Download Common Continuous Drips Used in the CC Setting

Common Medications/Continuous Drips
Used In the Critical Care Setting
Drugs that cause vasoconstriction (improves BP)
Medication
Dose/Frequency
Purpose
Nsg. Considerations
Dopamine
(Intropin)
.5-2 mcg/kg/min
(not really a
renal dose)
-second drug
choice for
symptomatic
bradycardias
-use in shock
states especially
in distributive
shock states.
-correct patient’s hypovolemia
first
-give through central line; may
cause tissue extravasation if
IV infiltrates (Regitine 5-10
mg in 10-15 ml of saline)
-increases HR; increases O2
demand on heart
-causes vasoconstriction
-no more renal dose; actually
blocks effect of aldosterone;
therefore, there’s a diuretic
effect.
-be careful of dose if patient in
cardiogenic shock; use 5-10
mcg/kg/min
-titrate drug; increase or
decrease by 1-2 mcg/kg/min
every 5-10 minutes.
2-5 mcg/kg/min
(dopaminergic
and beta)
5-10 mcg/kg/min
(beta)
10-20
mcg/kg/min
(pure alpha)
Medication
Dose/Frequency
Levophed
2-4 mcg/min is average
(Norepinephrine) maintenance dose;
titrate every 5 minutes
until desired effect
-may go to 30 mcg/min
via continuous infusion
(this drug is not
weight-based, unless
used in Peds)
Medication
Neosynephrine
Purpose
-especially
useful in
distributive or
vasodilatory
shock states
Dose/Frequency Purpose
-40-60 mcg/min -vasodilatory
by continuous
hypotension/shock
infusion and may
titrate up every 5
minutes for
optimal effect.
-has been up to
200 mcg/min.
Nsg. Considerations
-mostly alpha effects with
some Beta 1 effects
(contractility)
-coronary artery vasodilator
(much more so than
epinephrine)
-can increase O2 demand on
the heart
-hyperglycemic action much
less pronounced
-as a continuous drip, should
be given through a central
line
-can extravasate tissue if
IV infiltrates; (Regitine 510 mg in 10-15 ml of
saline).
Nsg. Considerations
-all alpha effects
-increases SVR which may
increase 02 demand on heart if
already compromised.
-as a continuous drip, should be
given through a central line
-can extravasate tissue if IV
infiltrates; (Regitine 5-10 mg
in 10-15 ml of saline).
Medication
Vasopressin
(ADH)
Dose/Frequency
40 units IVP as a
1-time dose only
Purpose
-Ventricular
Fibrillation
-Pulseless V-tach
-PEA
-Asystole
.2-.9 units/min
via continuous
IV infusion
Central Diabetes
Insipidus
.01-.04 units/min
via continuous
infusion
Septic shock
Nsg. Considerations
-has a long half-life
therefore titrate med
every 30 minutes to
desired effect (usually a
U.O. < 300 cc/hr)
-given as an alternative
to the first or second
dose of epinephrine but
once only (during a code
situation)
-Watch for
hyponatremia (may
produce water
intoxication)
-blood pressure may rise
-Severe vasoconstriction
and local tissue necrosis
if IV infiltrates
Drugs that cause vasodilation; (decreases BP in hypertensive
emergencies or reduces afterload in CHF)
Medication
Natrecor
(Nesiritide)
Dose/Frequency
-bolus of 2
mcg/kg followed
by a continuous
infusion of
0.01mcg/kg/min
Purpose
acutely
decompensated
CHF
Nsg. Considerations
-Natriuretic peptide
(BNP in a bag)
-Dilation and natriuresis
-Natrecor binds with
heparin; it is suggested
that it not be infused
through a central
heparin-coated catheter.
- watch for further
hypotension and
hyponatremia
-BNP levels will remain
elevated while on drip.
Nsg. Considerations
Medication
Dose/Frequency
Purpose
Nipride
(Nitroprusside)
.25 - .3
mcg/kg/min and
titrate every 1-2
minutes to a
maximum dose
of 10
mcg/kg/min
-hypertensive
emergencies
-acute left
ventricular failure
in combination
with Dobutamine
-hypotension can occur
very quickly- if so, hold
drip and place patient in
trendelenberg
-Potential of cyanide or
thiocyanate toxicity
-when weaning off,
titrate drug down by 2-3
cc’s every 10-15 minutes
(needs to be on oral
antihypertensives
first!)
Nitroglycerine
(Tridil)
-5-10 mcg/min
and titrate up
every 5 minutes
until desired
effect.
-maximum
dosing
(controversial)
up to 200
mcg/min)
-congestive heart
failure
- Control of chest
pain, and
hypertension
-monitor for hypotension
and for relief of chest
pain
-HA is common problem
(use pain rx)
-if becomes hypotensive,
may give fluid and/or
put in trendelenberg;
may have to hold drip or
titrate down by 5-10
mcg./min
-when weaning off of
drip, consider oral
nitrates first and then
titrate down 5-10
mcg/min every 10-15
minutes
Inodilators (Drugs that reduce afterload and improve
contractility)
Medication
Dobutamine
(Dobutrex)
Dose/Frequency
5-20 mcg/kg/min
via continuous
infusion
Primacor
(Milrinone)
-loading dose of
50 mcg/kg
slowly over 10
minutes
-0.25-0.75
mcg/kg/min
(.375
mcg/kg/min is
standard dosing)
Purpose
-decompensated
congested heart
failure
-cardiogenic
shock
-other shock
states in which
there’s also
reduced cardiac
contractility
-used in stress
tests
Nsg. Considerations
-improves blood pressure
by improving contractility
and stroke volume
-slight inodilator effect
-can increase HR
somewhat, which will
increase O2 demand
-should be given through
central line
-titrate drug; increase or
decrease by 1-2
mcg/kg/min every 5-10
minutes.
-decompensated -adjust dosage for patients
CHF
in renal failure
-decreases SVR
-long half-life
and provides
-proarrhythmic
positive inotropic -thrombocytopenia
support
-can be used for up to 48
-decreases
hours
preload
-NOT a Titratable med!
-use in patients
with low CO/CI,
high PCWP,
pulmonary
hypertension
Drugs that speed up the heart!!!
Medication Dose/Frequency
Purpose
Nsg. Considerations
Atropine
-symptomatic
bradycardias &
blocks
-PEA, Asystole
-.5 mg IVP for the bradycardias
and 1 mg for PEA or Asystole
-+chronotropic med so
increases O2 demand on heart.
-Maximize dosing before
moving to next medication or
therapy
-Blocks the vagus nerve
.5-1 mg. IVP every 3-5
minutes up to total
loading dose of .03-.04
mg/kg.
Can be given down the
ET tube if no IV
access- double the
dose, followed by 5 ml.
saline chaser and
ventilate with ambu
bag (Hold
compressions)
Medication
Dose/Frequency
Epinephrine
(adrenaline)
-1 mg. (1:10,000) IVP
every 3-5 minutes for as
long as code continues
Purpose
-pulseless
ventricular
tachycardia
-ventricular
-can be used as
fibrillation
continuous drip in shock -PEA, asystole
states (2-10 mcg/kg/min) -symptomatic
bradycardia
-can be given down the
-shock states;
ET tube if no IV access- especially the
double the dose (using
distributive
1:1000) followed by 5types
10 ml. of a saline chaser -anaphyllaxis
and ventilate with ambu
bag (hold
compressions)
Nsg.
Considerations
-has both alpha and
beta 1 and 2 effects
-increases O2
demand on the heart
-significant
hyperglycemic
action
-coronary artery
dilator but to a
lesser degree than
norepinephrine
-as a continuous
drip, should be
given through a
central line
-can extravasate
tissue if IV
infiltrates;
(Regitine 5-10 mg
in 10-15 ml of
saline)
-titrate drug;
increase or decrease
by 1-2 mcg/kg/min
every 5 minutes
Drugs that calm the heart down!!!
Medication Dose/Frequency
Adenosine Start with 6 mg IVP
May repeat doses of 12
mg. twice PRN
Purpose
-SVT’s or Narrow
QRS tachycardias if
vagals were
unsuccessful
-can be used in
accessory pathway
rhythms
Nsg. Considerations
Chemical defibrillator in which
there may be a brief period of
asystole.
-give the medication very
quickly at the port closest to
the insertion site (half-life is
about 10 seconds)
-300 mg. IVP
Amiodarone followed by 150 mg
(Cordarone) IVP in 3-5 minutes
-pulseless
ventricular
tachycardia or
ventricular
fibrillation
-can only be given with D5W,
not NS
-monitor patients for
bradycardias and blocks
-monitor for hypotension
because it causes vasodilation
and may have negative
inotropic effects
-may prolong QT interval
-150 mg. IVP given
over 10 minutes and
may be repeated every
10 minutes until
maximum dose (2.2 g
IV/24 hours)
Medication Dose/Frequency
Cardizem
.25-.35 mg/kg.
(Diltiazem) followed by drip at 515 mg/hr.
-Atrial and
Ventricular
tachyarrhythmias
Purpose
-tachyarrhythmias
Nsg. Considerations
-calcium channel blocker
-negative inotrope (reduces
contractility; therefore BP)
-depresses AV node
Medication
Lidocaine
Dose/Frequency
.5-.75 mg/kg.
loading dose IVP
Follow-up with a
drip at 1-4
mg/min
Total loading
dose of up to 3
mg/kg.
If the patient in a
code situation,
may repeat the
loading dose in
3-5 minutes.
Medication
Magnesium
Dose/Frequency
1-2 gms. IV/IO
diluted in 10 ml
D5W given over
5-20 minutes
Purpose
Ventricular
arrhythmias:
-Multifocal
PVC’s
-R-on-T
-PVC’s with
chest pain
-couplets,
bigeminy
Nsg. Considerations
Lidocaine toxicity
which is manifested
through LOC changes
and seizure activity.
Consider toxicity for
anybody with hepatic
insufficiency and the
elderly population
Therapeutic lidocaine
level- 2-6 mcg/ml
(send-out test)
Ventricular
tachycardia and
Ventricular
fibrillation
Purpose
Torsades de
Pointes (V-tach
associated with
prolonged QT
interval)
Nsg. Considerations
-occasional fall in
blood pressure if
given rapidly
-give cautiously in
patients with renal
failure
Drugs that anticoagulate/antiplatelet therapy (Acute Coronary
Syndromes)
Medication Dose/Frequency
Angiomax
Bolus dose of .75
mg/kg (slow IVP) just
before PTCA; then
begin 4-hour infusion
at 1.75 mg/kg/hr
(optional); after this,
give up to 20-hour
infusion at .2 mg/kg/hr
PRN
Nsg. Considerations
- Give with aspirin 300-325
mg.
-Bleeding is main potential
problem-DC if bleeding
Patients with HIT or occurs.
at risk for HIT
-May give with GP IIB/IIIA
inhibitors
-For patients with renal failure,
give same bolus but decrease
IV infusion by 20% (renal
insufficiency) to 90% (dialysisdependent)
Medication Dose/Frequency
Purpose
Nsg. Considerations
Integrilin
Bolus of 180 mcg/kg
Patients with
-Contraindications to GP IIb
then continuous
unstable angina or
IIIa inhibitors are:
infusion of 2
NSTEMI
Active internal bleeding
mcg/kg/min for 72-96
► Recent GI or GU bleeding
hours
PCI
► History of CVA within the
angioplasty/stent
last 2 years or CVA with
neurovascular deficit
► History of ICH, intracranial
neoplasm, AVM, aneurysm
Reopro
.25 mg/kg bolus
► History of
followed by continuous
thrombocytopenia
infusion of .125
► Major surgical procedure or
mcg/kg/min for 12-24
severe physical trauma within
hours
previous 6 weeks
Aggrastat
.4 mcg/kg/min for 30
minutes then .1
mcg/kg/min via
continuous infusion for
48-96 hours.
Purpose
Unstable angina in
patients undergoing
PTCA
-dose needs to be reduced if
renal insufficiency/failure a
problem
-monitor for bleeding and
thrombocytopenia
Medication
Aspirin
Dose/Frequency
160-325 mg and
non-enteric po
(chewed is
preferable)
If unable to take
by mouth, give
300 mg dose
rectally
Heparin
(unfractionated)
Lovenox
(fractionated
heparin)
Purpose
To reduce
platelet
aggregation
(clumping) in
patients with
ACS’s.
Also reduces
coronary
vasospasms by
blocking
thromboxane
Loading dose of Blocks thrombin
about 60 u/kg
in the clotting
IVP followed by cascade which
a continuous drip doesn’t allow
of about 12-15
fibrinogen to
u/kg/hr.
convert to fibrin.
-used in patients
with
NSTEMI/USA
30 mg/kg bolus
followed by 1
mg/kg
subcutaneously
BID
NSTEMI/USA
Nsg. Considerations
-if patient already on daily
aspirin and gets admitted for
ACS, give another dose ASAP.
-follow institution protocol
regarding dosing/testing
-usually maintain PTT at about
50-70 seconds
-monitor for bleeding from all
potential sources
-monitor for HIT
-Protamine sulfate (anecdote)
-monitor for HIT
-monitor for bleeding from all
potential sources
-Protamine sulfate (anecdote)
Drugs Used To Keep Patients Sedated/Paralyzed (ie,
maintenance on a mechanical ventilator)
Medication
Diprivan
(Propofol)
Medication
Norcuron
(Vecuronium)
Dose/Frequency Purpose
5-50 mcg/kg/min -For RSI
-maintenance on a
mechanical
ventilator
-can be used for
procedural sedation
but only if
anesthesiologist at
the bedside to
maintain airway
Dose/Frequency Purpose
.08-.1 mg/kg
-RSI purposes
IVP
-maintenance of
vented patient
may be given by -patient with severe
continuous
intracranial
infusion at .1
hypertension
mg/kg/hr
Nsg. Considerations
-is only a sedative; has no pain
control qualities (get an order
for IV drip pain med)
-check for egg allergies
-is a negative inotropic med (may
need inotropic support)
-follow triglycerides
-has caloric value
-watch for propofol syndrome
Nsg. Considerations
-used as last resort
-non-depolarizing NMBA
-doesn’t address sedation or pain
-requires pain/sedation meds via
continuous infusion
-monitor level of paralysis with
TOF (goal is 2/4 twitches)
-can cause long term neuropathy
Good Brain Drug for Cerebral Edema
Medication
Mannitol
(Osmitrol)
Dose/Frequency Purpose
Nsg. Considerations
.5-1 gm/kg IVP -Cerebral edema Osmotic diuretic so avoid in hypovolemic
or IVPB
-Intracranial
patients.
Hypertension
-Rhabdomyolysis Pulls water from normal brain tissue; not injured
tissue
Draw dose up using filtered needle.
Maintain patient’s serum osmolality < 300-320.
Monitor electrolytes and fluid status