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Medications Flashcards

(22 cards)

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1
Q

Lorazepam/Ativan

A
  1. Class: Benzodiazepines (Sedation)
  2. Use: Long term sedation; intermittent therapy
  3. Starting Dose: 1 mg/hr
  4. Max Dose: 8 mg/hr
  5. Range and frequency of titration: Increase or decrease by 0.5 mg/hr q 30 minutes
  6. Duration/Half-life: 6–8 hr
  7. Nursing considerations: Propylene glycol toxicity (esp.w/ infusion); delirium; preferred BZD in cirrhosis.
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2
Q

Versed/Midazolam

A
  1. Class: Benzodiazepines (Sedation)
  2. Use: Short term sedation, frequent Neuro checks
  3. Starting Dose: 1 mg/hr
  4. Max Dose: 10 mg/hr
  5. Range and frequency of titration: Increase or decrease by 1 mg/hr q 30 minutes
  6. Duration/Half-life: 2–4 hr
  7. Nursing considerations: Accumulates in adipose tissue; delirium; unpredictable elimination; less hypotension than propofol or dexmedetomidine
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3
Q

Propofol/Diprivan

A
  1. Class: Phenol derivatives (Sedation)
  2. Use: Short term sedation, frequent Neuro checks
  3. Starting Dose: 5 mcg/kg/minute
  4. Max Dose: 80 mcg/kg/min
  5. Range and frequency of titration: Increase or decrease by 5 mcg/kg/min q 15 min
  6. Duration/Half-life: 3-10 min with short term use
  7. Nursing considerations: Hypotension ; change tubing every 12 hours; increases Triglycerides; Propofol related infusion syndrome
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4
Q

Precedex/Dexmedetomidine

A
  1. Class: Alpha2-adrenergic agonists (Sedation)
  2. Use: Sedation, Intubation Avoids common side effects of other sedatives
  3. Starting Dose: 0.2 mcg/kg/hr
  4. Max Dose: 1.5 mcg/kg/hr
  5. Range and frequency of titration: Increase or decrease by 0.1 mcg/kg/hr q 15 minutes
  6. Duration/Half-life: 1-2 hr
  7. Nursing considerations: Avoids common side effects of other sedatives. Has some analgesic effects; can cause hypotension a/o bradycardia; intended for light sedation ; expensive
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5
Q

Levophed/Norepinephrine

A
  1. Class: Alpha/beta agonists (Vasopressors)
  2. Use: Preferred vasopressor for most situations, less tachycardia than epinephrine or dopamine.
  3. Starting Dose: 5 mcg/minute
  4. Max Dose: 80 mcg/minute (1 mcg/kg/min)
  5. Range and frequency of titration: Increase or decrease by 1 mcg/min q 5 minutes
  6. Duration/Half-life: 1-2 min
  7. Nursing considerations: Notify provider at 30 mcg/kg/min. Max dosage may be increased with provider order; may be especially necessary in obese patients.
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6
Q

Vasopressin/Pitressin

A
  1. Class: Posterior pituitary hormones (Vasopressors)
  2. Use: Usually 2nd line added on to norepinephrine (especially in septic shock) Elevate BP
  3. Starting Dose: 0.04 Units/minute
  4. Max Dose: 30 Units/hr
  5. Range and frequency of titration: Increase or decrease by 0.1 Units/hr q 30 minutes
  6. Duration/Half-life: 20 min
  7. Nursing considerations:Should not be used alone initially but can be used alone once catecholamine agent weaned off; higher doses have risk for Gi ischemia; is typically not titrated (on or off)
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7
Q

Angiotensin II/Giapreza

A
  1. Class: Angiotensin II analogues (Vasopressors)
  2. Use: Elevate BP
  3. Starting Dose: 20 ng/kg/min
  4. Max Dose: 80 ng/kg/min
  5. Range and frequency of titration: Increase or decrease by 15 ng/kg/hr q 5 minutes
  6. Duration/Half-life: 1 min
  7. Nursing considerations:Monitor for arterial thrombotic and thromboembolic events. Monitor platelet count and observe patients for signs and symptoms of thrombocytopenia
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8
Q

Dopamine/Inotropin

A
  1. Class: Adrenergics (Vasopressors)
  2. Use: Rarely used due to risk of arrhythmias; potentially useful for hypotension with bradycardia
  3. Starting Dose: 5 mcg/kg/min
  4. Max Dose: 40 mcg/kg/min
  5. Range and frequency of titration: Increase or decrease by 2.5mcg/kg/min q 5 minutes
  6. Duration/Half-life: <10 min after infusion
  7. Nursing considerations: High risk for tachyarrhythmias; shown to lead to worse outcomes in cardiogenic shock.
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9
Q

Phenylephrine/Neosynephrine

A
  1. Class: Adrenergics Sympathomimetic (Vasopressors)
  2. Use: Hypotension with tachycardia and preserved cardiac output; neurogenic shock.
  3. Starting Dose: 40 mcg/min
  4. Max Dose: 360 mcg/min
  5. Range and frequency of titration: Increase or decrease by 20 mcg/min q 10 minutes
  6. Duration/Half-life: 15-20
  7. Nursing considerations: May be preferred in pts with severe tachycardia; provides no inotropic support; max dose may be increased with provider order
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10
Q

Epinephrine

A
  1. Class: Adrenergics (Vasopressors)
  2. Use: Cardiogenic or anaphylactic shock; can be 2nd line agent for septic shock; often used as salvage therapy
  3. Starting Dose: 1 mcg/min
  4. Max Dose: 30 mcg/min
  5. Range and frequency of titration: Increase or decrease by 1 mcg/min q 5 minutes
  6. Duration/Half-life: 2-3 min
  7. Nursing considerations: Least selective vasopressor; reported to cause more Gi hypoperfusion compared to norepinephrine
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11
Q

Amiodarone/Cordarone

A
  1. Class: Benzofuran derivatives (Antiarrhythmic)
  2. Use: Atrial and ventricular arrhythmias.
  3. Starting Dose: 1 mg/min x 6 hrs then 0.5 mg/min
  4. Max Dose: 1 mg/min
  5. Range and frequency of titration: Increase or decrease by 0.5 mg/hr q 6 hours
  6. Duration/Half-life: 9-36 days
  7. Nursing considerations: Extremely long half life; generally minimal effects on hemodynamics
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12
Q

Diltiazem/ Cardizem

A
  1. Class: Calcium channel blockers (Antiarrhythmic)
  2. Use: Atrial fibrillation or flutter
  3. Starting Dose: 5 mg/hr
  4. Max Dose: 15 mg/hr
  5. Range and frequency of titration: Increase or decrease by 1 mg/hr q 10 minutes
  6. Duration/Half-life: 1-10 hr
  7. Nursing considerations: Contraindicated in acute decompensated heart failure. Don’t infuse for longer than 24 hours
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13
Q

Isoproterenol/Isoprenaline

A
  1. Class: Calcium channel blockers (Antiarrhythmic)
  2. Use: Atrial fibrillation or flutter
  3. Starting Dose: 2 mcg/min
  4. Max Dose: 10 mcg/min
  5. Range and frequency of titration: Increase or decrease by 1 mcg/min q 10 minutes
  6. Duration/Half-life: 10-15 min
  7. Nursing considerations: Very Expensive
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14
Q

Brevibloc/ Esmolol

A
  1. Class: Cardio selective beta blockers (Antiarrhythmic)
  2. Use: Tachyarrhythmias (usually SVT or Thyroid storm)
  3. Starting Dose: 50 mcg/kg/min
  4. Max Dose: 200 mcg/kg/min
  5. Range and frequency of titration: Increase or decrease by 25-50 mcg/kg/min q 5 min
  6. Duration/Half-life: 30 min after discontinuation of infusion
  7. Nursing considerations: Quick onset/offset; commonly accompanied by high infusion rate
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15
Q

Milrinone/ Primacor

A
  1. Class: Bipyridine phosphodiesterase inhibitors (Intropes)
  2. Use: Heart failure exacerbation or other myocardial dysfunction(sepsis,s/p, CABG, ect.)
  3. Starting Dose: 0.375 mcg/kg/min
  4. Max Dose: 0.75 mcg/kg/min
  5. Range and frequency of titration: Generally not titrated.
  6. Duration/Half-life: 3–6 hr
  7. Nursing considerations: Can be used in patients receiving beta-blockers; causes more hypotension than dobutamine; should be adjusted for renal dysfunction; can cause thrombocytopenia.
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16
Q

Dobutamine/Dobutre

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A
  1. Class: Adrenergics–beta1 agonists (Intropes)
  2. Use:eart failure exacerbation or other myocardial dysfunction(sepsis,s/p, CABG, ect.)
  3. Starting Dose: 2.5 mcg/kg/min
  4. Max Dose: 20 mcg/kg/min
  5. Range and frequency of titration: Generally not titrated.
  6. Duration/Half-life: <5 min
  7. Nursing considerations: Should not be used in patients receiving beta-blockers; may cause hypotension (especially in patients with sepsis)
17
Q

Labetolol

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A
  1. Class: Alpha–beta blockers (Vasodilators)
  2. Use: Acute CVA; aortic dissection; pregnancy
  3. Starting Dose: 1 mg/min
  4. Max Dose: 6 mg/min
  5. Range and frequency of titration: Increase or decrease by 0.5 mg/min q 20 min
  6. Duration/Half-life: 16–18 hr
  7. Nursing considerations: Long half life - titrate slowly to avoid overdose use with extreme caution in patients with bronchospastic lung disease, contraindicated in acute HF
18
Q

Nitroglycerine

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A
  1. Class: Nitrates (Vasodilators)
  2. Use: Acute coronary syndromes; pulmonary edema
  3. Starting Dose: 5 mcg/min
  4. Max Dose: 200 mcg/min
  5. Range and frequency of titration: Increase or decrease by 5 mcg/min q 5 minutes (For greater than 20mcg: Increase or decrease by 10 mcg/min q 5 minutes)
  6. Duration/Half-life: 3-5 min
  7. Nursing considerations: Common side effect is headache - titrate slowly to decrease incidence; contraindicated with right ventricular failure.
19
Q

Nicardipine/ Cardene

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A
  1. Class: Calcium channel blockers (Vasodilators)
  2. Use: Long term sedation; intermittent therapy
  3. Starting Dose: 5 mg/hr
  4. Max Dose: 15 mg/hr
  5. Range and frequency of titration: Increase or decrease by 2.5 mg/hr q 5 minutes
  6. Duration/Half-life: <8 hr
  7. Nursing considerations: Can cause rebound tachycardia; contraindicated in advanced aortic stenosis; commonly accompanied by high infusion rate; peripheral infusion site should be changed every 12 hours.
20
Q

Cisatracuruim/Nimbex

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A
  1. Class: Nondepolarizing neuromuscular blockers (Paralytic agent)
  2. Use:Typically used for ventilator dyssynchrony (especially in ARDS) or to facilitate short procedures
  3. Starting Dose: 3 mcg/kg/min
  4. Max Dose: 10 mcg/kg/min
  5. Range and frequency of titration: Increase or decrease by 1 mcg/kg/min q 15 minutes.
  6. Duration/Half-life: 20-35 min
  7. Nursing considerations: Ensure adequate ventilatory support, ensure adequate analgesia and sedation prior to use and do not wean analgesia/sedation while the patient is paralyzed. Provide eye care (tape eyes shut and moisture w/ petroleum or artificial tears. Usually need frequent ETT suctioning and turning
21
Q

Ketamine

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A
  1. Class: Dissociative Anesthetic (Analgesic)
  2. Use: Has analgesic and sedative properties; Adjunct to traditional agents due to hypotension
  3. Starting Dose: (Nonintubated: 0.1 mg/kg/hr) Intubated: 0.5 mg/kg/hr
  4. Max Dose: Nonintubated: 0.5 mg/kg/hr to 2 mg/kg/hr) Intubated: up to 4 mg/kg/hr
  5. Range and frequency of titration: Increase or decrease by 0.5 mg/hr q 30 minutes
  6. Duration/Half-life: 5-30min (recovery can take up to 4 hours)
  7. Nursing considerations: Sympathomimetic effects (increase BP/HR) Psychotropic effects, respiratory depression with high doses, hypersalivation.
22
Q

Fentanyl

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A
  1. Class: Opioid agonists (Analgesic)
  2. Use: Rapid onset or Bronchospasm
  3. Starting Dose: 25 mcg/hr
  4. Max Dose: 200 mcg/hr
  5. Range and frequency of titration: Increase or decrease by 10 mcg/hr q 15 minutes
  6. Duration/Half-life: 30–60 min
  7. Nursing considerations: Least hemodynamic effects most respiratory depression.

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