Summary
Summary NURB 3150 Essential ICU Drip List.
- Course
- Nurb 3150
- Institution
- Northwestern State University Of Louisiana
Detailed Summary on;Essential ICU Drip List.
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Important ICU Drip List:Vasopressors AKA “Pressors”
Norepinephrine (Levophed, Levo):
o Indications: Hypotension in cardiogenic, septic, and neurogenic shock.
o Mechanism of Action: Binds to Alpha 1 (constricts peripheral blood vessels) and Beta 1 receptors
(increase HR and CO). Thus, increasing HR, Contractility, SVR, Systemic BP and Coronary blood
flow.
o Titration: Typically started at 0.1 mcg/kg/min, titrated by 0.03 q3min, max dose 0.4 but can
increase dose until next pressor is available, to keep MAP > 65 mmHg.
o Adverse Effects: Tachycardia, Dysrhythmias, Myocardial ischemia, can cause Tissue necrosis if ran
through a peripheral vessel.
o Clinical Pearls: 1st line pressor in septic shock, most commonly used pressor in MICU. Preserves
renal and mesenteric blood flow and dilates coronary blood vessels.
Epinephrine (Epi):
o Indications: Hypotension, Septic or Anaphylactic shock.
o Mechanism of Action: Stimulates Beta 1 and 2 at lower doses. Higher doses stimulate Alpha 1 and
2 causing vasoconstriction.
o Titration: Starts at 0.3 to 3 mcg/kg/min to keep MAP.
o Adverse Effects: Tachycardia, Hyperglycemia, increasing Dysrhythmias, ST segment depression
related to myocardial ischemia.
o Clinical Pearls: Does not preserve renal or mesenteric blood flow. It relaxes smooth muscle of
bronchial tree. Almost never a 1st line pressor w/ the exception of anaphylaxis/ACLS. Typically the
last pressor to add of these 4 listed.
Phenylephrine (Neosynephrine, Neo, Phenyl):
o Indications: Hypotension, Septic, or Anaphylactic shock.
o Mechanism of Action: Alpha 1 receptor agonist.
o Titration: Starts at 0.5 to 3 mcg/kg/min to keep MAP > 65 mmHg. Titrate by 0.5.
o Adverse Effects: Reflex bradycardia, Myocardial ischemia.
, o Clinical Pearls: NO Beta receptor stimulation, so it does not directly affect cardiac output. Can
adjunct w/ Dopamine if bradycardia occurs. Good pressor choice for tachycardia pts. w/ ectopy.
Can be given as a “push” for transient hypotension related to intubation or anesthesia.
Vasopressin (Vaso):
o Indications: Used as an adjunct when fluids/vasopressors are ineffective. Vasopressor sparing
agent used to reduce vasopressor dose needed to maintain BP.
o Mechanism of Action: Stimulates V-1 receptors in blood vessels and V-2 receptors in kidneys.
Causes Vasoconstriction, Water retention, and Urine concentration.
o Titration: STARTS at 0.03/0.04 units/min and is weaned down. Only wean every 30 mins to
prevent reflex hypotension.
o Adverse Effects: Myocardial ischemia, especially w/ high doses.
o Clinical Pearls: Typically the 2nd agent used w/ Norepinephrine for shock. Do not wean first.
High Dose Dopamine:
o Indications: Hypotension associated w/ shock, Bradycardia, or Heart block.
o Mechanism of Action: Alpha 1 receptor agonist. Increases SVR and BP and acts as a pressor.
o Titration: 10 – 20 mcg/kg/min. Titrate to keep MAP > 65.
o Adverse Effects: Tachycardia, Dysrhythmias, Angina, Hypotension, Headache, Tissue necrosis in
extravasation.
o Clinical Pearls: Increased mortality in cardiogenic shock. The only pressor/inotrope where effects
are dose dependent.
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