Page 259 - Critical Care Notes

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heparin, Heparin: Anticoagulant. Uses: labeled indications: Prophylaxis and
treatment of thromboembolic disorders; as an anticoagulant for extracorpo-
real and dialysis procedures. Unlabeled uses: STEMI as an adjunct to throm-
bolysis; unstable angina/NSTEMI; anticoagulant used during PCI. Dosages:
Acute coronary syndromes: IV infusion (weight based dosing per institution-
al nomogram recommended: STEMI, as adjunct to fibrinolysis: Initial bolus
of 60 units/kg (max: 4,000 units) then 12 units/kg/hr as continuous infusion.
Check aPTT every 4–6 hr: adjust to target of 1.5–2 times the upper limit of
control (50–60 sec). Duration of heparin therapy depends on concurrent
therapy and the specific patient risks for systemic or venous thromboem-
bolism. Unstable angina: IV bolus initially 60 units/kg, followed by an initial
infusion of 12 units/kg/hr. Check aPTT every 4–6 hr; adjust to target rate of
1.5–2 times the upper limit of control (50–70 sec). Continue for 48 hr in low-
risk patients managed with a conservative strategy. PCI: No prior anticoagu-
lation therapy: if no GPIIb/IIIa inhibitor use planned: IV bolus 70–100 units,
kg or if planning GPIIB/IIIa inhibitor use: IV bolus of 50–70 units/kg Prior anticoag-
ulant therapy: If no GPIIb/IIIa inhibitor use planned: additional heparin as
needed or if planning GPIIb/IIIa inhibitor use: additional heparin as needed.
Thromboprophylaxis (low-dose heparin): SC 5,000 units every 8–12 hr.
Treatment of venous thromboembolism: Start warfarin on the first or
second treatment day and continue heparin until INR is >2 for at least
24 hr (usually 5–7 days).
hetastarch, Hespan: Plasma expander. Uses: Plasma volume expander,
hypovolemia. Dosages: IV infusion 500–1,000 mL (30–60 g), total dose
not to exceed 1,500 mL/day, not to exceed 20 mL/kg/hr (hemorrhagic shock).
ibutilide, Covert: Antiarrhythmic agent, class III. Uses: Acute termination of
atrial fibrillation or flutter of recent onset. Dosages: Atrial fibrillation/
flutter: IV < 60 kg: 0.01 mg/kg over 10 min. > 60 kg: 1 mg over 10 min. Note:
Discontinue infusion if arrhythmia terminates, if sustained or nonsustained
VT occurs, or if marked prolongation of QT/QTc occurs. If the arrhythmia
does not terminate within 10 min after the end of the initial infusion, a
second infusion of equal strength may be infused over a 10-min period.
isoproterenol, Isuprel: Beta-adrenergic agonist. Uses: Bronchospasm,
asthma, heart block, ventricular dysrhythmias, shock. Dosages: Asthma,
bronchospasms: SL 10–20 mg every 6–8 hr, max 60 mg/day; INH 1 puff, may
repeat in 2–5 min, maintenance 1–2 puffs 4–6 times/day; IV 10–20 mcg dur-
ing anesthesia. Shock: IV infusion 0.5–5 mcg/min. 1 mg/500 mL D5W, titrate
to BP, CVP, hourly urine output.
labetalol, Normodyne: Antihypertensive, antianginal. Uses: Mild to moderate
HTN; treatment of severe HTN. Dosages: HTN: PO 100 mg twice a day; may
be given with a diuretic; may increase to 200 mg twice a day after 2 days;
may continue to increase every 1–3 days; max 2,400 mg/day in divided doses.
Hypertensive crisis: IV infusion 200 mg/160 mL D5W, infuse at 2 mL/min; stop
infusion at desired response, repeat every 6–8 hr as needed; IV bolus 20 mg
over 2 min, may repeat 40–80 mg every 10 min, not to exceed 300 mg.
CC MEDS