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ICU Drugs Crib Cheat Sheet by

The following information is for educational purposes only. Clinical interpretation must be used in the healthcare setting and within limits of competency. Please check local guidance and protocols as well as indications and contraindications of medications.

Sedati­on/­Ana­lgesia Infusions

Drug
Dose Range
Addi­tional inform­ation
Fentanyl IV
25-400­mcg/hr
Opiate of choice in renal impairment
Propofol IV
0-300mg/hr Max 4mg/kg/hr (IBW)
Short acting. No analgesic proper­ties. Hypote­nsive effect.
Midazolam IV
0-10mg/hr
Accumu­lates in renal impairment and in obesity – may take days to clear
Morphine IV
1-10mg/hr
Avoid use in renal impairment
Thiope­ntone IV
3-8mg/­kg/hr (ABW)
Used for raised ICP. Risk of accumu­lation. Can cause disruption of potassium homeos­tasis. Aim K+ to be lower end of normal range
Ketamine IV (analg­esia)
Loading dose: 0.2mg/kg (ABW) STAT Initial mainte­nan­ce: 0.3mg/­kg/hr (ABW) and titrate (up to 0.6mg/­kg/hr)
May lower seizure threshold. Very halluc­ino­genic and can induce catatonia. NOT indicated for ‘normal’ acute pain.
Patients should ideally have EEG or BIS monitoring to assess level of sedation.
Ketamine: Different vial strengths and admini­str­ation rates used for bronch­ospasm & asthma vs analgesia.
 

Paralysis

Drug
Dose Range
Addi­tional inform­ation
Atracurium
 
Used for cardio­vas­cularly stable patients at low risk of bronch­ospasm. Histamine release. Short duration of action
Cisatr­acurium
 
Lacks histam­ine­-re­leasing effects therefore used in cardio­vas­cularly unstable patients at risk of bronch­ospasm. More potent & slightly longer duration of action than atracurium
Rocuronium
 
Most rapid onset of non-de­pol­arising agents
check local guidelines for dose ranges and availa­bility of monitoring such as train of four and BIS. Be aware of renal function and dose adjust­ments.

Cardio­vas­cular Drugs

Drug
Dose Range
Addi­tional inform­ation
Adenosine
3mg bolus
Rapid intrav­enous injection. If no response after 1-2 min, give 6mg. If no response after 1-2 min, give 12mg
Amiodarone
Loading dose of 300mg over 1 hour (prescribe as a STAT dose). Then start infusion of 900mg over 23 hrs
Digoxin
IV/PO/­Enteral loading dose of 0.5-1mg in 1-2 divided doses 4-8 hours apart, dependent on response
Mainte­nance dose 62.5-250 mcg/day depending on plasma levels and clinical response. Therap­eutic plasma level 0.8 – 2micro­gram/L
GTN IV
0.5-10 mg/hr
rw every 24hr due to ceiling effect
Labetolol IV
15-120 mg/hr

Inotro­pes­/Va­sop­ressors

Drug
Dose Range
Addi­tional inform­ation
Noradr­enaline
0.01 – 1 mcg/kg/min (IBW)
>0.2­5m­cg/­kg/min – seek senior review
Adrenaline
0.01 – 1 mcg/kg/min (IBW)
>0.2­5m­cg/­kg/min – seek senior review
Dobutamine
2.5 – 20 mcg/kg/min (IBW)
Terlip­ressin
0.05-0.2 mg/hour
Monitor for excessive peripheral vasoco­nst­riction and raised lactate.
 

Respir­atory

Drug
Dose Range
Addi­tional inform­ation
Aminop­hylline IV
5mg/kg loading dose then 0.3-1 mg/kg/hr (IBW)
Patients taking oral theoph­ylline / aminop­hylline should not receive a loading dose. Start continuous infusion at 0.5mg/­kg/hr and adjust according to plasma theoph­ylline concen­tration
Salbutamol IV
0.18 – 1.2 mg/hr
Epopro­stenol nebulised
5 – 20 nanogr­ams­/kg/min (ABW)
For pulmonary hypert­ension or hepato­-pu­lmonary syndrome
Ketamine IV (Bronc­hospasm & asthma)
0.5 – 2.5 mg/kg/hr (ABW)
Dose should be maintained at the minimum amount providing adequate response; increased adverse cardio­vas­cular effects with increased dose
Ketamine: Different vial strengths and admini­str­ation rates used for analgesia

VTE Prophy­laxis

Renal function
Drug
Patient Weight (ABW)
Dose
eGFR> 30ml/min
Enoxaparin S/C
<50kg
20mg OD
  
50-100kg
40mg OD
  
101-150kg
80mg OD (or 40mg BD)
  
>150kg
120mg OD (or 60mg BD)
eGFR < 30ml/min or RRT
Heparin S/C
<100kg
5000 units BD
  
>100kg
5000units TDS

Prokin­etics

Drug
Dose Range
Addi­tional inform­ation
Metocl­opr­amide IV
10mg TDS (max 3-5 days)
Avoid long-term use, due to risk of neurol­ogical side effects
Erythr­omycin IV
250mg 6hourly
Risk of prolonged QTc syndrome – daily ECGs
Review daily

Stress Ulcer Prophy­laxis

 
Pantop­razole 40mg IV OD or Omeprazole 40mg IV.
If patient is absorbing enteral feed for >24 hours or E+D, stop PPI or consider switch to PO PPI. 
           
 

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