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



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)



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



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



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



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




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


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



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



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:



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)


BW in kg

mcg/kg/min x BW in kgsmgtts/min = ---------------------------------

26.6 (constant)

Single dose Dobutamine (250/250 0r 500/500)


BW in kg


16.6 (constant)

Double dose Dobutamine (500/250 0r 1000/500)


BW in kg


33.3 (constant)

Drugs Commonly Available in the Critical Care Unit

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