Adult Critical Care Medicine Drugs Cheat Sheet 2013©Edward M. Omron MD, MPH, FCCPPulmonary Critical Care Medicine1. Vasopr...
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Critical Care Medicine Drug Sheet

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Commonly used drugs in the ICU, intensive care unit
Edward Omron MD, MPH, FCCP
Pulmonary, Critical Care, and Internal Medicine
Morgan Hill, CA 95037

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Critical Care Medicine Drug Sheet

  1. 1. Adult Critical Care Medicine Drugs Cheat Sheet 2013©Edward M. Omron MD, MPH, FCCPPulmonary Critical Care Medicine1. Vasopressors/Inotropesa. NorepinephrineDose: 1-5 mcg/min initial, double dose every 5 min to achieve MAP> 65 mm Hg(Usual range is 5 – 40 mcg/min, up to 75 mcg/min have been used), 1stpressor in shockb. VasopressinPulseless VT/VF dose: 40 Units IV or intratracheal onceDose: 0.04 Units/minute, use in conjunction with Norepinephrine for salvage BP effectc. DobutamineDose: 2-5 mcg/kg/min (usual dose is 5-20 mcg/kg/min), inotrope and systemic vasodilatorGoal directed therapy protocol, ScvO2 < 70%, lactate > 4 mmol/Ld. EpinephrineDose: 2 mcg/min initially, double dose every 5 minutes to achieve effect(Usual dose is 5-20 mcg/min) chronotrope, inotrope, and vasoconstrictore. PhenylephrineDose: 50 to 100 mcg bolus IV, maint 50-300 mcg/min, do not use in septic shock unlessserious arrhythmias with norepinephrine, cardiac output high with low blood pressure2. Sedatives and Analgesics (Titrate to a defined RASS Score, Sedation Vacation)a. FentanylEndotracheal tube tolerance: 25 mcg/hr infusionAnalgesic comfort range: 50- 100 mcg/hr infusion(0.5 -1.5 mcg/kg/hour)High lipid solubility, decreases gut motility, tachyphylaxis commonElimination: Hepatic, half life 3-5 hoursb. MidazolamUsual dose 1-5 mg/hour infusionHigh lipid solubility, short acting initially, tachyphylaxis commonElimination: Hepatic, half life 3-5 hours.c. PropofolNo analgesic properties, no loading dose in critically ill, 2 calories/mLLight sedation: 5-25 mcg/kg/min; Heavy sedation 30-75 mcg/kg/minRapid onset and offset, hypertriglyceridemia and hyperlipidemiaElimination: Hepatic, half-life 30 minutes, monitor for infusion syndromed. LorazepamDose: 1-5 mg/hr infusion or bolus q2, q4, q6 pending severity of anxietyPropylene glycol poisoning in acute kidney failure, >3 days infusion withOsmolar Gap Metabolic Acidosise. PrecedexDose: 0.2-1.4 mcg/kg/hour, monitor for bradicardia/hypotensionMechanims: alpha 2 agonist similar to clonidine, sedative, hypnotic, analgesicContra-indications: hypovolemia, renal or hepatic insufficiency, may havenegative chronotropic effect, respiratory depression at higher doses, consider in activedelirium by CAM ICU assessment or drug withdrawal protocol3. Antiarrhythimicsa. AmiodaroneAtrial Fibrillation or Ventricular Arrhythmia: Bolus 150 mg over 10 minutes, repeat q5-10minutes; pulseless V.Tach or V. Fib: Bolus 300 mg and repeat 150 mg q5-10 minutesMaintenance: 1 mg/min for 6 hours, then 0.5 mg/min afterwardsMay cause hypotension, transaminitis, hypothyroidism, and ILD; half -life 55 daysb. LidocaineSalvage RX in cardiac arrhythmias, ventricular tachycardia/fibrillation and may causehypotension, methemoglobinemia, and malignant hypothermia; supplanted by amiodaroneDose: 1-1.5 mg/kg IVP over 3 minutes, may repeat doses of 0.5-0.75 mg/kg in 5-10minutes for total 3 mg/kg dose. Maintenance: 1-4 mg/min IVc. Magnesium ChlorideManagement of ventricular arrhythmias, including torsade de pointes and atrialtachyarrhythmias: 2 grams Magnesium Sulphate IVP Stat.4. Vasodilators, Antihypertensives, and Beta Blockersa. LabetololDose: 10 – 20 mg IV q10 – 20 minutes, may increase to 20 – 40 mg q10 – 20 min ifNo effect. Infusion Technique: Start at 1 mg/min, titrate up every 5 minutesUpper limits of dose limited by B-blockade effect, monitor heart rate closelyb. Cardene (Nicardipine)Malignant hypertension: 5 mg/hour titrate 5-15 minutes to 15 mg/hr IVc. HydralazineHypertensive emergency: 5-20 mg IVP q1-q6 hoursd. NitroglycerinMyocardial ischemia/afterload reduction/CHF: 10 mcg/min initial titrate to 150-200mcg/min IV, Initial venous then arterial dilation; hypotension/ tachyphylaxis raremethemoglobinemiae. NitroprussideHypertensive Crisis/CHFDose: 1 mcg/kg/min, increase every 5 minutes (Usual dose 1 – 5 mcg/kg/min)Monitor for cyanide toxicity, carboxyhemoglobinemia, and methemoglobinemiaCannot use in evolving acute kidney injury.f. Cleviprex(Clevidipine)Malignant hypertension: 1-2 mg/hr increase every 90 seconds, maintainence 4-6 mg/hr,Not to exceed 21 mg/hr; very expensive, equal alternativesg. EsmololSupraventricular tachycardias, Hypertensive Emergency:Begin at 50 mcg/kg/min (Usual dose is 50- 200 mcg/kg/min)Ultra short acting beta blocker, half -life 20 minutes, not very potent antihypertensiveAll information contained on the handout is intended for informational and educational purposes.The information is not intended nor suited to be a replacement or substitute for professionalmedical treatment or for professional medical advice relative to a specific medical question orcondition. Do not use the information on this handout for diagnosing or treating any medical orhealth condition in the absence of a board certified physician in Critical Care Medicine.

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