NURS-442: Application of Pharm Principles (Module 2)

Why are high-alert medications particularly challenging in critical care?

They require precise dosing and rapid adjustments to prevent patient harm

How does clinical judgment contribute to medication safety in critical care?

Nurses must apply the rights of medication administration and interpret patient responses in real time

What technologies can enhance medication safety in critical care?

Smart pumps, barcode scanning, and electronic health records

Why is interdisciplinary collaboration important for medication safety?

Clear communication and teamwork among healthcare professionals are essential for maintaining medication safety

What is the mechanism of action of nitroglycerin?

It dilates venous vessels, reducing preload and myocardial oxygen demand

What is the starting IV dose of nitroglycerin?

5 mcg/min

How should IV nitroglycerin be adjusted after initiation?

Titrate upward carefully using an infusion pump

What should be continuously monitored during IV nitroglycerin administration?

Blood pressure, heart rate, and symptoms

When should nitroglycerin be avoided?

In patients with hypotension or recent phosphodiesterase inhibitor use

What adverse effects should nurses monitor for with nitroglycerin?

Headache, dizziness, and hypotension

What is the systolic blood pressure hold parameter for nitroglycerin?

SBP >/= 90

What vasopressors are identified as commonly used in critical care?

Norepinephrine, dopamine, vasopressin, and dobutamine

What equipment and access are required for vasopressor administration?

Central venous access, smart infusion pumps, cardiac monitoring, and arterial lines

What patient parameters should be continuously monitored during vasopressor therapy?

Blood pressure, heart rhythm, urine output, and peripheral perfusion

What is the goal when titrating vasopressors?

To maintain adequate perfusion while avoiding excessive vasoconstriction

What is the standard dosage range for norepinephrine?

0.01–3 mcg/kg/min

What is the standard dosage range for dopamine?

2–20 mcg/kg/min

What is the standard dosage of vasopressin?

0.03 units/min (not titrated)

What is the standard dosage range for dobutamine?

2–20 mcg/kg/min

What is the standard dosage range for epinephrine?

0.01–0.5 mcg/kg/min

What additional safety check may be required when administering vasopressors?

A two-nurse check, depending on facility policy

What should the nurse verify in the medication orders before titrating vasopressors?

Titration parameters and guidelines

What equipment is required for vasopressor administration?

A central line and smart pump

What complication should nurses monitor for in the fingers and toes of patients receiving vasopressors?

Ischemia

What is the target MAP when administering vasopressors?

At least 65 mmHg

What monitoring must be implemented during vasopressor administration?

Continuous cardiac monitoring

What is an emergency in patients receiving vasopressors?

Extravasation

What life-threatening ventricular arrhythmias can amiodarone treat?

Ventricular fibrillation and pulseless ventricular tachycardia

What routes can be used to administer amiodarone during cardiac emergencies?

IV or IO

What monitoring is essential during amiodarone administration?

Continuous ECG monitoring and vital sign assessment

What cardiovascular adverse effects should nurses monitor for during amiodarone administration?

Hypotension and bradycardia

In what patients should amiodarone be used cautiously?

Patients with a prolonged QT interval

What medication-preparation consideration is important for safe amiodarone administration?

Proper diluent selection and adherence to administration protocols

What is the initial amiodarone dose for cardiac arrest?

300 mg IV/IO bolus

What repeat dose of amiodarone may be given during cardiac arrest if needed?

150 mg IV/IO

What is the amiodarone dose for a stable arrhythmia?

150 mg IV over 10 minutes

Is amiodarone dosing fixed or weight-based?

Fixed

When is amiodarone given in relation to defibrillation?

After defibrillation

What is the initial continuous IV infusion rate of amiodarone?

1 mg/min for 6 hours

What is the subsequent amiodarone infusion rate?

0.5 mg/min for the following 18 hours

What are the steps for administering amiodarone during cardiac arrest?

Confirm VF/VT, ensure IV/IO access, administer a rapid IV push, continue CPR and ACLS protocol, and prepare an infusion if ROSC is achieved

What is the initial IV/IO bolus dose of lidocaine for persistent VF/VT?

1–1.5 mg/kg

What repeat dose of lidocaine may be administered?

0.5–0.75 mg/kg

What is the maximum total dose of lidocaine?

3 mg/kg

Is lidocaine dosing fixed or weight-based?

Weight-based

Why does lidocaine require especially careful monitoring?

It has a very narrow therapeutic window

What are the steps for administering lidocaine for persistent VF/VT?

Identify persistent VF/VT, ensure IV/IO access, administer the IV bolus, flush the line, continue CPR, and reassess the rhythm

What class of antiarrhythmic is lidocaine, and what is it used to treat?

A Class Ib antiarrhythmic used for ventricular arrhythmias

What should be continuously monitored during lidocaine therapy?

ECG, blood pressure, heart rate, and neurological status

What symptoms are especially important to monitor for as signs of lidocaine toxicity?

Neurological symptoms

Which patients may require lidocaine dosage adjustments to prevent toxicity?

Patients with hepatic impairment or advanced age

What condition is continuous IV heparin often used to treat?

Pulmonary embolism

Why is IV heparin often used for loading and maintenance therapy?

IV administration has an immediate onset, while SQ administration may take 10–15 minutes

What is the initial bolus dose of heparin?

60–80 units/kg

What is the continuous heparin infusion rate?

12–18 units/kg/hr

What laboratory tests can be used to titrate a continuous heparin infusion?

aPTT or anti-Xa factor assay

When can a stable patient receiving continuous IV heparin transition to subcutaneous therapy?

After two consecutive aPTT or factor assay levels are within the therapeutic range

How frequently are heparin monitoring levels typically drawn?

Every 6 hours

What is the major high-risk complication of continuous heparin therapy?

Bleeding

What should nurses know when caring for a patient receiving continuous heparin?

Where the antidote is located

What phrase summarizes the expected effects of digoxin?

"Slow and strong"

What does digoxin's positive inotropic effect mean?

It increases the force of myocardial contraction

What does digoxin's negative chronotropic effect mean?

It slows heart rate and AV-node conduction

What are the common therapeutic uses of digoxin?

Mild to moderate heart failure and resting ventricular rate control in chronic atrial fibrillation

What should guide patient-specific digoxin hold parameters?

The prescription and agency policy

How long should the nurse auscultate the patient's apical pulse before administering digoxin?

One full minute

What pulse abnormalities should the nurse identify before administering digoxin?

Bradycardia or an irregular rhythm

What cardiac findings should the nurse assess before administering digoxin?

Rhythm and conduction, including new or worsening dysrhythmias

What aspects of clinical status should be assessed before administering digoxin?

Dizziness, weakness, perfusion, and symptoms of heart failure

What should the nurse do if the assessment is concerning before digoxin administration?

Hold the medication according to the order or agency policy and notify the provider

Why do patients with renal impairment require close monitoring during digoxin therapy?

Reduced clearance can increase digoxin exposure; monitor BUN, creatinine, and eGFR

What factors increase concern for digoxin toxicity?

Renal impairment, electrolyte disturbances, older age, and impaired renal function

What combination is identified as a high-risk pattern for digoxin toxicity?

Digoxin plus a potassium-wasting diuretic plus hypokalemia

What electrolytes should be monitored during digoxin therapy?

Potassium, sodium, and calcium

What gastrointestinal symptoms may indicate digoxin toxicity?

Nausea, vomiting, and abdominal discomfort

What neurologic symptoms may indicate digoxin toxicity?

Fatigue, weakness, and confusion

What visual disturbances may indicate digoxin toxicity?

Blurred vision or yellow-green halos

What cardiac findings may indicate digoxin toxicity?

Bradycardia or a new dysrhythmia

What is the priority nursing response when digoxin toxicity is suspected?

Hold digoxin per order or policy, assess the ECG and labs, and notify the provider

What medication-safety preparation is emphasized for digoxin toxicity?

Have the antidote ready

What is essential when managing high-risk medications in critical care?

Precise administration and continuous monitoring

How should nurses integrate clinical judgment into medication therapy?

Combine pharmacological knowledge with clinical judgment to adjust therapy based on patient response and safety

How does technology enhance medication safety?

Infusion pumps and monitoring devices improve medication safety but require verification

What practices help prevent medication errors and improve critical care outcomes?

Evidence-based practices and vigilant monitoring