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Critical Care Medications
Terms in this set (106)
___________ is the antidote for the treatment of acetaminophen toxicity and used for the prevention of contrast induced nephropathy.
___________ acts as a glutathione substitute and free radical scavenger. Directly combines with the toxic acetaminophen metabolite (NAPQI) to allow for NAPQI elimination from the body.
_____________ is an adjunct to therapy for urgent or planned (within 24 hours) percutaneous coronary intervention (PCI) for prevention of ischemic cardiac complications. Requires dedicated line and use of 0.2 micron filter.
Diazepam and chlorpromazine are physically incompatible with _____________, do not administer simultaneously.
Ofirmev (acetaminophen IV)
______________ is an anti-dysrhythmic used to terminate supraventricular tachydysrhythmias by transiently blocking the AV node thereby restoring normal sinus rhythm.
administer Adenosine as a ____ mg IV bolus over 1 second followed by 10-20 mL flush of NS. Up to two more _____ mg IV boluses may be administered as necessary.
Contraindications to adenosine include 2nd or 3rd degree AV block, sick sinus syndrome, symptomatic ___________, a-fib/flutter with underlying WPW syndrome.
Due to adenosine's very short half life (~10 sec) NS must be simultaneously administered, med is to be given in most __________ IV port.
_____________ is a thrombolytic, high risk, high alert medication used for treatment of STEMI; acute massive PE; or acute ischemic stroke. This medication initiates local fibrinolysis by binding to fibrin in a thrombus (clot) and converts entrapped plasminogen to plasmin.
Alteplase (Activase, t-PA)
Alteplase administration requires neuro checks every 15 minutes x ___ hours, every 30 minutes x ____ hours, then every 1 hour x ____ hours.
2; 6; 16.
__________ is an anti-dysrhythmic medication used to control ventricular and atrial tachydysrhythmias. This medication prolongs atrial and ventricular re-polarization by inhibiting potassium channels, slows the heart rate and impedes AV node conduction by blocking beta receptors and calcium channels.
For pulseless VT/VF give ______ mg Amiodarone IVP. May repeat w/ 150 mg IVP in 5 minutes.
For other tachydysrhythmias give 150 mg IV over 10 minutes, then 1 mg/min for 6 hours, then 0.5 mg/min for 18 hours. This medication requires _________ for administration.
300mg; in-line filter
_____________ is a vagolytic/antidote for symptomatic bradycardia, premedication for ketamine procedural sedation and pediatric RSI; also given for organophosphate poisoning. This medication is an anticholinergic agent, inhibits vagal-mediated bradycardia and dries secretions.
Atropine may be given for bradycardia in adults: 0.5 mg (if stable) to 1 mg (if unstable) every 3-5 minutes for total of ____ doses.
__________ is a loop diuretic for management of heart failure and hypertension. This medication decreases sodium and chloride reabsorption in the ascending loop of Henle thus increasing excretion of water. 1 mg of this medication is equivalent to 40 mg of furosemide. Rapid administration may cause ototoxicity.
Adverse reactions of Bumex include ____________, hypotension, hyperuricemia, dehydration, ototoxicity.
____________ is an electrolyte that temporarily stabilizes the cardiac membrane in the presence of hyperkalemia and is given in ACLS, management of hyperkalemia, hypocalcemia and calcium channel blocker toxicity and for the treatment of severe hypomagnesemia.
in ACLS, calcium chloride is given in a prefilled syringe of ________ mg/10 mL. (compatible with LR and NS). Repeat at 10-minute intervals as needed.
Do NOT infuse calcium chloride in the same IV line as ________-containing solutions. Contraindications include hypercalcemia, digitalis toxicity, and ventricular fibrillation.
Calcium gluconate and calcium chloride are both given in ACLS. Calcium __________ is preferred in conscious patients.
______________ is a high risk, high alert paralytic used as a long acting paralytic agent for use in the mechanically ventilated intubated patient only/ to prevent shivering in therapeutic hypothermia. Patient MUST be intubated and must have adequate sedation and analgesia before initiating and do NOT titrate sedation or analgesia down.
____________ is a synthetic adrenal corticotropin hormone which stimulates. the release of cortisol from the adrenal glands. This medication is a diagnostic agent used to determine adrenal sufficiency (stim-test)
___________ is a glucocorticoid steroid anti-inflammatory with many uses including cerebro-protection in meningitis, cerebral edema, and alternate to methylprednisone in acute spinal cord injury. Contraindicated in pt with systemic fungal infections.
____________ is an inotrope that blocks the action of Na+/K+ ATPase pump. This increases intracellular concentration of Ca2+ which improves cardiac contractility. Also increases vagal tone, reflexively reduces sympathetic tone, and decreases sinus rate. This medication provides rate and/or rhythm control in atrial fibrillation. Also for symptomatic control of CHF.
Give digoxin cautiously in the elderly and with patients who have renal failure or hypokalemia. The antidote for digoxin is...
Digibind or Digifab
Dosing for Digoxin: loading dose can be given IV or PO. Usual load (aka digitalizing dose) is ___mg in divided doses (0.5 mg once, then 0.25mg twice, each dose separated by 6-8 hours. Loading dose not recommended in heart failure.
_____________ is an anti-dysrhythmic/anti-hypertensive that decreases SA-node and AV-node conduction. Blocks calcium channels causing coronary and peripheral smooth muscle vasodilation. This medication is used for rate control of SVTs including atrial fibrillation, flutter, adn PSVT.
Give initial diltiazem bolus of 0.25mg/kg (max 20 mg) IV over 2 minutes. May repeat in ____ minute intervals with 0.35mg/kg (max 25mg) for two more doses. Continuous Diltiazem infusion not to exceed. ___ mg/hr. Avoid combination therapy with beta-blockers.
___________ is an inotrope used to improve cardiac output in patients with severe HF or cardiogenic shock. This medication works as beta-1 and beta 2 adrenergic agonist increasing cardiac contractility and heart rate. Also produces modest vasodilatory response.
In case of extravasation of dobutamine, administer ___________ (5mg/10mL) in small amounts into the extravasated area.
Dobutamine dosing: initial, 2 mcg/kg/min; maintinence 2-20 mcg/kg/min (max 40 mcg/kg/min).
_________________ is a vasopressor: dose-dependent dopaminergic given for refractory hypotension after adequate volume resuscitation. Given at 2-20 mcg/kg/min (max 20mcg/kg/min) dose based on desired effect.
In case of extravasation of dopamine, administer ___________.
____________ is an antihypertensive that inhibits angiotensin-converting enzyme (ACE) blocking the production of angiotensin II, a potent vasoconstrictor. This medication is used for management of hypertensive crisis. Initial dose of 0.625-1.25 mg IVP over 5 minutes. Maintenance dose given every 6 hours.
Pregnancy category X.
___________ is a low molecular weight heparin which has anti-factor Xa and anti-thrombin (aka anti-factor IIa) activities. Used for treatment/prophylaxis of DVT/PE; treatment of acute STEMI; and prophylaxis of ischemic complications.
Baseline BUN and serum creatinine must be drawn prior to initiating this medication.
Nurses MUST check _______ function before administering enoxaparin.
_____________ is a vasopressor, inotrope, high-risk/high-alert medication. Direct acting sympathomimetic drug with alpha 1, beta 1, and beta 2 effects. Used in hypotension despite adequate fluid resuscitation; status asthmaticus; anaphylaxis; and myocardial stimulant in CPR.
Dosing for Epinephrine in ACLS: 1mg IV/IO of the _____________ concentration. (2-2.5 mg of 1:1000 concentration ET diluted in 5 mL of NS) every 3-5 minutes
Dosing for Epinephrine in anaphylaxis: ______ to ______ mg IM of the ________ concentration.
Dosing for Epinephrine in status asthmaticus: 0.3-0.5 mg of the 1:1000 concentration every 20 minutes x 3 doses.
Dosing for Epinephrine in hypotension: _____ to ______ mcg/min.
__________ check concentration of epinephrine being administered. VERIFY with another nurse or physician. As a general rule, epinephrine 1:1000 (1mg/mL) is most commonly used IM. While epinephrine 1:10,000 (0.1mg/mL) is most commonly used IV. Avoid extravasation. Last line therapy for. refractory hypotension.
_______________ is an anti-platelet agent that inhibits platelet aggregation by reversibly binding to GB IIa/IIIa of human platelets, thus preventing binding of fibrinogen, von Willebrand factor, and other adhesive ligands. Used for the treatment of patient with ACS including patients undergoing PCI.
Eptifibatide (Integrilin) requires dose adjustment in patients with _____________ insufficiency. The 100 mL vial should be spiked with a ________ infusion set. This medication is contraindicated in patients with active bleeding, severe hypertension that is not adequately controlled, renal dialysis, any history of hemorrhagic stroke.
_____________ is an anti-hypertensive/Anti-dysrhythmic ultra short-acting (~9 min), a cardioselective beta-blocker used for heart rate control in supraventricular tachydysrhythmias (atrial flutter), and for hypertensive emergencies involving aortic dissection.
Standart infusion concentration for esmolol is 2500mg/250mL
Bolus 500 mcg/kg IVP over 1 minute followed by continuous infusion: 50 mcg/kg/min. (maximum dose is _______ mcg/kg/min)
________________ is a gastric acid suppressant that inhibits hydrogen-potassium ATP pumps and is given for the treatment of GERD, stress ulcer prophylaxis and prevention of gastric re-bleeding after endoscopic hemostasis.
Reconstitute freeze-dried powder with 5mL NS; give as an injection over 3 minutes.
______________ is a sedative/hypnotic ultra short-acting (~5-10 min) non-barbiturate used for the induction of anesthesia for RSI and procedural sedation.
Dosing for etomidate for RSI: ____ mg/kg IV over 30-60 seconds.
For procedural sedation: ______ mg/kg iV over 30-60 seconds.
____________ is an opiate agonist at the mu-receptors which produces analgesia.
25-300 mcg/hr continuous infusion, increase continuous infusion by 25-50 mcg/hr increments every 15-30 minutes. Re-bolus with every infusion rate increase.
__________ is an anti-epileptic used for the short term parenteral management/prevention of seizure disorders by stabilizing hyper-excitation of neuronal membranes preventing the occurrence of seizures.
fosphenytoin may be given IM route, doses greater than ______mg should be injected in two separate sites.
Therapeutic range of serum phenytoin is ______-_____ mcg/ml
___________ is an antihypertensive medication and is a direct acting systemic arterial vasodilator used for the treatment of hypertension.
Dosing for hypertension: bolus with initial dose of 10-20 mg IVP over 2-4 minutes every 4-6 hours.
Dosing for preeclampsia/eclampsia: ____ mg IVP and repeat every 30 minutes as needed.
___________ is a high-risk/high-alert electrolyte used to treat hyponatremia and elevated ICP in traumatic head injury.
Hypertonic saline requires independent double checks with co-sign of MAR, avoid rapid correction of serum sodium (<____mEq/L change in sodium per 24 hours) to prevent brain injury.
central line administration is required.
pontine demyelination can occur with rapid sodium correction.
___________ is a non-barbiturate dissociative anesthetic/analgesic agent structurally related to phencyclidine used to induce sedation. during procedural sedation and RSI.
Dosing of Ketamine:
IVP: ___-___mg/kg IVP over 1-2 minutes. (rebolus with 1/3-1/2 initial dose until the desired level of sedation is achieved)
Contraindicated in children age <3 months.
Adverse reactions: hypertension, tachycardia, increased ICP, emergence reactions
____________ is an antihypertensive used for the management of hypertensive urgency/emergency and hypertensive patients with CVA.
Dosing for labetalol:
bolus dosing: 20 mg IVP over 2 minutes then 20-40 mg IVP every 10-20 minutes (max total dose is ____ mg) until MAP or SBP goal range has been achieved.
Continuous infusion: initiate at 2 mg/min; increase infusion by 1-2 mg/min. Avoid exceeding this mg total dose for both bolusing and con. infusion.
The maximum effect of labetalol is seen within _____ minutes of IV administration.
Contraindications: shock, 2nd or 3rd degree block, _______ or asthma.
____________ is an anti-dysrhythmic that acts by depressing diastolic depolarization and automaticity in the ventricles. Na+ channel blocker. Used for control of ventricular dysrhythmias and prevention of increases in ICP/IOP with RSI.
Standard infusion concentration for lidocaine is 2gm/500mL
Prefilled syringe: 100mg/___mL
Lidocaine must be given at least ____ minutes prior to intubation to effectively prevent changes in ICP.
Lorazepam is contraindicated in patients < ____ months old.
_________ is a high-risk, high alert anti-dysrhythmic/electrolyte that acts as a calcium channel blocker in the myocardium and is used for torsades de pointes, pre-eclampsia, status asthmaticus, consider in patients with refractory pulseless VF/VT.
Dose and administration of magnesium sulfate in...
ACLS: ____-____g IVP over 1-2 minutes.
Torsades De Pointes: 1-2 grams over 15 minutes in 100 ml D5W.
Pre-eclampsia: ____ grams over 20 minutes, then 2 g/hour by continuous infusion.
This medication is contraindicated in patients with ________. If a patient loses deep tendon reflexes, severe respiratory depression, the infusion should be discontinued immediately.
_____________ is an osmotic diuretic used for control of ICP and occasionally used in rhabdomyolysis.
mannitol vials must be visually inspected for crystals before administration. A ______-set must be used.
Monitor serum osmolality (not to exceed 320 mOsm).
Contraindications to mannitol administration include anuria, severe dehydration, severe _______ congestion/edema.
______________ is an anti-inflammatory given for inflammatory reactions including anaphylaxis, asthma exacerbation etc. Also used in acute spinal cord injury (SCI) and organ donor protocol (ODP).
Monitor serum glucose closely with SCI infusion.
___________ is a sedative/hypnotic that enhances GABA receptor hyper-polarization and is used for sedation in many situations including acute agitation, conscious sedation, RSI and occasionally status epilepticus.
contraindicated in narrow angle glaucoma and in intrathecal or epidural administration
RSI dosing for versed: ____mg/kg IVP.
Status epilepticus dosing for versed: ____ - ____ mg IV/IN; may repeat as necessary for seizure termination.
Contraindications to morphine sulfate include paralytic ileus, respiratory depression, severe _________, and upper airway obstruction.
___________ is a calcium channel blocker/anti-hypertensive that inhibits calcium ion from entering the "slow channels" or select voltage-sensitive areas of vascular smooth muscle and myocardium during depolarization, producing a. relaxing of coronary vascular smooth muscle and coronary vasodilation; potent peripheral vasodilator with minimal effects on inotropy.
____________ releases nitric oxide to produce vasodilation of the cerebral, cardiac, and pulmonary vasculature. Also produces systemic vasodilation to reduce overall blood pressure.
Contraindications to nitroglycerin include concurrent use of _________, vardenafil (Levitra) or tadalafis (Cialis)
___________ is a direct-acting arterial and venous vasodilator and is given for hypertensive emergency and also for acute decompensated heart failure.
Dose and administration of Nitroprusside:
initial rate of 0.5 mcg/kg/min by continuous infusion. maximum infusion rate of ____ mcg/kg/min.
Rates greater than 4 mcg/kg/min OR infusions greater than 24 hours may cause toxicity
When administering Nitroprusside arterial line placement is required for blood pressure measurement.
PROTECT from _____, discard drug if it is bluish, dark brown, green, or red in color.
___________ is a high risk, high alert vasopressor that stimulates both alpha 1 and beta 1 receptors leading primarily to systemic vasoconstriction (alpha effects) and to a lesser extent, increased cardiac contractility, heart rate, arteriole constriction in skin, gut, and kidney (beta effects). Used for the treatment of refractory hypotension AFTER adequate volume resuscitation.
levophed is contraindicated in patients with hypotension due to _________ volume deficit.
_____________ is a hormone that inhibits the secretion of insulin, and a number of pancreatic enzymes and growth hormone. Used for the control of esophageal varicieal bleeds, sulfonylurea induced hypoglycemia (SIH), VIPomas, gastrinomas, acromegaly, and insulinomas.
Adverse reactions to octreotide include bradycardia, ___________, diarrhea, constipation, and nausea.
____________ acts on CNS causing depression of sensory cortex, decrease motor activity, and produces drowsiness, sedation, hypnosis. Given for procedural sedation, barbiturate coma (particularly in TBI) and status epilepticus.
____________ acts on CNS causing depression of sensory cortex, decrease motor activity, and produces drowsiness, sedation, hypnosis. For status epilepticus/seizure disorders and alcohol withdrawal.
Contraindications fo phenonbarbital includes porphyria and severe ________ impairment.
______________ is a powerful post-synaptic a-receptor stimulant with little effect on b-receptors in the heart. Peripheral resistance increases considerably due to constriction beds and both systolic and diastolic BP increases. Marked reflex bradycardia may also occur.
_________ is used to treat hypotension during spinal anesthesia, shock, hypersensitivity reactions, drug-induced hypotension. Also used as an alternative to dopamine in organ donation patients
contraindications: narrow-angle glaucoma, severe hypertension, VT
___________ is an anti-epileptic for acute control of seizures.
all infusion must be __________ with proper IV tubing. NOT for IM administration. Not useful for seizures caused by drug overdose or drug/alcohol withdrawal.
phenytoin (dilantin); filtered
_____________ is a Class Ia antiarrhythmic that decreases myocardial excitability and conduction velocity and is used for the treatment of life-threatening ventricular arrhythmias.
Procainamide contains sodium metabisulfite which may cause allergic-type reactions including anaphylactic symptoms and life threatening asthmatic episodes, this is seen more frequently in _________.
____________ is a sedative-hypnotic that is structurally unrelated to other sedative hypnotics, its mechanism is not well defined. lol
Propofol does not affect _______.
Propofol is in lipid emulsion, _________ technique is critical. Tubing any unused propofol must be discarded after 12 hours from spiking vial.
Propofol is contraindicated in patients with hypersensitivity to propofol components like soybean oil, glycerol, _____ lecithin, and disodium edetate.
____________ is a neuromuscular blocker that blocks acetylcholine receptors of the neuromuscular junction preventing. depolarization within unless than 60 seconds after administration.
Dosing for Rocuronium during RSI: ___ mg/kg IVP over 1 minute.
Requires independent double checks with co-sign of MAR.
_________ is an electrolyte given in ACLS, in TCA overdose, salicylate overdose, rhabdo, hyperkalemia, and prevention of contrast induced nephropathy. This medication raises blood and urine pH. in TCA overdose provides sodium to overcome sodium channel blockade and cardiovascular effects. Enhances renal elimination of salicylates.
____________ is a depolarizing skeletal muscle relaxant. It depolarizes the postsynaptic membrane, producing repetitive excitation of the motor end plate. Flaccid paralysis subsequently follows within 1 minute of an IV injection of succinylcholine. This medication is the paralytic of choice in RSI when no contraindications exist.
Look up succinylcholine dosing.
Contraindications to succinylcholine administration include personal or familial history of malignant hyperthermia or skeletal muscle myopathy, upper motor neuron injury, _______ beyond 24 hours from injury, hyperkalemia.
______________ acts directly on vascular smooth muscle to cause vasoconstriction and is used to increase peripheral vascular resistance in cases of ACLS and refractory hypotension in patients with. septic shock.
Give vasopressin in ACLS: _____ unit IV bolus once over 1-2 minutes as alternative to epinephrine
_________ is a non-depolarizing neuromuscular blocking agent used to facilitate post-intubation procedures, therapeutic hypothermia and ICU ventilation.
contraindications to vecuronium administration include significant _______ or _________ failure.
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