Critical Care Pharmacology Flashcards

Question

Lidocaine

Answer 1

Class: Sodium channel blocker (Antiarrhythmic Class Ib) MOA: Suppresses ventricular ectopy by reducing automaticity Indications: Ventricular arrhythmias (VT, VF) Dose: 1–1.5 mg/kg IV bolus → infusion 1–4 mg/min Side Effects: Neurotoxicity (confusion, seizures), bradycardia Monitoring: Mental status, ECG, lidocaine level if long-term Nursing Notes: Use in ACLS when amiodarone unavailable or contraindicated Avoid in severe hepatic dysfunction

Answer 2

Class: Antiarrhythmic (unclassified) MOA: Transiently blocks AV node conduction → resets SVT Indications: Narrow-complex SVT (diagnostic & therapeutic) Dose: 6 mg rapid IV push → repeat 12 mg if needed Side Effects: Flushing, chest pain, brief asystole, dyspnea Monitoring: Continuous ECG Nursing Notes: Must be given rapidly with saline flush Effects are immediate but short (<10 seconds) Inform patient: may feel “impending doom”

Answer 3

Class: Non-dihydropyridine calcium channel blocker (Antiarrhythmic Class IV CCB) MOA: Slows AV node conduction → ↓ HR Indications: A-fib/flutter with RVR, SVT Dose: 0.25 mg/kg IV bolus → 5–15 mg/hr IV infusion Side Effects: Bradycardia, hypotension, AV block Monitoring: BP, HR, ECG Nursing Notes: Use caution with beta-blockers Slower onset than adenosine for SVT Avoid in CHF or heart block

Answer 4

Class: Electrolyte, antiarrhythmic adjunct MOA: Stabilizes cardiac membrane; blocks early after-depolarizations Indications: Torsades de pointes, hypomagnesemia Dose: 1–2 g IV over 10–20 min Side Effects: Flushing, hypotension, bradycardia Monitoring: ECG, magnesium level, reflexes Nursing Notes: First-line for Torsades May also help with digoxin-induced arrhythmias Slow infusion if non-emergent

Answer 5

Class: Sodium channel blocker (Antiarrhythmic Class Ia) MOA: Slows conduction and prolongs repolarization Indications: Stable monomorphic VT, SVT, A-fib with WPW Dose: 20–50 mg/min IV until: Arrhythmia suppressed, Max 17 mg/kg, OR hypotension/QRS widening Then maintenance: 1–4 mg/min Side Effects: Hypotension, QRS widening, lupus-like syndrome Monitoring: ECG (QRS duration), BP, renal function Nursing Notes: Titrate slowly to avoid hypotension Avoid with prolonged QT or heart failure

Answer 6

Class: Anticholinergic MOA: Blocks parasympathetic influence on SA/AV nodes → ↑ HR Indications: Symptomatic bradycardia Dose: 0.5 mg IV q3–5 min (max 3 mg) Side Effects: Dry mouth, blurred vision, tachycardia, confusion Monitoring: HR, rhythm, mental status Nursing Notes: Ineffective for Mobitz II or 3rd-degree block May cause paradoxical bradycardia if given too slowly

Answer 7

Class: Cardiac glycoside MOA: Inhibits Na+/K+ ATPase → ↑ intracellular Ca²⁺ → ↑ contractility & vagal tone → ↓ HR Indications: A-fib (rate control), heart failure (not 1st line) Dose: 0.25–0.5 mg IV loading, then 0.125–0.25 mg daily Side Effects: Bradycardia, arrhythmias, visual changes, nausea Monitoring: HR, ECG, digoxin level, K⁺, renal function Nursing Notes: Toxicity risk ↑ with hypokalemia Therapeutic level: 0.5–2 ng/mL Monitor for vision changes (“yellow-green halos”)

Answer 8

Definition: A medication that affects the strength of cardiac muscle contraction Positive inotrope: Increases contractility (e.g., dobutamine, milrinone, digoxin) Negative inotrope: Decreases contractility (e.g., beta-blockers, CCBs) Use in ICU: Improves cardiac output in shock or heart failure

Answer 9

Definition: A medication that affects the heart rate Positive chronotrope: Increases HR (e.g., atropine, epinephrine) Negative chronotrope: Decreases HR (e.g., beta-blockers, diltiazem) Use in ICU: Heart rate control in bradycardia, tachyarrhythmias

Answer 10

Definition: Medications that reduce anxiety, agitation, and promote relaxation or sleep. Use in ICU: Facilitate mechanical ventilation, procedures, or reduce stress. Examples: Propofol, Dexmedetomidine, Midazolam

Answer 11

Definition: Medications that reduce or eliminate pain. Use in ICU: Pain control during procedures, mechanical ventilation, or critical illness. Examples: Fentanyl, Morphine, Hydromorphone

Answer 12

Definition: Informal term for neuromuscular blocking agents that induce temporary paralysis by blocking neuromuscular transmission. Use in ICU: Intubation, surgery, severe ARDS requiring ventilator synchrony Examples: Rocuronium, Vecuronium, Succinylcholine

Answer 13

Definition: Medications that block transmission of nerve impulses at the neuromuscular junction, causing paralysis of skeletal muscle. Types: Depolarizing: Succinylcholine Non-depolarizing: Rocuronium, Vecuronium, Cisatracurium Use in ICU: Facilitate intubation, manage refractory hypoxemia or severe ventilator dyssynchrony

Answer 14

Class: General anesthetic / Sedative MOA: GABA agonist → CNS depression Use: Sedation for mechanical ventilation Dose: 5–50 mcg/kg/min IV infusion Side Effects: Hypotension, bradycardia, respiratory depression, Propofol Infusion Syndrome (PRIS) Monitoring: BP, HR, triglycerides, sedation level Nursing Notes: Lipid-based → check triglycerides No analgesia provided Use separate IV line

Answer 15

Class: Alpha-2 agonist MOA: Decreases norepinephrine release → sedation without respiratory depression Use: Light sedation, especially in extubation Dose: 0.2–1.5 mcg/kg/hr IV Side Effects: Bradycardia, hypotension Monitoring: HR, BP, sedation level Nursing Notes: Does not suppress respiration May be ideal for non-intubated or weaning patients

Answer 16

Class: Benzodiazepine MOA: Enhances GABA → CNS depression Use: Sedation, status epilepticus, agitation Dose: 1–5 mg IV bolus, 0.5–10 mg/hr IV infusion Side Effects: Hypotension, respiratory depression, delirium Monitoring: BP, RR, sedation level Nursing Notes: Tolerance and accumulation possible in prolonged use Avoid in delirium-prone patients

Answer 17

Class: Opioid MOA: Mu-opioid receptor agonist Use: Pain control, adjunct to sedation Dose: 25–100 mcg IV q1–2h; infusion: 25–200 mcg/hr Side Effects: Respiratory depression, bradycardia, constipation Monitoring: RR, BP, pain score Nursing Notes: Preferred for hemodynamic stability Rapid onset, short duration

Answer 18

Class: Opioid MOA: Mu-opioid receptor agonist Use: Moderate to severe pain Dose: 2–4 mg IV q2–4h; infusion: 2–10 mg/hr Side Effects: Hypotension, histamine release, constipation Monitoring: BP, RR, pain level Nursing Notes: Avoid in renal failure (active metabolites) Slower onset than fentanyl

Answer 19

Class: Opioid MOA: Mu-opioid receptor agonist Use: Severe pain Dose: 0.2–1 mg IV q2–3h; infusion: 0.5–3 mg/hr Side Effects: Respiratory depression, nausea, constipation Monitoring: RR, pain score Nursing Notes: More potent than morphine Less histamine release

Answer 20

Class: Non-depolarizing paralytic MOA: Blocks ACh at NM junction → paralysis Use: Rapid sequence intubation, paralysis Dose: 0.6–1.2 mg/kg IV bolus; infusion: 10–12 mcg/kg/min Side Effects: Prolonged paralysis Monitoring: TOF (train-of-four), ventilator synchrony Nursing Notes: Requires sedation & analgesia Renal/hepatic clearance → adjust in dysfunction

Answer 21

Class: Non-depolarizing paralytic MOA: Blocks ACh at NM junction Use: Long-term paralysis Dose: 0.1 mg/kg IV bolus; infusion: 1–2 mcg/kg/min Side Effects: Prolonged paralysis Monitoring: TOF, sedation Nursing Notes: Slower onset than rocuronium Avoid accumulation in hepatic/renal failure

Answer 22

Class: Non-depolarizing paralytic MOA: Blocks ACh at NM junction Use: Long-term paralysis, especially in organ dysfunction Dose: 0.1–0.2 mg/kg bolus; infusion: 1–3 mcg/kg/min Side Effects: Bradycardia, hypotension Monitoring: TOF Nursing Notes: Organ-independent metabolism (Hofmann elimination) Preferred in liver/renal failur

Answer 23

Class: Depolarizing paralytic MOA: Mimics ACh → initial depolarization → paralysis Use: Rapid sequence intubation Dose: 1–1.5 mg/kg IV bolus Side Effects: Hyperkalemia, bradycardia, malignant hyperthermia Monitoring: K⁺, HR, signs of MH Nursing Notes: Contraindicated in burns, trauma, neuromuscular disease Short onset and duration

Answer 24

Class: Benzodiazepines Mechanism of Action (MOA): Enhance the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABA-A receptor, resulting in sedative, hypnotic, anxiolytic, anticonvulsant, and muscle relaxant properties. Uses: Anxiety, seizures, insomnia, alcohol withdrawal, sedation Examples: Lorazepam, Diazepam, Midazolam

Answer 25

Class: Typical and atypical antipsychotics MOA: Primarily block dopamine D2 receptors in the brain, reducing psychotic symptoms. Atypical antipsychotics also affect serotonin receptors. Uses: Schizophrenia, bipolar disorder, agitation, delirium Examples Haloperidol, Quetiapine

Answer 26

Class: Barbiturates MOA: Enhance GABA activity by increasing the duration of chloride channel opening at the GABA-A receptor, leading to CNS depression. Uses: Seizure control, anesthesia induction, sedation Examples: Pentobarbital, Phenobarbital

Answer 27

Class: Opioid analgesics MOA: Bind to opioid receptors (mu, kappa, delta) in the CNS, inhibiting ascending pain pathways, altering pain perception and response. Uses: Moderate to severe pain, anesthesia adjunct, cough suppression Examples: Morphine, Fentanyl, Hydromorphone

Answer 28

Class: Depolarizing and non-depolarizing NMBAs MOA: Depolarizing: Mimic acetylcholine at the neuromuscular junction, causing continuous stimulation and subsequent desensitization leading to paralysis (e.g., Succinylcholine). Non-depolarizing: Compete with acetylcholine for receptors at the neuromuscular junction, preventing depolarization and causing muscle relaxation (e.g., Atracurium, Cisatracurium). Uses: Facilitate intubation, muscle relaxation during surgery

Answer 29

Class: Benzodiazepine MOA: Enhances GABA activity at the GABA-A receptor, producing anxiolytic, sedative, and anticonvulsant effects. Use: Anxiety, status epilepticus, preoperative sedation Dose: 1–4 mg IV/IM/PO every 4–6 hours as needed Side Effects: Drowsiness, respiratory depression, hypotension Monitoring: Respiratory rate, blood pressure, level of sedation Nursing Notes: Monitor for signs of dependence and withdrawal with prolonged use

Answer 30

Class: Benzodiazepine MOA: Enhances GABA activity at the GABA-A receptor, leading to sedative and muscle relaxant properties. Use: Anxiety, seizures, muscle spasms, alcohol withdrawal Dose: 2–10 mg IV/IM/PO every 6–8 hours as needed Side Effects: Sedation, respiratory depression, hypotension Monitoring: Respiratory rate, blood pressure, level of consciousness Nursing Notes: Long half-life; caution in elderly due to increased fall risk

Answer 31

Class: NMDA receptor antagonist MOA: Blocks NMDA receptors in the CNS, producing dissociative anesthesia and analgesia. Use: Induction and maintenance of anesthesia, procedural sedation, pain management Dose: 0.5–2 mg/kg IV over 60 seconds for induction Side Effects: Hypertension, tachycardia, hallucinations Monitoring: Heart rate, blood pressure, emergence reactions Nursing Notes: Preserves airway reflexes; useful in asthmatic patients

Answer 32

Class: Typical antipsychotic (butyrophenone) MOA: Blocks dopamine D2 receptors in the brain, reducing psychotic symptoms. Use: Schizophrenia, acute psychosis, agitation, delirium Dose: 2–10 mg IM/IV every 4–8 hours as needed Side Effects: Extrapyramidal symptoms, QT prolongation, sedation Monitoring: ECG for QT interval, signs of movement disorders Nursing Notes: Use with caution in elderly due to increased risk of mortality

Answer 33

Class: Atypical antipsychotic MOA: Antagonizes multiple neurotransmitter receptors in the brain, including serotonin 5-HT2 and dopamine D2 receptors. Use: Schizophrenia, bipolar disorder, major depressive disorder Dose: Initial: 25 mg twice daily; maintenance: 300–800 mg/day Side Effects: Sedation, weight gain, orthostatic hypotension Monitoring: Metabolic profile, blood pressure, mental status Nursing Notes: Titrate slowly to minimize side effects

Answer 34

Class: Barbiturate MOA: Enhances GABA activity by increasing the duration of chloride channel opening at the GABA-A receptor, leading to CNS depression. Use: Sedation, seizure control, preoperative sedation Dose: 100–200 mg IM/IV as a single dose Side Effects: Respiratory depression, hypotension, bradycardia Monitoring: Respiratory rate, blood pressure, level of consciousness Nursing Notes: High potential for dependence; monitor for signs of overdose

Answer 35

Class: Opioid antagonist MOA: Competitively binds to opioid receptors, displacing opioids and reversing their effects. Use: Opioid overdose reversal Dose: 0.4–2 mg IV/IM/SC every 2–3 minutes as needed; max 10 mg Side Effects: Withdrawal symptoms, hypertension, tachycardia Monitoring: Respiratory rate, oxygen saturation, level of consciousness Nursing Notes: Short half-life; may require repeated dosing

Answer 36

Class: Non-depolarizing NMBA MOA: Competes with acetylcholine at nicotinic receptors, preventing depolarization and causing muscle relaxation. Use: Facilitate endotracheal intubation, provide skeletal muscle relaxation during surgery or mechanical ventilation. Dose: 0.4–0.5 mg/kg IV bolus; maintenance: 0.08–0.1 mg/kg every 20–45 minutes. Side Effects: Hypotension, bronchospasm, histamine release. Monitoring: Neuromuscular function, vital signs. Nursing Notes: Metabolized via Hofmann elimination; suitable for patients with hepatic or renal impairment.

Answer 37

Class: Non-depolarizing NMBA MOA: Binds to nicotinic receptors at the neuromuscular junction, inhibiting acetylcholine and causing muscle relaxation. Use: Facilitate tracheal intubation, provide skeletal muscle relaxation during surgery or mechanical ventilation. Dose: 0.15–0.2 mg/kg IV bolus; maintenance: 0.03 mg/kg every 20 minutes or continuous infusion. Side Effects: Bradycardia, hypotension. Monitoring: Neuromuscular function, vital signs. Nursing Notes: Undergoes Hofmann elimination; minimal accumulation in renal or hepatic impairment.

Answer 38

Class: Non-depolarizing NMBA MOA: Blocks acetylcholine at nicotinic receptors, preventing depolarization and inducing muscle paralysis. Use: Adjunct to general anesthesia for muscle relaxation during surgery or mechanical ventilation. Dose: 0.04–0.1 mg/kg IV bolus; maintenance: 0.01 mg/kg every 30–60 minutes. Side Effects: Tachycardia, hypertension, prolonged paralysis. Monitoring: Neuromuscular function, heart rate, blood pressure. Nursing Notes: Long duration of action; primarily renal excretion.

Answer 39

Class: Acetylcholinesterase inhibitor MOA: Inhibits acetylcholinesterase, increasing acetylcholine levels at neuromuscular junctions, enhancing muscle contraction. Use: Reversal of non-depolarizing neuromuscular blockade, treatment of myasthenia gravis. Dose: 0.03–0.07 mg/kg IV with atropine or glycopyrrolate to counteract muscarinic effects. Side Effects: Bradycardia, salivation, nausea. Monitoring Heart rate, respiratory function, muscle strength. Nursing Notes: Administer with anticholinergic to prevent bradycardia.

Answer 40

Class: Acetylcholinesterase inhibitor MOA: Inhibits acetylcholinesterase, increasing acetylcholine at neuromuscular junctions, improving muscle strength. Use: Treatment of myasthenia gravis, reversal of non-depolarizing neuromuscular blockade. Dose: 30–60 mg orally every 3–4 hours; IV dosing varies. Side Effects: Muscle cramps, fasciculations, gastrointestinal upset. Monitoring: Muscle strength, respiratory function. Nursing Notes: Adjust dose based on patient response; monitor for cholinergic crisis.

Answer 41

Class: Acetylcholinesterase inhibitor MOA: Inhibits acetylcholinesterase, increasing acetylcholine levels, enhancing neuromuscular transmission. Use: Diagnosis of myasthenia gravis (Tensilon test), reversal of non-depolarizing neuromuscular blockade. Dose: 2 mg IV test dose; additional 8 mg IV if no adverse reaction. Side Effects: Bradycardia, hypotension, increased salivation. Monitoring: Heart rate, respiratory function. Nursing Notes: Short duration of action; have atropine available to counteract severe bradycardia.

Answer 42

Class: Anticholinergic MOA: Blocks muscarinic receptors, inhibiting parasympathetic nerve impulses. Use: Prevention of motion sickness, postoperative nausea and vomiting. Dose: Transdermal patch delivering 1.5 mg over 72 hours. Side Effects: Dry mouth, drowsiness, blurred vision. Monitoring: Mental status, urinary retention. Nursing Notes: Apply patch behind ear; replace every 72 hours.

Answer 43

Class: Anticholinergic MOA: Blocks muscarinic receptors, reducing secretions and inhibiting vagal reflexes. Use: Preoperative reduction of salivary, tracheobronchial, and pharyngeal secretions; reversal of neuromuscular blockade. Dose: 0.1–0.2 mg IV prior to anesthesia; 0.2 mg IV with neostigmine for reversal. Side Effects: Dry mouth, tachycardia, urinary retention. Monitoring: Heart rate, secretions. Nursing Notes: Does not cross the blood-brain barrier; less CNS effects.

Answer 44

Class: Selective relaxant binding agent MOA: Encapsulates and inactivates steroidal non-depolarizing neuromuscular blocking agents (e.g., rocuronium, vecuronium). Use: Reversal of neuromuscular blockade induced by rocuronium or vecuronium. Dose: 2–4 mg/kg IV based on depth of blockade; 16 mg/kg for immediate reversal. Side Effects: Bradycardia, hypotension, nausea. Monitoring: Neuromuscular function, vital signs. Nursing Notes: Rapid reversal; monitor for recurrence of blockade.

Answer 45

Class: Benzodiazepine antagonist MOA: Competitively inhibits benzodiazepine binding at GABA-A receptors, reversing sedative effects. Use: Reversal of benzodiazepine-induced sedation or overdose. Dose: Initial 0.2 mg IV over 15 seconds; may repeat up to total dose of 3 mg. Side Effects: Seizures, dizziness, nausea. Monitoring: Level of consciousness, respiratory status. Nursing Notes: Use with caution in patients with benzodiazepine dependence; risk of seizures.

Answer 46

Class: Hypertonic glucose solution MOA: Provides rapid increase in blood glucose levels. Use: Treatment of hypoglycemia. Dose: 25–50 mL IV bolus of D50 as needed. Side Effects: Hyperglycemia, phlebitis at injection site. Monitoring: Blood glucose levels, IV site. Nursing Notes: Ensure patency of IV line; administer slowly to prevent hyperglycemia.

Answer 47

Class: Acetylcholinesterase inhibitors MOA: Inhibit acetylcholinesterase, the enzyme that breaks down acetylcholine → increased acetylcholine at neuromuscular junctions → enhanced muscle contraction Use: Myasthenia gravis, reversal of non-depolarizing neuromuscular blockers, Alzheimer’s disease (some agents) Examples: Neostigmine, Pyridostigmine, Edrophonium Side Effects: Bradycardia, GI upset, increased secretions, muscle cramps Monitoring: Respiratory status, strength, signs of cholinergic crisis Nursing Notes: Administer with anticholinergics to avoid muscarinic side effects when reversing NMBAs

Answer 48

Class: Heparin antidote MOA: Positively charged molecule that binds negatively charged heparin → neutralizes anticoagulant effect Use: Reversal of heparin or LMWH Dose: 1 mg per 100 units of heparin remaining in circulation (max: 50 mg over 10 minutes) Side Effects: Hypotension, bradycardia, allergic reactions Monitoring: aPTT, bleeding, hemodynamics Nursing Notes: Administer slowly IV to prevent hypotension or anaphylactoid reactions

Answer 49

Class: Fibrinolytic (tissue plasminogen activator) MOA: Converts plasminogen to plasmin → breaks down fibrin in clots Use: Ischemic stroke (within 3–4.5 hrs), PE, MI (select cases), central line occlusion Dose: Stroke: 0.9 mg/kg IV (max 90 mg), 10% bolus, remainder over 60 minutes Side Effects: Bleeding, intracranial hemorrhage, hypotension Monitoring: Neuro status, CBC, coagulation labs Nursing Notes: Absolute contraindications include recent surgery, bleeding, or hemorrhagic stroke

Answer 50

Class: Antifibrinolytic MOA: Inhibits activation of plasminogen to plasmin → prevents breakdown of fibrin clots Use: Trauma, heavy menstrual bleeding, surgery-related hemorrhage Dose: 1 g IV over 10 minutes, repeat after 8 hours if needed Side Effects: Seizures, thrombosis (rare), nausea Monitoring: Signs of bleeding or clotting, renal function Nursing Notes: Use caution in patients with history of thromboembolism

Answer 51

Class: Non-barbiturate sedative/hypnotic MOA: Enhances GABA activity at GABA-A receptors → sedation without analgesia Use: Induction of anesthesia, rapid sequence intubation Dose: 0.2–0.6 mg/kg IV bolus Side Effects: Adrenal suppression, myoclonus, nausea Monitoring: Respiratory and cardiovascular status Nursing Notes: No analgesic properties; monitor adrenal function in critically ill

Answer 52

Class: Unfractionated heparin (UFH) MOA: Activates antithrombin III → inhibits thrombin and factor Xa → prevents clot formation Use: DVT/PE prevention and treatment, ACS, anticoagulation for procedures Dose: Varies by indication; infusion usually started with 5,000 unit bolus, followed by 1,000 units/hr Side Effects: Bleeding, heparin-induced thrombocytopenia (HIT), osteoporosis (long-term) Monitoring: aPTT, platelet count Nursing Notes: Antidote is protamine sulfate; monitor closely for HIT

Answer 53

Class: Buffer/alkalinizer MOA: Neutralizes hydrogen ions → increases serum pH; also used to treat acidosis and stabilize cardiac cells in hyperkalemia Use: Metabolic acidosis, TCA overdose, hyperkalemia, cardiac arrest Dose: 1 mEq/kg IV push or infusion Side Effects: Metabolic alkalosis, fluid overload, hypokalemia Monitoring: ABGs, electrolytes, cardiac rhythm Nursing Notes: Use with caution; can shift K⁺ intracellularly and cause paradoxical acidosis if not ventilated

Answer 54

Class: Direct thrombin inhibitor MOA: Directly inhibits thrombin → prevents fibrin formation and clot propagation Use: Anticoagulation in patients with HIT Dose: 2 mcg/kg/min IV infusion; adjust to aPTT target Side Effects: Bleeding, hypotension Monitoring: aPTT, liver function Nursing Notes: Hepatically cleared (preferred in renal dysfunction); overlap with warfarin during transition

Critical Care Pharmacology Flashcards

(78 cards)