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Drugs for ICU Patien
| Question | Answer |
|---|---|
| Morphine Sulfate IM, IV, PO | general opiate of choice |
| Hydromorphone | Dilaudid; use in morphine intolerance, hemodynamic instability or renal dysfunction |
| Fentanyl | Sublimaze; IV |
| Acetaminophen | NSAIDs may be added to opiates |
| Keterolact | Tordal; max use of 5 days |
| Lorazepam | Ativan; long-term sedation (>24-72 hrs) |
| Midazolam | Versed; acute and short term (<24-72 hrs) |
| Proprofol | Diprivan; use when rapid awakening needed |
| Haloperidol | Haldol; IV and PO; drug of choice for delirium |
| Pancuronium | Pavulon; general NMB of choice because of low cost; causes tachycardia |
| Vercuronium | norcuron; use in hemodyamic instability, renal dysfunction, cardiac disease |
| Cisatracurium | use in renal and hepatic dysfunction |
| Dexmedetomidine | Precedex; central alpha 2 agonist indicated for sedation <24 h (cont IV infusion); advantage is less resp depression; ADR - hypotension, bradycardia |
| Traumatic Brain Injury Treatment | 1) Mannitol/Loops; 2) Propofol or Fentanyl sedation; Pentobarbital if refractory intracranial HTN; 3) Vecuronium if refractory intracranial HTN; 4) vasopressors/inotropes to maximize fluid status or for shock; 5) phenytoin x 7 days 6) Nimodipine 4 hemmor |
| Treatment for acute spinal cord injury | Methylprednisolone for 24 hours if within 3 hours of injury; for 48 hrs if within 3-8 hrs; none if more than 8 hours of injury |
| Severe sepsis | sepsis + major organ dysfunction (hypotension unresponsive ot fluids, oliguria, acute mental status change, lactic acidosis, respiratory insufficiency, coaguloathy) |
| Septic shock | severe sepsis + hypotension that is not fully responsive to fluids |
| common community acquired organisms leading to sepsis | strep pneumoniae, staph aureus, h. influenza, atypicals, e. coli |
| nosocomial organisms leading to sepsis | pseudomonas, staph aureus, SPACE, klebsiella, candida |
| Sepsis treatment | 1) fluids, 2) vasopressors/inotropes 3) drotrecogin alpha 4) low dose hydrocortisone; 5) vasopressin to increase BP if refractory to others, high doses may lead to cardiac arrest |
| vasopressors/inotropes | dopamine, norepinephrine, epinephrine, phenylephrine, dobutamine |
| drotrecogin alpha | xigris; recombinant protein C; used in severe illness with apache score > 25; CI in bleeding, recent trauma, stroke |
| Sodium Value | 135-145 |
| Cl- value | 95-105 |
| K+ value | 3.5-5 |
| Magnesium value | 1.5-2.2 |
| Phosphorous value | 2.5-4.5 |
| Ca++ value | 8.5-10.5 |
| Hypovolemia hyponaetremia | Na+ and water loss; extrerenal fluid loses (GI, wounds0, diuretics, adrenal insufficiency |
| euvolemia hyponaetremia | moderate water retention; SIADH, renal failure, CBZ, NSAIDS, chlorpropramide |
| Hypervolemic hyponaetremia | Na+ and water retention; CHF, cirrhosis, nephrotic syndrome, glucocorticoids |
| Causes of hypokalemia | diuretics, beta agonists, glucocorticoids, ampho B, cisplatin, GI losses |
| Causes of hyperkalemia | renal dysfunction, acidosis, ACE Is, K+ sparing diuretics, trimethoprim, PO salt substitutes, adrenal insufficiency |
Created by:
cytoskeletor
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