2
Common Medications for H1N1/SRI• Antiviral
– Tamiflu• Antibiotics
– Ceftriaxone– Zithromycin– Pip/Tazocin
• Sedation– Propofol– Versed
• Analgesic– Morphine– Fentanyl
• Vasopressors– Dopamine– Epinephrine– Norepinephrine– Vasopressin
3
Antiviral MedicationOseltamivir (Tamiflu)
• Dose 75 mg PO/NG BID for at least 7 days, current experience is showing it could be needed up to 3-4 weeks
• The treatment of influenza infection in patients who have been symptomatic for no more than 2 days, or as prophylaxis once exposure has occurred. Alleviates symptoms and decreases duration of symptoms.
• Adverse Effects: Nausea and Vomiting
4
Antibiotics
• These medications are commonly given for the prevention and treatment of pneumonia/bacterial infections associated with the severe respiratory illness aspect of H1N1.
• It is important to start these medications IMMEDIATELY after they have been ordered by the Physician, as they may be fighting a larger scale bacterial infection on top of the H1N1 viral infection.
• Common antibiotics that may be administered to a H1N1/SRI patient – Ceftriaxone, Azithromycin, Piperacillin/Tazobactam due to the broad
spectrum.
5
AntibioticsPiperacillan/Tazobactam
• Usual dose is 3.375 to 4.5 Grams every 6 or 8 hours based on renal function.
• Administration – I.V over at least 30 minutes
• Adverse Effects may include Diarrhea, nausea and vomiting.
6
AntibioticsCeftriaxone
• Usual Dose is 1-2 Gram daily via IV route
• Administration – I.V or intermittent does
• Adverse Effects – Thrombophlebitis (pain at injection site)
7
AntibioticsAzithromycin
• Usual dose is 500 mg IV daily for 5 days
• Administration – Intermittent IV only
• Adverse Effects: nausea, vomiting, diarrhea, pain at injection site
8
Sedation/Analgesia
• Recent experiences in other areas of the country and world have reported that H1N1/SRI patients require a significantly large amount of sedation and analgesic.
• Routine assessments of your patient including respiratory status, level of consciousness, and agitation level will help determine the need for further sedation.
9
Sedation/Analgesia• Routinely in a critical care setting, the order for sedation
and analgesia will be written with no time frame other than PRN.
i.e. Morphine 5 mg IV PRN
• The ICU RN must use knowledge, experience and judgment to decide how much or how little of the specific drug is needed for the patient.
10
Sedation/Analgesia
• Assessments to determine need for sedation/analgesia are:
• Neurologic
• Determine LOC and level of agitation or sedation
11
Sedation/Analgesia
• Respiratory • Current mode of ventilation (full support [AC],
partial support [PS], no support or not ventilated)• Respiratory rate ( if too slow and not on full
ventilatory support use caution with amount of drug)
• Asynchronous with ventilator – may need more sedation or neuromuscular blocking agent
12
Sedation/Analgesia
• Cardiovascular
• Blood Pressure and Heart Rate – Will patient’s BP and HR support the administration of sedation and/or analgesic? These drugs tend to drop BP.
13
SedationPropofol
• Supplied in a concentration of 10 mg/mL
• 0-350 mg is the dose range for sedation
• Main adverse effects are HYPOTENSION and Respiratory Depression/Failure.
14
SedationVersed (Midazolam)• Can be given Direct IV, Intermittent or Continuous infusion
• Direct IV dose is 1-2 mg over 2-3 minutes
• Continuous infusion is 1-2 mg/hr and then titrated to desired effect
• Adverse Effects include hypotension, respiratory depression/failure
15
AnalgesiaMorphine• Can be given Direct IV, Intermittent or Continuous Infusion as well as SC
and IM
• Usual dose for Direct IV/Intermittent administration seen in ICU is 5 mg IV PRN (No time limit)
– decision on how much drug to give is left to the ICU RN or MD
• Usual dose for Continuous infusion is 1-10 mg/hr
• Adverse Effects – Respiratory and cardiovascular depression
16
AnalgesiaFentanyl
• Can be given Direct IV, Intermittent or Continuous infusion
• Usual dose for direct IV/Intermittent is 25-100 mcg
• Usual dose for Continuous infusion is 100-200 mcg/hr and titrated to effect.
• Adverse Effects are respiratory depression and cardiovascular depression.
17
VasopressorsDopamine • Indication
– Hypotension (SBP <70-100)
• Route
– IV infusion
• Dose
– Titrate to effect
• Increase in increments of 1-4 mcg/kg/min
• Adverse Effects
– Tachycardia, tachyarrhythmias, angina, palpitations, nausea
– At high dose - ↓ renal function, ↓ peripheral perfusion
18
VasopressorsNorepinephrine• Indication
– Hemodynamically significant hypotension
• Route of Administration
– IV infusion
• Dose
– 0.5-30 mcg/min titrated to effect
• Adverse Reactions
– Reflex bradycardia, hypertension, angina, ↓ renal function, ↓ peripheral perfusion
19
VasopressorsEpinephrine• Indication – Severe hypotension, bradycardia
• Route of Administration – Continuous IV infusion
• Can be given Direct IV push in cardiac arrest situation (1mg)
• Dose
– 1-30 mcg/min titrated to effect
• Adverse Effects
– Reflex bradycardia, hypertension, angina, ↓ renal function, ↓ peripheral perfusion
20
VasopressorsVasopressin• Indication – treatment of shock and hypotension, used for vasoconstrictive
purposes
• Route of Administration – Continuous IV infusion
– Can be given Direct IV in cardiac arrest situation (40u)
• Dose - 0.02 – 0.06 units/min
• Adverse Effects: Peripheral vasoconstriction and bronchial constriction
21
Neuromuscular Blocking Agents• NMBAs must be given with sedation and analgesic
• Patient must be on Full Support ventilation [i.e. AC Mode] prior to receiving NMBA
• Patient must be monitored continuously– cardiac – respiratory
• Ventilator alarms are tightened• ETCO2 placed in-line (alarms set)
Top Related