Drugs to know in the Neuro Icu

[AstarteRN]

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 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.

Thanks a lot!

AstarteRN

[Kidrn911]

I don't know a lot about Neuro ICU

I would suspect

Mannitol

Decadron

Drivipan

to be a few you need to know

[KelRN215, BSN, RN]

Decadron and Mannitol definitely.

[CCRNCMC11]

Nipride!

[ayla2004, ASN, RN]

nimodipine, kepra, soduim valopate, afentail,

[traumasurgRN]

Nimodipine is another important neuro drug to know. It helps increase blood flow to injured brain tissue. Its taken orally or down an OGT/NGT. NEVER aspirate it and try to push it IV, pushing it IV can cause your patient to arrest.

Even though many bleeds are caused by HTN, remember that you don't want to keep their BP/MAP to low, you want to maintain adequate perfusion to the brain tissues, se be careful with the antihypertensives.

[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)

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.

[CCRNCMC11]

No don't disregard the nipride comment bc it was the only and I repeat only bp lowering agent the neurosurgeons where I worked used. Every nsicu is different so you can't say that it is never used. Also, I work CVICU and I frequently use neo iv push (under the MDA's license) to treat low bp especially emergently

[Bhenry BSN RN]

Nipride works by causing Vasodilation thus it would increase the Inter-cranial Pressure (ICP). That is why we use Nicardipine to help lower BP versus Nipride. Nipride has more neurological effects vs nicardipine.

I've never heard of an RN pushing Neo. It's great for increasing BP but it is short acting and should be used as a drip if the patient remains hypotensive.

Per Illinois State law on nursing practice I know were not allowed to push Propofol/Diprivan unless an anesthesiologist is present and ordering the push. We usually leave it up to them to push it anyways.

[chillnurse, BSN, RN, NP]

pretty much everything you need in the icu plus mannitol.

[liberated847]

Nipride works by causing Vasodilation thus it would increase the Inter-cranial Pressure (ICP). That is why we use Nicardipine to help lower BP versus Nipride. Nipride has more neurological effects vs nicardipine. I've never heard of an RN pushing Neo. It's great for increasing BP but it is short acting and should be used as a drip if the patient remains hypotensive. Per Illinois State law on nursing practice I know were not allowed to push Propofol/Diprivan unless an anesthesiologist is present and ordering the push. We usually leave it up to them to push it anyways.

We push small Neo blouses in the Cath lab during interventions as needed on hypotensive patients

[Cuddleswithpuddles]

I recommend familiarizing yourself with tPA. My ICU not only regularly receives patients who have received it for ischemic strokes but we also give it at the bedside. Know the inclusion and exclusion criteria, what side effects to look out for and when to stop it if you are in the process of giving it.