ICU Meds

Receptor specificity (adrenergic agonist)- alpha 1, alpha 2, beta 1, beta 2

Classification:  Catecholamine

• Therapeutic Uses:
• Because it activates all four subtypes it produces broad spectrum of beneficial sympathomimetic effects
• Alpha 1 - vasoconstriction
• Beta 2 - bronchodilation
• combines alpha & beta - treatment of choice for anaphylactic shock

• Adverse effects:
• Hypertensive crisis
• Dysrhythmias
• Angina Pectoris
• Necrosis (extravasation)
• Hyperglycemia

• Receptor specificity: Pure alpha 1 agonist
• Noncatecholamine 

Powerful vasoconstrictor 

• Parenterally - elevates BP (vessels alpha 1)
• Locally - reduces nasal congestion

Can be coadministered with local anesthesia to retard anesthetic absorption

Uses:  hypotension shock, maintain BP for spinal anesthesia, paroxysmal supraventricular tachycardia

Side Effects:  headache, anxiety, tremor, insomnia, dizziness, palpitations, tachycardia, HTN, ectopic beats angina, N&V, gangrene, necrosis

AKA: antidiuretic hormone

• Promotes renal conservation of water (reabsorption)
• Stimulates contraction of vascular smooth muscle and GI smooth muscle 

• Therapeutic uses:
• Diabetes Insipidus
• Cardiac Arrest - used to enhance CPR.  It vasoconstriction increases blood flow to heart and brain.  

• Adverse effects:
• water intoxication
• excessive vasoconstriction

Receptor - direct acting receptor stimulant (alpha 1, alpha 2, beta 1)

• Therapeutic uses:
• hypotensives states
• Cardiac arrest
•  
• IV infusion only
• Monitor Cardiovascular status continually

Receptor Specificity:  dopamine, beta 1, alpha 1 (at high doses)

• Therapeutic uses:
• Shock - Beta 1 (increases CO = tissue perfusion), Dopamine (receptors in kidneys dilate renal vessels = renal perfusion)
• Heart Failure - beta 1 increases myocardial contractility which increases CO
• Acute Renal Failure - low dose dopamine increases renal blood flow and urine output

• Adverse effects:
• tachycardia
• dysrhythmias
• anginal pain

• Elicits 2 therapeutic responses 
• - vasoconstriction
• - mydriasis (pupil dilation)

Receptors located in Heart

• Therapeutic application:
• Cardiac Arrest
• Heart Failure
• Shock
• AV Heart Block

• Adverse effects:
• Altered Heart Rate or Rhythm
• Angina Pectoris

Receptors located in lungs and uterus

• Therapeutic Application: 
• Asthma
• Delay of preterm labor

• Adverse Effects:
• Hyperglycemia
• Tremor

increases force of contraction

Both reduce force of contraction, slow heart rate, and suppress conduction through the AV node.

• Drugs that prevent calcium ios from entering cells.  Have greatest effect on heart and blood vessels.
•  
• Widely used to treat:  HTN, angina, & cardiac dysrhythmias

In the heart:  Contractile force diminished, pacemaker (SA node) declines (reduced heart rate), decreases velocity of conduction through the AV node

Calcium Channel Blocker, very similar to verapamil

Lowers BP through arteriolar dilation

Used for angina pectoris, essential HTN, cardiac dysrhythmias

• Adverse effects:
• dizziness, flushing, headache, edema of ankles/feet
• Exacerbation of cardiac dysfunction in pts with bradycardia, sick sinus syndrome, heart failure, or 2nd or 3rd degree heart block.

IV = Cardizem

Acts directly on VSM to promote vasodilation (primarily veins)

Decreases cardiac oxygen demand by dilating veins, decreases venous return to heart thereby decreasing ventricular filling

• Adverse effects:  
• headache, hypotension, tachycardia

Potent & efficacious vasodilator (venous & arteriolar dilation)

Fastest acting antihypertensive agent available, making it drug of choice for hypertensive emergencies

Can cause retention of Na & water, furosemide can help offset this effect

• Adverse effects:
• Excessive Hypotension
• Cyanide Poisoning
• Thiocyanate toxicity

• IV INF
• degraded by light
• soln should be faint brown
• Monitor BP continuously during INF with arterial line 
• INF rate is 0.3 mcg/kg/min - 10 mcg/kg/min, if after 10 min at max rate an adequate drop in BP does not occur infusion should be stopped

Calcium Channel Blocker

At therapeutic level produces selective blockage of calcium channels in blood vessels and has minimal direct effects on the heart

• Indications:
• essential HTN
• Effort-induced angina pectoris

• Adverse effects:
• flushing, headache, asthenia (weakness), dissiness, palpitations, edema of ankels/feet

• general anesthetics
• IV sedative-hypnotic for ventilation

Rapid onset & short duration of action

NO effect on pain!

• Run propofol along
• It easily grows bacteria, change lines Q12 hours

• Adverse effects:
• profound resp. depression (including apnea)

Strong opioid analgesic

Primarily used for induction and maintenance of surgical anesthesia.  

Rapid onset, short duration

• Opioid 
• Selective alpha 2 adrenergic agonist
• Acts in the CNS to cause sedation and analgesia

Short term sedation, & intubated, mechanically ventilated pts

• Adverse effects:
• hypotension
• bradycardia

Benzodiazepine

IV midazolam may be used for induction of anesthesia & to produce conscious sedation

Conscious sedation produced by combining midazolam with an opioid analgesic (morphine, fentanyl).  State characterized by sedation, analgesia, amnesia, & lack of anxiety.  Pt unperturbed & passive, but responsive to commands.  

Dose - CONT INF IV 0.01-0.05 mg/kg over several minutes

• Adverse effects:
• Respiratory depression
• respiratory and cardiac arrest