ICU Medications PDF

ICU Medications Study online at https://quizlet.com/_gei05u 1. Vasopressors 2. What does a pos- 1. Increases Heart Contractility itive inotrope do? 3. What does a pos- 1. Increases Heart Rate itive chronotrope do? 4. What does a pos- 1. Increased electrical signals and automaticit...

ICU Medications Study online at https://quizlet.com/_gei05u 1. Vasopressors 2. What does a pos- 1. Increases Heart Contractility itive inotrope do? 3. What does a pos- 1. Increases Heart Rate itive chronotrope do? 4. What does a pos- 1. Increased electrical signals and automaticity of the itive dromotrope heart. do? *Automaticity is the heart's ability to generate its own electrical impulses and contract rhythmically. 5. What does Al- Alpha-1 Stimulation Results In: pha-1 stimulation do? 1. Vasoconstriction (Increased BP) 6. What does Al- Alpha-2 Stimulation Results In: pha-2 stimulation do? 1. Inhibit the Release of Norepinephrine, Acetylcholine, and Insulin 7. What does Beta-1 Stimulation Results In: Beta-1 stimula- tion do? 1. Positive Chronotrope (Increased HR) 2. Positive Inotrope (Increased Contractility) 3. Increased Release of Renin 8. What does Beta-2 Stimulation Results In: Beta-2 stimula- tion do? 1. Vasodilation (Decreased BP) 2. Bronchodilation 9. Where are Beta-1 1. Beta-1 Cells are Located in Cardiac Myocytes cells located? 1 / 10  ICU Medications Study online at https://quizlet.com/_gei05u 10. Where are Beta-2 1. Beta-2 Cells are Located mainly in the lungs of smooth cells located? vascular muscle. 11. What is the Mech- 1. Norepinephrine works by stimulating Beta-1 and Al- anism of Action pha-1 with very little effect on Beta-2. (Stronger Alpha than of Norepineph- Beta). rine? 2. Beta-1 Stimulation: Positive Chronotrope and Positive Inotrope. 3. Alpha-1 Stimulation: Vasoconstriction (Except the coro- naries, which is good because we need to perfuse them) 12. What is the Mech- 1. Epinephrine works by stimulating Alpha, Beta-1, and anism of Action Beta-2 adrenergic receptors. (Stronger Beta affect than of Epinephrine? norepinephrine) 2. Alpha stimulation is responsible for the increase in SVR (Vasoconstriction) 3. Beta-1 stimulation is responsible for positive Inotrop- ic (Increased Contractility), chronotropic (Increased HR), and dromotropic. It can also cause a release of renin. 4. Beta-2 stimulation causes bronchodilation. 13. What is the Mech- 1. Phenylephrine is a direct alpha-adrenergic agonist with anism of Ac- virtually no beta effect. tion of Phenyle- phrine? 2. This produces systemic vasoconstriction. 3. This can increase coronary perfusion without raising HR, so it's good for CAD or Aortic Stenosis. 4. Baroreceptor reflex in the carotid sinus and aortic arch may cause reflex bradycardia. *Caution: Be careful with aortic regurgitation because this will increase LV afterload and worsen the problem. 2 / 10  ICU Medications Study online at https://quizlet.com/_gei05u 14. What is the Mech- 1. Vasopressin is produced in the hypothalamus and anism of Action stored in the posterior pituitary gland. of Vasopressin? 2. It increases Cyclic Adenosine Monophosphate, which increases water permeability at the renal tubule. (This decreases urine output and increases osmolality. Thus the body retains fluid to increase the blood pressure.) 3. Vasopressin is also a direct vasoconstrictor. 4. The receptors are V1 and V2. V1 is mainly responsible for vasoconstriction. V2 is responsible for fluid reabsorp- tion and the increase in blood volume. 15. What is the Mech- 1. Dopamine works by stimulating alpha, beta, and anism of Action dopaminergic receptors. The effect is dose-dependent. of Dopamine? 2. Lower doses mainly affect the D1 and D2 receptors. This is responsible for renal and mesenteric vasodilation. 3. Higher doses have a greater effect on Beta-1 receptors. This causes an increase in HR (Chronotropic), Contractil- ity (Inotropic), and renal vasodilation. 4. Even larger doses (>10mcg/kg/min) have a predomi- nately Alpha-1 effect. This causes vasoconstriction. 16. What is the Mech- 1. Dobutamine is a potent Beta-1 agonist with weaker anism of Action Beta-2 effects. of Dobutamine? 2. Beta-1 stimulation causes an increase in HR (Chronotropic) and Contractility (inotropic). (This helps increase Cardiac output due to the increase in stroke volume. 3. Weak Beta-2 effect produces vasodilation. 4. Higher doses can affect alpha receptors. 3 / 10  ICU Medications Study online at https://quizlet.com/_gei05u 5. Acts primarily as an inotrope. The chronotropic effect is greater than epinephrine but weaker than dopamine. 17. What is the Mech- 1. Milrinone is a phosphodiesterase 3 inhibitor that results anism of Action in vasodilation with some inotropic (increased contractility) of Milrinone? and little chronotropic effect (increased HR). 2. Increased inotropy (contractility) and pulmonary/periph- eral vascular dilation improve cardiac output. 3. This improved diastolic function by decreasing SVR. 4. Milrinone causes more vasodilation and decreases SVR more than dobutamine with less tachycardia. *Note: The effect is decreased in acidotic patients. 18. Anti-arrhythmic drugs 19. What is the Mech- 1. Procainamide is a Class 1a antiarrhythmic (Sodium anism of Ac- Channel Blocker - Moderate) tion of Pro- cainamide? 2. It works by blocking sodium channels and prolongs repolarization. This decreases myocardial excitability and conduction velocity. 3. Some Potassium channel effect prolongs that effective refractory period. 4. Causes significant myocardial depression. 5. Can be used for a broad spectrum of tachyarrhythmias but can widen QRS and cause hypotension. 20. What is the Mech- 1. Lidocaine is a Class 1b antiarrhythmic (Sodium Channel anism of Action Blocker - Mild). of Lidocaine? 2. It works by blocking the permeability of the neuronal 4 / 10  ICU Medications Study online at https://quizlet.com/_gei05u membrane to sodium ions. 3. It suppresses the automaticity of ectopic foci and treats ventricular arrhythmias. 3. This shortens repolarization. 21. What is the Mech- anism of Action of Metoprolol? 22. What is the Mech- 1. Amiodarone is a Class III antiarrhythmic (Potassium anism of Action channel blocker) of Amiodarone? 2. It can also affect sodium and calcium channels. 3. This prolongs the action potential and refractory period in myocardial tissue, which decreases AV conduction and inhibits abnormal automaticity. 4. Much less of a cardiac depressant than Procainamide so it preserves peripheral and coronary vasodilation. 23. What is the Mech- 1. Diltiazem is a Calcium Channel Blocker and Class IV anism of Ac- Anti-arrhythmic tion of Diltiazem (Cardizem)? 2. It inhibits calcium ions from entering channels or areas of smooth vascular muscle. 3. Produces Negative Inotropic (Decreased Contractility), Chronotropic (Decreased HR), and Dromotropic effects. 4. Slows SA node, AV node, Cardiac Myocytes, and Smooth Muscle. 5. Overall, it relaxes coronary smooth muscle, causes vasodilation, and increases myocardial oxygen delivery. 24. Why use 1. They are both calcium channel blockers and act similar- Nicardipine in- ly. 5 / 10  ICU Medications Study online at https://quizlet.com/_gei05u stead of Dilti- azem? 2. Nicardipine produces a stronger vasodilatory with a different effect on the heart rate. 3. Nicardipine increases heart rate, while diltiazem de- creases heart rate. 4. Nicardipine is more selective for vascular smooth mus- cle than cardiac muscle, so it can significantly decrease SVR without decreasing contractility. *Caution: Nicardipine can cause prolonged QT interval and is contraindicated in hepatorenal impairment and CHF. 25. Opioids and Se- dation Medica- tions 26. What is the Mech- 1. Propofol works by causing global CNS depression. anism of Action of Propofol? 2. It potentiates the activity of GABA-A receptor and reduces glutamatergic activity through NMDA receptor blockade. This enhances the inhibitory effects of GABA and produces sedation. 27. What is the Mech- 1. Dexmedetomidine is an alpha-2 receptor agonist. anism of Action of Dexmedetomi- 2. Its actions are due to the activation of g-proteins by the dine? alpha-2a receptor, which inhibits norepinephrine release. 3. This causes sympatholysis, which decreases the vaso- constriction response of epinephrine and norepinephrine. (Why you see decrease in HR and BP) 28. What is the Mech- 1. Fentanyl works by binding to the MU 1 and MU 2 anism of Action receptors. of Fentanyl? 2. This increases the pain threshold, alters pain reception, and inhibits ascending pain pathways. 6 / 10  ICU Medications Study online at https://quizlet.com/_gei05u 3. Because of its high lipid solubility, it has inactive lung sites (about 75%). More releases with every breath. It takes about 5 min for respiratory depression to occur. 29. What is the Mech- 1. Midazolam works by binding to the benzodiazepine anism of Action receptor in the postsynaptic GABA neuron at several CNS of Midazolam? sites (including the limbic system). 2. It enhances the inhibitory effects of GABA on neuron excitability by increasing neuronal membrane permeability to chloride ions. 3. The shift in chloride ions creates hyper-polarization (less excitable state) and stabilization. 30. What is the Mech- 1. Morphine works by binding to the MU 1 and Mu 2 anism of Action receptors of the CNS. of Morphine? 2. This inhibits the ascending pain pathways, altering the perception of and response to pain, which produces gen- eralized CNS depression. 31. What is the Mech- 1. Etomidate works on the GABA receptor to produce a anism of Action sedative effect. of Etomidate? 2. It is a carbolized imidazole that produces rapid induction of sedation with minimal cardiovascular effects. 3. May cause adrenocortical suppression that last 4-8 hours. 32. Neuromuscular Blocking Agents 33. What is the Mech- 1. Succinylcholine is a depolarizing neuromuscular agent. anism of Ac- tion of Succinyl- 2. It acts similarly to acetylcholine and produces depolar- choline? ization of the motor endplate at the myoneural junction, which causes flaccid muscle paralysis (basically over- 7 / 10  ICU Medications Study online at https://quizlet.com/_gei05u whelms the receptor site). 3. This can cause hyperkalemia because the sodium and potassium channels open and potassium releases into the vessel (This is transient and does not maintain). 4. Can cause a transient rise in ICP in neuro patients. 5. Can cause malignant hypothermia in undiagnosed mus- cular dystrophy (don't use in pediatrics). 34. What is the Mech- 1. Rocuronium is a non-depolarizing neuromuscular block- anism of Action ing agent that blocks receptors at the neuromuscular junc- of Rocuronium? tion. 2. This prevents acetylcholine from binding to receptors and prevents depolarizing from occurring 3. Liver and Kidney disease will cause a prolonged dura- tion. 4. This often needs a reversal agent: Sugammadex 35. What is the Mech- 1. Vecuronium is a non-depolarizing neuromuscular block- anism of Action ing agent that blocks acetylcholine from binding to recep- of Vecuronium? tors on the motor end plate, which inhibits depolarization. 2. This prevents acetylcholine from binding to receptors, so depolarization can not occur. 3. Liver and kidney disease may cause a prolonged dura- tion. 36. What is the Mech- 1. Nimbex is a non-depolarizing neuromuscular blocking anism of Action agent. of Cisatracurium (Nimbex)? 2. It blocks the receptors at the neuromuscular junction to prevent acetylcholine from binding, which prevents depo- larization from occurring. 8 / 10  ICU Medications Study online at https://quizlet.com/_gei05u 3. There is no histamine release, so this drug is more CV stable than atracurium. (Histamine causes vasodilation and a drop in BP) 37. ACLS Medica- tions 38. What is the Mech- 1. Atropine is a muscarinic receptor antagonist that blocks anism of Action acetylcholine from binding. of Atropine? 2. It blocks acetylcholine at parasympathetic sites in smooth muscles, secretory glands, and the CNS to act as a positive chronotrope (Increase HR) and dry up secre- tion. 39. What is the Mech- 1. Atropine acts in purinergic receptors that are labeled P1 anism of Action and P2. of Adenosine? 2. P1 is subdivided three ways: A1- Cardiomycytes (Negative ionotrope and chronotrope) A2- Endothelial and vascular smooth muscle (coronary vasodilation) A3- Mast cells (airway hyper-responsiveness). 3. This is typically used as an antiarrhythmic to slow con- duction time through the SA and AV node, interrupting re-entry pathways through the AV node, which restores NSR. 4. Hyper-polarization from the SA node is what leads to the decrease HR (Heart does not respond to endogenous catecholamine release at this time). 40. Miscellaneous Mediations 9 / 10  ICU Medications Study online at https://quizlet.com/_gei05u 41. What is the Mech- 1. Nitroglycerin forms free radical nitric oxide which ends anism of Action up creating vasodilation on peripheral veins and arteries of Nitroglycerin? (mainly veins). 2. This dilates the coronary arteries. 3. This reduces cardiac oxygen demand by decreasing preload and afterload. 42. What is the Mech- 1. Nitroprusside causes peripheral vasodilation by directly anism of Ac- acting on venous and arterial smooth muscle. tion of Nitroprus- side? 2. This reduces peripheral resistance, which increases cardiac output due to the decrease in afterload. 3. Be careful with cyanide poisoning (It is metabolized into cyanide ions). 10 / 10