By John Papadopoulos
This is a no-nonsense consultant to drug therapy within the in depth care unit. It covers the main in general encountered stipulations and is geared up by means of procedure. administration of every situation is tersely defined step by step in desk structure. The booklet additionally contains non-drug details that's necessary to making knowledgeable, evidence-based pharmacotherapy judgements, equivalent to probability ratings, scales, and evaluation instruments.
The moment variation has been revised to mirror the newest serious care perform guidance and up to date drug and non-drug information.
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Extra info for Pocket Guide to Critical Care Pharmacotherapy
5 times the recommended intravenous dose diluted with 5–10 mL of normal saline or sterile water; technique—stop CPR, administer medication beyond the tip of the endotracheal tube, follow with five quick insufflations to aerosolize the drug, and then resume CPR 6. All antiarrhythmic agents can be proarrhythmogenic. Sequential use of more than one agent can result in an adverse drug event. Do not use more than one antiarrhythmic agent unless absolutely necessary. 5–5 mg IVP over 2 min • • May administer a second dose of 5–10 mg 15–30 min after the initial dose, if inadequate response.
Age > 70 years, SBP < 120 mmHg, HR > 110/min]). 125 twice daily and titrate to 25 mg twice daily as tolerated every 3–5 days ■ Propranolol □ 1 mg slow intravenous push (IVP), repeated every 5 min. 1 mg/kg in three divided doses every 2–3 min. 24 s, evidence of hypoperfusion, active asthma. 4 mg tablets every 5 min × three doses on presentation. Initiate intravenous pharmacotherapy if chest pain persists ○ Start continuous IV infusion at 5–10 mcg/min and titrate using 5–10 mcg/min increments until symptoms resolve or systolic blood pressure (SBP) <90 mmHg or mean arterial pressure (MAP) falls by ≥30 mmHg from baseline.
1 mg/kg in three divided doses every 2–3 min. 24 s, evidence of hypoperfusion, active asthma. 4 mg tablets every 5 min × three doses on presentation. Initiate intravenous pharmacotherapy if chest pain persists ○ Start continuous IV infusion at 5–10 mcg/min and titrate using 5–10 mcg/min increments until symptoms resolve or systolic blood pressure (SBP) <90 mmHg or mean arterial pressure (MAP) falls by ≥30 mmHg from baseline. Usual maximum dose = 200 mcg/min ○ Avoid in patients with: ■ Right ventricular infarction ■ If presenting systolic blood pressure (SBP) is <90 mmHg or ≥30 mmHg below baseline MAP ■ Presence of profound bradycardia or tachycardia ■ Recent use (within 24 h of sildenafil or vardenafil or within 48 h of tadalafil) of a phosphodiesterase-5 inhibitor for erectile dysfunction (or pulmonary hypertension) ○ Use beyond 48 h is indicated in patients with persistent angina or pulmonary congestion ○ Dilates large coronary arteries and collateral vessels ○ Some intravenous preparations contain significant amounts of ethanol Adjuvant pharmacotherapy or device therapy • Angiotensin converting enzyme inhibitors (ACE-I)—(oral therapy within 24 h after presentation) ○ Greatest benefit in patients with left ventricular dysfunction (ejection fraction <40 %), anterior wall infarction, or pulmonary congestion.