Indications, Dosing, Pharmacokinetics, Nursing Considerations, Side Effects, and Continuous Drips
Used for the management of diabetes mellitus to control blood glucose levels.
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.
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)
Used for the management of hypertension.
Oral bioavailability: 40-60%. Metabolized in the liver; half-life is about 3-4.5 hours.
Initial Rate: 5 mg/hr. Titration: Increase by 5 mg/hr every 15 mins. Max Rate: 20 mg/hr.
Monitor blood pressure and heart rate. Assess for peripheral edema. Educate patients about avoiding grapefruit juice.
Nicardipine is used for the management of hypertension and angina pectoris. It works by relaxing blood vessels, lowering blood pressure and improving blood flow.
Nicardipine has an oral bioavailability of approximately 35%. It is metabolized in the liver, with a half-life of about 2-4 hours.
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.
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.
Potential side effects of nicardipine include hypotension, tachycardia, headache, and nausea.
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:
IV Administration:
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: Nurses should continuously monitor the patient's ECG during the infusion, watch for signs of hypotension and bradycardia, and assess for pulmonary toxicity.
Potential side effects of amiodarone include hypotension, bradycardia, pulmonary toxicity, and liver enzyme abnormalities.
Used as a vasopressor, indicated as either first, second, or third line for the treatment of acute hypotensive states such as shock.
Onset of action: 1-2 minutes. Duration: 1-2 minutes after stopping infusion. Metabolized by MAO and COMT.
Potential side effects of Levophed include hypertension, arrhythmias (most common PVCs, SVT), extravasation can cause tissue necrosis, headache.
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.
Onset of action: within a few minutes. Half-life: approximately 2 hours. Metabolized in the liver.
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.
Monitor sedation levels and vital signs. Assess for signs of hypotension and bradycardia. Ensure continuous cardiac monitoring during administration.
Medication Overview: Insulin, Cardizem, Cardine, Amio, Levophed, and Precedex