Drugs to know in the Neuro Icu - page 3

Hi everyone, I am a new graduate RN who was just hired into a neuro-surgical intensive care unit. My manager said that I should brush up on my neuro A & P as well as review some of the more... Read More

  1. by   offlabel
    Quote from Bhenry BSN RN
    Disregard the Nipride comment. We never use nipride to decrease BP in the neuro ICU. It's a better cardiac medication to decrease blood pressure and spare the coronary arteries.

    BP Lowering Drugs:
    Cardene (Nicadipine)
    Hydralazine (Apresoline)
    Metoprolol (Usually Oral, sometimes given 5mg IVP as a rate control medication.)

    BP Increasing agents:
    Neo-synephrine (Phenyephrine) - You will never see this in the CVICU but you will see it in the Neuro ICU a lot. Used a lot for repaired aneurysms to protect from vasospasms. Also used in Ischemic CVA's increase BP to keep around 180 systolic to help perfuse the brain.
    Levophed (Norepinephrine)- usually second line in neuro but is a very common medical icu drug.

    Other Neuro ICU meds.
    Nimodipine - subarrachnoid hem (SAH) related to aneursyms.
    Decadron - masses/Tumors in the brain.
    Nuvigil - We give these to our patients who are very lethargic/somnulent from Ischemic CVA's
    Sinemet - Same as Nuvigil (this is a parkonsons medication)
    3% sodium chloride solution (IV drip) - Cerebral edema- Check Serum sodium labs frequently with this medication.
    Mannitol - Check Serum Osmolaltiy labs with this drug.
    Diprivan - Great sedative that is short lasting to get a good neuro exam. Monitor liver function with this medication. Lipids, triglycerides, AST, ALT

    Ill add more, I have to run a few errands real quick.
    Some misunderstanding of some agents here... with regard to nipride, it is a sub optimal agent because of what we have instead, ie cardene etc...not sure what "spares the coronary arteries" means.

    It's use in cardiovascular patients has dropped off considerably in the last decade.

    Phenylepherine is one of the most common infusions in the CVICU there is. Very useful drug for post cardiac surgery patients.

    Some clarification in it's use in the treatment of persistent cerebral artery vasospasm...it doesn't treat the spasms themselves. It has been used as a part of so called HHH therapy (hypertension, hypervolemia, hemodilution) to over come reduction in CBF that results from vessel spasm.

    Any discussion about diprivan infusion should include PRIS (propofol infusion syndrome) risk and assessment. Lots more than LFT's in play there.
    Last edit by offlabel on Jun 24, '16
  2. by   jacksj15
    We use precedex quite a bit. Doesn't cause respiratory depression like prop but can cause some sensitive pts to brady down.