DRUGS COMMONLY AVAILABLE IN THE CRITICAL CARE UNIT

Adenosine (Adenocard)
Classification:
 Antidysrhytmic
Effects
 Restores normal sinus rhythm by slowing conducting time through the
atrioventricular node
Indications
 Narrow complex supraventricular tachycardia
CI
 Hypersensitivity, second or third degree AV block, asthma,
 Not recommended in the tx of atrial fibrillation, atrial flutter, and VT
Dose and Route
 6 mg IV bolus over 1 to 2 secs
Nursing Considerations
 Evaluate heart rate and rhythm
 Measure PR interval for the development of AV block
 Observe for adverse effects: non-myocardial chest discomfort, hypotension,
dyspnea

Amiodarone (Cordarone)
Classification
 Antidysrhytmic
Effects
 Decreases cardiac workload and myocardial consumption through its
vasodilatory effects
Indications
 Atrial and ventricular tachydysrhytmias
CI
 Severe sinus bradycardia, 2nd or 3rd degree AV block (unless pacemaker is
functioning), cardiogenic shock
Dose and Route
 300 mg IV push
Nursing Considerations
 Monitor HR, rhythm, and BP
 Observe for adverse effects: hypotension, dysrhytmias, hepatotoxicity, cardiac
arrest

Atenolol (Tenormin)
Classification
 B-Adrenergic blocking agent
Effects
 Reduces HR, CO, BP, and myocardial oxygen consumption
 Promotes redistribution of blood flow from adequately supplied areas of the heart
to ischemic areas
Indications
 SVT
CI
 Sinus bradycardia, 2nd and 3rd degree heart block
 Cardiogenic shock
Dose and Route
 5 mg IV
Nursing Considerations
 Monitor cardiac rhythm, HR, BP; notify physician if bradycardia (<60bpm) or
hypotension (SBP ,100 mm Hg) develops
 Observe for adverse effects: breathing difficulties, bradycardia, heart block,
hypotension, and cardiac failure

Atropine
Classification
 Anticholinegic
Effects
 Increases conduction through the AV node and increases the HR
Indications
 Symptomatic sinus bradycardia, asystole
CI
 Asthma, narrow angled glaucoma, obstructive disease of the GI and urinary
tracts, MG, and paralytic ileus
Dose and Route
 For bradycardia: 0.5 mg IV bolus
 For asystole: 1 mg IV
Nursing Considerations
 Monitor HR for response to therapy (>60 bpm is desirable); be alert for
development of ventricular fibrillation or VT
 Excessive doses can result to tachycardia, flushed hot skin, delirium, coma, or
death

Calcium Chloride
Classification
 Electrolyte replenisher
Effects
 Replaces and maintains calcium in body fluids
Indications
 Hypocalcemia, hyperkalemia, calcium channel blocker overdose
CI
 VF, hypercalcemia, renal calculi, digitalis toxicity
Dose and Route
 8 to 16 mg/kg IV
Nursing Considerations
 Monitor BP (peripheral vasodilation will occur)
 Monitor serial serum calcium levels
 Monitor ECG
 Monitor electrolye imbalances
 Observe adverse effects: bradycardia, cardiac arrest, constipation, fatigue,
depression, loss of appetite

Digoxin (Lanoxin)
Classification
 Cardiac glycoside, inotropic, antidysrhytmic
Effects
 Increases myocardial contractility, decreases HR, and enhances CO, which
improves renal blod flow and increases urinary output.
Indications
 Patients with heart failure, cardiogenic shock, atrial dysrhytmias such as atrial
fibrillation, and atrial flutter
CI
 Patients who demonstrates s/sx of digitalis toxicity, 2nd and 3rd degree heart
block
Dose and Route
 Doses must be individualized
 Usual loading dose is 10-15 mcg/kg
 Usual maintenance dose is 0.125 to 0.5 mg per day
Nursing Considerations
 Check potassium and magnesium levels before administration (hypokalemia and
hypomagnesia are associated with increased risk of digitalis toxicity)
 Check calcium levels (hypercalcemia can increase risk of digitalis toxicity)
 Take apical pulse before administration (if <60 bpm, consult with physician)
 Be prepared to treat overdose with IV mgSO4 or digoxin immune Fab (Digibind)
 Observe for digitalis toxicity: nausea and vomiting, anorexia, epigastric pain,
unusaul fatigue, diarrhea, dysrhythmias,
 Excessive slowing of HR, irritability, or confusion

Diltiazem (Cardizem)
Classification
 Calcium channel blocker, antidysrhythmic
Effects
 Dilates coronary arteries and arterioles
Indications
 Control of rapid ventricular response in atrial fibrillation and flutter, conversion of
PSVT
CI
 2nd or 3rd degree heart block, severe hypotension, cardiogenic shock
Dose and Route
 Initially, administer 0.25 mg/kg intravenously over 2 minutes
 If an infusion is required, rate is 5 mg/hr; maximum dose is 15 mg/hr
Nursing Considerations:
 Evaluate dysrhythmia control
 Monitor HR, rhythm, and BP
 Observe for adverse effetcts: dysrhythmias, hypotension, flushing, chest pain,
heart failure, dyspnea and edema

Dobutamine (Dobutrex)
Classification:
 Inotrope, B1 – agonist
Effects
 Increases myocardial contractility, and increases CO without significant change
in BP
 Increases coronary blood flow and myocardial oxygen consumption
Indications
 Heart failure, cardiac decompensation
CI
 Shock without adequate fluid replacement
Dose and Route
 IV infusion of 2 to 20 mcg/kg/min titrated to desired patient response
Nursing Considerations:
 Infusion pump should be used to regulate flow rate
 Check BP and HR every 2 to 5 minutes during initial administration of the drug
 Observe for adverse effects: tachycardia, hypertension, chest pain, shortness of
breath, and cardiac dysrhytmias

Dopamine (Intropin)
Classification
 Sympathomimetic, vasopressor, inotropic
Effects
 In low doses (1-2 mcg/kg/min): increaes blood flow to the kidneys, thereby
increasing glomerular filtration rate, urine flow, and Na excretion
 In low to moderate doses (2-10 mcg/kg/min): increases myocardial contractility,
and CO
 In high doses (10-20 mcg.kg/min): it increases peripheral resistance and renal
vasoconstriction
Indications
 Shock state, symptomatic bradycardia
CI
 Uncorrected tachydysrythmias, VF
Dose and Route
 Initially 2 to 10 mcg/kg
 Increase infusion by 5 to 10 mcg/kg/min every 1 to 30 until desired effect
Nursing Considerations
 Monitor BP and HR every 2 to 5 mins initially during titration of the drug
 Measure urine output hourly to evaluate renal function. ( Doses greater than 20
mcg/kg/min decreases renal perfusion)
 Determine pulse pressure because a decrease indicates excessive
vasoconstriction
 Observe for adverse effects: tachycardia, headache, dysrryhtmias, nausea and
vomiting, hypotension, chest pain, shortness of breath, and vasoconstriction
 (numbness, tingling, pallor, cold skin, decreased pulses, decreased cerebral
perfusion, and decrease urine output)

Epinephrine (Adrenalin)
Classification
 Bronchodilator, vasopressor, cardiac stimulant
Effects
 Increases myocardial contractility, HR, SBP, and CO
 Relaxes bronchial smooth muscle
Indications
 Cardiac arrest, hypersensitivity reactions, acute asthma attacks, symptomatic
bradycardia, severe hypotension
CI
 Acute narrow angle glaucoma and coronary insufficiency
Dose and Route
 For patients in cardiac arrest: Give 1 mg IV every 3 to 5 minutes
Nursing Considerations
 Monitor continuous ECG
 Monitor BP and HR
 Observe for adverse effects: chest pain, dysrhytmias, headache, restlessness,
dizziness, nausea and vomiting, weakness, hypertensive crisis, and decreased
perfusion to fingers and toes.

Furosemide (Lasix)
Classification
 Diuretic, antihypertensive
Effects
 Promotes the excretion of fluid of fluid and electrolytes and reduces plasma
volume.
Indications
 Edematous state: heart failure, pulmonary edema, hepatic and renal disease,
and hypertension
Contraindications
 Sensitivity to furosemide and sulfonamides
Dose and Route
 0.5 to 1 mg/kg over 1 to mins; if no response 2 mg/kg over 1 to 2 mins
Nursing Considerations
 Check potassium levels before administration
 Assess lungs to evaluate pt response to therapy
 Monitor urine output to evaluate drug effectiveness
 Monitor serial BUN and creatinine levels to assess renal function
 Monitor BP, I&O, and assess serial weights
 Advise pt to report ringing in ears, severe abdominal pain, or sore throat and
fever (these may indicate furosemide toxicity?
 Observe for adverse effects: orthostatic hypotension, electrolyte imbalance, and
hepatic dysfunction

Heparin
Classification
 Anticoagulant, antithrombotic
Effects
 Prevents conversion of fibrinogen to fibrin and prothrombin to thrombin
Indications
 Treatment of thrombosis and emboli; adjunct therapy in AMI
CI
 Hypersensitivity, active bleeding, hemophilia, recent intracranial, intraspinal or
eye surgery, severe thrombcytopenia, severe hypertension, or bleeding disorders
Dose and Route
 Adjunct treatment in AMI: bolus with 60 IU/kg, follow with infusion 12 IU/kg/min
Nursing Considerations
 Assess for bleeding
  Monitor aPTT results
 Monitor HCt and Hgb levels and platelet count
 Monitor HR and BP
 Avoid IM injections

Lidocaine
Classification
 Antidysrhytmic
Effect
 Lidocaine supresses the automaticity to ectopic foci
Indications
 Cardiac arrest from VF and VT; stable VT, and wide complex tachycardia of
uncertain type
CI
 Severe heart block without pacemaker
Dose and Route
 Loading dose: 1 to 1.5 mg/kg IV push
 Repeat with 0.5 to 0.75 mg/kg every 5 to 10 minutes (Maximum 3 mg/kg)
 Maintenance infusion: 1 to 4 mg/min

Magnesium Sulfate
Classification
 Electrolyte replenisher, antidysrhytmic, anticonvulsant
Effects
 Replaces and maintains magnesium levels in body fluids
 Depresses the CNS, producing anticonvulsant effects; decreases incidence in
dysrhytmias
Indications
 Seizure associated with eclampsia, and pre-eclampsia, hypomagnesemia, life
threatening dysryhthmias secondary to digitalis toxicity
CI
 Heart block, renal failure
Dose and Route
 For hypomagnesemia: infusion of 5 g/1000 mL D5W over 3 hours
 For seizures: 1 to 4 g as a 10% solution
Nursing Considerations
 Monitor HR and BP every 2 to 5 minutes during drug titration

Mannitol
Classification
 Osmotic diuretic
Effects
 Increases osmotic pressure of fluid in renal tubules and decreases reabsorption
of water and electrolytes; increases urine output and Na and Cl excretion
Indication
 Increased ICP
CI
 Active intracranial bleeding, anuria, severe pulmonary congestion, severe heart
failure, fluid and electrolyte depletion, and renal dysfunction
Dose and Route
 IV infusion of 0.5 to 1 g/kg over 5 to minutes; additional doses of 0.25 to 2/g/kg
every 4 to 6 hours as needed
Nursing Considerations
 Monitor HR, BP, and ICP (if available)
 Assess hydration status and monitor urine output every hour
 Monitor serum electrolyte, BUN, creatinine levels and ABGs
 Observe for adverse effects: seizures, rebound increased ICP, acidosis,
hypotension, fluid and electrolyte imbalances

Morphine Sulfate
Classification
  Opiate analgesic
Effects
 Decrease pain impulse transmission, decreases myocardial oxygen
requirements; relieves pulmonary congestion
Indications
 Chest pain with ACS unresponsive to nitrates, cardiogenic pulmonary edema
CI
 Hypersensitivity, RR <12 breaths/min
Dose and Route
 2 to 4 mg IV over 1 to 15 mins every 5 to 3o minutes
 Individualized based on pt response
Nursing Considerations
 Administer slowly via IV route
 Assess pain using pt’s self report
 Monitor RR, HR, and BP
 Observe for adverse effects: bradycardia, orthostatic hypotension, respiratory
depression and apnea

Naloxone (Narcan)
Classification:
 Opioid antagonist
Effect
 Competes for opioid receptor sites in the CNS
Indications
 Patients with known or suspected opioid-induced respiratory depression
CI
 Hypersensitivity
Dose and Route
 0.4 to 2 mg IV over 15 sec; dose may be repeated every 2 to 3 mins
Nursing Considerations
 Monitor respiratory rate and depth continuously
 Provide O2 and artificial ventilation as necessary
 Observe for adverse effects: nausea and vomiting, sweating, tachycardia,
hypertension, pulmonary edema, VT, and VF

Nitroglycerine (Tridil, Nitrol)

Classification
 Vasodilator, antianginal, antihypertensive
Effects
 Decreases venous return, preload, myocardial oxygen demand, BP, MAP, CVP,
and PAWP
 Improves coronary artery blood flow and oxygen delivery
Indications
 Angina, HPN, heart failure in AMI
CI
 Hypersensitivity to nitrates, pts with head trauma, and cerebral hemorrhage
Dose and Route
 Initial infusion: 5 mcg/min; increase by 5 mcg every 3 to 5 mins and titrate to
desired response
Nursing Considerations
 Monitor HR ( a 10 beat/min increase suggests adequate vasodilation)
 Monitor BP
 Observe for adverse effects: headache, dizziness, dry mouth, blurred vision,
orthostatic hypotension, tachycardia, angina, flushing, palpitations, nausea, and
restlessness
 Report unrelieved angina, side effects, extreme dizziness, pressure in head,
dyspnea, fever, and weak or fast HR

Norepinephrine (Levophed)
Classification
 Sympathomimetic, vasopressor
Effects
  Produces vasoconstriction, increases myocardial contractility, and dilates
coronary arteries
Indications
 Hypotensive states
CI
 Peripheral vascular thrombosis
Dose and Route
 IV infusion 0.5 10 1 mcg/min; titrate every 3 to 5 minutes, up to 30 mcg/min, to
desired BP
Nursing Considerations
 Monitor BP continuously until stabilized at desired level, then check BP every 5
minutes
 Monitor continuous ECG
 Use infusion pump to regulate the flow
 Assess for s/sx of excessive vasocontriction: cold skin, pallor, decrease pulses,
decreases cerebral perfusion, and decreased pulse pressure
 Report decreased urinary output
 Taper medication gradually
 Observe for adverse effects: headache, VT, bradycardia, VF, angina, dyspnea,
decreased urinary output, restlesness, and hypertensive states

Sodium Bicarbonate
Classification
 Alkanizer, antacid, electrolyte replenisher
Effects
 Increases the plasma bicarbonate, buffers excess hydrogen ion concentration,
and increases blood pH
Indications
 Metabolic acidosis, hyperkalemia, and need to alkalanize the urine
CI
 Respiratory acidosis, hypocalcemia, hypertension, impaired renal function
Dose and Route
 IV dose in 1 mEq/kg initially, then 0.5 mEq/kg every 10 minutes if indicated by
arterial pH and PCO2
 IV infusion: 2 to 5 mEq/kg
Nursing Considerations
 Obtain ABGs before administration
 Flush line before and after administration
 Observe for adverse effects: restlessness, tetany, hypokalelmia, alkalosis, and
hyponatremia

Other Drugs:
Aminophylline
 Pharmacologic Class: Xanthine
 Bronchodilator
 Uses: bronchial asthma, bronchospasm, Cheyne-Stokes respirations
Verapamil
 Calcium-channel blocking agent, vasodilator
 used to treat hypertension, angina pectoris, and certain cardiac arrhythmias
Hydralazine
 an antihypertensive and vasodilator drug that relaxes arteriolar smooth muscle
by direct action. It is used as the hydrochloride in peripheral vascular disease,
thrombophlebitis and congestive heart failure.
Metoclopramide
 a dopamine antagonist that stimulates motility of the upper gastrointestinal tract,
relaxes the pyloric sphincter, and promotes gastric emptying. Used as an
antiemetic.
Sodium Luminal
 Pharmacologic class: Barbiturate
 Therapeutic class: Anxiolytic, anticonvulsant, sedative-hypnotic
 Used for tonic-clonic (grand mal) and partial seizures
Diazepam (Valium)
  Pharmacologic class: Benzodiazepine
 Therapeutic class: Anxiolytic, anticonvulsant, sedative-hypnotic, skeletal muscle
relaxant (centrally acting)
Midazolam (Dormicum)
 Act as sedative, hypnotic, amnestic, anticonvulsant, anxiolytic.
Phenytoin (Dilantin)
 Pharmacologic class: Hydantoin derivative
 Therapeutic class: Anticonvulsant
Hydrocortisone
 Pharmacologic class: Short-acting corticosteroid
 Therapeutic class: Anti-inflammatory (steroidal)
Propanolol (Inderal)
 Pharmacologic class: Beta-adrenergic blocker (nonselective)
 Therapeutic class: Antianginal, antiarrhythmic (class II), antihypertensive,
vascular headache suppressant
Transderm nitro
 Vasodilator
Nitrostat (Nitroglycerine)
 Relaxes blood vessels allowing more blood to flow through.
 Reduces the workload on the heart and improves blood flow to the heart.
Nifedipine (Adalat)
 Calcium channel blocker
 Antihypertensive, anti angina

E-cart Drugs

 15 Einephrine
 4 Ca Gluconate
 3 Aminophylline
 6 Dopamine
 3 Cordarone
 3 Lanoxin
 2 Verapamil
 5 Atropine sulphate
 3 Hydralazine
 3 Metoclopramide
 5 Lasix
 2 NaCl
 1 Heparin
 1 Sodium Luminal
 1 Valium
 3 Vit K
 3 Diphenhydramine
 2 Phenytoin
 2 Narcan
 3 MgSO4
 3 Sterile H2O for injection
 3 D50/50 vial
 2 Sodium bicarb
 1 Lidocaine vial
 3 Hydrocortisone
 3 Inderal 40 mg/tab
 2 Transderm nitro
 3 Nitrostat 400 mcg/tab
 4 Nifedipine 5 mg/cap

DRUG CALCULATIONS

DRUG CONCENTRATION IN MG/ML OR MCG/ML

1 mg = 1000 mcg
1 g = 1000 mg
  To determine the amount of drug in one mL, divide the amount of drug in solution
by the amount of solution
mg
--------------
mL
Example:
200 mg = 0.4 mg/mL
500 mL

Determine mcg/mL

 Change mg to mcg
200 mg x 1000 mcg = 200,000 mcg

 Divide mcg by mL of solution

200,000 mcg = 400 mcg/mL
500

CALCULATING MCG/KG/MIN

 Three parameters to be known:

1. Patient weight in kg
2. Infusion rate (mL/hr)
3. Drug concentration

Formula:
conc (mcg/mL) x mL/hr
Mcg/kg/min= ------------------------------
kg x 60 min/hr

CALCULATING THE AMOUNT OF FLUID TO INFUSE (ML/HR)

Three parameters must be known to determine the infusion rate:

1. The patient weight in kg
2. The dose ordered by the physician in mcg/kg/min
3. The drug concentration in mcg/min

Formula:
mcg/kg/min ordered x kg x 60 min
mL/hr = -------------------------------------------
concentration (mcg/mL)

Short- cuts:

Single dose Dopamine (200/250 0r 400/500)

13.3 (constant) x mgtts/min

mcg/kg/min = ------------------------------------
BW in kg

mcg/kg/min x BW in kgs
mgtts/min = ---------------------------------
13.3 (constant)

Double dose Dopamine (400/250 0r 800/500)

26.6 (constant) x mgtts/min

mcg/kg/min = ------------------------------------
BW in kg
 mcg/kg/min x BW in kgs
mgtts/min = ---------------------------------
26.6 (constant)

Single dose Dobutamine (250/250 0r 500/500)

16.6 (constant) x mgtts/min

mcg/kg/min = ------------------------------------
BW in kg

mcg/kg/min x BW in kgs
mgtts/min = ---------------------------------
16.6 (constant)

Double dose Dobutamine (500/250 0r 1000/500)

33.3 (constant) x mgtts/min

mcg/kg/min = ------------------------------------
BW in kg

mcg/kg/min x BW in kgs
mgtts/min = ---------------------------------
33.3 (constant)