Adult Critical Care Medicine Drugs Cheat Sheet 2013©
Edward M. Omron MD, MPH, FCCP
Pulmonary Critical Care Medicine
1. Vas...
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Adult Critical Care Medicine Drugs Cheat Sheet 2013 Edward Omron MD

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Critical Care Drugs for ICU housestaff
Edward Omron MD, MPH, FCCP
Morgan Hill, CA 95037
www.docomron.com
http://www.youtube.com/user/edofiron1

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Adult Critical Care Medicine Drugs Cheat Sheet 2013 Edward Omron MD

  1. 1. Adult Critical Care Medicine Drugs Cheat Sheet 2013© Edward M. Omron MD, MPH, FCCP Pulmonary Critical Care Medicine 1. Vasopressors/Inotropes/Paralytics a. Norepinephrine Dose: 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), 1st pressor in shock b. Vasopressin Pulseless VT/VF dose: 40 Units IV or intratracheal once Dose: 0.04 Units/minute, use in conjunction with Norepinephrine for salvage BP effect c. Dobutamine Dose: 2-5 mcg/kg/min (usual dose is 5-20 mcg/kg/min), inotrope and systemic vasodilator Goal directed therapy protocol, ScvO2 < 70%, lactate > 4 mmol/L d. Epinephrine Dose: 2 mcg/min initially, double dose every 5 minutes to achieve effect (Usual dose is 5-20 mcg/min) chronotrope, inotrope, and vasoconstrictor e. Phenylephrine Dose: 50 to 100 mcg bolus IV, maint 50-300 mcg/min, do not use in septic shock unless serious arrhythmias with norepinephrine, cardiac output high with low blood pressure f. Dopamine Dose:1-20 mcg/kg/min , mostly used for B1 effects/chronotropy, high incidence of atrial / ventricular dysrhythmias and tachycardia. Do not use with Linezolid. g. Vecuronium (non-depolarizing skeletal muscle relaxant) Dose: load 0.1 mg/kg IVP, maintenance 1 mcg/kg/min IV. Do not use with Dantrolene. 2. Sedatives and Analgesics (Titrate to a defined RASS Score, Sedation Vacation) a. Fentanyl Endotracheal tube tolerance: 25 mcg/hr infusion Analgesic comfort range: 50- 100 mcg/hr infusion(0.5 -1.5 mcg/kg/hour) High lipid solubility, decreases gut motility, tachyphylaxis common Elimination: Hepatic, half life 3-5 hours b. Midazolam Usual dose 1-5 mg/hour infusion High lipid solubility, short acting initially, tachyphylaxis common Elimination: Hepatic, half life 3-5 hours. c. Propofol No analgesic properties, no loading dose in critically ill, 2 calories/mL Light sedation: 5-25 mcg/kg/min; Heavy sedation 30-75 mcg/kg/min Rapid onset and offset, hypertriglyceridemia and hyperlipidemia Elimination: Hepatic, half-life 30 minutes, monitor for infusion syndrome d. Lorazepam Dose: 1-5 mg/hr infusion or bolus q2, q4, q6 pending severity of anxiety Propylene glycol poisoning in acute kidney failure, >3 days infusion with Osmolar Gap Metabolic Acidosis e. Precedex Dose: 0.2-1.4 mcg/kg/hour, monitor for bradicardia/hypotension Mechanims: alpha 2 agonist similar to clonidine, sedative, hypnotic, analgesic Contra-indications: hypovolemia, renal or hepatic insufficiency, may have negative chronotropic effect, respiratory depression at higher doses, consider in active delirium by CAM ICU assessment or drug withdrawal protocol 3. Antiarrhythimics a. Amiodarone Atrial Fibrillation or Ventricular Arrhythmia: Bolus 150 mg over 10 minutes, repeat q5-10 minutes; pulseless V.Tach or V. Fib: Bolus 300 mg and repeat 150 mg q5-10 minutes Maintenance: 1 mg/min for 6 hours, then 0.5 mg/min afterwards May cause hypotension, transaminitis, hypothyroidism, and ILD; half -life 55 days b. Lidocaine Salvage RX in cardiac arrhythmias, ventricular tachycardia/fibrillation and may cause hypotension, methemoglobinemia, and malignant hypothermia; supplanted by amiodarone Dose: 1-1.5 mg/kg IVP over 3 minutes, may repeat doses of 0.5-0.75 mg/kg in 5-10 minutes for total 3 mg/kg dose. Maintenance: 1-4 mg/min IV c. Magnesium Chloride Management of ventricular arrhythmias, including torsade de pointes and atrial tachyarrhythmias: 2 grams Magnesium Sulphate IVP Stat. 4. Vasodilators, Antihypertensives, and Beta Blockers a. Labetolol Dose: 10 – 20 mg IV q10 – 20 minutes, may increase to 20 – 40 mg q10 – 20 min if No effect. Infusion Technique: Start at 1 mg/min, titrate up every 5 minutes Upper limits of dose limited by B-blockade effect, monitor heart rate closely b. Cardene (Nicardipine) Malignant hypertension: 5 mg/hour titrate 5-15 minutes to 15 mg/hr IV c. Hydralazine Hypertensive emergency: 5-20 mg IVP q1-q6 hours d. Nitroglycerin Myocardial ischemia/afterload reduction/CHF: 10 mcg/min initial titrate to 150-200 mcg/min IV, Initial venous then arterial dilation; hypotension/ tachyphylaxis rare methemoglobinemia e. Nitroprusside Hypertensive Crisis/CHF Dose: 1 mcg/kg/min, increase every 5 minutes (Usual dose 1 – 5 mcg/kg/min) Monitor for cyanide toxicity, carboxyhemoglobinemia, and methemoglobinemia Cannot 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 alternatives g. Esmolol Supraventricular 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 antihypertensive All 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 professional medical treatment or for professional medical advice relative to a specific medical question or condition.

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