Common medications used in critical area, update

abciximab, Reopro: Antiplatelet agent, glycoprotein IIb/IIIa inhibitor.

Uses: Prevention of cardiac ischemic complications in patients undergoing PCI; prevention of cardiac ischemic complications in patients with unstable angina/ NSTEMI unresponsive to conventional therapy when PCI is scheduled with- in 24 hr. 

Dosages: Adult PCI: IV bolus 0.25 mg/kg, administer 10–60 min before start of PCI by an infusion of 0.125 mcg/kg/min (max 10 mcg/min) for 12 hr; Unstable angina/NSTEMI unresponsive to conventional medical therapy with planned PCI within 24 hr: IV bolus 0.25 mg/kg followed by an 18–24 hr infusion of 10 mcg/min, concluding 1 hr after PCI.

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adenosine, Adenocard: Antidysrhythmic. 

Uses: SVT, as a diagnostic aid to assess myocardial perfusion defects in CAD. 

Usual dosages: IV bolus 6 mg over 1–3 sec followed by rapid 20 mL NS flush. If conversion to NSR does not occur within 1–2 min, give 12 mg by rapid IV bolus; may repeat 12-mg dose again in 1–2 min. Administer via closest proximal port. A rapid 20-mL NS flush (as fast as possible) should be administered after each dose. Patient may be placed in mild reverse Trendelenburg position before giving drug and a rhythm strip recorded during administration

Nursing Implications

1. It is very important that medication be given rapid IV bolus (1-2 sec.).

2. Infuse as close to IV site as possible and flush with NS after each dose

3. Continuous ECG and BP monitoring

Special Considerations and Calculations

1. Caffeine and theophylline block the effect of adenosine. Larger doses of adenosine may be required.

2. Recurrence of SVT occurs in approximately 30% of treated patients

3. Adenosine has become the drug of choice over verapamil for SVT in children of any age. Its

major therapeutic advantage is that it works within 15 to 30 seconds and has a half-life of < 10

seconds so the side effects last less than one minute.

4. Reconstituted in NS - supplied as 6mg/2mL

5. Dilutions can be made with NS for doses < 0.2 ml (0.6 mg)

6. Store at room temperature - DO NOT refrigerate because crystallization will occur

amiodarone, Cordarone: Antidysrhythmic. 

Uses: Severe VT, SVT, atrial fibrillation, VF not controlled by first-line agents, cardiac arrest. Dosages: PO loading dose 800–1,600 mg/day for 1–3 wk; then 600–800 mg/day for 1 mo; maintenance 400 mg/day; IV loading dose (first rapid) 150 mg over the first 10 min, then slow 360 mg over the next 6 hr; maintenance 540 mg given over the remaining 18 hr, decrease rate of the slow infusion to 0.5 mg/min.

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alteplase, Activase: Thrombolytic enzyme.
Uses: Lysis of obstructing thrombi associated with AMI, ischemic conditions requiring thrombolysis (i.e., PE, DVT, unclotting arteriovenous shunts, acute ischemic CVA).
Dosages: >65 kg IV a total of 100 mg; 6–10 mg given IV bolus over 1–2 min, 60 mg given over first hr, 20 mg given over second hr, 20 mg given over third hr, 1.25 mg/kg given over 3 hr for patients <65 kg.

Nursing Implications

Assessment & Drug Effects

• Monitor for S&S of excess bleeding q15min for the first hour of therapy, q30min for second to eighth hour, then q8h. Monitor neurological checks throughout drug infusion q30min and qh for the first 8 h after infusion.
• Protect patient from invasive procedures because spontaneous bleeding occurs twice as often with alteplase as with heparin. IM injections are contraindicated. Also prevent physical manipulation of patient during thrombolytic therapy to prevent bruising.
• Lab tests: Coagulation tests including APTT, bleeding time, PT, TT, INR, must be done before administration of drug. Also check baseline Hct, Hgb, and platelet counts, in case of bleeding. Draw Hct following drug administration to detect possible blood loss.
• Keep patient in bed while receiving this medication.
• Check vital signs frequently. Be alert to changes in cardiac rhythm.
• Stop therapy immediately if dysrhythmias occur.
• Report signs of bleeding: gum bleeding, epistaxis, hematoma, spontaneous ecchymoses, oozing at catheter site, increased pain from internal bleeding. Stop the infusion, then resume when bleeding stops.
• Use the radial artery to draw ABGs. Pressure to puncture sites, if necessary, should be maintained for up to 30 min.
• Continue monitoring vital signs until laboratory reports confirm anticoagulant control; patient is at risk for postthrombolytic bleeding for 2–4 d after intracoronary alteplase treatment.

Patient & Family Education

• Report immediately a sudden severe headache.
• Report blood in urine and bloody or tarry stools.
• Report any signs of bleeding or oozing from cuts or places of injection.
• Remain quiet and on bedrest while receiving this medicine.