ICU Drugs

slows conduction time in the AV node

adenosine

adenosine

found in A1 and A2 receptors

-A1: AV node

-A2: endothelial cells

-6-12-12

vasodilation

along with lowering conduction time, adenosine can also cause

6 mg rapid IVP followed by 20 mL saline flush

Wait 1-2 minutes....

If no response, 12 mg rapid IVP followed by saline flush

Wait 1-2 minutes...

If no response, 12 mg rapid IVP followed by saline flush

adenosine dosing

activates plasminogen

TPA

plasminogen--plasmin--dissolves fibrin

process of plasminogen

0.9 mg/kg IV infusion

dosing for TPA

10%; first minute

____ of the TPA dose is given in the ___ ____

slows K+ outflow during repolarizing phase; increases refractory period

amiodarone MOA

myocytes and pacemaker cells

what cells does amio affect

slows conduction of SA and AV node

main MOA of amio

150 mg/100 mL over 10 minutes

first infusion dosage for amio

1 mg/min for 6 hours, 0.5 mg/mL for 18 hours

infusion dosage for amio

argatroban

direct thrombin inhibitor

turns fibrinogen into fibrin

thrombin

atropine

Anticholinergic (PNS)

binds to muscarinic receptors acetylcholine receptors preventing PNS activation

how does atropine work

0.1mg/mL IV

dose of atropine

blocks PNS activation of vagus nerve which lowers conduction time

how does atropine help symptomatic bradycardia

symptomatic bradycardia

what is atropine mainly used for

heart transplant

atropine does not work in ____ ____ because of the denervation of the vagus nerve

1 mg IVP every 3-5 minutes 3x

what is the dose of atropine for symptomatic brady

precedex

selective alpha 1 adrenergic agonist

activates alpha 2 receptors presynaptically which prevents the release of norepinephrine which stops neuronal firing which causes sedation

molecular level of precedex

stops SNS and lowers BP and HR

postsynaptic effects of precedex binding to alpha 2 receptors

4 mcg/mL

concentration of precedex drip

02-1.4 mcg/kg/hr

dosage of precedex drip

Diltiazem (Cardizem)

calcium channel blocker for HTN

blocks calcium in the heart and blood vessels

diltiaziem......

negative inotropic and chrontropic effects

in terms of the heart, diltiaziem has...

smooth muscle relaxation which causes arterial vasodilation

in terms of blood vessels, diltiaziem can cause

arrhythmias with RVR, HTN, angina

what is diltiaziem used for

1mg/ml

concentration of diltiaziem drip

5-15 mg/hr

What is the dose range for Cardizem (Diltiazem)?

beta 1 agonist which increases contractility

dobutamine MOA

2-20 mcg/kg/min

dose of dobutamine infusion

dopamine

precursor to norepi which becomes epi

increases inotropy and chronotropy via beta 1 receptors

at lower doses, dopamine

vasoconstriction via alpha 1 receptors

at higher doses, dopamine causes

<10 mcg/kg/min

low dose of dopamine

10 mcg/kg/min

higher dose of dopamine

bradycardia or shock

what is the reason you would give dopamine

NON SELECTIVE adrenergic agonist

epinephrine drug class

alpha 1 and 2, beta 1 and 2

epi works on these receptors

alpha 1 receptors

vasoCONSTRICTION -> increase BP

Alpha 2 receptors

smooth muscle contraction and neurotransmitter inhibition

beta 1 receptors

increase heart rate

beta 2 receptors

bronchodilation

0.1 mg/mL every 3-5 min

epi dose during cardiac arrest

0.05-2 mcg/kg/min

epi IV infusion dose

cardio selective beta blocker (beta 1) for short term use

esmolol

esmolol MOA

short acting beta 1 antagonist

50-300 mcg/kg/min

infusion dosing for esmolol

GABA agonist

etomidate MOA

GABA

a major inhibitory neurotransmitter

0.2-0.3 mg/kg IVP

intubation dose of etomidate

binds to opioid receptors in the CNS blocking pain and causing sedation

fentanyl MOA

mu and kappa

what are the main receptors in the CNS

mu receptors

analgesia, respiratory depression, euphoria, sedation, physical dependence

25-100 mcg

IVP dose of fentanyl

25-250 mcg/hr

IV infusion dose of fentanyl

inhibits thrombin formation by inhibiting factor X which inhibits prothombin conversion to thrombin

heparin MOA

thrombin formation

prothrombin activator converts prothrombin to thrombin

DIC

bleeding and clotting

-tissue damage--coag stimulates substances--fibrin clots form--consumes excessive clot factors which causes bleeding

-heparin can treat the clotting aspect of this

body activates platelets

what happens in heparin induced thrombocytopenia (HIT)

1.5-3

aptt for heparin

12-18 units/kg/hr

normal iv infusion dose of heparin

anti Xa

measures unbound factor Xa which inversely proportional to heparin

-higher Xa= lower heparin

enhances GABA

versed MOA

1-2 mg

dose of versed

Sympathomimetic; binds to both alpha- & beta1-adrenergic receptors, constricts blood vessels & increases heart rate

levophed mechanism of action

pH, body temperature

what are some things that can lower levopheds effectiveness

(SBP + 2DBP)/3

MAP =

0.025-1 mcg/kg/min

dose of levophed

GABA receptor agonist

propofol mechanism of action

1-3 mg/kg

IVP dose of propofol

5-50 mcg/kg/min

IV infusion dose for propofol

Inhibits neuromuscular transmission by competitively binding (antagonizing) with acetylcholine motor endplate receptors resulting in muscle paralysis.

rocuronium mechanism of action

10 mg/mL

concentration of roc in a vial

0.6-1.2 mg/kg

Rocuronium induction dose

BIS monitor

monitors how sedated a patient is while paralyzed

90-100

what BIS score means the patient is awake

40-60

what is the goal BIS score while a patient is paralyzed

train of four

sends electrical impulses causing muscle contraction

-used during paralysis

2-3 out of 4 impulses

what is the train of four goal while paralyzed

sodium bicarbonate

buffer agent for prolonged metabolic acidosis

increases plasma bicarb level, which buffers excess H+ ions

MOA of bicarb

50 mEq

how much is in 1 amp of bicarb

0.5-1 mEq/kg/hr

what is the normal IV infusion dose of sodium bicarb