Page 256 - Critical Care Notes

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CC MEDS
atenolol, Tenormin: Antianginal; beta blocker, beta-1 selective. Uses: Treatment
of HTN, alone or in combination with other agents; management of angina
pectoris; secondary prevention of MI. Dosages: HTN: PO 25–50 mg once
daily, may increase to 100 mg/day: doses >100 mg are unlikely to produce
any further benefit. Angina pectoris: PO 50 mg once daily; may increase to
100 mg/day. Some patients may require 200 mg/day. Post MI: PO 100 mg/day
or 50 mg twice a day for 6–9 days.
atracurium, Tracrium: Neuromuscular blocker. Uses: Facilitation of tracheal
intubation, skeletal muscle relaxation during mechanical ventilation, surgery,
or general anesthesia. Dosages: IV bolus 0.3–0.5 mg/kg, then 0.8–0.10 mg/kg
20–45 min after first dose if needed for prolonged procedures.
atropine: Antidysrhythmic, anticholinergic, antimuscarinic. Parasympatholytic
uses: Bradycardia, 40–50 bpm, bradydysrhythmia, reversal of anticholinesterase
agents, insecticide poisoning, blocking cardiac vagal reflexes, decreasing secre-
tions before surgery, antispasmodic with GU, biliary surgery, bronchodilator.
Dosages: Bradycardia/bradydysrhythmias: IV bolus 0.5–1 mg given every
3–5 min, not to exceed 2 mg. Organophosphate poisoning: IM/IV 2 mg every hr
until muscarinic symptoms disappear, may need 6 mg every hr. Presurgery
SC/IM/IV 0.4–0.6 mg before anesthesia.
bivalirudin, Angiomax: Anticoagulant, thrombin inhibitor. Uses: Anticoagulation
used in conjunction with aspirin for patients with unstable angina undergoing
PTCA or PCI with provisional glycoprotein IIb/IIIa inhibitor; anticoagulant used
in conjunction with aspirin for patient undergoing PCI with (or even at risk)
for HIT/thrombosis syndrome (HITTS). Dosages: IV bolus initially 0.75 mg/kg
immediately before procedure, followed by 1.75 mg/kg/hr for the duration
of procedure and up to 4 hr post procedure if needed; may determine ACT
5 min after bolus dose: may administer additional bolus of 0.3 mg/kg if
necessary. If continuous anticoagulation is needed after the initial 4-hr post-
procedure infusion, the infusion may be continued at 0.2 mg/kg/hr for up to
an additional 20 hr (U.S. labeling) or 0.25 mg/kg/hr for 4–12 hr post procedure
(Canadian labeling). Please note: There are many off-label uses for this drug
in the United States.
cisatracurium, Nimbex: Neuromuscular blocker agent, nondepolarizing. Uses:
Adjunct to general anesthesia to facilitate endotracheal intubation and to
relax skeletal muscles during surgery; to facilitate mechanical ventilation in
ICU patients; does not relieve pain or produce sedation. Dosages: Operating
room administration: intubating dose IV 0.15-0.2 mg/kg as components of
propofol/nitrous oxide/oxygen induction-intubation technique. (Note: May
produce generally good or excellent conditions for tracheal intubation in
1.5–2 min with clinically effective duration of action during propofol anesthe-
sia of 55–61 min) Initial dose after succinylcholine for intubation 0.1 mg/kg.
Maintenance dose IV 0.03 mg/kg 40–60 min after initial dose, then at ~20-min
intervals based on clinical criteria. Continuous infusion: After initial bolus a
diluted solution can be given by continuous infusion for maintenance of
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