Common ICU Drugs Guidelines

Drug Names Therapeutic Action Indications Contra- Side Effects Dosage Nursing
indications Considerations

Drug scientific -As a precursor to - Cardiac -Uncontrolled - Chest pain. - At lower doses ( 2-5 -Careful monitoring of
name epinephrine. It acts as dysfunction due tachycardia. - Palpitation. mcg/kg/min ) causes patient Hemodynamics
Dopamine beta adrenergic to MI, CHF, - Tachycardia. renal vasodilatation
Hydrochloride stimulant resulting in cardiogenic shock - Ventricular - Dyspnea. - Be alert to signs of
increased cardiac irritability. - Headache. - At moderate doses cardiac compromise e.g.
Drug Trade contractility & -Hypotension - Nausea. ( 5-15 mcg/kg/min ) chest pain
Name myocardial workload unresponsive to -Hypertension - Vomiting. cause ↑HR &
Dopamine (+ve Inotropic). fluid therapy. - Tissue necrosis myocardial - Central line is preferred
or intropin if the IV line contractility
-Peripheral -Renal failure infiltrates - Be alert of peripheral
Drug Class vasoconstriction both -At high doses extravasations
Autonomic venous & arterial (greater than 15
Nervous mcg/kg/min ) causes
System Agent peripheral
(Sympathomim vasoconstriction &
etic) hypertension
 Drug Names Therapeutic Indications Contra- Side Effects Dosage Nursing
Action indications Considerations

Drug scientific name -Increases the -Short term - Preexisting -Cardiac dysrhythmia. - Usually 2-20 -Careful monitoring of
Dobutamie contractile force treatment of cardiac hypertension. - Chest pain. mcg/kg/min. patient Hemodynamics.
Hydrochloride. of the heart & dysfunction - Tachycardia. - Tachycardia. - Start at lowest dose.
dilate peripheral secondary to poor -Acute coronary - Nausea. - Do not inject directly
Drug trade Name vasculature. cardiac contractility syndrome. - Vomiting. (infusion only).
Dobutrex. such as - Tissue necrosis if the - Central line is
decompensate IV line infiltrates. preferred.
Drug Class cardiomyopathy & - Be alert of
Autonomic Nervous CHF. extravasations.
System Agent
(Sympathomimetic).

Drug Names Therapeutic Indications Contra- Side Effects Dosage Nursing

Action indications Considerations
Drug scientific name -Increases heart - Severe -Preexisting -Decreased renal - Initially ( 0.5 – 1 -Careful monitoring of
Norepinephrine rate , blood pressure hypotension hypertention . perfusion mcg /min ). patient BP every 15
Bitartrate & produces - Refractory to -Hypotension - Tachycardia min
peripheral high dose of from -Cardiac -Titrate up to 30 -Monitor tachycardia
Drug Trade Name vasoconstriction dopamine hypovolemia dysrhythmia mcg /min as or cardiac rhythm
Levophed therapy needed. changes
- Post cardiac - Monitor UOP to early
Drug Class arrest detect renal
Autonomic Nervous hypotension vasoconstriction
System
Agent
(Sympathomimetic)

Drug Names Therapeutic Action Indications Contra- Side Effects Dosage Nursing
indications Considerations
Drug scientific name -Vasoconstriction - Cardiac arrest - Preexisting Palpitation, - From ( 0.01 -Careful monitoring of
Epinephrine hypertension –0.2 patient Hemodynamics
Hydrochloride - Bronchodilatation - Ventricular Tachycardia, mcg/kg/min
tachycardia - Preexisting - Protect it from light
Drug Trade Name - Increases HR Tachycardia Hypertension whether still packed or
Epinephrine - Ventricular being used as infusion
-Increases myocardial fibrillation - Acute coronary Cardiac dysrhythmia
Drug Class contraction force syndrome
Autonomic Nervous - A systole Tissue necrosis if the
System Agent - Ischemic Chest IV line infiltrates
(Sympathomimetic) -Broncho- pain
spasm Transient elevations
- Anaphylactic of blood glucose
Reactions level

Drug Names Therapeutic Action Indications Contra- Side Effects Dosage Nursing Considerations
indications
Drug scientific name - Relax both venous & -Hypertensive - Patient with - Accidental - From 0.5 -10 -Start at low dose and
Nitroprusside Sodium arterial smooth muscles emergency significant hypotension mcg/kg/min titrate every 5 -10 min
which result in hypotension - Nausea administered as until the desired BP is
Drug Trade Name decreasing BP - known allergy - Vomiting. an infusion obtained
Nipride -Peripheral
vasodilatation - Monitor BP closely every
Drug Class - Increases COP by 5 min
Cardiovascular Agent decreasing afterload
Antihypertensive - Administer the drug in a
Agent light resistant container
Vasodilator and wrap it in foil
immediately after
preparation .

Drug Names Therapeutic Action Indications Contra- Side Effects Dosage Nursing Considerations
indications
Drug scientific -Systemic arterial & - Acute MI -Preexisting Hypotension - From ( 5 - 50 mcg/min -Careful monitoring of
name venous dilatation Hypotension administered as an patient BP every 5 min
Nitroglycerin - Decrease BP - CHF Palpitation, infusion for development of
-Enhance oxygen & Hypersensitivity hypotension
Drug Trade blood supply to - Pulmonary Tachycardia, - Titrate every 5-10 min
Name ischemic cardiac edema to obtain desired - Sublingual tablets
Tridil or tissues Headache, response of BP & chest should be protected from
Nitrostate Hypertension pain light , air & temperature
Or Nitrolingual Skin flushing extremes
- Sublingual tablets
Drug Class ( 0.15 , 0.3 , 0.4 , 0.6 mg)
Cardiovascular - Sublingual aerosol
Agent canister delivers 0.4
Vasodilator mg/spray

Drug Names Therapeutic Action Indications Contra- Side Effects Dosage Nursing
indications Considerations
Drug scientific name - Increase HR - Complete heart - Dysrhythmia - Palpitation - From 2.0 – -Careful monitoring of
Isoproterenol block - Tachycardia 10.0 mcg/min patient Hemodynamics
- Bronchodilatation - Coronary heart - Hypotension IV infusion & continuous ECG
Drug Trade Name - Broncho-spasm disease - Ventricular rhythms
Isuprel -Decrease peripheral irritability (VT or
vascular resistance -Bradycardia VF)
Drug Class unresponsive to - Restlessness.
Autonomic Nervous atropine - Nausea.
System Agent -Vomiting.
(Sympathomimetic)

Drug Names Therapeutic Indications Contra- Side Effects Dosage Nursing

Action indications Considerations
Drug scientific name - Decrease - Angina - Acute CHF - Bronchospasm -Available in 1 ml -Careful monitoring of
Propranolol HR & BP. ampules containing patient
-Suppress - VT - Heart Block - Bradycardia 1 mg/ml Hemodynamics &
Drug Trade Name cardiac continuous ECG
Inderal Dysthymias. -VF - Hypotension - Hypotension Patient can be rhythms
given from 1-3
Drug Class -SVT - COPD mg/kg
Autonomic Nervous
System Agent
(Sympatholytic)
Antihypertensive Agent
Antiarrhythmic Agent
Beta blocker

Drug Names Therapeutic Indications Contra- Side Effects Dosage Nursing Considerations
Action indications
Drug scientific name -Delays -Atrial fibrillation -Hypotension Bradycardia 2-ml ampules -Careful monitoring of patient
Verapamil atrioventricular(AV containing Hemodynamics & continuous
) nodal conduction - Atrial flutter -Left ventricular Hypotension 2.5 mg/ml ECG rhythm
DrugTrade Name & inhibits atrial dysfunction
Isoptin dysrhythmias - Supraventricular Headache
tachycardia
Drug Class Dizziness
Calcium channel blocker

Drug Names Therapeutic Indications Contra- Side Effects Dosage Nursing Considerations
Action indications
Drug scientific name Breaks down - Acute MI - CPR - Hemorrhage - 1.5 million units - Careful monitoring of
blood clots - Severe IV over one hour patient Hemodynamics &
Streptokinase thus restoring hypotension -Allergic reaction ( available in 12 leads ECG
Drug Trade Name blood flow (bronchospasm, vials) - Be alert of bleeding risk
Streptase - Active internal flushed skin &
bleeding itching) -Monitor coagulation
Drug Class profile
Thrombolytic Agent

Drug Names Therapeutic Indications Contra- Side Effects Dosage Nursing Considerations
Action indications
Drug scientific Inhibits platelet -Acute -Active - Hemorrhage. - Initially 0.4 - Careful monitoring of
name aggregation thus Coronary bleeding mcg/kg/min for patient Hemodynamics
Tirofiban inhibits Syndrome -Bleeding -Vasovagal 30 minutes then - Be alert of bleeding risk
Hydrochloride-de thrombotic events (ACS) abnormalities reaction followed by 0.1 -Monitor coagulation profile
during acute mcg/kg/min
Drug Trade coronary -Thrombocytopenia
Name syndrome -Anemia
Aggrastat

Drug Class
Antiplatelet
Agent

Drug Names Therapeutic Action Indications Contra- Side Effects Dosage Nursing
indications Considerations
Drug scientific name -Blocks the effect of-Vagally induced Hypersensitiv Palpitation, - 0.5 – 1.0 mg -Careful monitoring
Atropine acetylcholine inBradycardia ity Tachycardia, every 3-5 min of patient HR &
Sulfate smooth & cardiac & Dry mouth to a max dose cardiac rhythm
muscle ( inhibit the bronchoconstrictio Dilated of 0,04mg/kg
Drug Trade Name vagal tone) n pupils -Administration
Atropine Delirium should be rapid IV
- Depress the action - A systole Blurred push to prevent a
Drug Class to SA & AV nodes vision reflex Bradycardia
Autonomic Nervous of the heart
System Agent Headache
(Anticholinergic )
 Drug Names Therapeutic Indications Contra- Side Effects Dosage Nursing
Action indications Considerations
Drug scientific -Suppresses the - Acute - Hypersensitivity Hypotension - Available in 5 ml -Careful monitoring of
name automiticity of ventricular prefilled syringe patient Hemodynamics
Lidocaine conduction tissue dysrhythmias Bradycardia containing 20 during & after
Hydro-chloride & refractory as VT , VF , mg/ml for IV push administration
period in cardiac PVCs Dysrhythmias
Drug Trade Name tissues - 50 ml prefilled - Use cautiously in
Xylocaine Drowsiness syringe containing 1 patients with renal or
-Raise ventricular or 2 g for infusion hepatic dysfunction
Drug Class fibrillation Nausea,
Cardiovascular threshold - From 1.0 to 1.5
Agent Vomiting mg/kg IV over 2-3
Anti-dysrhythmia min
Central Nervous
System Agent

Drug Names Therapeutic Action Indications Contra- Side Effects Dosage Nursing
indications Considerations
Drug scientific name - Facilitates conduction - -Digitalis Rapid - Available in 10 ml -Careful
Calcium chloride in tissues as nerves , Hypocalcaemia toxicity administration vials & prefilled monitoring of
muscles & cardiac may result in syringe containing patient ECG
Drug Trade Name tissues Bradycardia , 100mg/ml rhythm
Calcium chloride hypotension
-Increases calcium - From 2-4 mg/kg of
Drug Class concentration in blood 10% solution slow IV
Electrolyte & tissues push

Drug Names Therapeutic Action Indications Contra- Side Effects Dosage Nursing Considerations
indications
Drug scientific name -Major cation in Potassium - Renal failure - Cardiac arrest - From 0.3 – -Careful monitoring of
Potassium Chloride intracellular fluid replacement especially in renal 0.5 meq/kg patient ECG & plasma
therapy - Severe Burns impairment potassium levels
Drug Trade Name - Conduction of nerve - Tissue necrosis
KCL impulses in the heart. - Severe as a result of - Monitor acid base
Dehydration extravasation balance
Drug Class - Contraction of cardiac
Electrolyte and smooth muscles - Central line is needed &
do not give by direct IV

Drug Names Therapeutic Action Indications Contra- Side Effects Dosage Nursing
indications Considerations
Drug scientific - Increases pH in the -Metabolic acidosis -CHF - Decrease oxygen - Available in -Careful
name blood & urine delivery in the tissues ampules containing monitoring of
Sodium Bicarbonate -Prolonged -Renal 4.3%, 7. 5% or patient ABGs
- Act as buffering resuscitation failure - Metabolic alkalosis 8.4%
Drug Trade Name agent for acids in the -Adequate
Sodium Bicarbonate blood & interstitial - Hypernatremia Adult dose is 1 oxygenation
fluid mEq/dl
Drug Class
Alkalizing Agent

Drug Names Therapeutic Indications Contra- Side Effects Dosage Nursing

Action indications Considerations

Drug scientific - Dilates bronchial - Acute COPD -Coronary artery - Tachycardia - Available in -Careful monitoring of
name smooth muscles disease - hypotension ampules 10 ml patient Hemodynamics
Aminophylline -Asthma - liver & kidney - Nausea containing 25 mg
- Has +ve intropic diseases - Vomiting - Loading dose 4-6 - All patients receiving
Drug Trade effect - mg/kg IV over 20 min this drug should have
Name Hypersensitivity ECG monitoring
Theophylline to compounds

Drug Class
Bronchodilator

Drug Names Therapeutic Indications Contra- Side Effects Dosage Nursing Considerations
Action indications
Drug scientific name -Promoting - COPD -Excessive Hypertension 2.5 mg mixed with -Careful monitoring of
Albuterol relaxation of - Acute asthma tachycardia palpitation, 3-5 ml saline & patient Hemodynamics
bronchiole Tachycardia, nebulized as
Drug Trade Name smooth muscle. -Preexisting Nausea, needed - Close cardiac monitor
Ventolin hypertension Vomiting
Dilated pupils
Drug Class -Cardiac
-Autonomic Nervous dysrhythmias
System Agent
(Sympathomimetic)
Bronchodilator

Drug Names Therapeutic Action Indications Contra- Side Effects Dosage Nursing
indications Considerations
Drug scientific name -CNS depressant - Moderate -Allergy to Hypotension - Available in 10 ml -Careful monitoring of
Morphine to severe compounds ampules containing patient Hemodynamics
Sulfate - Analgesic pain Headache, 0.5 mg/ml
-Decreased - Be prepared to assist
Drug Trade Name -Decreases myocardial - CHF conscious level Vomiting - Adult dose range with ventilation or
Duramorph or oxygen consumption from 2-10 mg intubation
Astramorph -Myocardial -Respiratory -Localized - Administer the drug
Decreases pulmonary chest pain depression allergy reaction slowly
Drug Class edema with IV
Central Nervous administration
System Agent
-Narcotic Analgesic

Drug Names Therapeutic Indications Contra- Side Effects Dosage Nursing

Action indications Considerations
Drug scientific name - Inhibit basal - Treatment of -Allergy to Bradycardia with rapid 50 mg/50 ml -Careful monitoring of
Ranitidine Hydrochloride gastric acid GI ulcer & GI compounds administration IV over 15-30 patient vital signs
secretion bleeding min
DrugTradeName Zantac Nausea, - Close cardiac rhythm

Drug Class Vomiting

GIT Agent
Constipation
H2Receptor antagonist

High-alert medications
High-alert medications are drugs that bear a heightened risk of causing significant patient harm when
they are used in error it commonly include:

 Cancer chemotherapeutic
 Benzodiazepines
 (epinephrine, isoproterenol, agents and norepinephrine)
 Intravenous calcium
 IV Heparin
 Thrombin inhibitors
 Pediatric sedation
 Warfarin
 IV Digoxin
 IV Magnesium
 Hypertonic saline
 Insulin
 Phosphate salts
 Potassium chloride
 IV Lidocaine
 Neuromuscular blocking
 Narcotics
 Three principles may be used to safeguard the use of high-alert medications:

1. Reduce or eliminate the possibility of error

(for example, reducing the number of high-alert medications stocked by the hospital; reducing
the available concentrations and volumes; and removing high-alert drugs from clinical areas).
2. Make errors visible
(for example, having two individuals independently check infusion pump settings for high-
alert drugs is one way to make errors visible and thus caught before reaching the patient).
3. Minimize the consequences of errors
(for example, fatal errors have occurred when the contents of 50mL vials of 2% lidocaine were
injected instead of mannitol, which has a similar appearance – had lidocaine 2% been only
available in the clinical area in a 10mL vial, if administered erroneously in place of another
drug in a 10ml vial, the amount of lidocaine injected would likely not have been fatal).