Icu Drugs

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Cardizem (diltiazem):

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works on the arterioles/ heart
USE: HTN (by arteriolar dilation), angina, and dysrhythmias (i.e arterial flutter and A. fib.)
MOA: blocks calcium channels in the heart and blood vessels
AE: dizziness, flushing, H/A, and edema of the ankles and feet. Cardizem can exacerbate cardiac dysfunction in pt. with bradycardia, heart failure, or second degree or third degree AV block
INTERACTIONS: can exacerbate digoxin induced suppression of AV conduction, and can intensify the heart effects of beta blockers
NURSING INV: if take is digoxin or a beta blocker they should be monitored closely for cardiac status. Assessment- monitor BP and HR before therapy and during therapy. monitor EKG for prolonged PR interval. monitor I and O's and daily weight. Assess for S/S of CHF (crackels/rales, peripheral edema, dyspnea, weight gain, and JVD). Assess angina-location, duration, intensity, and precipitating factors. Monitor serum potassium for hypokalemia. monitor renal and liver functions periodically during long term therapy

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Adenosine Adenocard, Adenoscan

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Half life <10 seconds
USE/INDICATIONS: Conversion of paroxysmal supra-ventricular tachycardia to NSR (normal sinus rhythm) treatment of arrhythmia associated with faulty AV node function
MOA: slows conduction time thru the av node and produces coronary artery vasodilation.
ADVERSE EFFECTS: apprehension, dizziness, HA, blurred vision, throat tightness, SOB, chest pressure, hyperventilation, facial flushing, transient arrhythmias, chest pain, hypotension, palpitations, metallic taste, nausea, sweating, burning sensation, numbness, tingling, heaviness in arms, head pressure and light headedness.
CAUTION: when using with carbamazepine, digoxin, caffeine, theophylline
NURSING INV: monitor HR, BP, & respiratory status frequently, continuous ECG during therapy. Monitor for facial flushing, warn pt to stand slowly (orthostatic BP)
Watch for sound alike: adenosine phosphate
Given IV: warm to room temp to use, solution must be clear, can crystallize if refrigerated.

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Magnesium sulfate (IV) (9.9% Mg; 8.1 mEq Mg/g)

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USE: treatment/prevention of hypomagnesemia; tx. hypertension; anticonvulsant associated w/eclampsia; acute nephritis
MOA : role in neurotransmission and muscular excitability
ADVERSE EFFECTS: drowsiness, decreased resp. rate, arrhythmias, bradycardia, hypotension, diarrhea, muscle weakness, flushing, sweating, hypothermia
INTERACTIONS: Potentiate (increase effect of) calcium channel blockers & neuromuscular blocking agents
NURSING INV: Hypomagnesemia/Anticonvulsant – monitor HR, BP, RR, ECG throughout administration (resp. rate should be 16/min before each dose); monitor neurologic status before & throughout therapy; institute seizure precautions; patellar reflex should be tested before each dose, if response absent NO ADDITIONAL doses should be delivered until response is obtained; monitor newborn for hypotension, hyporeflexia, resp. depression; monitor intake & output ratios (urine maintained @ least 100ml/4hr); Labs – serum Mg, renal fx.; 2ND RN NEEDS TO CHECK DOSAGE BEFORE GIVING

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Kalcinate, calcium gluconate

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USE: Hypocalcemia, emergency treatment of hyperkalemia and hypermagnesemia, cardiac arrest
MOA: Acts as activator in transmission of nerve impulses and contraction of cardiac, skeletal, and smooth muscle
ADVERSE EFFECTS: Syncope, arrhythmias, cardiac arrest, constipation, N/V, phlebitis
INTERACTIONS: Digoxin (increased risk of toxicity if hypercalcemia present), Calcium Channel Blockers (excessive amnts may decrease effects of blockers), Diruetics (be cautious of hypercalcemia)
NURSING INV: Observe for hypocalcemia: muscle twitching, cardiac arrhythmias, Chvostek’s or Trousseau’s sign; Monitor BP, pulse, and ECG frequently; Assess IV site

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Tridil, Nitroglycerine

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Organic Nitrate
USE: Treatment of angina pectoris if patient is not responding to sublingual. Given to heart failure pt or CHF, reduces preload (fluid volume) by working as a massive vasodilator.
MOA: Converts nitrate to nitric oxide which is its active form, in the presence of a sulfhydryl source.
SE: palpitations, vasodilation, syncope, hypotension, restlessness, weakness
NURSING INV: This drug is given by IV infusion. Monitor for interactions with other medications such as Aspirin, Heparin, and Calcium channel blockers. Watch for hypotension (orthostatic), and for dizziness.

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Dobutamine (Dobutrex)

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USE: treatment of heart failure
MOA: Stimulates beta1-adrenergic receptors. Increases contractility & CO without drastically affecting HR.
ADVERSE EFFECTS: hypertension, increased HR, premature ventricular contractions, SOB, H/A, hypotension, palpitations, nausea, vomiting.
INTERACTIONS: Be careful when administering Nitroprusside. It may also increase cardiac output. Beta blockers may negate the effect of Dobutamine. Arrythmias & hypertension may result with use of anesthetics, MAO inhibitors, oxytocics, & tricyclic antidepressants.
NURSING INV: Monitor BP, HR, ECG, and urinary output. Assess pulses frequently, medicine may cause hypokalemia. Monitor electrolytes. Have second nurse double check before administering medication to pt. Must be diluted in at least 50 ml prior to administration. Given through continuous infusion. Rate should be set at 2.5-10 mcg/kg/minute.

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DOPAMINE (Intropin)

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Class: Adrenergic Dopaminergic Catecholamine, Symathomimetic
HALF LIFE: 2-4 minutes, Lasts: 10- 15 minutes. Increases heart rate and cardiac contractility, the predominant effects are based on the dose.
MOA: metabolized by monoamine oxidase
USE: Cardiogenic shock, cardiogenic shock with pulmonary edema (CHF), hypovolemic shock, neurogenic shock, septic shock. Contraindications: women taking oxytocin, uncorrected tachydysrtyhmias, Uncorrected hypovolemia
ADVERSE EFFECTS: dysrythmias, HTN, hypotension, H/A, nausea, vomiting, dizziness, tremors, tachycardia, widened QRS complex, dyspnea.  Can cause tissue necrosis if it infiltrates.
NURSEING INV: monitor closely: urine flow, cardiac output and blood pressure, changes in skin color and temperature **Antidote for peripheral necrosis: Regitine (phentolamine), should be infiltrated into area (because it is an adrenergic blocking agent**

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Amrinone

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Phosphodisterase Inhibitor
USE: Short term treatment (2-3 days) of heart failure in patients who have already tried other drugs and not responded. It is given by IV infusion.
MOA: Increases myocardial contractility and promotes vasodilation by unclear mechanisms
S/E: Nausea and vomiting, hypotension, arrhythmias
NURSING INV: Constant monitoring is required. The drug must be protected from light and not mixed with glucose-containing solutions such as dextrose.

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Norepinephrine Levodopa norepinephrine

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MOA:
INDICATION: blood pressure control in acute hypotensive states like MI, septicemia and blood transfusions (Cardiac Arrest); restoration of BP
SE: Ischemic injury, bradycardia, arrhythmias, anxiety, HA, extravasation at injection site
NURSING INV: use with caution in pt with MAOI, watch for hypertension, watch for HA, give in a large vein to reduce chance of necrosis

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Epinephrine (Adrenalin)

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MOA: Direct Receptor Binding, Promotion of Norepinephrine release, blocks Norepinephrine reuptake, and inhibits the inactivation of Norepi.
USE: used for delay absorption of anasthetics, controls bleeding, reduces nasal congestion, increases blood pressure. Can be used to overcome Av heart block and to restore cardiac functions during a cardiac arrest. It is widely used in anaphylactic shock.
ADVERSE EFFECTS: Hypertensive Crisis (alpha 1 activation causes dramatic increase in pressure due to vasoconstriction), dysrythmias, angina (activation of beta 1 receptors can cause increase in cardiack work and oxygen demand), Necrosis due to extravasation (due to localaized vasoconstriction), Hyperglycemia in diabetics (Breakdown of glycogen through activation of beta 2 receptors in liver and skeletal muscle).
INTERACTIONS: MAOI's ( MAO is an enzyme that inactivates epinephrine, inhibition prolongs and intensifies epi's effect), TCA's (block the uptake of catecholamines, resulting in longer and more intense effects of epi than desired), Anesthetics (render the myocardium very hypersensitive to beta 1 agonists which may cause tachydysrythmias), Alpha Adrenergic Blocking Agents (can prevent receptor activation by epinephirine, also used in treating toxicity), Beta Adrenergic Blocking Agents (can prevent receptor activation by epinephrine, may also reduce adverse effects caused by epi).
NURSING INV: Always double check the dosage of the medication (IV administration is less concentrated and if given wrong dosage results may be fatal), Monitor for signs of excessive cardiovascular activation (dysrythmias, HTN), Monitor for extravasation of the medication at the IV site.May need alpha adrenergic blocking agent if effects become to serious.

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Sodium Nitroprusside [Nitropress]

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Extremely powerful vasodilator (venous & arterial), which is also the fastest acting antihypertensive available, making it the drug of choice for hypertensive emergencies.
MOA: breaks down in the body to release nitric oxide, which activates guanylate cyclase (enzyme present in VSM). This enzyme is ultimately what causes the vasodilation.
Indications: Used to lower BP rapidly in a hypertensive emergency. It should be used in conjunction with an oral antihypertensive at the same time. In addition, furosemide may be needed to prevent excessive fluid retention, because this medication can cause fluid and sodium to be retained by the body.
Adverse Effects: excessive hypotension (h/a, palpitations, N&V, sweating), cyanide poisoning (rare, but can happen in patients with liver disease), Thiocyanate toxicity (disorientation, psychotic behavior, and delirium).
NURSEING INV: continuous monitoring of BP, stop infusion if cyanide toxicity occurs, plasma thiocyanate monitoring if patient is on medication for more than 3 days, DO NOT mix any other drugs with the nitroprusside

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Vasopressin- (pitressin,pressyn)-

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MOA: alters permeability of the renal collecting ducts, allowing reabsorption of water. Stimulates muscle of GI tract , acts as vasoconstrictor. Decreases urine output & increases urine osmolality in diabetes Insipidus.
USE: Central diabetes insipidus due to deficiency of ADH.
ADVERSE EFFECTS: dizziness, angina, chest pain, abdominal cramps, diarrhea, n/v, sweating, trembling, fever, water inox w/ high doses.
INTERACTIONS: Antidiuretic effect may be decreased by concurrent admin. of alcohol, lithium, demeclocycline, heparin, or norepinephrine. The antidiuretic effect may be increased by concurrent administration of carbamazepine, chlorpropamide, clofibrate, tricyclic antidepressants, or fludrocortisones. Ganglionic blocking agents may also increase the vasopressor effect.
NURSING INV: Monitor EKG throughout therapy and continuously throughout cardiopulmonary resuscitation. Monitor urine osmolality and volume frequently. Assess for s/s of dehydration. Weigh patient daily, monitor I&O, and assess for edema. Monitor urine specific gravity throughout therapy. Watch for s/s of water intoxication.

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Generic name: Atropine
Trade name: Sal-Tropine, AtroPen

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MOA: muscarinic antagonist. Produces selective blockade of muscarinic cholinergic receptors. Atropine will: increase HR, decrease secretion from salivary glands, relaxes bronchi, decreases the tone of the bladder, decreases tone and motility of GI tract, dilates pupils, mild CNS excitation
USE: pretreatment for surgery to prevent dangerous reductions in HR (preanesthetic medication and tx of bradycardia), useful with pt. that has bradycardia, intestinal hypertonicity and hypermotility (such as diverticulitis), antidote for muscarinic poisoning (agents such as cholinesterase inhibitors)
ADVERSE EFFECTS: Dry mouth, blurred vision, photophobia, elevation of intraocular pressure, urinary retention, constipation, anhidrosis, tachycardia, asthma
Interactions: enhance antimuscarinic effects: antihistamines, phenothiazine antipsychohtics, tricyclic antidepressants
NURSEING INV: atropine is contraindicated in glaucoma, intestinal atony, urinary tract obstruction, and tachycardia. Dry mouth may interfere with swallowing so advise pt. to moisten mouth by sipping water prior to oral administration and chew gum. Warn pt. to avoid hazardous activities if vision is impaired. Advise pt. to wear sunglasses outdoors. Advise patients that urinary retention can be minimized by voiding just prior to taking anticholinergic med. Advise pt. that constipation can be reduced by increasing dietary fiber and fluids. Advise pt. to avoid vigorous exercise in warm environments. Monitor pulse for accelerations.

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Sodium Bicarbonate (Baking Soda, Soda Mint, Citrocarbonate, Bell-Ans)

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USE: used to alkalinize blood and urine (making the blood and urine less acidic) in certain conditions such as metabolic acidosis, and it promotes excretion of certain drugs in overdose situations.
MOA: an alkaline, and a vital component of the body's pH buffering system maintaining acid-base homeostasis. By releasing bicarbonate ions, it acts an alkalinizing agent neutralizing acid. Taken orally, it can neutralize gastric acids.
ADVERSE EFFECTS: Metabolic alkalosis, hypernatremia, hypocalcemia, hypokalemia, sodium and water retention, and edema. PO route may cause flatulence, gastric distention, and N/V. IV route may cause irritation at the intravenous site. INT: increased blood levels of quinidine, amphetamines, flecainide (anti-arrhythmics), and mexiletine (anti-arrhythmics). Do not take enteric-coated products within 1-2 hours of oral administration, it may make the protective coating ineffective. may decrease the absorption of ketoconazole. Burnett's syndrome when taken with Ca (stones). NURSING INV: Assess fluid balance throughout therapy to include daily weights, lung sounds, edema, and strict I's & O's
Assess patietn for s/s of acidosis, alkalosis, hypernatremia, or hypokalemia throughout therapy.
Observe the IV site closely to avoid extravasation, tissue irritation, or cellulitits.
Monitor serum Na+, K+, Ca+, bicarb concentrations, serum osmolarity, acid-base balance, urine pH, and renal function prior to and periodically throughout therapy.
As an antacid, assess patient for epigastric or abdominal pain, frank or occult blood in the stool, emesis, or gastric aspiration.
Advise patient to avoid intake of milk products while taking this med d/t increase risk of milk-alkali syndrome.
Emphasize the importance of regular follow-up exams to monitor serum electrolyte levels, acid-base balance, and to monitor progress.
As an antacid: Instruct patient to take as directed, a missed dose should be taken as soon as possible unless it's almost time for the next dose.
Advise patient to avoid routine use of sodium bicarbonate for indigestion; dypepsia for >2 wks should be evaluated by a physician.
Instruct patient to notify health care professional if indigestion is accompanied with chest pain, difficulty breathing, sweating (diaphoresis), or if stools become dark and tarry.

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PROCAINAMIDE

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USE: treatment of a wide variety of ventricular and atrial arrhytrhmias.
MOA: decreases myocardial excitability, may depress myocardial contractility, suppresses arrhythmias...its an antiarrhythmic
ADVERSE REACTIONS: seizures confusion, asystole, heart block, vent. arryth., hypotn, diarrhea, agranulocytosis, anorexia, N/V
NURSING INV: monitor EEG pulse and BP before giving and throughout therapy, IF IV -discontinue if arrhythmia is observed, QRS widens by 50 %, PR interval is prolonged, blood pressure drops > 15 mm Hg, or toxic SE develop, patient should remain supine throughout IV to avoid hypotn. CBC should be monitored every 2 wks.

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Amiodarone (Cordarone)

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USE: is a member of a new class of antiarrhythmic drugs that is used for life-threatening recurrent ventricular arrhythmias when other antiarrythmiacs do not work or their side effects are not tolerated. Usually used for v. tach or v. fib. MOA: prolongs the action potential and refractory period. Inhibits adrenergic stimulation. Slows the sinus rate, increases PR intervals and QT intervals, and decreases peripheral vascular resistance (vasodilation). ADVERSE EFFECTS: Adverse reactions are very common in all patients. The most common ones are pulmonary toxicity, exacerbation of arrhythmia, and rare serious liver injury. The most serious ones reported are ARDS (adult respiratory distress syndrome), CHF or worsening of arrhythmias, bradycardia, hypotension, liver function abnormalities, toxic epidermal necrolysis (rare), and corneal microdeposits. Most side effects are dose and length of administration related, many are reversible with med being stopped. The thyroid may be affected (hypo or hyper may occur). Interactions: increases warfarin (coumadin) levels, decrease coumadin dose by 30-50%. There is an increased risk of heart arrythmias, and arrest with beta blockers and calcium channel blockers. Volatile anesthetics can cause increased cardiac depression. Food/drug interaction is noted with grapefruit juice- the drug does not metabolize in the GI tract and becomes toxic. an increase in digoxin levels, so dig. doses should be reduced by 50 %. Interventions: Assess for ARDS! (dyspnea, tachypnea, rales, crackles, infiltrates) Monitor B/P-hypotension usually occurs first few hours-slow rate. Recommend opthalmic exams. Assess for s/s thyroid dysfunction. Monitor labs (liver enzymes, thyroid levels) Always have another nurse double and triple check dosing!! Many fatal med errors have occurred! Assist patient with ambulation to prevent falls. Give through an inline filter. Pts may experience a bluish discoloration of face, neck, and arms with long use. Is usually reversible.

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Propofol (Diprivan)

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MOA: Short acting; MOA is unknown provides no analgesia USE: Used as a sedative/hypnotic for the induction of anethesia; can be used to help maintain sedation of patients who are intubated or mechanically ventilated patients ADVERSE EFFECTS: Respiratory depression, apnea, hypotension, bradycardia, burning, stinging, nausea, flushing INTERACTIONS: Additive CNS depression with the use of other CNS depressants like alcohol, antihistamines, opioid analgesics, sedatives/hypnotics; theophylline may antagonize the CNS affects; poses a high risk for bacterial infection because it is supplied in a mixture of soybean oil, glycerol, and egg lechithin, which are very prone to bacterial growth NURSING INV: Assess respiratory status, pulse, & BP during therapy; maintain airway and place airway equipment nearby; assess sedation, Store at 22 degrees Celcius; use open vials within 6 hours to decrease infection risk

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Milrinone (Primacor)

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MOA: Increases myocardial contractility. Decreases preload and afterload by a direct dilating effect on vascular smooth muscle. Increased cardiac output (Inotropic effect) IND: Short term treatment of CHF unresponsive to conventional therpy with digoxin, diuretics, and vasodilators. ADV EFF: H/A, ventricular arrhythmias, angina, chest pain, hypotension, skin rash, liver function abnormalities, hypokalemia, thrombocytopenia, INTERACT: None significant INTERVENT: Monitor HR and Bp. If Bp drops excessively stop it. Monitor ECG during infusion because arrhythmias are common.

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Potassium

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MOA: Maintain acid base balance, isotonicity, and electrophysiologic bakance of the cell. Activator in many enzymatic reactions, essential to transmission of nerve impulses, contraction of cardiac, skeletal, and smooth muscle, gastric secretion, renal function, and carb. Metabolism IND: Treatment/prevention of potassium depletion. Arrhythmias due to digoxin toxicity. ADV EFF: Confusion, weakness, arrhythmias, abdominal pain, N/V/D, paralysis INTERACT: Potassium-sparing diuretic, ACE inhibitor, or Angiotensin II receptor antagonist may lead to hyperkalemia. Anticholinergics may increase GI mucosal lesions in patients taking wax matrix potassium chloride preparations Intervent.: Assess for hypokalemia, monitor pulse, Bp, and ECG, monitor potassium before and during treatment, and Bi carb, pH. Toxicity and overdose stop potassium and give sodium bicarb to fix acidosis, give insulin and dextrose to facilitate passage of potassium into the cell.

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Lidocaine

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USE: ventricular arrhythmias MOA: suppresses automaticity and spontaneous depolarization of the ventricles during diastole by altering the flux of sodium ions across cell membranes with little or no effect on heart rate. SE: seizures, confusion, drowsiness, cardiac arrest, stinging, anaphylaxis NURSING INV: Monitor ECG continuously and BP and respiratory status during admin

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Lorazepam (Ativan)

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MOA: CNS depressant; benzodiazepine USE: Used to treat anxiety, insomnia, provides sedation; treats status epilepticus ADVERSE EFFECTS: Dizziness, drowsiness, lethargy, head ache, blurred vision, apnea, cardiac arrest, bradycardia, hypotension, dependence INTERACTIONS: Additive sedative effect with other CNS depressants, Probenecid may decrease metabolism of lorazepam, enhancing its action; phenytoin) or theophyllines because they may decrease Lorazepam \\\\\\\\\\\\\\\'s effectiveness; phenytoin) or theophyllines because they may decrease Lorazepam \\\\\\\\\\\\\\\'s effectiveness, digoxin NURSING INV: Assess level of anxiety or sedation; Assess for dependence if long term therapy; if used for treating status epilepticus, assess seizure characteristics, location, and protect patient from injury, do not use if you have narrow-angle glaucoma, psychosis, or severe liver disease

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Xigris (drotrecogin)

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MOA: Probably acts by suppressing widespread inflammation associated with sepsis. Decrease mortality due to sepsis IND: To reduce mortality in adult pts with sepsis. ADV EFF: Bleeding INTERACT: Antiplatelet agents, anticoagulants, thrombolytic agents, or other agents that may affect coagulation increases risk of serious bleeding. Arnica, chamomile, clove, dong quai, feverfew, garlic, ginger, gingko, Panax ginseng may increase bleeding. INTERVENT: Assess for signs of bleeding and hemorrhage and infection. Monitor PT, aPTT.

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Magnesium

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MOA: Essential for the activity of many enzymes. Play important role in neurotransmission and muscular excitability. IND: Treatment/prevention of hypomagnesemia. As a. lazative, bowel evacuant in preparation for surgical/radiographic procedures. ADV EFF: Diarrhea, flushing, sweating INTERACT: Potentiates Neuromuscular blocking agent. May decrease absorption of fluoroquinolones, nitrofurantoin, and tetracyclines, penicillamine. INTERVENT: Assess for abdominal distention, bowel sounds, bowel function. Make sure the pt chews tablet thoroughly to prevent it from entering the small intestines.