NUR 508 Medication Assignment

Name: Carla Joisil

The purpose of this assignment is to prepare you for your ICU clinical experience where you will see many of the
below drugs used in the clinical setting. Please research the below listed drugs and fill out the chart accordingly.
This assignment is due to your clinical instructor at the beginning of your first patient care day for 508
clinical.

Medication

Amiodarone

Indications &
normal dose
range

Side Effects

Metabolism &
Excretion

Other notes/
considerations

Antiarrhythmic,
Prophylaxis and
treatment of
ventricular
arrhythmias and
supraventricular
arrhythmias,
particularly atrial
fibrillation, treatment
of nonexertional
angina

CNS: muscle
weakness, fatigue,
dizziness
CV: hypotension,
sinus arrest,
cardiogenic shock
Special Senses:
blurred vision, corneal
microdeposits
GI: anorexia, nausea,
vomiting,
constipation,
hepatotoxicity
Metabolic:
hyperthyroidism or
hypothyroidism
Respiratory:
pulmonary toxicity,
fatal gasping
syndrome with IV in
children
Skin:
photosensitivity, rash

Metabolism: Mostly
in liver and some
enterohepatic cycling
via CYP2C8 and 3A4
Excretion: mainly in
bile and feces; also in
breast milk

Black Box Warning:

Amiodarone has been
associated with
pulmonary toxicity,
liver injury, and
development of
arrhythmias

Dosage: Adult PO
Loading Dose 8001600 mg/day in 1-2
doses for 1-3 wk
PO Maintenance
Dose 400-600
mg/day in 1-2 doses
IV Loading Dose
150 mg over 10 min
followed by 360 mg
over next 6 h

Contraindications:
hypersensitivity to
amiodarone or benzyl
alcohol, cardiogenic
shock, severe sinus
node dysfunction,
history of torsades de
pointes, pregnancy,
lactation
Onset: PO 2-3 days
to 1-3 wks
Half-life: Biphasic,
initial 2.5-10 days,
terminal 40-55 days

Heparin

IV Maintenance
Dose 540 mg over 18
h (0.5 mg/min) may
continue at 0.5
mg/min Convert IV
to PO Duration of
infusion less than 1
wk use 800-1600 mg
PO Child: IV 5 mg/kg
then repeat to max of
300 mg total
Anticoagulant,
prophylaxis and
treatment of venous
thrombosis and
pulmonary embolism,
treatment of
disseminated
intravascular
coagulation (DIC),
maintain potency of
indwelling IV
catheters
Dosage: Treatment
of thromboembolism
Adult: IV 5,000-unit
bolus dose then
20,000-40,000 units
infused over 24 h
dose adjusted to
maintain desired aPTT
or 5000-10,00 units IV

Other: angioedema
with chronic use

Hematologic:
Spontaneous
bleeding, transient
thrombocytopenia
Body as a whole:
fever, pruritus,
tingling of hands and
feet, elevated BP,
headache,
bronchospasm,
anaphalactoid
reactions
Endocrine:
osteoporosis,
suppressed renal
function, rebound
hyperlipidemia
(following termination
of heparin therapy)
GI: increased AST,
ALT
Urogenital: priapism

Metabolism: in liver
and
reticuloendothelial
system
Excretion: in urine

Antidote: protamine
sulfate
Monitor aPTT levels
closely; should be
kept between 1.5-2.5
X normal control level
Onset: 20-60 min
subcutaneous
Half-life: 90 min
Contraindications:
hypersensitivity to
heparin, active
bleeding, absorbic
acid deficiency,
threatened abortion,
recent surgery of eye,
brain, or spinal cord;
spinal tap; shock

Dobutamine

piggyback 14-6h
Subcutaneous
10,000-20,000 units
followed by 800020,000 units q8-12h
Child: IV 50 units/kg
bolus then 20,000
units/m2/24h or 50100 units/kg q4h
Open Heart Surgery
Adult: IV 150-400
units/kg
Prophylaxis of
Embolism Adult:
Subcutaneous 5000
units q8-12h until
patient is ambulatory
Cardiac stimulant,
increases cardiac
output and decreases
pulmonary wedge
pressure and total
systemic vascular
resistance, increases
conduction through
AV node, treatment of
adults with cardiac
decompensation due
to depressed
myocardial
contractility
(cardiogenic shock)

(rare)
Skin: injection site
reactions, vasospasm

CNS: headache ,
tremors,
paresthesias, fatigue
(with overdosage)
CV: increased heart
rate and BP, angina
pain
GI: nausea, vomiting
Other: nonspecific
chest pain, SOB

Metabolism: in liver
and other tissues by
COMT
Excretion: in urine

Correct hypovolemia
prior to start of
therapy
Monitor ECG and BP
continuously
Onset: 2-10 min
Half-life: 2 min
Contraindications:
hypersensitivity to
other
sympathomimetic
amines or sulfites,
ventricular

Dopamine

Levophed

Dosage: Cardiogenic
Decompensation
Adult: IV 0.5-1
mcg/kg/min the
titrate up to 2.5-15
mcg/kg/min (max: 40
mcg/kg/min)
Adolescent/Child: IV
2-20 mcg/kg/min
To correct
hemodynamic
imbalance in shock
syndrome, acute
renal failure,
barbiturate
intoxication
Dosage:
Shock/Surgery Adult:
IV 2-5 mcg/kg/min
increased gradually
up to 20-50
mcg/kg/min if
necessary
Adolescent/Child: IV
1-5mcg/kg/min
increased gradually
up to 20mcg/kg/min
CHF Adult: IV 3-10
mcg/kg/min
To restore BP in
certain acute
hypotensive states,

tachycardia,
hypovolemia

CV: hypotension,
tachycardia, angina
pain,
vasoconstriction,
aberrant conduction
GI: nausea, vomiting
CNS: headache
Skin: necrosis,
gangrene,
piloerection
Other: dyspnea,
dilated pupils (high
doses)

Metabolism:
inactive in the liver,
kidney, and plasma
by monoamine
oxidase and COMT
Excretion: in urine

Body as a whole:
restlessness, anxiety,
tremors, dizziness,

Metabolism: in liver
and other tissues by
catecholamine O-

Black Box Warning:

Dopamine
extravasation may
cause necrosis and
sloughing of
surrounding tissue
Onset: less than 5
min
Half-life: 2 min
Contraindications:
pheochromocytoma,
uncorrected
tachyarrhythmia or
ventricular fibrillation,
persistent
hypotension

Monitor BP, mental

status, and I&Os

treatment of cardiac
arrest
Dosage: Hypotension
Adult: IV initial 8-12
mcg/min titrate to
response;
maintenance dose
usually 2-4 mcg/min

Neosynephrine

To maintain BP during
anesthesia, treat
vascular failure in
shock, to overcome
paroxysmal
supraventricular
tachycardia; used
topically for rhinitis;
mydriatic for
opthalmoscopic
examination or
surgery, relief of
uveitis (eye

weakness, hepatic or
renal necrosis
CV: palpitation,
hypertension, reflex
bradycardia, fatal
arrhythmias
GI: vomiting
Metabolic:
hyperglycemia
CNS: headache,
cerebral hemorrhage,
convulsions
Respiratory:
respiratory difficulty
Skin: tissue necrosis
at site (with
extravasation)
Special Senses:
blurred vision,
photophobia
Special Senses:
transient stinging,
headache, blurred
vision, rebound nasal
congestion, nasal
burning, sneezing
CV: palpitation,
tachycardia,
bradycardia
(overdosage)
hypertension
Body as a whole:
trembling, sweating

methyltransferase
and monamine
oxidase
Excretion: in urine

Contraindications: use
on sole therapy in
hypovolemic states
except as temporary
emergency measure,
profound hypoxia or
hypercarbia,
hypertension,
hyperthyroidism,
lactation
Onset: very rapid

Metabolism: in liver
and tissues by
monoamine oxidase

Onset: immediate IV;

10-15 min
IM/Subcutaneous
Monitor infusion site
for extravasation
Monitor BP, pulse,
and central venous
pressure during IV
administration
Contraindications:

inflammation)

Nitroglycerine

Dosage: Hypotension
Adult:
IM/Subcutaneous 110 mg (initial dose
not to exceed 5 mg) q
10-15 min as needed
IV 0.1-0.18 mg/min
until BP stabilizes;
then 0.04-0.06
mg/min for
maintenance
Supraventricular
Tachycardia Adult: IV
0.25-0.5 mg blus,
then 0.1-0.2 mg
doses (total max: 1
mg)
Vasoconstrictor Adult:
Intranasal 203 drops
or sprays of 0.250.5% solution q3-4h
as needed
Child (6-12y):
Intranasal 203 drops
or sprays of 0.25%
solution q3-4h as
needed
Prophylaxis,
treatment, and
management of
angina pectoris; IV

pallor, tingling of
extremities,
sleeplessness,
dizziness, weakness,
tremor, severe
visceral or peripheral
vasoconstriction,
necrosis of IV
infiltrates

CNS: headache,
blurred vision,
dizziness, vertigo,
faintness

severe CAD, severe

hypertension, cardiac
disease, MAOI, labor,
deliver, narrow-angle
glaucoma

Metabolism:
extensively in liver
Excretion: inactive
metabolites in urine

Use caution when

giving to patients with
hypotension or
hypovolemia since

nitro used to control

BP in perioperative
hypertension, CHF
associated with acute
MI; to produce
controlled
hypotension during
surgical procedures;
treatment of pain
associated with
chronic anal fissure
Dosage: Angina
Adult: Sublingual 1-2
sprays (0.4-0.8 mg) or
a 0.3-0.6mg tablet
q3-5min as needed
(max: 3 doses in 15
min) PO 1.3-9 mg q812h IV Start with
5mcg.min and titrate
q3-4min until desired
response (up to
200mcg.min)
Transdermal Unit
Apply one q24h or
leave on for 10-12 h,
then remove and
have a 10-12h nitrate
free interval
Topical Apply 1.55cm (1/2-2 in) of
ointment q4-6h

CV: postural
hypotension,
palpitations,
tachycardia, syncope,
circulatory collapse
GI: nausea, vomiting,
involuntary passing of
urine and feces,
abdominal pain, dry
mouth
Hematologic:
Methemoglobinemia
(high doses)
Skin: cutaneous
vasodilation with
flushing, rash,
dermatitis,
anaphylactoid
reaction
Body as a whole:
muscle twitching,
pallor, perspiration,
cold sweat, local
sensation in oral
cavity at point of
dissolution of
sublingual forms

the IV dug may

precipitate a severe
hypotensive state
Onset: 2min SL
Half-life: 1-4 min
Contraindications:
hypersensitivity or
tolerance to nitrates,
severe anemia,
glaucoma,
hypotension,
uncorrected
hypovolemia,
constrictive
pericarditis,
pericardial
tamponade,
restrictive
cardiomyopathy

Propofol

Child: IV 0.25-0.5
mcg.kg/min, titrate by
0.5-1mcg/kg/min q3-5
min (max:
5mg.kg.min)
Anal Fissure Adult:
Topical 1 inch every
12 h for up to 3 wk
Induction or
maintenance of
anesthesia as part of
a balanced
anesthesia technique;
conscious sedation in
mechanically
ventilated patients
Dosage: Induction of
Anesthesia Adult: IV
2-2.5mg/kg q 10 sec
until induction onset
Adult (55y or older):
IV 1-1.5 mg/kg
q10sec until induction
onset
Adolescent/Child (3y
or older): IV 2.5
mg/kg over 20-30 sec
Maintenance of
Anesthesia Adult: IV
100-200 mcg/kg/min
Adult (55y or older):
IV 50-100mcg/kg/min

CNS: headache,
dizziness, twitching,
bucking, jerking,
thrashing,
clonic/myoclonic
movements
Special Senses:
decreased intraocular
pressure
CV: hypotension,
ventricular asystole
(rare)
GI: vomiting,
abdominal cramping
Respiratory: cough,
hiccups, apnea
Other: pain at
injection site

Metabolism:
extensively in liver
Excretion: about
88% of dose
recovered in urine as
metabolites

Monitor
hemodynamic status
and assess for doserelated hypotension
Take seizure
precautions
Onset: 9-36 sec
Half-life: 5-12h
Contraindications:
hypersensitivity to
propofol, patients
with increased
intracranial pressure
or impoaired cerebral
circulation; obstetrical
procedures; lactation

Child/Infant (2mo or
older): IV 125150mcg/kg/min
Conscious Sedation
Adult: IV
5mcg/kg/min for at
least 5 min, may
increase by 510mcg/kg/min q510min until desired
level of sedation is
achieved (may need
maintenance rate of
5-80 mcg/kg/min)