Nursing 416, Titration Drugs

Front 1

Heparin
What is the class and uses for Heparin

Back 1

Class: anticoagulant
Uses: MI, USA, PE, A-fib, DIC, Mechanical devices

Front 2

Heparin
What is the expected unfractionated heparin level

Back 2

0.3-0.69

Front 3

Heparin
How many hours should u wait to make a change in hep?

Back 3

6 hours

Front 4

Heparin
General effect?

Back 4

prolongs clotting time

Front 5

Heparin
lab tests?

Back 5

aPTT, ACT, PT, clotting time

Front 6

Heparin
side effects

Back 6

hemorrhage
heparin induced thrombocytopenia and thrombosis syndrome
(HITTS)

Front 7

Heparin
Onset

Back 7

immediate

Front 8

Heparin
Peak

Back 8

5-10 minutes

Front 9

Heparin
duration

Back 9

2-6 hours

Front 10

Heparin
antidote?

Back 10

protamine
1 mg neutralizes 100 u of Hep

Front 11

Fentanyl:
Class and uses

Back 11

C- opiod
U- pain control, sedation, analgesia

Front 12

Fentanyl:
expected outcome

Back 12

relief of pain and agitation without detioration in VS

Front 13

Fentanyl:
What should you monitor

Back 13

pain, resp (rate and effort), BP, LOC

Front 14

Fentanyl:
side effects

Back 14

constipation
nausea
resp depression
itching
pinpoint pupils
hypotension (less so than morphine!)

Front 15

Major side effect/concern in relation to
Fentanyl?

Back 15

if given too rapidly IV, causes chest wall and skeletal rigidity

Front 16

Fentanyl:
Usual dose
onset
peak
Duration

Back 16

Usual dose:10-100 mcg/hr
Onset: 1-2 minutes
Peak: 3-5 minutes
Duration: .5-1 hour (shorter than morphine(4-6 hours))

Front 17

Fentanyl-- titration
usuall starting dose:
usual concentration:
usual breakthrough dose:

Back 17

starting: 10mcg/hr
concentration: 10mcg/cc
breakthrough (bolus dose)--use judgment-usually 5-10mcg

Front 18

Propofol:
Class:
Uses

Back 18

Class: general anesthetic
Uses: anesthesia, ICU sedation for agitation
(not an analgesic!)

Front 19

Propofol:
adverse effects

Back 19

apnea, sedation, hypotension, hyperlipidemia, bacterial growth, metobolic acidosis, fever, chills body aches

Front 20

what is PRIS

Back 20

propofol infusion syndrome-rare but potentially lethal complication resulting from a prolonged continuous administration of propofol. cardinal signs and symptoms- metabolic acidosis, rhabdomyolysis, renal failure, cardiac arrhythmias and a progressive, often therapy-resistant cardiac failure. The pathophysiology of this syndrome appears to involve a disturbance of mitochondrial metabolism induced by propofol.

Front 21

Propofol:
Usual dose:

Back 21

Usual dose:
0.3-3mg/kg/hr
or
5-50mcg/kg/min

Front 22

Propofol
Onset:
Duration:

Back 22

Onset:30 seconds
Duration: 3-10 minutes

Front 23

How often should you change propofol bottle?

Back 23

Q12 hours
contains egg, soy, lipids
high potential for bacterial growth

Front 24

Propofol- titration
initial and increased by?

Back 24

initial- 0.3mg/kg/hr (or 5mcg/kg/min)

increase Q 5-10 minutes by
0.3-0.6 mg/kg/hr
or
5-10mcg/kg/min

Front 25

propofol and elderly?

Back 25

decrease dose by 80%

Front 26

how slow/fast should you wean patient from propofol?

Back 26

SLOWLY!
cut in half wait 10 minutes
etc

Front 27

Insulin:
Class:
Uses:

Back 27

Class: Hormone
Uses: control glucose

Front 28

Insulin:
expected outcome

Back 28

CBG of 80-100

Front 29

Insulin
Adverse effects

Back 29

hypoglycemia

Front 30

Insulin:
Initial dose?

Back 30

depends on blood glocose!

Front 31

Insulin:
Onset?
Peak?
Duration?

Back 31

onset: 10-30 minutes
peak: 15-30 min
duration: 30-60 min

Front 32

Dopamine
Class?

Back 32

alpha and beta agonist

Front 33

Dopamine:
.5-5mcg/kg/min does what?

Back 33

renal artery dilation
(BP decreased)
increase urine output

Front 34

Dopamine:
5-10 mcg/kg/min does what?

Back 34

increase cardiac output

Front 35

Dopamine:
>10 mcg/kg/min

Back 35

vasoconstriction and contractility

Front 36

Dopamine:

outcomes are........

Back 36

Dose related!

Front 37

Dopamine:
monitor patient for...

Back 37

tachycardia, dysrhythmias,hypotension (with low or high doses)
NECROSIS!!

Front 38

Dopamine:
Onset?
Peak?
Duration?

Back 38

onset <5 minutes
peak 5 minutes
duration 10 minutes

Front 39

Titrating dopamine:
if desired outcomes not yet reached?

Back 39

increase by
1-2 gtts/hr or
0.5 mcg/kg/min

increase Q 3-7 minutes

Front 40

Titrating dopamine:
if outcomes greater than desired?

Back 40

decrease by
1-2gtts/hr or
.5 mcg/kg/min

decrease Q 5-10 minutes

Front 41

Levophed:
Generic?
Class?
Uses?

Back 41

generic: norepinephrine, levaterenol

Class: alpha and beta andrenergic agonist

uses: hypovotension

Front 42

Levophed:
Expected outcomes?

Back 42

MAP> 60

Front 43

Levophed:
monitor for ....

Back 43

BP, HR, CO, pulses, skin color, and temperature

Front 44

Levophed:
adverse effects

Back 44

very potent vasoconstrictor-- increased afterload--
Very dangerous for people with MI

also- headache, bradycardia, metabolic acidosis, phlebitis, necrosis, dysrhythmias

Front 45

Levophed:
Usual dose:

Back 45

2-12 mcg/min

Front 46

Levophed:
Onset?
Peak?
Duration?

Back 46

onset- immediate
peak- very rapid
duration- 1-2 minutes

Front 47

Levophed:
must be mixed in.....

Back 47

dextrose solution

Front 48

Levophed titration:
usual dose?
titrate by ?

Back 48

usual initial dose: 8-12mcg/min
titrate by: .5-1 mcg/min

may increase quickly because peak is less than one minute

Front 49

Levophed:
decrease titration.. (slow? fast?)

Back 49

Slowly!
15 minutes or so