Cardiac gtts???

  1. So...I'm a newly transferred MICU RN from a trauma unit. I have a TON of things that I have to learn, computer coarses and all. I'm trying to also learn some of the major gtts that are used on my new floor. I have a list of the gtts that I want to learn, but am unsure of exactly what/how much I need to know for each.

    For example: Levophed

    Action: vasopressor - dilates coronary arteries more than twice as much as epi.
    Dosage: 8-12 mcg/min initially; then adjust 2-4 mcg/min to maintain desired BP.
    Assessment: check BP q2m until BP stabled then check q5m
    Precautions: can casue severe tissue necrosis (blanching along vein pathway)

    I have a pretty good IV drug book to get information out of, but I want to make sure that I know enough, but not too much (my brain can only hold so much into info at one time!)

    Thanks in advance for any assitance! :redpinkhe
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  2. 12 Comments

  3. by   rnspark
    Levophed vasoconstricts not dialate. I would first get familiar with hospital protocols such as the max rate for neo, levo, dopamine, etc... Some hospitals allow these to be run at small doses through peripheral lines, but many only allow to be run through central lines. Side effects of these medications are a huge help. For example, a person with a high heart rate on levophed may do better with a neosynepherine drip. Definitely know the drug, what it is used for, and its mechanism of action. Experience titrating these drugs varies greatly from patient to patient. Some are very sensitive where titrating just a half a mcg makes a big difference on blood pressure. I know it may say 8-12mcg initially but all that goes out the window when you have a crashing patient and you may have to just max the drip out from the get go.
  4. by   xtine618
    Sometimes using a drug book can be difficult because there is SO much information. You should ask your coworkers if there is a list of frequently used gtts and those usually will have the max dose for your facility and some other info like what to titrate it by.
  5. by   FIREMEDIC-CCRN
    I believe the first poster was correct, Levophed dilates the coronary arteries and vasoconstricts peripherally.
  6. by   meandragonbrett
    You need to know how these drugs act and what they act up on. For a good intro to some of the drugs you see in the ICU frequently, visit www.icufaqs.org and they have two FAQs one on meds in general and one on vasoactive medications.
  7. by   detroitdano
    Quote from FIREMEDIC-CCRN
    I believe the first poster was correct, Levophed dilates the coronary arteries and vasoconstricts peripherally.
    Yep. Levophed has alpha and beta agonistic properties, compared with Neosynephrine which is pure alpha. It is the beta agonistic effects of Levophed which cause dilation of coronary arteries.
  8. by   beetlebum
    I agree with you about levophed as an alpha agonist (constricts blood vessels peripherally), but the beta 1 agonist is a cardiac stimulation effect, such as increasing contractility, an inotropic effect. Explain to me how does levophed dilate coronary arteries? In dilating coronary arteries, I am thinking of nitrates??
  9. by   Bubbles_RN
    To begin with, figure out which ones are most commonly used at your facility. Then figure out what they do, how they work, and major side effects. Your facility IV manual should help with it as well. Ours is awesome, lets ya know how to mix it, what it does and what to watch for without info overload of a drug book.
  10. by   Five&Two Will Do
    I like Tarascons pocket critical care guide, but as has been previously stated each facility has its own guidelines for gtt's. For example we have several nurses on this unit that came from a major medical center in the area. I received a patient from the ER the other day that coded in the elevator on the way up. RT was bagging as they rolled through the door. VFIB= shocks with epi and CPR and finally we have a pulse but no pressure. levo, dop, and neo all running wide open along with NS bolus. Our max neo is 180, apparently where the others came from it was 300. Go figure, it worked at the time, but I did titrate the neo down asap.
  11. by   haji
    wow i have never heard or read anywhere that levophed dilates the coronary arteries. it might increase coronary perfusion by increasing diastolic arterial pressure. maybe you are thinking of nitroglycerin?

    levophed has some effect on beta receptors but mostly works on alpha. So you get some beta 1 effects (increased heart rate and contractility - the opposite of lopressor) but mostly you get alpha (vasoconstriction).

    i always look up a drug in lexicomp if i'm not familiar with it, but as an icu nurse you need to know the basics like levophed. one good place to start is "pharmacology for the prehospital professional". its a free podcast by an icu doctor, covers lots of the meds we use in critical care.
  12. by   detroitdano
    Quote from detroitdano
    Yep. Levophed has alpha and beta agonistic properties, compared with Neosynephrine which is pure alpha. It is the beta agonistic effects of Levophed which cause dilation of coronary arteries.
    Beta adrenergic receptors, when stimulated, will cause dilation.

    B1-agonists cause coronary artery dilation. B2-agonists (your nebs) cause bronchial dilation.
  13. by   detroitdano
    Really not sure why I quoted myself LOL.
  14. by   airborneinf82
    Selective beta-adrenergic receptor activation demonstrated that both beta 1- and beta 2-adrenergic receptors elicit dilation of large coronary arteries, and that the vasodilation was direct, i.e., it was not mediated by increases in coronary blood flow.
    Alpha- and beta-adrenergic control of larg... [Basic Res Cardiol. 1990] - PubMed - NCBI

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