Page 262 - Critical Care Notes

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CC MEDS
Postoperative opioid-induced respiratory depression: IV 0.1–0.2 mg every
2–3 min prn. Opioid overdose: IV/SC/IM 0.4 mg (10 mcg/kg) (not opioid
dependent), may repeat every 2–3 min (opioid dependent).
nesiritide, Natrecor: Vasodilator. Uses: Acutely decompensated CHF. Dosages:
IV bolus 2 mcg/kg, then IV infusion 0.01 mcg/kg/min nitroglycerine: Coronary
vasodilator, antianginal. Uses: Chronic stable angina pectoris prophylaxis of
angina pain, CHF associated with AMI, controlled hypotension in surgical
procedures. Dosages: SL, transdermal, topical doses available. IV infusion
uses listed only IV 5 mcg/min, then increase by 5 mcg/min every 3–5 min; if
no response after 20 mcg/min, increase by 10–20 mcg/min until desired
response
nicardipine, Cardene: Antianginal agent; calcium channel blocker, dihydropyri-
dine. Uses: Chronic stable angina (immediate release product only); manage-
ment of HTN (immediate and sustained release products); IV only for short-
term use only when oral treatment not feasible. Dosing: Angina: Immediate
release, PO 20 mg 3 times day; usual range 60–120 mg/day; increase dose at
3-day intervals. HTN: PO immediate release initial dose 20 mg 3 times a day;
usual dose 20–40 mg 3 times a day (allow 3 days between dose increases).
Sustained release: Initial 30 mg twice a day. Acute HTN: IV initial dose 5 mg/hr
increased by 2.5 mg/hr every 5 min (for rapid titration) to every 15 min (for
gradual titration) up to max of 15 mg/hr; rapidly titrated patients, consider
reduction to 3 mg/hr after response is achieved.
nitroglycerin: Antianginal agent, vasodilator. Uses: Labeled indications:
Treatment or prevention of angina pectoris. Unlabeled indications: Short-
term management of pulmonary HTN, esophageal spastic disorders,
uterine relaxation. Dosages: Angina/coronary artery disease: PO 2.5–6.5 mg
3–4 times/daily. IV 5 mcg/min, increase by 5 mcg/min every 3–5 min to
20 mcg/min. If no response at 20 mcg/min, may increase by 10–20 mcg/min
every 3–5 min. Topical ointment 1/2 inch–2 inches every 6 hr; patch,
transdermal 0.2–0.4 mg/hr initially and titrate to doses of 0.4–0.8 mg/hr
(tolerance is minimized by using patch 12–14 hr/day and off 10–12 hr/day
SL 0.3–0.6 mg every 5 min for max of 3 doses in 15 min, may also use
prophylactically 5–10 min before activities that may provoke an attack.
Translingual 1–2 sprays onto or under tongue every 3–5 min for max of
3 doses in 15 min, may also be used prophylactically 5–10 min before activi-
ties that may provoke an angina attack. Esophageal spastic disorders: SL
0.3–0.5 mg. Uterine relaxation: IV bolus 100–200 mcg; may repeat dose
every 2 min as necessary.
nitroprusside, Nitropress: Antihypertensive, vasodilator. Uses: Hypertensive
crisis, to decrease bleeding by creating hypotension during surgery, acute
heart failure. Dosages: IV infusion dissolve 50 mg in 2–3 mL of D5W, then
dilute in 250–1,000 mL of D5W; infuse at 0.5–8 mcg/min.
norepinephrine, Levophed: Adrenergic. Uses: Acute hypotension, shock.
Dosages: IV infusion 8–12 mcg/min titrated to BP.
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