ICU Meds

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ICU Meds
2013-04-29 20:00:45
ICU Meds

ICU Meds
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  1. Epinephrine
    Receptor specificity (adrenergic agonist)- alpha 1, alpha 2, beta 1, beta 2

    Classification:  Catecholamine

    • Therapeutic Uses:
    • Because it activates all four subtypes it produces broad spectrum of beneficial sympathomimetic effects
    • Alpha 1 - vasoconstriction
    • Beta 2 - bronchodilation
    • combines alpha & beta - treatment of choice for anaphylactic shock

    • Adverse effects:
    • Hypertensive crisis
    • Dysrhythmias
    • Angina Pectoris
    • Necrosis (extravasation)
    • Hyperglycemia
  2. Neosynephrine (phenylephrine)
    • Receptor specificity: Pure alpha 1 agonist
    • Noncatecholamine 

    Powerful vasoconstrictor 

    • Parenterally - elevates BP (vessels alpha 1)
    • Locally - reduces nasal congestion

    Can be coadministered with local anesthesia to retard anesthetic absorption

    Uses:  hypotension shock, maintain BP for spinal anesthesia, paroxysmal supraventricular tachycardia

    Side Effects:  headache, anxiety, tremor, insomnia, dizziness, palpitations, tachycardia, HTN, ectopic beats angina, N&V, gangrene, necrosis
  3. Vasopressin (ADH)
    AKA: antidiuretic hormone

    • Promotes renal conservation of water (reabsorption)
    • Stimulates contraction of vascular smooth muscle and GI smooth muscle 

    • Therapeutic uses:
    • Diabetes Insipidus
    • Cardiac Arrest - used to enhance CPR.  It vasoconstriction increases blood flow to heart and brain.  

    • Adverse effects:
    • water intoxication
    • excessive vasoconstriction
  4. Norepinephrine (Levophed)
    Receptor - direct acting receptor stimulant (alpha 1, alpha 2, beta 1)

    • Therapeutic uses:
    • hypotensives states
    • Cardiac arrest
    • IV infusion only
    • Monitor Cardiovascular status continually
  5. Dopamine
    Receptor Specificity:  dopamine, beta 1, alpha 1 (at high doses)

    • Therapeutic uses:
    • Shock - Beta 1 (increases CO = tissue perfusion), Dopamine (receptors in kidneys dilate renal vessels = renal perfusion)
    • Heart Failure - beta 1 increases myocardial contractility which increases CO
    • Acute Renal Failure - low dose dopamine increases renal blood flow and urine output

    • Adverse effects:
    • tachycardia
    • dysrhythmias
    • anginal pain
  6. Alpha 1 activation (agonists)
    • Elicits 2 therapeutic responses 
    • - vasoconstriction
    • - mydriasis (pupil dilation)
  7. Beta 1 activation
    Receptors located in Heart

    • Therapeutic application:
    • Cardiac Arrest
    • Heart Failure
    • Shock
    • AV Heart Block

    • Adverse effects:
    • Altered Heart Rate or Rhythm
    • Angina Pectoris
  8. Beta 2 Activation
    Receptors located in lungs and uterus

    • Therapeutic Application
    • Asthma
    • Delay of preterm labor

    • Adverse Effects:
    • Hyperglycemia
    • Tremor
  9. Inotrope
    increases force of contraction
  10. CCBs and beta blockers - similarity?
    Both reduce force of contraction, slow heart rate, and suppress conduction through the AV node.
  11. Calcium Channel Blockers
    • Drugs that prevent calcium ios from entering cells.  Have greatest effect on heart and blood vessels.
    • Widely used to treat:  HTN, angina, & cardiac dysrhythmias

    In the heart:  Contractile force diminished, pacemaker (SA node) declines (reduced heart rate), decreases velocity of conduction through the AV node
  12. ditialazem (Cardizem)
    Calcium Channel Blocker, very similar to verapamil

    Lowers BP through arteriolar dilation

    Used for angina pectoris, essential HTN, cardiac dysrhythmias

    • Adverse effects:
    • dizziness, flushing, headache, edema of ankles/feet
    • Exacerbation of cardiac dysfunction in pts with bradycardia, sick sinus syndrome, heart failure, or 2nd or 3rd degree heart block.

    IV = Cardizem
  13. Nitroglycerin
    Acts directly on VSM to promote vasodilation (primarily veins)

    Decreases cardiac oxygen demand by dilating veins, decreases venous return to heart thereby decreasing ventricular filling

    • Adverse effects:  
    • headache, hypotension, tachycardia
  14. sodium nitroprusside (Nitropress)
    Potent & efficacious vasodilator (venous & arteriolar dilation)

    Fastest acting antihypertensive agent available, making it drug of choice for hypertensive emergencies

    Can cause retention of Na & water, furosemide can help offset this effect

    • Adverse effects:
    • Excessive Hypotension
    • Cyanide Poisoning
    • Thiocyanate toxicity

    • IV INF
    • degraded by light
    • soln should be faint brown
    • Monitor BP continuously during INF with arterial line 
    • INF rate is 0.3 mcg/kg/min - 10 mcg/kg/min, if after 10 min at max rate an adequate drop in BP does not occur infusion should be stopped
  15. nicardipine (Cardene)
    Calcium Channel Blocker

    At therapeutic level produces selective blockage of calcium channels in blood vessels and has minimal direct effects on the heart

    • Indications:
    • essential HTN
    • Effort-induced angina pectoris

    • Adverse effects:
    • flushing, headache, asthenia (weakness), dissiness, palpitations, edema of ankels/feet
  16. propofol
    • general anesthetics
    • IV sedative-hypnotic for ventilation

    Rapid onset & short duration of action

    NO effect on pain!

    • Run propofol along
    • It easily grows bacteria, change lines Q12 hours

    • Adverse effects:
    • profound resp. depression (including apnea)
  17. fentanyl
    Strong opioid analgesic

    Primarily used for induction and maintenance of surgical anesthesia.  

    Rapid onset, short duration
  18. dexmedetomidine (Precedex)
    • Opioid 
    • Selective alpha 2 adrenergic agonist
    • Acts in the CNS to cause sedation and analgesia

    Short term sedation, & intubated, mechanically ventilated pts

    • Adverse effects:
    • hypotension
    • bradycardia
  19. midazolam (Versed)

    IV midazolam may be used for induction of anesthesia & to produce conscious sedation

    Conscious sedation produced by combining midazolam with an opioid analgesic (morphine, fentanyl).  State characterized by sedation, analgesia, amnesia, & lack of anxiety.  Pt unperturbed & passive, but responsive to commands.  

    Dose - CONT INF IV 0.01-0.05 mg/kg over several minutes

    • Adverse effects:
    • Respiratory depression
    • respiratory and cardiac arrest