ادوية العناية المركزة

1. Drugs In
ICU

2. Introductio
n
▶ Drug as “ a chemical substance used in the treatment, cure, prevention, or
diagnosis of disease or used to otherwise enhance physical or mental well-
being “.
▶ Drugs may be prescribed for a limited duration, or on a regular basis for
chronic disorders .
▶ e drugs in I.C.U is ve impo ant as fast inter v
ention .
▶ Most of I.C.U cases are life threating so we need drugs that decrease
fatal chance &
improving the hea & lungs function .

3. Outlin
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1.
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Introduction
e Classi cation Of Drugs in ICU related their
a ect:
Cardiovascular System Drugs.
Respirator y
System Drugs.
Ne ous System Drugs.
Urinar y
System Drugs.
G.I.T System Drugs.
Documentation

4. A) Cardiovascular
Drugs
1
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Vasopressors:
Adrenalin (Generic Name: Epinephrine Injection)
α-adrenergic e ects can increase coronar y
& cerebral per f
usion pressure by
vasoconstriction
β-adrenergic can increase myocardial contractility
Indication:
It is a chemical that narrows blood vessels & opens airways in the lungs.
ese e ects can reverse severe low blood pressure.
Epinephrine injection is used to treat severe allergic reactions (anaphylaxis).
Contraindication:
Hear tdisease or high blood pressure
A hear trhythm disorder VT VFiB.
Coronar y
ar t
er y
disease.
A thyroid disorder (storm).

5. Con
t.
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Epinephrine side ef f
ects:
Fast, pounding or uneven
hea beats.
Sweating.
Nausea & vomiting.
Pale skin.
Dizziness.
Weakness or tremors.
Headache.
Feeling ne ous or anxious.
Dose & route of administration
1 mg/mlinjection q3-5 min

6. Other
Vasopressors:
1
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Levophed (norepinephrine bitar t
rate)
Vasoconstrictor, similar to adrenaline, used to treat life-threatening low blood
pressure
(hypotension).
Dose in Acute Hypotension Initial: 0.05-0.1 mcg/kg/min IV infusion; titrate to
e ect
Maximum: 1-2 mcg/kg/min
Dobutamine
Sympathomimetic with Beta 1 increase myocardial contractility & stroke volume,
resulting in increased cardiac output.
Used in the treatment of cardiogenic shock & severe hear tfailure. 3-Dopamine
Sympathomimetic
Used for hypotension (shock) & hea block to increase hear trate when atropine
has not
been e ective
Dose: 1-20mcg/kg/min (in 250ml D5W)

7. 2- Anti-Arrhythmic
drugs:
1
2
3
Cordarone
Generic Name: Amiodarone
It works on cardiac cell membranes .
It relaxes the smooth muscles.
Indication
Hemodynamically unstable ventricular
tachycardia, supraventricular tachycardia,
ventricular brillation.
Contraindication
Allergic to any ingredient in Cordarone ,
including iodine.
Complete, 2ND degree, 3RD degree, or severe
sinoatrial hear tblock; an abnormally slow
hear t
beat; or shock due to serious hea
problems.
Cardiogenic shock.

8. Cont.
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Side ef f
ects
CNS:
Headache, dizziness, involunta movement, tremors, peripheral
neuropathy,
ataxia, malaise.
CVS:
Hypotension, bradycardia, sinus arrest, CHF, SA node dysfunction,
AV block.
Eye: blurred vision, photophobia, d eyes.
Endocrine: hypo/hype hyroidism
Resp:
Pulmona brosis/toxicity, pulmona in ammation, ARDS.
Gastrointestinal:
nausea, vomiting, diarrhea, abdominal pain, anorexia, hepatotoxicity.
Rash, photosensitivity, blue-gray skin discoloration, alopecia,
u icaria.
Weakness, pain in extremities.

9. Anti-Arrhythmic
Medication

10. 3-
Digitalis
•
•
Digitalis medicines are used to improve the strength & e ciency of the hear t
, or to control the
rate &
rhythm of hea beat.
is leads to better blood circulation & reduced swelling of hands and ankles in patients with
hear tproblems.
Digoxin Generic Name: Digoxin Injection

11. A TROPIN
E
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Ter t
iar y
amine .
Can rapidly cross the blood–brain barrier.
Dosage & Packaging
Intravenously or intramuscularly in a range of 0.01–0.02 mg/kg, up to the usual
adult dose of 0.4–0.6 mg .
Clinical Considerations
e most e cacious anticholinergic (parasympatholytic) for treating
bradyarrhythmias.
Patients with corona a e disease may not tolerate the increased myocardial
oxygen demand & decreased oxygen supply associated with the tachycardia
caused by atropine.
Ipratropium bromide, is available in a metered-dose inhaler for the treatment of
bronchospasm.
Provides an antisialagogue e ect.
Atropine should be used cautiously in patients with narrow-angle glaucoma,
prostatic
hyper t
rophy, or bladder-neck obstruction.

12. Other Common
Drugs:
DRUG CLASSIFIED AFFECT
CALC IUM
CHLORIDE
Antidotes Disturbances Of Hyperkalemia, Or Hypocalcemia
Magnesium sulfate overdose
Cardiac arrest
•
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SODIUM
NITROPRUSSIDE
ANTIHYPERTENSVE
VASODILATOR
Used To Management Of hype ensive Crisis
Congestive Hea Failure.
•
•
ANGITENSIN-
CONVERTING ENZYME
INHIBITOR
ANTIHYPERTENSVE Hype ension
Congestive Hea Failure
•
•
ADENOSIINE
(ADENOCARD)
ANTI-ARRHYTHMIC AGENT
ANTI-ARRHYTHMIC
Paroxysmal Supra Ventricular Tachycardia
•

13. B) Respirato
Drugs:
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Bronchodilators:
1)Atrovent Generic Name: ipratropium inhalation
Is a derivative of atropine but is a quaterna amine and therefore does
not cross
the blood–brain barrier
Indication :
Used to prevent bronchospasm, or narrowing airways in the lungs,
bronchitis, emphysema, or COPD (chronic obstructive pulmona
disease).
Contraindication:
Narrow-angle glaucoma
An enlarged prostate or a bladder obstruction (increase retention).
Side ef f
ects:
Headache, dizziness.
Nausea, upset stomach.
Blurred vision

14. Ventolin
Generic Name: albuterol
inhalation
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Indication
Ventolin is a sympathomimetic (beta agonist) bronchodilator that relaxes the
smooth
muscle in the airways which allows air to ow in and out of the lungs more
easily.
Used to treat or prevent bronchospasm in people with reversible obstructive
airway disease
Contraindication:
Allergic to albuterol.
Hea disease, high blood pressure, or congestive hea failure a hea rhythm
disorder
Side ef f
ects:
Chest pain & fast, pounding, or uneven hea beats.
Tremor & ne ousness.
Low potassium (confusion, uneven hea rate, extreme thirst, leg discomfo ,
muscle
weakness or limp feeling)

15. C) Ne ous System
Drugs:
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Narcotics: (ANALGESIA)
1) M ORPHINE
Morphine is a μ opioid with intermediate onset & duration of action.
Extensive clinical experience makes morphine a valuable rst-line opioid.
Active metabolites include morphine-3-glucuronide (toxic, nonanalgesic) &
morphine-6-glucuronide (potent analgesic).
Neuraxially administered morphine has a duration of action of 12 to 24 hours.
e equianalgesic oral morphine dose is three to four times the IV dose.
( Iv : Oral ) (1 :3 )
To treat moderate to severe pain.
It works by dulling the pain perception center in the brain.
Extended-release formulations are used when around-the-clock pain relief is
needed.

16. Con
t.

17. Con
t.
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Side ef f
ect:
Shallow breathing, slow hea beat.
Seizure (convulsions).
Cold, clammy skin.
Confusion.
Severe weakness or dizziness; or Feeling light-headed,
fainting.
Less serious morphine side ef f
ects are more likely to occur,
such as:
Constipation.
Warmth, tingling, or redness under your skin.
Nausea, vomiting, stomach pain, diarrhea, loss of
appetite.
Dizziness, headache, anxiety.
Memo problems; or Sleep problems (insomnia).

18. 2) REMIFENTA N IL (ULTIV A )
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Remifentanil is a synthetic μ agonist, approximately equipotent with
fentanyl.
It is rapidly metabolized by blood & tissue esterases.
Has a constant context-sensitive half-time of ±3.5 min, independent of age,
weight,
organ function, & duration of infusion.
Bolus-dose administration carries the risk of acute bradycardia,
hypotension, &
respirato depression .
MEPERIDINE (PETHIDINE)
Meperidine is a phenylpiperidine opioid with additional antimuscarinergic &
serotonin reuptake-inhibiting e ects.
Meperidine may produce intense euphoria, but not always sedation or
anxiolysis.
Its analgesic e ect is not superior to that of morphine.
Meperidine should not be co-administered with M AO inhibitors.

19. Sedative( Hypnosis) :
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Midazolam is a (benzodiazepine).
Benzodiazepine binding to the GABA-A receptor
Midazolam (pH 3.5) is a water-soluble drug that is conve ed to a lipid-soluble drug when exposed
to the blood’s .
e lipid-soluble form of midazolam can readily cross the blood-brain barrier & exer tits
pharmacologic e ects.
It works in the central ne ous system (brain) to cause sedation, sho -term memo loss & to
reduce anxiety.
Highly lipid soluble unionized ring, accounting for its rapid onset of action.
It does not cause pain on injection IV but painful to IM route.
Indication:
Given continuously to maintain sedation
Used for general anesthesia.
ey are e ective in preventing & controlling grand mal seizures
Contraindication:
Patient with known hypersensitivity.
Narrow angel glaucoma.

20. Con
t.
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Side ef f
ect
Benzodiazepines given alone decrease ar t
erial blood pressure,
cardiac output & peripheral vascular resistance slightly, and
sometimes increase hear trate.
Depress the ventilato response to CO2 .
Benzodiazepines reduce cerebral oxygen consumption,
cerebral blood ow, & intracranial pressure.
Caution
CRF , CHF , COPD & sever hypotension.

21. Propofol (2,6–diisopropylphenyl)
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Propofol is extremely lipid-soluble.
Ampoules of the drug contain 200 mg of propofol in 20 mL (10 mg mL−1) & 100 mL
bottles containing 1% solution, are available for infusion
Infusion rate is approximately 2mg/kg /h in conjunction with a slow infusion of
morphine
(2mg/h) for sedation of patients in ICU & recover y
is rapid (usually < 30 min)..
It is isotonic to plasma and has a pH of 7.0 - 8.5 Anesthesia is induced within 20–40
s after I.V. administration
Propofol crosses the placenta.
Indication
For induction of general anesthesia
Sedation in ICU for pt. on M V
Sedation for diagnostic procedures (endoscopies).
Propofol reduces the duration of seizures
Cerebral metabolic rate, CBF & intracranial pressure are reduced.

22. Cont.
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Side ef f
ect
Profound hypotension after induction of anesthesia
After induction, apnea occurs more commonly
Low incidence of postoperative nausea & vomiting ( anti-emetic )
Plasma concentrations of co isol are decreased after administration of
propofol
Transient decrease in renal function.
Hepatic blood ow is decreased .
ere have been occasional repor t
s of convulsions & myoclonus during
recove
Skin rashes occur occasionally.
Pain on injection.
Propofol infusion syndrome is an adverse drug event associated with high
doses (>4
mg/kg per hour & long-term (>48 hours) use.
Causes ( Cardiomyopathy with acute cardiac failure, Myopathy ,Metabolic
acidosis,

23. Dexmedetomidin
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Selective alpha-2 adrenergic agonist
Has sedative, amnestic & mild analgesic e ects, yet does not depress
ventilation
Unique because arousal is maintained, despite deep levels of sedation
Patients can be aroused from sedation without discontinuing the drug
infusion &
when awake, patients are able to communicate and follow commands.
Lower prevalence of delirium
Side ef f
ect:
Hypotension and bradycardia

24. Haloperid
ol
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First-generation antipsychotic
Blocks dopamine receptors in the central ne ous system.
Following an IV bolus dose of haloperidol:
Sedation in 10–20 minutes (Not appropriate when rapid sedation is
required)
E ect lasts 3–4 hours
No respirator y
depression
Suited for sedation during weaning from mechanical ventilation.
Adverse ef f
ects
Extrapyramidal reactions (Rigidity and spasmodic movement)
Neuroleptic Malignant syndrome (Hyperpyrexia, severe muscle rigidity
&
rhabdomyolysis)
Prolongation of QT inter v
al (Trigger polymorphic VT)

25. D) G.I.T system
drugs
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Proton Pump Inhibitor
Omeprazole
Indication
Decreases gastric juice.
Used to treat symptoms of gastroesophageal ref l
ux disease (GERD)
& To
prevent VAP (Ventilator Associated Pneumonia).
It is also used to promote healing of erosive esophagitis
Contraindication:
Diarrhea from an infection with clostridium di cile bacteria
Inadequate vitamin B12
Low amount of magnesium in the blood
Liver problems
A type of kidney in ammation called interstitial nephritis
Subacute cutaneous lupus e thematosus
Systemic lupus e thematosus
An autoimmune disease
Osteoporosis

26. METOCLOPRAMID
E
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Metoclopramide antagonizes the ef f
ect of dopamine in the gut.
Increases lower esophageal sphincter tone.
Speeds gastric emptying, and lowers gastric uid volume.
e elimination half-life is 4 to 6 hours.
Central adverse e ects, including sedation, extrapyramidal
symptoms .
Relatively contraindicated in patients with epilepsy because it has
been repo ed to elicit seizures.

27. E) Urina system
drugs
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DIURETIC
Lasix
is medicine is a loop diuretic.
Loop diuretics make the kidneys eliminate larger amounts of
electrolytes (especially sodium and potassium salts) and water
than normal (diuretic e ect).
Loop diuretics are useful for treating many conditions in which
salt and
water retention (e.g., edema, swelling) are a problem.
Contraindication:
Anuric patient
Allergy to sulfa drugs
Side ef f
ects
D mouth, thirst, nausea, vomiting
Feeling weak, drowsy, restless, or light-headed
Fast or uneven hear t
beat
Muscle pain or weakness

28. Muscle
Relaxant
Blocking
Agents
Depolarizing Nondepolarizing
Shor t
-acting
Succinylcholine
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Shor t
-acting
Gantacurium
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Intermediate-acting
Atracurium
Cisatracurium
Vecuronium
Rocuronium
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Long-acting
Pancuronium
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29. Succinylcholine
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Consists of two joined ACh molecules
Rapid onset of action (30–60 s) and shor tduration
Mechanism of action:
ese drugs act like acetylcholine but persist at the synapse at high
concentration &
for longer duration & constantly stimulate the receptor.
First, opening of the Na+ channel occurs resulting in depolarization, this leads
to transient twitching of the muscle, continued binding of drugs make the
receptor incapable to transmit the impulses, paralysis occurs.
Indication
When rapid endotracheal intubations is required.
Electroconvulsive shock therapy ECT.
Side ef f
ects:
Bradycardia and sinus arrest. (Muscarinic stimulation of the sinus
node)
Increase intraocular pressure due to contracture of extra ocular
muscles .
Increase in lower esophageal sphincter tone.
Fasciculations
Muscle pains
Postoperative myalgias
Hyperkalemia in patients with trauma or burns

30. 
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Unwanted ef f
ects:
Prolonged Paralysis – scoline apnea (reduced levels of normal
pseudocholinesterase)
Intracranial Pressure
Histamine Release .
Masseter Muscle Rigidity - transiently increases muscle tone in the
masseter
muscles.
Malignant Hyper t
hermia - potent triggering agent in patients
susceptible to
malignant hype hermia
Cont.

31. Nondepolarizing Muscle
Relaxants
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1.
2.
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4.
5.
ATRACURIUM
Clinical Considerations
Atracurium triggers dose-dependent histamine release that
becomes signi cant at doses above 0.5 mg/kg.
Slowly administar t
ion reduces the histamine release .
It must be stored at 2–8°C, as it loses 5% to 10% of its potency
for each month it is exposed to room temperature.
At room temperature, it should be used within 14 days to
prese e potency.
Side E ects:
Hypotension and Tachycardia.
Bronchospasm
Laudanosine Toxicity (Laudanosine is a metabolite of the
neuromuscular-blocking drugs atracurium & cisatracurium
with potentially toxic systemic e ects. It crosses the blood-
brain barrier and may cause excitement and seizure activity.)
Temperature and pH Sensitivity
Allergic Reactions – rare

32. Nondepolarizing Muscle
Relaxants
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C ISATRACURIUM ( N IMBEX)
Clinical Considerations
Cisatracurium is a stereoisomer of atracurium that is four times more potent.
Cisatracurium should be stored under refrigeration (2–8°C)
Should be used within 21 days after removal from refrigeration and exposure to room
temperature.
Cisatracurium shares with atracurium the production of laudanosine, pH and temperature
sensitivity (hofmann elimination) & chemical incompatibility.
Dose-dependent increase in plasma histamine levels following administration.
Cisatracurium does not alter hea rate or blood pressure .