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 commonly used medications. He mentioned steroids and anti-hypertensives as important. I was hoping someone would be willing to share with me a brief list of the most commonly used medications so I can begin reviewing. I would also appreciate any tips or advice you may have for a new nurse in this setting.
On top of the aforementioned medications, you might want to familiarize yourself with the application and operation of a cooling blanket as these neuro patients tend to develop "neurogenic fevers".
Ketamine (we start/manage infusions but do not titrate without an order or bolus)
dopamine
phenylephrine
norepinephrine
vasopressin
epinephrine
sodium bicarb
cardene
fentanyl
clevidipine
mannitol
Sodium 3%
decadron
insulin gtt
labetolol
pentobarb
rocuronium
etomidate (sp?)
precedex
antiepileptics
I would also look into storming, central fevers, ICP management, brain death criteria, ABG's, autonomic dysreflexia, ventrics, cranial nerves, IVIG, sodium/osmolarity
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)
Labetolol
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.
Epinephrine
Vasopressin
Dopamine
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)
Keppra
Fosphenytoin
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.
Pheebz777, BSN, RN
225 Posts
On top of the aforementioned medications, you might want to familiarize yourself with the application and operation of a cooling blanket as these neuro patients tend to develop "neurogenic fevers".