CVICU Drips Flashcards
Lidocaine
1-4 mg/min
used for ventricular arrhythmias (PVCs, V-tach, Vfib)
decrease ventricular excitability,
increase ventricular threshold
concentration: 2g in 250mL D5W
half-life: bolus 10min, gtt 1.5-2hrs
onset 45-90 sec
duration 10-20 min
Amiodarone
bolus over 10mins 100mg/100mL D5W
1mg/min over 6 hours
0.5 mg/min over 18 hours
moa: prolongs action potential and refractory period, slows sinus rate, increase RP & QT interval, decrease PVR
used for life-threatening ventricular arrythmias, aFib and a-flutter
1st 24 hours: 900mg/500mL D5W
maintenance 500mg/250mL D5W
peripheral: 500mg/500mL D5W
half-life 25-110 days
Cardizem (diltiazem)
bolus: 0.25 mg/kg over 2min
gtt: 5-15 mg/hr
moa: relaxes smooth muscle, increases coronary artery blood flow
Calcium Channel Blocker - relaxes coronary vascular smooth muscle by inhibiting calcium ions during depolarization of the vascular smooth muscle
used for ventricular rate control in Afib/A-flutter and HTN
concentration 1:1
half-life: 3-5 hours
onset: 3 min
duration: bolus 1-3 hours, gtt 0.5-10 hours after d/c
Precedex (dexametomidine)
0.1-0.7 mg/kg/hr
selective alpha 2 adrenoceptor agonist with anesthetic and sedative properties; inhibits norepinephrine release
needs renewal orders q24hr
do not use in AV block
concentration:
250mg/50mL NS
400mg/100mL NS
Half-life: 6 min
onset: 5-10 min
Peak: 15-30 min
Duration: 60-120 min
Versed (midazolam)
1-6 mg/hr
MOA: benzo, slows activity in the brain to allow for sleep
used for anxiety, agitation, & mechanical ventilation
keep dose at steady rate
usually paired with Fentanyl (wean Fent first)
Concentration: 50mg/50mL D5W
Half life: 2-6 hours
Onset: 3-5 min
Duration: 2 hours
Fentanyl (Sublimaze)
25-200 mcg/kg/min
MOA: opiate, analgesic
used for long term sedation and pain
Risk for Paralytic Ileus
Concentration: 2500mcg/250mL NS
Half-life: 2-4 hrs
Onset: Immediate
Duration: 30-60 min
Propofol
5-50 mcg/kg/min
MOA: short-acting general anesthetic, global CNS depression
used for intubated patients
change tubing q12hr, watch for allergies to soy/eggs, decreases cardiac output
Half-life: 40 min
Onset: 60 sec
Duration: 3-10 min
Nitroglycerin
start: 5-10 mcg/min and increase 5-10 mcg/min every 5-10 min
max: 200 mcg/min
MOA: vasodilation of the coronary arteries, peripheral arteries/veins with venous dilation > arterial dilation
reduces preload which reduces myocardial O2 demand
used for angina, heart failure, acute pulmonary edema, HTN, pulmonary HTN, and prevents LIMA spasms
Do not use if patient on viagra (sildenafil, vardenafil, or tadalafil)
If patient on heparin = high doses of NG can cause heparin resistance
Concentration: 50 mg/250mL D5W
Half-life: 1-4 min
Onset: 2-5 min
Duration: 10-20 min
Nipride (Nitroprusside)
0.1-10 mcg/kg/min
MOA: causes peripheral vasodilation by direct action on the venous and arterial smooth muscle. Decreases PVR, SVR, and BP
Use in HTN crisis
Do not use if patient used viagra
Can cause light sensitivity
Concentration: 50mg/250mL, 100mg/250mL D5W
Half-life: 2min
Onset: <2min
Duration: 1-10min
Vasopressin
Shock: 0.01-0.04 u/min
Cardiac Arrest: 40 unit bolus
MOA: anti-diuretic hormone that is released from the posterior pituitary in response to hypovolemia, hypotension, high osmolality in the blood; non-adrenergic peripheral vasoconstrictor
Goal: to conserve body water by causing the renal tubules to reabsorb water causing peripheral vasoconstriction which increase BP and afferload
Used for: DI, GI bleed, Cardiac arrest, shock
Concentration: 60u/100mL NS
Half-life: 10-20min
Onset: unknown
Duration: 30-60min
Epinephrine
0.01-3 mcg/kg/min
MOA: potent Beta-1 inotropic agent. Increases Cardiac Output by increasing HR and Contractility. B2 causes mild vasodilatory effects and bronchodilator.
Works on all receptors.
Used for: low CO, hypotension
Monitor for increases BG, dysrhythmias, and will cause vasoconstriction at high doses
Concentration: 4, 8, 16mg/250mL D5W
Half-life: 2min
Onset: immediate
Duration: 5-10min
Neo (Phenylephrine)
0.5-9mcg/kg/min
MOA: Potent alpha agonist which increase SVR which increases SBP/DBP. Alpha 1 agonist, No beta-adrenergic activity
Used for: shock, hypotension
Monitor kidneys, caution w/arterial grafts
Concentration: 50mg/250mL D5W
Half-life: 5min
Onset: immediate
Duration: 15-20min
Levo (Norepinephrine, Levophed)
0.05-3 mcg/kg/min
MOA: stimulates alpha-adrenergic receptors and Beta-1 receptors to increased contractility and HR. Also causes vasoconstriction.
Alpha 1 and 2, Beta receptors.
Alpha > Beta
Used for: severe hypotension, low CO with low BP
Half-life: 3min
Onset: rapid
Duration: 1-2min
Isuprel (Isoproterenol)
2-20 mcg/min
MOA: B1 & B2 agonist,
B1 (Increases HR and contractility)
B2 (vasoconstriction of peripheral vasculature and bronchial relaxation ie. decreased SVR)
Used for: support HR and contractility following cardiac treatment, for patients with high grade heart block until pacing can be instituted
Concentration: 1mg/250 mL D5W or NS
Half-life: 2.5-5 min
Onset: immediate
Duration: 10-15 min
Cleviprex (Clevidipine)
1-32 mg/hr
MOA: potent arterial vasodilating activity, inhibits calcium channel ion from entering ca channels thus decreased BP and SVR
Used for: HTN
Do not use: egg or soy allergy, severe aortic stenosis
Remember:
change tubing q12hr
peripherally - have carrier fluid @ 20-30 mL/hr
centrally - do not infuse in the same line as other meds
No MORE than 1000mL or 21mg/hr in 24 hours is recommended!
Concentration: 25mg/50mL, 50mg/100mL
