[sameericu]

I am working in cardiac surgical ICU i really need the medication information in ICU

[sharrie]

Could you be a bit more specific about what information you need

[sameericu]

all support using post op

[sharrie]

SameerICU, I am still unclear about exactly what you need. Which particular medication and what do you want to know about it. You need to be a little more specific so we are able to answer your question as fully as possible.

Also does your question relate to any UK issues or is it a general ICU question

[sharrie]

Thanks for your PM Sameericu, I have moved your thread to the ICU forum for more appropriate input.

From your message I understand the particular drugs your are interested in
are adrenaline, nor-adrenaline, dopamine and dobutamine.

Obviously there is a great deal of information already available about these drugs and I would suggest that you start with the medication information sheets that come with all drugs.

The drugs that you mention are all inotropic medications which alter the force of muscular contraction, the ones above are all positive inotropes which increase the force of contraction

Adrenaline or Ephinepharine which is a fight or flight hormone, it increases heart rate and stroke volume and contricts aterioles in the skin and gut.

It is used in cardiac arrest or other cardiac arrythmias that cause reduces cardiac output.

I remember a time when adrenaline infusion were used frequently in the ICU setting but there are better alternatives now and I believe it's use is much reduced.


Nor-Adrenaline (norepinepharine) has similar actions to epinepharine and if you do a little search through this section you will find quite a bit of information about it and it's side effects

Dopamine - the only time I have seen dopamine use is at a renal dose as it was thought to improve renal perfusion and reduce incidence or acute renal failure however I think this is now not the case.

http://www.bestbets.org/cgi-bin/bets.pl?record=00368

I am sure that there will be some very clever ICU nurses along shortly who will be able to give you more up to date information and uses of these drugs, it has been a while since I have worked in ICU so my information is mostly out of date.

[Christie RN2006]

From XB9S's post, I guess you are asking about those 4 drugs... I am yet to see the docs at my facility use an adrenaline infusion. We use epinephrine (we call it epi) infusions very rarely and usually they are a "if all else fails" med. We do use epi pushes routinely in cardiac arrest situations.

Dopamine is used pretty commonly where I work. For us we consider the max infusion to be 20mcg. Dopamine is most commonly used to help increase the blood pressure, but it also can be used to help the kidneys. If it is used for a renal dose, we do not titrate it, and the docs usually want us to run it around 2-4mcg. If the dopamine is used for BP, we generally titrate it to keep the systolic blood pressure greater than 90. One major downside to dopamine is that a lot of times it increases the patients heart rate and sometimes it increases their heart rate so much that you have to switch to another drug.

Dobutamine is not seen very often where I work. It is similar to dopamine in that it increases the heart rate. Our docs usually use it for patients who are having low BP and low heart rates.

Those are the basics that I know about those drugs. You can find a wealth of information online or in a drug reference book.

[Christie RN2006]

I forgot to mention noradrenaline aka norepinephrine or levophed is also commonly used where I work. Levophed is used to increase blood pressure. Some of our docs really like levophed because it is usually well tolerated by patients it doesn't tend to effect the heart rate like dopamine does. The major downfall to levophed is that it causes severe vasoconstriction in the extremities and patients extremities can become ischemic and if used long term, patients could lose toes, etc.

[fatoma]

Beta blocking agents are used for angina pectoris to decrease myocardial oxygen demand, this can be accomplished by lowering the heart rate and decrease myocardial contractlility, the heart reduces cardiac workload therefore decreases oxygen demand....it is also used post MIsin early stage accompanying the adminstration of thrombolytic agent which has resulted in reduction in the mortality of 15%....in heart failure class 2, and 3...for arrhythmias like A-fib or flutter...and in hypertension.

antihypertensives are very important, like beta blockers, vasodilators like nitrates, ACE inhibitors, angiotensin II receptor blockers, Ca channel blockers, and diuretics
besides anti-cloting agents(anti-platelet such as aspirin and anti-coagulant therapies like heparin, and warfarin)

cholesterol lowering medications like Statin.

positive inotrps...all these drugs and others are used depends on the patient's condetion and the surgery performed.

this is in general, if you want to know about particuar medications we can discuss it here in detail

regards

[fatoma]

sorry thought u asked about cardiac...confused