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ICU FINAL DRUG GUIDELINES
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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
Prepared by / Shaimaa Elhadery, lecturer of Nursing, Faculty of Nursing Modern University for Technology & Information Nov.2011
Drug
Scientifi
c Name
Drug
Trade
Name
Drug
Class
Therapeutic
Action
Indications Contra-
indications
Side Effects Dosage Nursing
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
Prepared by / Shaimaa Elhadery, lecturer of Nursing, Faculty of Nursing Modern University for Technology & Information Nov.2011
Drug
Scientifi
c Name
Drug
Trade
Name
Drug
Class
Therapeutic
Action
Indications Contra-
indications
Side Effects Dosage Nursing
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
Prepared by / Shaimaa Elhadery, lecturer of Nursing, Faculty of Nursing Modern University for Technology & Information Nov.2011
Drug
Scientifi
c Name
Drug
Trade
Name
Drug
Class
Therapeutic
Action
Indications Contra-
indications
Side Effects Dosage Nursing
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
Prepared by / Shaimaa Elhadery, lecturer of Nursing, Faculty of Nursing Modern University for Technology & Information Nov.2011
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
Prepared by / Shaimaa Elhadery, lecturer of Nursing, Faculty of Nursing Modern University for Technology & Information Nov.2011
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
Prepared by / Shaimaa Elhadery, lecturer of Nursing, Faculty of Nursing Modern University for Technology & Information Nov.2011
Drug
Scientific
Name
Drug
Trade
Name
Drug
Class
Therapeutic
Action
Indications Contra-
indications
Side Effects Dosage Nursing
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
Prepared by / Shaimaa Elhadery, lecturer of Nursing, Faculty of Nursing Modern University for Technology & Information Nov.2011
Drug
Scientific
Name
Drug
Trade
Name
Drug
Class
Therapeutic
Action
Indications Contra-
indications
Side Effects Dosage Nursing
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
Prepared by / Shaimaa Elhadery, lecturer of Nursing, Faculty of Nursing Modern University for Technology & Information Nov.2011
Drug
Scientific
Name
Drug
Trade
Name
Drug
Class
Therapeutic
Action
Indications Contra-
indications
Side Effects Dosage Nursing
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
Side Effects Dosage Nursing
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
Prepared by / Shaimaa Elhadery, lecturer of Nursing, Faculty of Nursing Modern University for Technology & Information Nov.2011
Drug
Scientific
Name
Drug
Trade
Name
Drug
Class
Therapeutic
Action
Indic
ations
Contra-
indications
Side Effects Dosage Nursing
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
Side Effects Dosage Nursing
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
Prepared by / Shaimaa Elhadery, lecturer of Nursing, Faculty of Nursing Modern University for Technology & Information Nov.2011
Drug
Scientifi
c Name
Drug
Trade
Name
Drug
Class
Therapeutic
Action
Indications Contra-
indications
Side Effects Dosage Nursing
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
Prepared by / Shaimaa Elhadery, lecturer of Nursing, Faculty of Nursing Modern University for Technology & Information Nov.2011
Drug
Scientifi
c Name
Drug
Trade
Name
Drug
Class
Therapeutic
Action
Indications Contra-
indications
Side Effects Dosage Nursing
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
Prepared by / Shaimaa Elhadery, lecturer of Nursing, Faculty of Nursing Modern University for Technology & Information Nov.2011
Drug
Scientifi
c Name
Drug
Trade
Name
Drug
Class
Therapeutic
Action
Indications Contra-
indication
s
Side Effects Dosage Nursing
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
Side Effects Dosage Nursing
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
Prepared by / Shaimaa Elhadery, lecturer of Nursing, Faculty of Nursing Modern University for Technology & Information Nov.2011
Drug
Scientifi
c Name
Drug
Trade
Name
Drug
Class
Therapeutic
Action
Indications Contra-
indications
Side Effects Dosage Nursing
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
Prepared by / Shaimaa Elhadery, lecturer of Nursing, Faculty of Nursing Modern University for Technology & Information Nov.2011
Drug
Scientifi
c Name
Drug
Trade
Name
Drug
Class
Therapeutic
Action
Indications Contra-
indications
Side Effects Dosage Nursing
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
Prepared by / Shaimaa Elhadery, lecturer of Nursing, Faculty of Nursing Modern University for Technology & Information Nov.2011
Drug
Scientifi
c Name
Drug
Trade
Name
Drug
Class
Therapeutic
Action
Indications Contra-
indications
Side Effects Dosage Nursing
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
Prepared by / Shaimaa Elhadery, lecturer of Nursing, Faculty of Nursing Modern University for Technology & Information Nov.2011