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ICU COMMONLY USED MEDICATIONS Flashcards

1
Q

Albuterol Name/Classification/Indications

A
  • Ventolin, Proventil
  • Beta-2 adrenergic agonist/bronchodilator
  • Treat bronchospasm in patients w/ reversible obstructive airway disease or acute bronchospastic attack
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2
Q

Albuterol Mechanism of Action

A
  • Attaches to beta 2 receptors on bronchial cell membranes, stimulating intracellular enzyme to reduce calcium levels/increase intracellular levels of cAMP, relaxing bronchial smooth-muscle cells and inhibition of histamine release
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3
Q

Albuterol Route/Dosing

A
  • Inhalation aerosol: 1-2 inhalation q 4-6 h
  • E.R. tablets: 4-8 mg q 12 h
  • Tablets: 2-4 mg TID-QID
  • Syrup: 2-4 mg (1-2 tsp) TID-QID
  • Inhalation solution: 2.5 mg TID-QID neb over 15 min
  • Inhalation capsules: 1-2 capsules q 4-6 h
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4
Q

Albuterol Time of Onset/Peak/Half-Life

A
  • Inhalation aerosol: 5-15 min/50-55 min/3-6 h
  • E.R. tablets: 30 min/2-3 h/12 h
  • Tablets: 30 min/2-3 h/4-8 h
  • Syrup: Rapid/2 h/unknown
  • Inhalation solution: 5-15 min/1-2 h/3-6 h
  • Inhalation capsules: 5-15 min/0.5-3 min/2-6 h
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5
Q

Albuterol Contraindications

A
  • Hypersensitivity
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6
Q

Albuterol Adverse Reactions

A
  • Anxiety
  • Dizziness
  • Hypotension/tachycardia/chest pain/palpitations
  • Dry mouth/throat
  • Hyperglycemia
  • Cough/dyspnea/paradoxical bronchospasm
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7
Q

Albuterol Special Nursing Considerations

A
  • Use cautiously in patients w/ cardiac disorders/diabetes/HTN/seizures
  • Monitor potassium (cause hypokalemia)
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8
Q

Albuterol Interactions w/ Food/Drug/Testing

A
  • Inhibited effects of albuterol w/ beta blockers
  • Decreased serum digoxin level, MAOI, tricyclic
  • Hypokalemia w/ potassium-lowering/wasting drugs
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9
Q

Levalbuterol Name/Classification/Indication

A
  • Xopenex
  • Sympathomimetic amine/bronchodilator
  • Prevent/treat bronchospasm in reversible obstructive airway disease
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10
Q

Levalbuterol Mechanism of Action

A
  • Same as albuterol
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11
Q

Levalbuterol Route/Dosing

A
  • Inhalation aerosol: 1-2 inhalation q 4-6 h

- Inhalation solution: 0.63-1.25 mg TID q 6-8 h

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12
Q

Levalbuterol Time of Onset/Peak/Half-Life

A
  • Inhalation: 10-17 min/1.5 h/5-6 h
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13
Q

Levalbuterol Contraindications

A
  • Hypersensitivity
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14
Q

Levalbuterol Adverse Reactions

A
  • Anxiety/chills/hypertonia/headache
  • Arrhythmias, chest pain, HTN, tachycardia
  • Dry mouth
  • Asthma exacerbation/cough
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15
Q

Levalbuterol Special Nursing Considerations

A
  • Use cautiously in patients w/ arrhythmias, DM, HTN, hyperthyroidism, seizures
  • Oral sol’n only by nebulizer
  • Monitor BP & HR
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16
Q

Levalbuterol Interactions w/ Food/Drug/Testing

A
  • Blocked effects of beta blockers
  • Decreased digoxin level
  • Increased risk of hypokalemia w/ loop/thiazide diuretics
  • Increased risk of adverse CV effects w/ MAOI, tricyclic antidepressants, sympathomimetics
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17
Q

Propofol Name/Classification/Indications

A
  • Diprivan
  • Sedative-hypnotic
  • To provide sedation for critically ill patients
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18
Q

Propofol Mechanism of Action

A
  • Decreases cerebral blood flow, oxygen consumption, and intracranial pressure/increases cerebrovascular resistance
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19
Q

Propofol Route/Dosing

A
  • I.V. infusion: 2.8-130 mcg/kg/min (usual 27 mcg/kg/min)
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20
Q

Propofol Time of Onset/Peak/Half-Life

A
  • Within 40 sec/Unknown/3-5 min
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21
Q

Propofol Contraindications

A
  • Hypersensitivity, eggs/egg products, soybeans/soy products
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22
Q

Propofol Adverse Reactions

A
  • Bradycardia/hypotension/arrhythmias

- Propofol infusion syndrome

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23
Q

Propofol Special Nursing Considerations

A
  • Caution w/ cardiac disease, peripheral vascular disease, impaired cerebral circulation, or ICP (may aggravate)
  • Monitor triglyceride level, made of pure lipids - increased risk for pancreatitis
  • Stopping abruptly will cause rapid awakening/anxiety/agitation
  • Monitor for propofol infusion syndrome - metabolic acidosis, hyperkalemia, rhabdo, renal/cardiac failure
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24
Q

Propofol Interactions w/ Food/Drug/Testing

A
  • With CNS depressants/alcohol use: additive CNS depressant/respiratory depressant/hypotensive effects
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25
Lorazepam Name/Classification/Indications
- Ativan - Benzodiazepine/antianxiety, anticonvulsant, sedative - Treatment of anxiety/pre-op sedation/status epilepticus
26
Lorazepam Mechanism of Action
- Potentiate effects of neurotransmitters by binding to receptors of CNS
27
Lorazepam Route/Dosing
- P.O.: 1-3 mg BID-TID or 2-4 mg at bedtime - I.V.: 0.044 mg/kg or 2 mg - I.M.: 0.05 mg/kg - I.V. for seizures: 4 mg @ 2 mg/min, repeat q 10-15 min
28
Lorazepam Time of Onset/Peak/Half-Life
- I.V. - 5 min/unknown/12-24 h | - I.M. - 15-30 min/unknown/12-24 h
29
Lorazepam Contraindications
- Acute glaucoma, hypersensitivity, psychosis, intraarterial delivery
30
Lorazepam Adverse Effects
- Drowsiness/unsteadiness/confusion - Chest pain/tachycardia - Blurred vision - Respiratory depression
31
Lorazepam Special Nursing Considerations
- Increased risk of suicide in patients w/ untreated depression - Can cause physical/psychological dependence - Monitor respiratory status
32
Lorazepam Interactions w/ Food/Drug/Testing
- Increased CNS depression w/ alcohol - Additive CNS depression w/ other CNS depressants - Increased blood digoxin levels - Decreased therapeutic effects of fentanyl
33
Midazolam Name/Classification/Indications
- Versed - Benzodiazepine/sedative-hypnotic - Induce preoperative sedation/amnesia or control preoperative anxiety, relieve agitation and anxiety in mechanically ventilated patients
34
Midazolam Mechanism of Action
- Sedation effect by increasing gamma-aminobutyric acid, inhibitory neurotransmitter - producing calming effect, relaxing skeletal muscles, induces sleep
35
Midazolam Route/Dosing
- Oral sol'n (children): 0.5 mg/kg - I.V.: 1.5 mg over 2 min (over 60 y/o), 2.5 mg over 2 min, 5 mg max (under 60 y/o) - I.M.: 0.02-0.05 mg/kg (over 60 y/o), 0.07-0.08 mg/kg - I.V. infusion: 0.01-0.05 mg/kg over several minutes, repeated at 10-15 min. Maintenance 0.02-0.1 mg/kg/hr
36
Midazolam Time of Onset/Peak/Half-Life
- I.V.: 1.5-5 min/rapid/2-6 h | - I.M.: 5-15 min/15-60 min/2-6 h
37
Midazolam Contraindications
- Acute angle-closure glaucoma, alcohol intoxication, coma, hypersensitivity, shock
38
Midazolam Adverse Effects
- Agitation/delirium/dreaming - Cardiac arrest/hypotension/PVCs/tachy - Shallow breathing/respiratory arrest
39
Midazolam Special Nursing Considerations
- Determine if pt consumes alcohol, antihypertensives, antibiotics, or protease inhibitors - can produce prolonged sedative effect
40
Midazolam Interaction w/ Food/Drug/Testing
- Increased risk of hypotension w/ antihypertensives - Increased CNS depression w/ CNS depressants & alcohol - Avoid grapefruit/grapefruit juice - can increase level of midazolam
41
Haloperidol Name/Classification/Indications
- Haldol - Antidyskinetic, antipsychotic - Treat psychotic disorders/acute psychotic episodes/nonpsychotic behavior disorders/Tourette's syndrome
42
Haloperidol Mechanism of Action
- Block postsynaptic dopamine receptors in the limbic system and increases brain turnover of dopamine
43
Haloperidol Route/Dosing
- P.O. tabs: 0.5-5 mg BID-TID | - I.M.: 2-5 mg up to every 60 min, can repeat q 4-8h
44
Haloperidol Time of Onset/Peak/Half-Life
- I.M. - Unknown/3-4 days/unknown
45
Haloperidol Contraindications
- Epilepsy/other CNS depressants/CAD/Parkinson's disease/hyper/hypotension
46
Haloperidol Adverse Effects
- Agitation/anxiety/extrapyramidal reactions/QT-interval prolongation/torsades de pointes/anemia
47
Haloperidol Special Nursing Consideration
- Should not be used to treat dementia-related psychosis - Cautious use in pts with history of prolonged QT interval - Monitor CBC
48
Haloperidol Interaction w/ Food/Drug/Testing
- Increased CNS depression w/ alcohol
49
Fentanyl Name/Classification/Indications
- Sublimaze - Opioid, analgesic/anesthetia adjunct - Adjunct to regional anesthesia/manage postoperative pain/breakthrough pain in cancer patients
50
Fentanyl Mechanism of Action
- Binds to opioid receptors in CNS, altering perception of response to pain by inhibiting pain pathways
51
Fentanyl Route/Dosing
- I.V.: 0.05-0.1 mg slow over 1-2 min - I.M.: 0.05-0.1 mg - Transdermal
52
Fentanyl Time of Onset/Peak/Half-Life
- I.V.: 1-2 min/3-5 min/30-60 min - I.M.: 7-15 min/20-30 min/1-2 h - Transdermal: 12-24 h/unknown/over 72 h
53
Fentanyl Contraindications
- Asthma, myasthenia gravis, opioid hypersensitivity/intolerance
54
Fentanyl Adverse Effects
- Agitation/hallucinations/seizures - Bradycardia/hypotension/orthostatic hypo/edema - Diaphoresis/rash
55
Fentanyl Special Nursing Consideration
- Not to be given to women during pregnancy/labor/while breastfeeding - Monitor for decrease in respiratory drive with pt history of hypoxia/respiratory depression - 100 mcg of fentanyl = 10 mg morphine!
56
Fentanyl Interaction w/ Food/Drug/Testing
- Hypotension w/ antihypertensives/diuretics - Increased CNS/respiratory depression w/ CNS depressants - Increased blood fentanyl level w/ grapefruit juice & alcohol
57
Hydromorphone Name/Classification/Indications
- Dilaudid - Analgesic - Relieve moderate to sever pain
58
Hydromorphone Mechanism of Action
- Bind w/ opioid receptor in spinal cord altering perception of pain
59
Hydromorphone Route/Dosing
- P.O. sol'n: 2-5-10 mg q 3-6 h - P.O. tablets: 2-4 mg q 4-6 h - I.V.: 0.2-1 mg q 2-3 h - I.M.: 1-2 mg q 2-3 - P.R.: 3 mg q 6-8 h
60
Hydromorphone Time of Onset/Peak/Half-Life
- P.O.: 30 min/1.5-2 h/4 h - I.V.: 10-15 min/15-30 min/2-3 h - I.M.: 15 min/30-60 min/4-5 h - P.R.: 30 min/unknown/4 h
61
Hydromorphone Contraindications
- Acute asthma, GI obstruction, ileus, upper respiratory tract obstruction
62
Hydromorphone Adverse Effects
- Confusion/hallucinations/headache - HTN, orthostatic hypotension/tachy - N/V/constipation
63
Hydromorphone Special Nursing Considerations
- Monitor for respiratory depression, especially in patients w/ significant respiratory disease - Monitor patients w/ seizure disorder - may aggravate or induce convulsions
64
Hydromorphone Interaction w/ Food/Drug/Testing
- Increased risk of ileus w/ anticholinergics | - Increased risk of orthostatic hypotension w/ antihypertensives/diuretics
65
Morphine Class/Indication
- Analgesic | - Relief/management of moderate to severe pain
66
Morphine Mechanism of Action
- Binds w/ and activates opioid receptors in brain and spinal cord to produce analgesia and euphoria
67
Morphine Route/Dosing
- P.O. capsules/oral sol'n/syrup/tablets: 5-30 mg q 3-4 h - P.O. ER: 30 mg q 24 h - I.V. infusion: 0.8 - 80 mg/hr - I.V. injection: 4-15 mg q 3-4 h - I.M./S.Q.: 2.5-20 mg q 3-4 h - Epidural: 5 mg single dose, 1-2 mg dose q 1 h - Intrathecal: 0.2-1 mg single dose - P.R.: 10-30 mg q 4 h
68
Morphine Time of Onset/Peak/Half-Life
- P.O.: Unknown/1-2 h/4-5 h - P.O. ER: Unknown/unknown/8-12 h - I.V.: Unknown/20 min/4-5 h - I.M.: 10-30 min, 30-60 min, 4-5 h - S.Q.: 10-30 min/50-90 min/4-5 h - Epidural: 15-60 min/unknown/24 h - Intrathecal: 15-60 min/unknown/24 h - P.R.: 20-60 min/unknown/unknown
69
Morphine Contraindications
- Acute asthma, respiratory depression, acute abdominal disorders, alcohol withdrawal syndrome, seizure disorders, brain tumor, HF
70
Morphine Adverse Effects
- Respiratory depression, seizure - Bradycardia, edema, hyper/hypotension, tachycardia, - Bronchospasm
71
Morphine Special Nursing Considerations
- Morphine decreases respiratory drive while increasing airway resistance - monitor respiratory status - Give oral form w/ food to minimize GI upset
72
Morphine Interaction w/ Food/Drug/Testing
- Increased CNS depression w/ alcohol, anticholinergics, CNS depressants, neuromuscular blockers
73
Flumazenil Name/Class/Indication
- Romazicon - Benzodiazepine antidote - Reversal agent for benzodiazepine toxicity/suspected overdose
74
Flumazenil Mechanism of Action
- Antagonizes CNS effects of benzo's by competing for their binding sites
75
Flumazenil Route/Dosing
- I.V.: 0.2 mg repeated after 40-60 sec, can repeat q 1 min as needed OR - I.V.: 0.2 followed by 0.3 30-60 sec later then 0.5 mg repeated q 1 min
76
Flumazenil Time of Onset/Peak/Half-Life
- I.V.: 1-2 min/6-10/variable
77
Flumazenil Contraindications
- Evidence of tricyclic antidepressant overdose, use of benzo's to control ICP, seizures
78
Flumazenil Adverse Effects
- Agitation/seizures/tremors | - HTN, palpitations
79
Flumazenil Special Nursing Considerations
- Monitor for rise in BP as indication of benzo withdrawal | - Monitor for resedation/hypoventilation after 2 hrs - has short half life
80
Flumazenil Interaction w/ Food/Drug/Testing
- Loss of effectiveness of benzo's or tricyclicc antidepressants (also risk for seizures) - Increased flumazenil clearance by half w/ food ingestion during I.V. injection
81
Naloxone Name/Class/Indication
- Narcan - Opioid antagonist - Treat known or suspected opioid overdose
82
Naloxone Mechanism of Action
- Competitively antagonizes receptors in the CNS reversing analgesia, hypotension, respiratory depression, and sedation
83
Naloxone Route/Dosing
- I.V./I.M./S.Q.: 0.4-2 mg q 2-3 min | - Nasal spray: 4 mg (1 spray) q 2-3 min alternating each nostril
84
Naloxone Time of Onset/Peak/Half-Life
- I.V.: 1-2 min/5-15 min/45 min - I.M./S.Q.: 2-5 min/5-15 min/45 min - Nasal: 1-3 min/unknown/unknown
85
Naloxone Contraindications
- Hypersensitivity
86
Naloxone Adverse Effects
- Excitement/irritability - HTN/v. fib/v. tach - Diaphoresis/N/V
87
Naloxone Special Nursing Considerations
- Keep CPR equipment available | - Nasal spray cannot be reused
88
Naloxone Interaction w/ Food/Drug/Testing
- Withdrawal symptoms may occur in opioid-dependent patients
89
Dexmedetomidine Name/Class/Indications
- Precedex - A2 - adrenoceptor agonist - Sedation of initially intubated and mechanically ventilated patients/sedation of non-intubated patients prior to and/or during procedures
90
Dexmedetomidine Mechanism of Action
- Decreases sympathetic activity, decreases norepinephrine and epinephrine levels
91
Dexmedetomidine Route/Dosing
- I.V.: 0.2-0.7 mcg/kg/h
92
Dexmedetomidine Time of Onset/Peak/Half-Life
- 5 min/15 min/2.5 h
93
Dexmedetomidine Contraindications
- None
94
Dexmedetomidine Adverse Effects
- Hypotension, bradycardia, transient hypertension
95
Dexmedetomidine Special Nursing Considerations
- Does not cause respiratory depression | - Facilitates extubation
96
Dexmedetomidine Interaction w/ Food/Drug/Testing
- Co-administration w/ other opioids, sedatives, hypnotics can enhance effect

ICU TRANSITION PROGRAM (3 decks)

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