Pharmacologic Therapy ICU AH4 WK 1

Levophed (Norepinephrine) Description

Vasopressor used to improve blood pressure and organ prefusion

Levophed (Norepinephrine) What to Monitor

BP (MAP), HR, Perfusion, I&0’s

Levophed (Norepinephrine) Titration Order Example

ORDERED DOSE:

0.03-3.3 mcg/kg/min x 82.5 kg

ADMIN DOSE:

2.475-272.25 mcg/min

RATE:

9.3-1,020.9 mL/hr

ROUTE:

Intravenous

INDICATION/GOAL:

For MAP less than 65 (Mean Arterial Pressure goal ≥ 65 mmHg)

STARTING DOSE:

Start at 0.05 mcg/kg/min

↑↓

TITRATION:

Titrate by 0.01 mcg/kg/min every minute

MAX DOSE:

3.3 mcg/kg/min x 82.5 kg (272.25 mcg/min)

Midazolam (Versed) Description

Sedative used for anxiety relief and to maintain ventilator synchrony

Midazolam (Versed) what to Monitor

Monitor sedation level and respiratory status

Propofol (Diprivan) Description

Sedative used for short-term sedation and ventilator

Propofol (Diprivan) what to monitor

BP, triglycerides, and hypotension

Titrated Using RASS scores

Propofol (Diprivan) Titration Order Example

ORDERED DOSE:

5-50 mcg/kg/min x 82.5 kg

ADMIN DOSE:

412.5-4,125 mcg/min

RATE:

2.5-24.8 mL/hr.

ROUTE:

Intravenous

INITIAL DOSE:

10 mcg/kg/min

TITRATION:

Titrate 5 mcg/kg/min every 5 minutes based on RASS score (Goal 0 - -2)

Fentanyl (Sublimaze) Description

Opioid analgesic used for moderate to severe pain

Fentanyl (Sublimaze) what to monitor

Pain level using CPOT pain assessments, RR, and Respiratory Depression

Fentanyl (Sublimaze) Titration Example

DOSE: 10-200 mcg/hr

RATE: 1-20 mL/hr

ROUTE: Intravenous

FREQUENCY: Continuous

BEGIN AT: 50 mcg/hr

TITRATION: May increase by 25 mcg/hour every 15 minute as needed to achieve CPOT calculated ≤ 4.

GOAL: CPOT ≤ 4

MAX RATE: 200 mcg/hour without prescriber order.