Eight Drugs Every ICU Nurse Needs to Know

THE LIFE OF MILLIONS OF PATIENTS ADMITTED TO AN EMERGENCY ROOM SETTING OR CRITICAL CARE UNIT is dependent upon the skill set and knowledge of the attending ICU or Intensive Care Unit nurse. Critical care doctors work under severe, extreme pressure, giving orders, ordering tests and reading lab reports. Therefore, it is imperative for them to have a professional team of men and women who can respond quickly and effectively during a crisis. These men and women should be able to function, even in the toughest of situations. Although, all nurses play a vital role in the well- being and recovery of patients, all nurses are not cut out to work in a fast pace setting, where life and death decisions are made nearly every second of every minute.

It is during one of these intensive life- threatening moments that an ICU nurse must make one of the most life altering decisions of his or her career. Which medication will work best and quickest if a patient is in duress? ICU nurses with extended knowledge of medication should not have a problem answering this question. However, an ICU or intensive care unit nurse who has been out of circulation for a while, will definitely need to find out the answer to these questions. Listed below is a guide listing at least eight common types of medications an ICU nurse needs to know about:

ADENOSINE

This medication has a very short life, normally about 10 seconds. This means that this medication must be used immediately. It is used to treat supraventricular and atrial tachycardia conditions. Doctors prescribe this drug for as a treatment for shingles, herpes, and a blood disorder known as porphyria cutanea tarda. A variation of this drug forms chemical compounds (AMP) and (ATP) adenosine monophosphate and triphosphate. While AMP treats shingles and herpes, ATP is used to treat kidney failure, hypertension, lung cancer and cystic fibrosis. When placed under the tongue this drug can increase physical energy. When administered intravenously, the drug can block nerve and surgical pain, in addition to promoting blood circulation. It aids in the treatment of an irregular heartbeat, and in the prevention of unstable metabolism systems, which causes people with advanced cancer to lose weight. Because of its multiple benefits to patients with various illnesses and diseases, this drug is used to:

• Treat lung cancer, pulmonary hypertension, high blood pressure, and herpes, etc.
• Treat varicose veins, bursitis, neuropathy, nerve pain
• Shingles

AMIODARONE

During a life threatening emergency crisis where heart disorders are known to exist, amiodarone can interfere with a heartbeat, or adversely affect the heart’s rhythm. However, it is among one of the most preferred choice of drugs, for patients facing blood flow problems of the heart. Patients are normally administered this drug in a hospital setting, where their heart rhythm can be monitored by an EKG, EGG or electrocardiograph. Patients with tachycardia experience faster than normal heart beats, even during periods of rest, which doctors consider to be abnormal. If this condition is not treated it could cause serious complications including heart failure. Patient with a ventricular fibrillation condition faces even more serious problems, as the heart quivers instead in lieu of pumping blood. This condition requires immediate medical intervention. This drug is used to:

• Regulate irregular heartbeats
• Dilate blood vessels
• Treat patients with congestive heart failure

EPINEPHRINE

This medication helps make breathing easier for patients suffering with blocked air passages, such as asthmatic patients, and patients with lung disorders. It is also a life saver for people with severe allergies or those who experience certain types of heart conditions. However, epinephrine is often added to selected forms of anesthesia to make the effects of the drug last longer. This drug quickens the rhythm of the heart, strengthens the contractions of the heart, and expands the airways of the lung. In fact, epinephrine is often referred to as adrenaline, because of its effect on the adrenal gland, which is part of the flight or fight reaction. Epinephrine increases blood pressure and heart rates, and it also releases glucose from the liver. Therefore, epinephrine is used to treat:

• Disorders of the adrenal glands (Addison’s Disease
• Allergic reaction
• Heart failure/ works as an heart stimulant

VASOPRESSIN

Vasopressin increases the re-absorption of water, and is used to treat diabetes insipidus. It is an alternative to epinephrine, and is often used in the intensive care unit to support the blood pressure of organ donor patients. It can be used in some instances to treat variceal bleeding, and cardiac arrest. For this reason, it is imperative to monitor the patient’s heartbeat, and note any dramatic changes. Patients with diabetes should have their intake and output recorded, as wells as close monitoring of vitals, lab work, creatinine, BUN, and electrolytes. The main problems to look for are dehydration and fluid retention. This drug is used to:

• Prevent the buildup of fluid in the abdomen
• Treat patients who have flat-lined
• Treat patients with severe kidney problems such as sodium and water retention

SOTALOL

This drug is used to treat life- threatening issues of the heart. It is effective in the treatment of patients suffering from ventricular arrhythmia and atrial fibrillation or atrial flutter. Also known as a beta- blocker, Sotalol effects the impulses of the nerves in their response to certain parts of the body. This drug causes the heart to beat slower, and at an even pace. This drug is available in tablet or solution form. The effects of this drug is long- term. It does work on the blood vessels and heart, to prevent tachyarrhythmia or an abnormal heartbeat. This drug is available in tablet or solution form, and it is used mainly to:

• Treat patients with an irregular heartbeat
• Treat patients diagnosed with atrial fibrillation and atrial flutter
• Control the nerve impulses in certain parts of the body

PROCAINAMIDE

This drug is used to treat patients with a life- threatening heart disorder known as ventricular tachycardia or an irregular heartbeat. Procainamide works by blocking some of the electrical signs in the heart, which can create an irregular heartbeat. Therefore, it is known as an anti- arrhythmic drug. Because this drug can cause adverse effects on the heart’s rhythm, the patient should be monitored closely, and caution should be taken when given to these patients:

• Elderly
• Patients with kidney problems
• Patients with liver disease
• Patients with low blood pressure
• Patients with low potassium
• Patients with an abnormal heartbeat

LIDOCAINE

Aside from being effective as an anti- itching drug, it is used to treat hemorrhoids, and certain other discomforts of the genital areas. Some form of Lidocaine is used as a local anesthetic during exams, and surgical procedures, like cystoscopy, and sigmoidoscopy. When applied to the skin this drug work as a smoothing agent against skin problems resulting from hives, insect bites, minor burns, eczema, and itching. The drug works by numbing the affected area, and is beneficial for:

• Causing temporary numbness
• Reducing or preventing pain following an insect bite or minor injury
• Treating hemorrhoids

ATROPINE

Atropine decreases the production of and secretion of saliva prior to surgery. Doctors use this medication to treat stomach spasms, spasms that occur in the intestine and other organs. In some cases, it is administered to counteract the effects of other medications. Atropine works by preventing the effects of acetylcholine in the nervous system, and in the salivary gland, urinary tract and other tissues. Before administering Atropine remember these facts:

• Check the patient’s history before administering this drug
• Can be administered by injection
• Can interfere with antidepressants

Summary

Although, these and other medication comes with possible side effects, doctors and clinicians agree that the benefits of administering these drugs, significantly outweigh the reactions. ICU nurses have to react quickly during a life and death situation. Their quick response, and timely decision making skills put them in high demand. Patients rely on the skills and knowledge intensive care unit nurses exhibit, and doctors rely on their education and experience. Mostly, doctors rely on the intensive care nurses’ ability to function effectively under pressure. Being able to make quick and accurate medical decisions is necessary for nurses working in an emergency or critical care unit.

ICU nurses who are not familiar with these and other medications, should familiarize themselves as quickly as possible, especially now, as new drugs are constantly flooding the market. Nevertheless, doctors have their own idea, whether through personal or professional preference or experience, as to what type of drug they prefer, based on proven results. Drugs with a good overall performance are most likely to be widely used, and highly recommended. ICU nurses should always check with the doctor in charge to ensure that the drug usage amount has changed or is the same.

Beware of patients with various illnesses, and diseases, as their body might not tolerate some medications. Medications reacting with other medications is not unusual. However, in some cases, most side effects can be prevented through research.