Page 255 - Critical Care Notes

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249
Commonly Used Critical Care Medications
This list is for reference use only and is not meant to replace any hospital policy
or protocol. ALWAYS administer medications with caution in those patients
with actual or suspected renal or liver impairment.
abciximab, Reopro: Antiplatelet agent, glycoprotein IIb/IIIa inhibitor. Uses:
Prevention of cardiac ischemic complications in patients undergoing PCI;
prevention of cardiac ischemic complications in patients with unstable angina/
NSTEMI unresponsive to conventional therapy when PCI is scheduled with-
in 24 hr. Dosages: Adult PCI: IV bolus 0.25 mg/kg, administer 10–60 min
before start of PCI by an infusion of 0.125 mcg/kg/min (max 10 mcg/min)
for 12 hr; Unstable angina/NSTEMI unresponsive to conventional medical
therapy with planned PCI within 24 hr: IV bolus 0.25 mg/kg followed by an
18–24 hr infusion of 10 mcg/min, concluding 1 hr after PCI.
adenosine, Adenocard: Antidysrhythmic. Uses: SVT, as a diagnostic aid to
assess myocardial perfusion defects in CAD. Usual dosages: IV bolus 6 mg
over 1–3 sec followed by rapid 20 mL NS flush. If conversion to NSR does
not occur within 1–2 min, give 12 mg by rapid IV bolus; may repeat 12-mg
dose again in 1–2 min. Administer via closest proximal port. A rapid 20-mL
NS flush (as fast as possible) should be administered after each dose.
Patient may be placed in mild reverse Trendelenburg position before giving
drug and a rhythm strip recorded during administration
alteplase, Activase: Thrombolytic enzyme. Uses: Lysis of obstructing thrombi
associated with AMI, ischemic conditions requiring thrombolysis (i.e., PE,
DVT, unclotting arteriovenous shunts, acute ischemic CVA). Dosages: >65 kg
IV a total of 100 mg; 6–10 mg given IV bolus over 1–2 min, 60 mg given
over first hr, 20 mg given over second hr, 20 mg given over third hr,
1.25 mg/kg given over 3 hr for patients <65 kg.
amiodarone, Cordarone: Antidysrhythmic. Uses: Severe VT, SVT, atrial fibrilla-
tion, VF not controlled by first-line agents, cardiac arrest. Dosages: PO load-
ing dose 800–1,600 mg/day for 1–3 wk; then 600–800 mg/day for 1 mo;
maintenance 400 mg/day; IV loading dose (first rapid) 150 mg over the first
10 min, then slow 360 mg over the next 6 hr; maintenance 540 mg given
over the remaining 18 hr, decrease rate of the slow infusion to 0.5 mg/min.
argatroban, Argatroban: Anticoagulant. Uses: Thrombosis, prophylaxis or treat-
ment; PCI, anticoagulation prevention/treatment of thrombosis in heparin-
induced thrombocytopenia. Dosages: Heparin-induced thrombocytopenia/
thrombosis syndrome (HIT or HITTS): IV: 2 mcg/kg/min (1 mg/mL) give
at 6 mL/hr for 50 kg, at 8 mL/hr for 70 kg, at 11 mL/hr for 90 kg, at
13 mL/hr for 110 kg, at 16 mL/hr for 130 kg. Hepatic dose: Continue
infusion 0.5 mcg/kg/min, adjust rate based on aPTT. PCI in HIT: IV infusion
25 mcg/kg/min and a bolus of 350 mcg/kg given over 3–5 min, check ACT
5–10 min after bolus is completed; proceed if ACT >300 sec.
CC MEDS