DRUGS in ICU.pptx

DRUGS used in ICU

1. Dr.Abdelrahman Youssif Cardiovascular Medicine Resident (MBBCH) Medical Treatment In Intensive Care Unit

2. Pressors NG Sedative Analgesic Paralytic agents

3. Norepinephrine Potent alpha ,some beta agonist Vasocontriction Dose: 1-2microgram /min

4. EPINEPHRINE Beta with very low dose ,alpha with higher dose Uses:cardiac arrest ,anaphylactic shock and bronchial asthma S/E: arrythmia ,coronary ischemia,renal vc Dose:1ml iv

5. DOPAMINE Renal dose :5micro/Kg /min Cardiac dose:5-10micro/min Vasopressor dose :10-20micro/min S/ E:tachyarrythmia

6. DOBUTAMINE Beta 1,mild beta 2 Used in cardiogentic shock May decrease peripheral vascualr resistance

7. VASOPRESSIN Vasoconstriction in septic shock May be used alternative to epinephrine in refractory VF

8. NITROGLYCERINE Venodilator in dose less than 40micro/min Arteriodilator in dose higher than 200micro/min Rapid onset ,short duration S/E increase ICT headache

9. SEDATION To relieve pain To decrease anxiety To decrease patient -ventilator dysynchrony

10. BENZODIAZEPINE Sedative hypnotics Anticonvulsant Anxiolytic Metabolized in liver excreted in urine Interact with erythromycin , inderal

11. Diazepam Larozepam Midazolam

12. PROPOFOL Sedative Anesthetic Anticonvulsant Rapid onset: less than 1 min Clearance not changed in liver or kidnet disease

13. S/E: Respiratory depression Hypotension Increase TG

14. HALOPERIDOL Tranquillizer No respiratory depresion or hypotension S/E: QT prolongation, NMS

15. PAIN IN THE ICU Pain cause: Catabolism Ileus ADH relsease Immune disturbance Hypercoagulability Increase cardiac work

16. Pain causes Lines Tubes Underlying illness

17. Morphine Metabolized by liver Cause Histamine relsease Fentanyl more potent .no histamine release S/E: Respiratory depression Hypotension Decrease GI motility Pruritis

18. Paralytics Used in intubation Facilitation of mechanical ventilation

19. complicaTIONS Neuromuscular blockade Muscle weakness Post paralytic syndrome

20. ATROPINE Parasympatholytic Increase heart rate ,AV conduction Use in resuscitation,bradycardia,HB Dose: 0.5-1mg

21. amiodarone Sodium,potassium and calcium channel blocker Alpha ,beta blocking action S/E: Prolong QT interval

22. Indication Refractory VF,VT Hemodynamically stable VT Resistant tachycardia

23. Dose: 300mg in 200ml G5% iv bolus 1mg /min for 8 hour then 0.5mg /min for 16 Max 2.2gm/d

24. precautions Cardiogenic shock Bradycardia ,HB Hypotension is the most common side effect

25. lidocaine Used in VT,VF Best in IHD Dose:1mg/kg bolus Drip: 2mg/min

26. SODIUM BICARBONATE Used in severe metabolic acidosis,Hyperkalemia Dose:1-2mmol/kg iv S/E: Intracelluar acidosis, Increase co2 Hypoxia Decrease myocardial contractility Hypernatemia

27. Dr.Abdelrahman Youssif #THECARDIOLOGIST THANK YOU