ICU Final Drugs Guidelines Nov 2011

Prepared by / Shaimaa Elhadery, lecturer of Nursing, Faculty of Nursing Modern University for Technology & Information Nov.2011

Common ICU Drugs Guidelines

Drug

Scientifi

c Name

Drug

Trade

Name

Drug

Class

Therapeutic

Action

Indications Contra-

indications

Side Effects Dosage Nursing

Considerations

1-

Dopamine

Hydrochlo

-rde

Dopamine

or

Intropin

Autonomic

Nervous

System

Agent

(Sympathom

imetic)

-As a precursor to

epinephrine. It acts

as beta adrenergic

stimulant resulting

in increased cardiac

contractility &

myocardial

workload (+ve

Intropics).

-Peripheral

vasoconstriction

both venous &

arterial

- Cardiac

dysfunction

due to MI,

CHF,

cardiogenic

shock

-Hypotension

unresponsive

to fluid

therapy.

-Renal failure

-Uncontrolled

tachycardia.

- Ventricular

irritability

-Hypertension

Chest pain,

palpitation,

Tachycardia,

Dyspnea,

Headache,

Nausea,

Vomiting &

Tissue

necrosis if the

IV line

infiltrates

- At lower doses (

2-5 mcg/kg/min )

causes renal

vasodilatation

- At moderate

doses ( 5-15

mcg/kg/min )

cause HR &

myocardial

contractility

-At high doses

(greater than 15

mcg/kg/min )

causes peripheral

vasoconstriction

& hypertension

-Careful monitoring

of patient

Hemodynamics

- Be alert to signs of

cardiac compromise

e.g. chest pain

- Central line is

preferred

- Be alert of

peripheral

extravasations


Drug

Scientifi

c Name

Drug

Trade

Name

Drug

Class

Therapeutic

Action

Indications Contra-

indications


Considerations

2-

Dobutamie

Hydrochlo

i-de

Dobutrex Autonomic

Nervous

System

Agent

(Sympathom

imetic)

-Increases the

contractile force of

the heart & dilate

peripheral

vasculature

-Short term

treatment of

cardiac

dysfunction

secondary to

poor cardiac

contractility

such as

decompensate

cardiomyopa-

thy & CHF.

- Preexisting

hypertension

- Tachycardia

-Acute

coronary

syndrome

Cardiac

dysrhythmia

Chest pain

Tachycardia,

Nausea,

Vomiting &

Tissue

necrosis if the

IV line

infiltrates

- Usually 2-20

mcg/kg/min

-Careful monitoring

of patient

Hemodynamics

- Start at lowest

dose

- Do not inject

directly ( infusion

only)

- Central line is

preferred

- Be alert of

extravasations


Drug

Scientifi

c Name

Drug

Trade

Name

Drug

Class

Therapeutic

Action

Indications Contra-

indications


Considerations

3-

Norepine-

phrine

Bitartrate

Levophed Autonomic

Nervous

System

Agent

(Sympathom

imetic)

-Increases heart

rate , blood pressure

& produces

peripheral

vasoconstriction

- Severe

hypotension

- Refractory to

high dose of

dopamine

therapy

- Post cardiac

arrest

hypotension

-Preexisting

hypertension

- Hypotension

from

hypovolemia

- Decreased

renal

perfusion

- Tachycardia

- Cardiac

dysrhythmia

- Initially ( 0.5 1

mcg /min )

-Titrate up to 30

mcg /min as

needed

-Careful monitoring

of patient BP every

15 min

-Monitor

tachycardia or

cardiac rhythm

changes

- Monitor UOP to

early detect renal

vasoconstriction


Drug

Scientifi

c Name

Drug

Trade

Name

Drug

Class

Therapeutic

Action

Indications Contra-

indications


Considerations

4-

Epinephri-

ne

Hydrochlo

-ride

Epinephri-

ne

Autonomic

Nervous

System

Agent

(Sympathom

imetic)

-Vasoconstriction

- Bronchodilatation

- Increases HR

-Increases

myocardial

contraction force

- Cardiac

arrest

- Ventricular

tachycardia

- Ventricular

fibrillation

- Asystole

-Broncho-

spasm

- Anaphylactic

Reactions

- Preexisting

hypertension

- Preexisting

Tachycardia

- Acute

coronary

syndrome

- Ischemic

Chest pain

Palpitation,

Tachycardia,

Hypertension

Cardiac

dysrhythmia

Tissue

necrosis if the

IV line

infiltrates

Transient

elevations of

blood glucose

level

- From ( 0.01

0.2 mcg/kg/min

-Careful monitoring

of patient

Hemodynamics

- Protect it from

light whether still

packed or being

used as infusion


Drug

Scientifi

c Name

Drug

Trade

Name

Drug

Class

Therapeutic

Action

Indications Contra-

indications

Side

Effects

Dosage Nursing

Considerations

5-

Nitropruss

ide

Sodium

Nipride Cardiovascu

-lar Agent

Antihyperte

nsive Agent

Vasodilator

- Relax both venous

& arterial

smooth muscles

which result in

decreasing BP

-Peripheral

vasodilatation

- Increases COP by

decreasing afterload

-Hypertensive

emergency

- Patient with

significant

hypotension

- known

allergy

- Accidental

hypotension

- Nausea

- Vomiting

- From 0.5 -10

mcg/kg/min

administered

as an infusion

-Start at low dose and

titrate every 5 -10 min

until the desired BP is

obtained

- Monitor BP closely

every 5 min

- Administer the drug in a

light resistant container

and wrap it in foil

immediately after

preparation


Drug

Scientifi

c Name

Drug

Trade

Name

Drug

Class

Therapeutic

Action

Indication

s

Contra-

indications

Side

Effects

Dosage Nursing

Considerations

6-

Nitroglyce

rin

Tridil or

Nitrostate

Or

Nitrolingu

al

Cardiovascu

lar Agent

Vasodilator

-Systemic arterial &

venous dilatation

- Decrease BP

- Enhance oxygen &

blood supply to

ischemic cardiac

tissues

- Acute MI

- CHF

- Pulmonary

edema

- Hypertension

- Preexisting

Hypertension

- Hypersensitivity

Hypotension

Palpitation,

Tachycardia

,

Headache,

Skin

flushing

- From ( 5 - 50

mcg/min

administered as an

infusion

- Titrate every 5-10

min to obtain desired

response of BP &

chest pain

- Sublingual tablets (

0.15 , 0.3 , 0.4 , 0.6

mg)

- Sublingual aerosol

canister delivers 0.4

mg/spray

-Careful monitoring

of patient BP every

5 min for

development of

hypotension

- Sublingual tablets

should be protected

from light , air &

temperature

extremes


Drug

Scientific

Name

Drug

Trade

Name

Drug

Class

Therapeutic

Action

Indications Contra-

indications


Considerations

7- Isoproterenol

Isuprel Autonomic

Nervous

System

Agent

(Sympathom

imetic)

- Increase HR

- Bronchodilatation

-Decrease

peripheral vascular

resistance

- Complete

heart block

- Broncho-

spasm

-Bradycardia

unresponsive

to atropine

- Dysrhythmia

- Coronary

heart disease

Palpitation,

Tachycardia,

Hypotension

Ventricular

irritability

(VT or VF)

Restlessness

Nausea,

Vomiting &

- From 2.0 10.0

mcg/min IV

infusion

-Careful monitoring

of patient

Hemodynamics &

continuous ECG

rhythms


Drug

Scientific

Name

Drug

Trade

Name

Drug

Class

Therapeutic

Action

Indications Contra-

indications


Considerations

8-

Propranolol

Inderal Autonomic

Nervous

System

Agent

(Sympatholy

tic)

Antihyperte

nsive Agent

Antiarryhyt

hmic Agent

Beta blocker

- Decrease HR & BP

- Suppress cardiac

Dysrthmias

- Angina

- VT

-VF

-SVT

- Acute CHF

- Heart Block

- Hypotension

- COPD

-

Bronchospasm

- Bradycardia

- Hypotension

- Available in 1

ml ampules

containing 1

mg/ml

Patient can be

given from 1-3

mg/kg

-Careful monitoring

of patient

Hemodynamics &

continuous ECG

rhythms


Drug

Scientific

Name

Drug

Trade

Name

Drug

Class

Therapeutic

Action

Indications Contra-

indications


Considerations

9-Vera-

pamil

- Isoptin Calcium

channel

blocker

- Delays

atrioventricular(AV

) nodal conduction

& inhibits atrial

dysrhythmias

- Atrial

fibrillation

- Atrial flutter

-

Supraventricu

lar

tachycardia

- Hypotension

- Left

ventricular

dysfunction

Bradycardia

Hypotension

Headache

Dizziness

2-ml ampules

containing 2.5

mg/ml

-Careful monitoring

of patient

Hemodynamics &

continuous ECG

rhythm

Drug

Scientific

Name

Drug

Trade

Name

Drug

Class

Therapeutic

Action

Indicatio

ns

Contra-

indications


Considerations

10-

Streptokinase

Streptase Thrombolyti

c Agent

Breaks down

blood clots thus

restoring blood

flow

- Acute MI

- CPR

- Severe

hypotension

- Active internal

bleeding

- Hemorrhage

- Allergic

reaction(

bronchospasm,

flushed skin &

itching)

- 1.5 million units

IV over one hour (

available in vials)

- Careful

monitoring of

patient

Hemodynamics &

12 leads ECG

- Be alert of

bleeding risk

-Monitor

coagulation profile


Drug

Scientific

Name

Drug

Trade

Name

Drug

Class

Therapeutic

Action

Indic

ations

Contra-

indications


Considerations

11-

Tirofiban

Hydrochlori

-de

Aggrastat Antiplatelet

Agent

Inhibits platelet

aggregation

thus inhibits

thrombotic

events during

acute coronary

syndrome

- Acute Corona

ry

Syndro

me

(ACS)

- Active bleeding

- Bleeding

abnormalities

- Hemorrhage

- Vasovagal reaction

- Thrombocytopenia

-Anemia

- Initially 0.4

mcg/kg/min for

30 minutes then

followed by 0.1

mcg/kg/min

- Careful monitoring of

patient Hemodynamics

- Be alert of bleeding risk

- Monitor coagulation

profile

Drug

Scientifi

c Name

Drug

Trade

Name

Drug

Class

Therapeutic

Action

Indications Contra-

indications


Considerations

12-

Atropine

Sulfate

Atropine Autonomic

Nervous

System

Agent

(Anticholine

rgic )

-Blocks the effect of

acetylcholine in

smooth & cardiac

muscle ( inhibit the

vagal tone)

- Depress the action

to SA & AV nodes

of the heart

- Vagally

induced

Bradycardia

&

bronchoconstr

iction

- Asystole

-

Hypersensitivi

ty

Palpitation,

Tachycardia,

Dry mouth

Dilated pupils

Delirium

Blurred vision

Headache

- 0.5 1.0 mg

every 3-5 min to

a max dose of

0,04mg/kg

-Careful monitoring

of patient HR &

cardiac rhythm

- Administration

should be rapid IV

push to prevent a

reflex Bradycardia


Drug

Scientifi

c Name

Drug

Trade

Name

Drug

Class

Therapeutic

Action

Indications Contra-

indications


Considerations

13-

Lidocaine

Hydro-

chloride

Xylocaine -

Cardiovascu

lar Agent

Anti-

dysrhythmia

Central

Nervous

System

Agent

-Suppresses the

automiticity of

conduction tissue &

refractory period in

cardiac tissues

- Raise ventricular

fibrillation

threshold

- Acute

ventricular

dysrhythmias

as VT , VF ,

PVCs

- Hypersensitivity

Hypotension

Bradycardia

Dysrhythmias

Drowsiness

Nausea,

Vomiting

- Available in 5

ml prefilled

syringe containing

20 mg/ml for IV

push

- 50 ml prefilled

syringe containing

1 or 2 g for

infusion

- From 1.0 to 1.5

mg/kg IV over 2-3

min

-Careful monitoring

of patient

Hemodynamics

during & after

administration

- Use cautiously in

patients with renal

or hepatic

dysfunction


Drug

Scientifi

c Name

Drug

Trade

Name

Drug

Class

Therapeutic

Action

Indications Contra-

indications


Considerations

14-

Calcium

Chloride

Calcium

Chloride

Electrolyte - Facilitates

conduction in

tissues as nerves ,

muscles & cardiac

tissues

-Increases calcium

concentration in

blood & tissues

- Hypocalcaemia

-Digitalis

toxicity

Rapid

administratio

n may result

in

Bradycardia

, hypotension

- Available in 10

ml vials &

prefilled syringe

containing

100mg/ml

- From 2-4

mg/kg of 10%

solution slow IV

push

-Careful

monitoring of

patient ECG

rhythm

Drug

Scientifi

c Name

Drug

Trade

Name

Drug

Class

Therapeutic

Action

Indications Contra-

indications

Side Effects Dosage Nursing Considerations

15- Potassium

Chloride

KCL Electrolyte - Major cation in

intracellular fluid

- Conduction of

nerve impulses in

the heart.

- Contraction of

cardiac and smooth

muscles

Potassium

replacement

therapy

- Renal

failure

- Severe

Burns

- Severe

Dehydration

- Cardiac

arrest

especially in

renal

impairment

- Tissue

necrosis as a

result of

extravasation

- From

0.3 0.5

meq/kg

-Careful monitoring of

patient ECG & plasma

potassium levels

- Monitor acid base balance

- Central line is needed &

do not give by direct IV


Drug

Scientifi

c Name

Drug

Trade

Name

Drug

Class

Therapeutic

Action

Indications Contra-

indication

s


Considerations

16-

Sodium

Bicarbona

te

Sodium

Bicarbona

te

Alkalizing

Agent

- Increases pH in the

blood & urine

- Act as buffering

agent for acids in the

blood & interstitial

fluid

- Metabolic

acidosis

- Prolonged

resuscitation

-CHF

- Renal

failure

- Decrease

oxygen delivery

in the tissues

- Metabolic

alkalosis

- Hypernatremia

- Available in

ampules

containing 4.3%,

7. 5% or 8.4%

Adult dose is 1

mEq/dl

-Careful monitoring

of patient ABGs

- Adequate

oxygenation

Drug

Scientifi

c Name

Drug

Trade

Name

Drug

Class

Therapeutic

Action

Indications Contra-

indications


Considerations

17-

Aminoph

ylline

Theophyll

ine

Bronchodil

ator

- Dilates bronchial

smooth muscles

- Has +ve intropic

effect

- Acute

COPD

-Asthma

-Coronary

artery

disease

- liver &

kidney

diseases

-

Hypersensiti

vity to

compounds

-

Tachycardia

- hypotension

- Nausea

- Vomiting

- Available in

ampules 10 ml

containing 25 mg

- Loading dose

4-6 mg/kg IV

over 20 min

-Careful

monitoring of

patient

Hemodynamics

- All patients

receiving this drug

should have ECG

monitoring


Drug

Scientifi

c Name

Drug

Trade

Name

Drug

Class

Therapeutic

Action

Indications Contra-

indications


Considerations

18-

Albuterol

Ventolin -Autonomic

Nervous

System

Agent

(Sympatho

mimetic)

-

Bronchodil

ator

- Promoting

relaxation of

bronchiole smooth

muscle.

- COPD

- Acute

asthma

-Excessive

tachycardia

- Preexisting

hypertension

- Cardiac

dysrhythmias

Hypertension

,

palpitation,

Tachycardia,

Nausea,

Vomiting

Dilated

pupils

2.5 mg mixed

with 3-5 ml

saline &

nebulized as

needed

-Careful

monitoring of

patient

Hemodynamics

- Close cardiac

monitor


Drug

Scientifi

c Name

Drug

Trade

Name

Drug

Class

Therapeutic

Action

Indications Contra-

indications


Considerations

19-

Morphine

Sulfate

Duramor

ph or

Astramor

ph

Central

Nervous

System

Agent

- Narcotic

Analgesic

-CNS depressant

- Analgesic

- Decreases

myocardial oxygen

consumption

Decreases

pulmonary edema

- Moderate to

severe pain

- CHF

- Myocardial

chest pain

-Allergy to

compounds

- Decreased

conscious

level

-Respiratory

depression

hypotension

Headache,

Vomiting

- Localized

allergy

reaction with

IV

administratio

n

- Available in 10

ml ampules

containing 0.5

mg/ml

- Adult dose

range from 2-10

mg

-Careful

monitoring of

patient

Hemodynamics

- Be prepared to

assist with

ventilation or

intubation

- Administer the

drug slowly


Drug

Scientifi

c Name

Drug

Trade

Name

Drug

Class

Therapeutic

Action

Indications Contra-

indications


Considerations

20-

Ranitidin

e

Hydrochl

oride

Zantac GIT Agent

H2

Receptor

antagonist

- Inhibit basal

gastric acid

secretion

- Treatment

of GI ulcer &

GI bleeding

-Allergy to

compounds

Bradycardia

with rapid

administratio

n

Nausea,

Vomiting

Constipation

50 mg/50 ml IV

over 15-30 min

-Careful

monitoring of

patient vital signs

- Close cardiac

rhythm

ICU Final Drugs Guidelines Nov 2011

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