Icu Drips

Authors: Flaherty, Alice W.; Rost, Natalia S.

Title: Massachusetts General Hospital Handbook of Neurology, The, 2nd Edition

Copyright 2007 Lippincott Williams & Wilkins

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Icu Drips

A. See also

Adrenergic Drugs, p. 155; Dopaminergic Drugs, p. 169.

B. Access

Most require central line.

C. Dobutamine

To treat heart failure. Increases cardiac output while decreasing SVR, so BP often does not change. Does not increase PCWP as much as DA does.

D. Dopamine (DA)

To treat low BP, low HR, or oliguric renal failure (controversial). You can give low doses by peripheral IV.

• SEs: Arrhythmia, tachycardia (especially if pt. is hypovolemic).

• Low-dose effects: 0.5-3 g/kg/min. Causes renal dilation, Na excretion, via DA receptors.

• Medium-dose effects: 5-10 g/kg/min. Causes positive inotropy, via -receptors.

• High-dose effects: >15 g/kg/min. Causes vasoconstriction, via -receptors. High doses sometimes dilate and even fix pupils.

E. Epinephrine

To treat anaphylaxis; to help circulation in cardiac codes.

F. Lidocaine

To decrease ectopy. Dangerous in bradycardia or AV block.

G. Nicardipine

Calcium channel blocker. Treats high BP in intracranial disease. Can infuse continuously.

H. Nitroglycerine (TNG, NTG)

To treat cardiac ischemia, coronary or esophageal spasm, CHF if BP not low. Low doses can be given by peripheral IV. It causes venous greater than arterial dilation. May reduce cardiac output. Unlike nitroprusside, it does not cause cerebral steal.

I. Nitroprusside (NTP)

To treat high BP in stroke, hypertensive crisis, aortic dissection. It causes arterial dilation and venodilation equally. Avoid in ischemic brain; it may cause cerebral steal by dilating peripheral vessels. Low doses can be given by peripheral IV. After 3 days of use, check thiocyanate levels daily.

J. Norepinephrine (Levophed)

To treat low BP in sepsis. Beta₁- and -receptor effects. Inotropic at 1-2 g/min; then vasoconstriction and venoconstriction.

K. Phenylephrine (Neosynephrine)

To treat low BP in stroke; second-line agent for septic shock. Pure -receptor effects, no (vasoconstricts without inotropy), so raises afterload without inotropic support.

P.172

Table 49. ICU drips.

Category	Target	Dose Per kg	Average Dose	Toxicity
Pressors
Dopamine (Intropin)	D1, D2	0.5-2 g/kg/min	50-150 g/min	-HR, arrhythmia, big pupils
	, D	2-10 g/kg/min	200-500 g/min	HTN
	, , D	>10 g/kg/min	500-1,000 g/min
Norepinephrine (Levophed)	1, 2 1 > 2		1-16 g/min	Vasospasm, acute renal failure
Phenylephrine (Neosynephrine)	1		10-300 g/min	Vasospasm, acute renal failure
Dobutamine (Dobutrex)	1	2-20 g/kg/min	100-1,000 g/min	Arrhythmia, initial SVR
Epinephrine (Adrenalin)	1, 2 1 2		0.25-4 g/min	Vasospasm, MI arrhythmia
Isoproterenol (Isuprel)	1, 2		0.1-20 g/min	Arrhythmia, MI hypotension
Amrinone (Inocor)	PDE-III inhibitor	0.75 mg/kg then 5-15 g/kg/min	40 mg over 3min then 250-900 g/min	HR , plts , hypotension
Cardiac
Lidocaine	Na channel	1 mg/kg then 1-4 mg/min	bolus 70-100 mg then 1-4 mg/min	Altered MS, seizures, arrhythmia
Procainamide	Na, K channels	15 mg/kg @ 50 mg/min, 1-4 mg/min	1 g over 20 min then 1-4 mg/min	Hypotension, long QT interval
Bretylium	K channel	5 mg/kg then 1-4 mg/min	350-700 mg then 1-4 mg/min	Hypotension, arrhythmia
Amiodarone	K channel	150-300 mg then 0.4-0.8 mg/kg/h	150-300 mg over 5 min then 3-6 mg/h	Hypotension, arrhythmia
Nitroglycerin	Amooth muscle		10-1,000 g/min	BP , hypoxia, methemoglobin
Nitroprusside (Nipride)	Direct vascular	0.1-10 g/kg/min	5-800 g/min	Thiocyanate toxicity
Esmolol (Brevibloc)	1 > 2 blocker	500 g/kg then 25-300 g/kg/min	20-30 mg over 1 min then 2-12 mg/min	CHF, hypotension
Enalapril (Vasotec)	ACE inhibitor	0.625-1.25 mg over 5 min then 0.625-5 mg q6h	K , BP , acute renal failure
Hydralazine (Apresoline)	Direct vasodilator	5-20 mg q3min up to 400 mg then 5-20 mg q6h	Angina, hypotension
Labetalol (Normodyne)	1, 1, 2 blocker	2.5-10 mg then 10-120 mg/h or 2.5-10 mg q15min	Neg inotrope, BP
Verapamil (Calan)	Ca channel	2.5-15 mg then 5-20 mg/h	AV block, BP
Diltiazem (Cardizem)	Ca channel	0.25 mg/kg over 2 min, reload 0.35 mg/kg q15min prn, then 10-15 mg/h	AV block, BP
Nicardipine (Cardene)	Ca channel	5 mg/h, titrate by 2.5 mg/h q5-15min then rate by 1-7.5 mg/h when goal BP reached	BP