Drips

MICU/CCU Drips – Blake Funke

  • Most of these have ordersets in Epic, you can choose “Do Not Titrate” (used sparingly when initiating on the floor) or “Titration Allowed” (to be used in ICU for nurse titration)

 

Vasopressors:

Drug

Dose

Receptors

Indications

Considerations

Norepinephrine (Levophed)

1 – 100 mcg/min

αα1 > β1

1st line septic shock

Peripheral ischemia, skin necrosis

Phenylephrine (Neosynephrine)

Bolus: 0.05 – 0.5 mg q 10-15 min

Infusion: 40-360 mcg/min

αα1

Used for periprocedural hypotension(Neostick)

or pts w/ tachyarrhythmias

Reflex bradycardia

Peripheral ischemia, skin necrosis

Epinephrine

1 – 40 mcg/min

αα1=β1=β2

Post PEA arrest

Anaphylaxis

Septic shock (severe)

Cardiac shock

Tachy-arrhythmias,

Peripheral ischemia, skin necrosis

Vasopressin

0.04 U/min (no titration); start at

NE > 50

V1, V2, V3

2nd line septic shock, Right heart failure

Hyponatremia

Bradycardia

ANG II

*needs approval by Dr. Rice or Dr. Semler

20 – 40 ng/kg/min

ANG II

Refractory vasodilatory shock

*typically multiple pressors at high doses

Thrombosis:

pt MUST have chemical DVT ppx; contraindicated in heart failure

Dopamine

2 – 20 mcg/kg/min

 

Dopamine

(1-5 mcg) > β1 (5-10 mcg) >α1 (>10mcg)

Hypotension

Cardiac shock

Renal protection

Tachy-arrhythmias ( risk ))

Peripheral ischemia, skin necrosis

Dobutamine

2.5 – 20 mcg/kg/min

β1 >>> β2

Cardiogenic shock

Vasodilation Hypotension

Tachycardia

Tachyphylaxis

Milrinone

0.375 – 0.75 mcg/kg/min

PDE-3

Cardiogenic shock

Hypotension

Renally cleared

 

 

 

 

Sedatives/Anxiolytics:

Drug

Dose

Class

Metabolism

Side Effects

Propofol

Infusion: 5 – 150 mcg/kg/min

General anesthetic

(GABA R agonist)

Hepatic

Renal (minor)

Severe Hypotension bradycardia

Propofol infusion syndrome

Dexmedetomidine (Precedex)

Infusion: 0.1 – 1.5 mcg/kg/h

Central αα2 agonist

Hepatic

Hypotension

Bradycardia

Midazolam (Versed)

Push: 0.5 – 5 mg

Infusion: 0.25 – 5 mg/h (no max dose)

Benzodiazepine

Hepatic &

Renal

Hypotension

 

Lorazepam (Ativan)

Push: 0.5 – 10 mg

Infusion: 0.5 – 5 mg/h (no max dose)

Benzodiazepine

Hepatic

Hypotension

Propylene glycol carrier - AG acidosis

               

 

Analgesic:

Drug

Dose

Metabolism

Side effects

Fentanyl

Push: 25 – 100 mcg

Infusion: 25 – 400 mcg/h

Hepatic

Hypotension, Serotonin syndrome, chest wall rigidity at high doses

Morphine

Push: 1 – 5 mg q1-2h prn

Infusion: 1 – 5 mg/h

Hepatic/Renal

Hypotension (profound), itching, constipation, HA; avoid in renal failure

Hydromorphone (Dilaudid)

Push: 0.25 – 1 q1-2h prn

Infusion: 0.5 – 3 mg/h

Hepatic

Hypotension, respiratory depression, itching

 

Anti-Arrhythmics:

Drug

Dose

Indications

Side effects

Comments

Adenosine

6 – 12 mg IV rapid push and flush; may repeat x2

PSVT conversion

Complete AV nodal blockade

10 second half-life

 

Must have continuous EKG/tele monitor

Amiodarone

ACLS: 300 mg IV push

Non-emergent: 150 mg over 10 min then 0.5 mg/min

Vtach/Vfib

Afib

Pulm, ophthalmic and thyroid toxicity w/ chronic use

Less hypotensive effect than other agents

Safe in heart failure

Diltiazem

Push: 10 – 20 mg q15 min x 2 if no response

Infusion: 5 – 15 mg/h

Afib

Aflutter

PSVT

Bradycardia

Hypotension

Avoid use in pts with HFrEF

Lidocaine

ACLS: 1 mg/kg x 1

Infusion: 1 – 4 mg/min

Vtach

Bradycardia

Heart block

Avoid use in liver failure or heart failure

Procainamide

15 mg/kg over 30 min then 1 – 6 mg/min

Vtach

Refractory afib

Bradycardia

Hypotension

Drug-induced lupus

Cytopenias