Name That Drip
I’m an alpha-2 agonist used primarily for sedation with some analgesia. My PICU starting infusion is 0.2 mcg/kg/hr.
What is dexmedetomidine (Precedex)?
According to the PICU sedation guideline, this opioid is preferred for children under 20 kg, including patients on ECMO.
What is morphine?
I act on alpha and beta adrenergic receptors and am also the medication used at 0.01 mg/kg IV/IO during pediatric cardiac arrest.
What is epinephrine?
An intubated 10-kg patient is started on hydromorphone because it is the preferred first-line opioid for patients under 20 kg. What’s the mistake?
What is morphine is the preferred opioid for children under 20 kg, including ECMO?
A 10-kg child needs epinephrine 0.01 mg/kg during cardiac arrest. How many milligrams should be administered?
What is 0.1 mg?
I’m a loop diuretic that increases excretion of sodium, chloride, and potassium.
What is furosemide (Lasix)?
I’m a PDE inhibitor that increases cardiac squeeze while relaxing blood vessels. Hypotension is one of my common side effects.
What is milrinone?
According to the guideline, this opioid is preferred for children over 20 kg, including patients on ECMO.
What is hydromorphone?
I have strong alpha and beta-1 activity with more moderate beta-2 effects, producing vasoconstriction while supporting heart rate and cardiac output.
What is norepinephrine?
Dexmedetomidine was just increased. Thirty minutes later, morphine is increased without additional direction from the LIP. What guideline consideration was missed?
What is allow 1 hour between infusion rate adjustments to assess the previous change?
A 15-kg patient needs a ketamine bolus of 0.5 mg/kg. What is the dose?
What is 7.5 mg?
When this anticoagulant is used to treat a clot, the teaching material identifies anti-Xa as a monitoring laboratory value.
What is heparin?
I’m a Class II antiarrhythmic and selective beta-1 blocker often used when rapid control of a tachyarrhythmia is needed.
What is esmolol?
A mechanically ventilated patient has renal or hepatic impairment. This opioid is the guideline’s preferred agent.
What is fentanyl?
I work through V1 receptors to produce vasoconstriction and can increase blood pressure without directly relying on adrenergic receptors.
What is vasopressin?
A nurse prepares to give a dexmedetomidine bolus to a patient with bradycardia. Identify the problem.
What is dexmedetomidine boluses are contraindicated with bradycardia?
A 25-kg patient is ordered a morphine bolus of 0.1 mg/kg. How many milligrams will the patient receive?
What is 2.5 mg?
I lower blood glucose by facilitating cellular uptake of glucose, but my PICU nurses also need to watch closely for hypoglycemia.
What is insulin?
I’m a beta-1 and beta-2 agonist. I increase heart rate and contractility while also causing peripheral vasodilation.
What is isoproterenol (Isuprel)?
SBS remains above goal despite escalation of the other sedative infusions. This medication can be given 0.5 to 1 mg/kg q4h PRN, with an infusion starting at 0.3 mg/kg/hr if needed.
What is ketamine?
I’m an alpha-1 adrenergic agonist that produces arterial and venous vasoconstriction without directly stimulating beta receptors.
What is phenylephrine?
A patient’s SBS remains above goal despite escalating opioid and dexmedetomidine therapy. The patient then has a positive delirium screen, so the plan is to increase the midazolam infusion. What should be questioned?
What is increasing the benzodiazepine? A positive delirium screen should prompt consideration of discontinuing benzodiazepines.
Calculate standard maintenance IV fluid for a 17-kg child using the 4-2-1 rule.
Answer: What is 54 mL/hr?
I’m a Class III antiarrhythmic used for serious atrial and ventricular arrhythmias and may cause hypotension and QT prolongation.
What is amiodarone?
I’m used for severe pulmonary hypertension, may be delivered subcutaneously for long-term therapy, and my dose is measured in ng/kg/min.
What is treprostinil (Remodulin)?
A mechanically ventilated patient develops a positive delirium screen while receiving this class of medication. The guideline recommends considering discontinuation of this class.
What are benzodiazepines?
Unlike the pressors in this category that raise blood pressure, I’m a calcium-channel blocker used to produce arterial vasodilation and decrease blood pressure.
What is nicardipine?
An intubated patient receiving fentanyl at 2.5 mcg/kg/hr has an order for a 1 mcg/kg fentanyl PRN. According to the sedation guideline’s Appendix A, what should the nurse catch?
What is the PRN dose does not match the infusion rate? The recommended fentanyl bolus at 2.5 mcg/kg/hr is 2.5 mcg/kg.
A 16-kg patient is receiving ketamine at 0.3 mg/kg/hr. How many milligrams of ketamine will the patient receive over 4 hours?
19.2 mg?
I’m used to maintain ductal patency in certain congenital heart conditions, but apnea is an important adverse effect.
What is alprostadil (PGE1)?