/kg, follow with infusion 12 IU/kg/minNursing Considerations
Assess for bleeding
Monitor aPTT results
Monitor HCt and Hgb levels and platelet count
Monitor HR and BP
Avoid IM injections
LidocaineClassification
AntidysrhytmicEffect
Lidocaine supresses the automaticity to ectopic fociIndications
Cardiac arrest from VF and VT; stable VT, and wide complex tachycardia of uncertain type
CI
Severe heart block without pacemaker Dose and Route
Loading dose: 1 to 1.5 mg/kg IV push
Repeat with 0.5 to 0.75 mg/kg every 5 to 10 minutes (Maximum 3 mg/kg)
Maintenance infusion: 1 to 4 mg/min
Magnesium SulfateClassification
Electrolyte replenisher, antidysrhytmic, anticonvulsantEffects
Replaces and maintains magnesium levels in body fluids
Depresses the CNS, producing anticonvulsant effects; decreases incidence indysrhytmias
Indications
Seizure associated with eclampsia, and pre-eclampsia, hypomagnesemia, lifethreatening dysryhthmias secondary to digitalis toxicity
CI
Heart block, renal failureDose and Route
For hypomagnesemia: infusion of 5 g/1000 mL D5W over 3 hours
For seizures: 1 to 4 g as a 10% solutionNursing Considerations
Monitor HR and BP every 2 to 5 minutes during drug titration
MannitolClassification
Osmotic diureticEffects
Increases osmotic pressure of fluid in renal tubules and decreases reabsorptionof water and electrolytes; increases urine output and Na and Cl excretion
Indication
Increased ICPCI
Active intracranial bleeding, anuria, severe pulmonary congestion, severe heartfailure, fluid and electrolyte depletion, and renal dysfunction
Dose and Route
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IV infusion of 0.5 to 1 g/kg over 5 to minutes; additional doses of 0.25 to 2/g/kgevery 4 to 6 hours as needed
Nursing Considerations
Monitor HR, BP, and ICP (if available)
Assess hydration status and monitor urine output every hour
Monitor serum electrolyte, BUN, creatinine levels and ABGs
Observe for adverse effects: seizures, rebound increased ICP, acidosis,hypotension, fluid and electrolyte imbalances
Morphine SulfateClassification
Opiate analgesicEffects
Decrease pain impulse transmission, decreases myocardial oxygenrequirements; relieves pulmonary congestion
Indications
Chest pain with ACS unresponsive to nitrates, cardiogenic pulmonary edema
CI Hypersensitivity, RR <12 breaths/min
Dose and Route
2 to 4 mg IV over 1 to 15 mins every 5 to 3o minutes
Individualized based on pt responseNursing Considerations
Administer slowly via IV route
Assess pain using pt’s self report
Monitor RR, HR, and BP
Observe for adverse effects: bradycardia, orthostatic hypotension, respiratorydepression and apnea
Naloxone (Narcan)Classification:
Opioid antagonistEffect
Competes for opioid receptor sites in the CNSIndications
Patients with known or suspected opioid-induced respiratory depressionCI
HypersensitivityDose and Route
0.4 to 2 mg IV over 15 sec; dose may be repeated every 2 to 3 mins
Nursing Considerations Monitor respiratory rate and depth continuously
Provide O2 and artificial ventilation as necessary
Observe for adverse effects: nausea and vomiting, sweating, tachycardia,hypertension, pulmonary edema, VT, and VF
Nitroglycerine (Tridil, Nitrol)Classification
Vasodilator, antianginal, antihypertensiveEffects
Decreases venous return, preload, myocardial oxygen demand, BP, MAP, CVP,and PAWP
Improves coronary artery blood flow and oxygen deliveryIndications
Angina, HPN, heart failure in AMICI
Hypersensitivity to nitrates, pts with head trauma, and cerebral hemorrhageDose and Route
Initial infusion: 5 mcg/min; increase by 5 mcg every 3 to 5 mins and titrate todesired response
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Nursing Considerations
Monitor HR ( a 10 beat/min increase suggests adequate vasodilation)
Monitor BP
Observe for adverse effects: headache, dizziness, dry mouth, blurred vision,orthostatic hypotension, tachycardia, angina, flushing, palpitations, nausea, andrestlessness
Report unrelieved angina, side effects, extreme dizziness, pressure in head,dyspnea, fever, and weak or fast HR
Norepinephrine (Levophed)Classification
Sympathomimetic, vasopressor Effects
Produces vasoconstriction, increases myocardial contractility, and dilatescoronary arteries
Indications
Hypotensive states
CI Peripheral vascular thrombosis
Dose and Route
IV infusion 0.5 10 1 mcg/min; titrate every 3 to 5 minutes, up to 30 mcg/min, todesired BP
Nursing Considerations
Monitor BP continuously until stabilized at desired level, then check BP every 5minutes
Monitor continuous ECG
Use infusion pump to regulate the flow
Assess for s/sx of excessive vasocontriction: cold skin, pallor, decrease pulses,decreases cerebral perfusion, and decreased pulse pressure
Report decreased urinary output Taper medication gradually
Observe for adverse effects: headache, VT, bradycardia, VF, angina, dyspnea,decreased urinary output, restlesness, and hypertensive states
Sodium BicarbonateClassification
Alkanizer, antacid, electrolyte replenisher Effects
Increases the plasma bicarbonate, buffers excess hydrogen ion concentration,and increases blood pH
Indications
Metabolic acidosis, hyperkalemia, and need to alkalanize the urineCI
Respiratory acidosis, hypocalcemia, hypertension, impaired renal functionDose and Route
IV dose in 1 mEq/kg initially, then 0.5 mEq/kg every 10 minutes if indicated byarterial pH and PCO2
IV infusion: 2 to 5 mEq/kgNursing Considerations
Obtain ABGs before administration
Flush line before and after administration
Observe for adverse effects: restlessness, tetany, hypokalelmia, alkalosis, and
hyponatremia
Other Drugs:Aminophylline
Pharmacologic Class: Xanthine
Bronchodilator
Uses: bronchial asthma, bronchospasm, Cheyne-Stokes respirationsVerapamil
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Calcium-channel blocking agent, vasodilator
used to treat hypertension, angina pectoris, and certain cardiac arrhythmiasHydralazine
an antihypertensive and vasodilator drug that relaxes arteriolar smooth muscleby direct action. It is used as the hydrochloride in peripheral vascular disease,thrombophlebitis and congestive heart failure.
Metoclopramide
a dopamine antagonist that stimulates motility of the upper gastrointestinal tract,relaxes the pyloric sphincter, and promotes gastric emptying. Used as anantiemetic.
Sodium Luminal
Pharmacologic class: Barbiturate
Therapeutic class: Anxiolytic, anticonvulsant, sedative-hypnotic
Used for tonic-clonic (grand mal) and partial seizuresDiazepam (Valium)
Pharmacologic class: Benzodiazepine
Therapeutic class: Anxiolytic, anticonvulsant, sedative-hypnotic, skeletal muscle
relaxant (centrally acting)Midazolam (Dormicum)
Act as sedative, hypnotic, amnestic, anticonvulsant, anxiolytic.Phenytoin (Dilantin)
Pharmacologic class: Hydantoin derivative
Therapeutic class: AnticonvulsantHydrocortisone
Pharmacologic class: Short-acting corticosteroid
Therapeutic class: Anti-inflammatory (steroidal)Propanolol (Inderal)
Pharmacologic class: Beta-adrenergic blocker (nonselective)
Therapeutic class: Antianginal, antiarrhythmic (class II), antihypertensive,
vascular headache suppressantTransderm nitro
Vasodilator Nitrostat (Nitroglycerine)
Relaxes blood vessels allowing more blood to flow through.
Reduces the workload on the heart and improves blood flow to the heart.Nifedipine (Adalat)
Calcium channel blocker
Antihypertensive, anti angina
E-cart Drugs
15 Einephrine
4 Ca Gluconate
3 Aminophylline
6 Dopamine
3 Cordarone
3 Lanoxin
2 Verapamil
5 Atropine sulphate
3 Hydralazine
3 Metoclopramide
5 Lasix
2 NaCl
1 Heparin
1 Sodium Luminal
1 Valium
3 Vit K
3 Diphenhydramine
2 Phenytoin
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2 Narcan
3 MgSO4
3 Sterile H2O for injection
3 D50/50 vial
2 Sodium bicarb
1 Lidocaine vial 3 Hydrocortisone
3 Inderal 40 mg/tab
2 Transderm nitro
3 Nitrostat 400 mcg/tab
4 Nifedipine 5 mg/cap
DRUG CALCULATIONS
DRUG CONCENTRATION IN MG/ML OR MCG/ML1 mg = 1000 mcg1 g = 1000 mg
To determine the amount of drug in one mL, divide the amount of drug in solutionby the amount of solution
mg--------------
mLExample:
200 mg = 0.4 mg/mL500 mL
Determine mcg/mL
Change mg to mcg
200 mg x 1000 mcg = 200,000 mcg
Divide mcg by mL of solution200,000 mcg = 400 mcg/mL
500
CALCULATING MCG/KG/MIN
Three parameters to be known:1. Patient weight in kg2. Infusion rate (mL/hr)3. Drug concentration
Formula:conc (mcg/mL) x mL/hr
Mcg/kg/min= ------------------------------kg x 60 min/hr
CALCULATING THE AMOUNT OF FLUID TO INFUSE (ML/HR)
Three parameters must be known to determine the infusion rate:1. The patient weight in kg2. The dose ordered by the physician in mcg/kg/min3. The drug concentration in mcg/min
Formula:mcg/kg/min ordered x kg x 60 min
mL/hr = -------------------------------------------concentration (mcg/mL)
Short- cuts:
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Single dose Dopamine (200/250 0r 400/500)
13.3 (constant) x mgtts/minmcg/kg/min = ------------------------------------
BW in kg
mcg/kg/min x BW in kgs
mgtts/min = ---------------------------------13.3 (constant)
Double dose Dopamine (400/250 0r 800/500)
26.6 (constant) x mgtts/minmcg/kg/min = ------------------------------------
BW in kg
mcg/kg/min x BW in kgsmgtts/min = ---------------------------------
26.6 (constant)
Single dose Dobutamine (250/250 0r 500/500)
16.6 (constant) x mgtts/minmcg/kg/min = ------------------------------------
BW in kg
mcg/kg/min x BW in kgsmgtts/min = ---------------------------------
16.6 (constant)
Double dose Dobutamine (500/250 0r 1000/500)
33.3 (constant) x mgtts/minmcg/kg/min = ------------------------------------
BW in kg
mcg/kg/min x BW in kgsmgtts/min = ---------------------------------
33.3 (constant)