Medication Overview: Insulin, Cardizem, Cardine, Amio, Levophed, and Precedex
Indications, Dosing, Pharmacokinetics, Nursing Considerations, Side Effects, and Continuous Drips
Insulin
Indication
Used for the management of diabetes mellitus to control blood glucose levels.
Dosing
Dosing varies based on type (rapid-acting, short-acting, intermediate-acting, long-acting).
Continuous IV insulin administration is titrated by protocol See below for detailed order sets by indication.
Pharmacokinetics
Onset, peak, and duration vary by type. Rapid-acting: Onset 15 minutes, peak 1-2 hours, duration 3-5 hours. Long-acting: Onset 1-2 hours, no peak, duration 24 hours.
Insulin Infusion Orders for Non-Diabetic Ketoacidosis
Goal BG Range: 110-180 mg/dl (Target 150 mg/dl)
Insulin Infusion Orders for Diabetic Ketoacidosis
Goal BG Range: 150-250 mg/dl (Target 150 mg/dl)
diltiazem (Cardizem)
Indication
Used for the management of hypertension.
Pharmacokinetics
Oral bioavailability: 40-60%. Metabolized in the liver; half-life is about 3-4.5 hours.
Continuous Drip
Initial Rate: 5 mg/hr. Titration: Increase by 5 mg/hr every 15 mins. Max Rate: 20 mg/hr.
Nursing Considerations
Monitor blood pressure and heart rate. Assess for peripheral edema. Educate patients about avoiding grapefruit juice.
nicardipine (Cardene)
Indication
Nicardipine is used for the management of hypertension and angina pectoris. It works by relaxing blood vessels, lowering blood pressure and improving blood flow.
Pharmacokinetics
Nicardipine has an oral bioavailability of approximately 35%. It is metabolized in the liver, with a half-life of about 2-4 hours.
Continuous Drip
Nicardipine infusion is initiated at 5 mg/hr and titrated up by 2.5 mg/hr every 5-15 minutes to achieve the desired blood pressure, with a maximum rate of 15 mg/hr. The goal is to maintain systolic blood pressure between 90-150 mmHg and diastolic between 55-90 mmHg.
Follow provider orders for dosing and titration.
Nursing Considerations
Nurses should closely monitor the patient's blood pressure and heart rate, and assess for signs of hypotension. They should also ensure proper IV line patency to prevent extravasation.
Side Effects
Potential side effects of nicardipine include hypotension, tachycardia, headache, and nausea.
amiodarone (Nexterone)
Indication
Indication: Amiodarone is used for the treatment of ventricular arrhythmias and atrial fibrillation, helping to control abnormal heart rhythms and maintain a normal sinus rhythm.
Pharmacokinetics
Pharmacokinetics:
IV Administration:
Onset of action: Within minutes.
Peak effect: 1-3 hours.
Distribution: Widely distributed in body tissues.
Half-life: Biphasic - initial rapid distribution phase (half-life of 4-6 hours) followed by a slower elimination phase (half-life of approximately 40-55 days).
Continuous Drip
Continuous Drip: Amiodarone infusion is initiated with a loading dose of 150 mg over 10 minutes, followed by 1 mg/min for 6 hours. The maintenance rate is then reduced to 0.5 mg/min for 18 hours or until the arrhythmia is controlled, with a maximum rate that requires provider notification.
Nursing Considerations
Nursing Considerations: Nurses should continuously monitor the patient's ECG during the infusion, watch for signs of hypotension and bradycardia, and assess for pulmonary toxicity.
Side Effects
Potential side effects of amiodarone include hypotension, bradycardia, pulmonary toxicity, and liver enzyme abnormalities.
norepinephrine (Levophed)
Indication
Used as a vasopressor, indicated as either first, second, or third line for the treatment of acute hypotensive states such as shock.
Pharmacokinetics
Onset of action: 1-2 minutes. Duration: 1-2 minutes after stopping infusion. Metabolized by MAO and COMT.
Continuous Drip
Initiate norepinephrine infusion at ordered mcg/min.
Increase or decrease infusion per order (typically 2 mcg/min) no more often than every 5 minutes to maintain ordered parameters.
Titrate to keep either Systolic BP or MAP above indicated pressure per order.
Notify provider if infusion exceeds indicated dose per order (often 80 mcg/min).
Recommended Initial Rate: 8 mcg/min.
Provided as an 8 mg (32 mcg/mL) in 250 mL normal saline bag.
Nursing Considerations
Continuous monitoring of blood pressure and heart rate.
Ensure patency of IV line to prevent extravasation.
Titrate dose based on patient response.
Side Effects
Potential side effects of Levophed include hypertension, arrhythmias (most common PVCs, SVT), extravasation can cause tissue necrosis, headache.
dexmedetomidine (Precedex)
Indication
Used for sedation of initially intubated and mechanically ventilated patients during treatment in an ICU setting; also for sedation of non-intubated patients before and/or during surgical and other procedures.
Pharmacokinetics
Onset of action: within a few minutes. Half-life: approximately 2 hours. Metabolized in the liver.
Continuous Drip
Initiate dexmedetomidine infusion at (provider order) mcg/kg/hour. Titrate by 0.1 mcg/kg/hour every 15 minutes to maintain ordered parameters. Goal SAS of 3-4. Notify provider if dose exceeds 1.5 mcg/kg/hr or if hemodynamically unstable.
Nursing Considerations
Monitor sedation levels and vital signs. Assess for signs of hypotension and bradycardia. Ensure continuous cardiac monitoring during administration.