Vasoactive Verses
At low doses it helps the kidney sing,
Mid-range it makes cardiac output swing.
Too high and you’ll find
A squeeze of the kind
That makes vessels clamp down like a string.
Dopamine
This agent provides sedation and amnesia but may drop blood pressure, not ideal for unstable patients.
Propofol
A milky white drip, smooth and sly,
Helps dreams come and quickly go by.
It calms without pain,
But drop pressure in vain
“Lights out!” says the vial with a sigh.
Propofol
I slip through smooth muscle and tell it to chill,
Low-key no calcium, no pressure to fill.
I favor the vessels or sometimes the heart,
But watch for edema when I play my part.
Give me the class and an example
Ca Channel Blockers
Clevidipine, Nicardipine, Amlodipine, Diltiazem
Which of the following medications needs to be pretreated with bronchodilators?
Ribavirin
Nitric Oxide
Cayston
Flolan
Ribavirin
Cayston
Pure constrictor, with alpha the key,
Raises blood pressure and SVR, you see?
Used for a pressor fix,
Or to clear up nasal icks
Reflex Brady plays along occasionally.
Phenylephrine
Your patient has hyperkalemia and crush injuries. Which paralytic should you avoid?
Succinylcholine
An alpha-two agent so keen,
Keeps patients sedate, yet still seen.
They’re calm, but can talk,
Or follow your walk—
It’s “coop sedation,” crisp and clean.
My path is downstream; I don’t stop the making,
I block the effect that the second is taking.
I spare you the cough, yet still guard the heart
Which blocker of binding plays my part?
Category and Example
ARBs
Losartan Valsartan
Which opioid used in critical care is a very potent synthetic narcotic that can cause chest wall rigidity?
Fentanyl
A drug that will boost a weak heart,
Mostly beta 1 it plays that part.
It pumps with a grin,
Drops afterload a tin,
Good for hearts that need a strong start.
Dobutamine
You need a non-depolarizing paralytic that lasts longer and is safer for unstable hemodynamics.
Rocuronium
Quite a trippy ride, yet a friend,
Keeps pain away and airways open to the end.
It’s weird, but it’s true,
They might see in two
Dissociation’s its favorite trend.
Ketamine
I quiet the enzyme that crafts a constrictor,
And keep your heart’s workload a little bit stricter.
I’m kind to the kidneys in diabetics’ plight,
But a bradykinin cough may wake you at night.
Category and Example
ACEi
Lisnopril, Enalapril
You are mamaging a patient on mechanical ventilation and wish to get a breathing trail started. The patient is on propofol and your unit is using the Richmond Agitation Sedation Scale (RASS) to assess level of sedation. The patient appears to be awake and agitated, makes eye contact in greater than 10 seconds. What is this patient's level of sedation by the RASS?
+2
There once was a peptide quite stern,
From the brain told the kidneys, “Hold water, not yern.”
It tightened the vein,
Raised pressure again,
And in septic nights helped perfusion return.
Vasopressin or ADH
You’re preparing to intubate a hypotensive trauma patient. Which induction agent keeps blood pressure most stable?
Etomidate
I’m swift with a hypnotic grace,
Yet blood pressure stays in its place.
Adrenal I blunt,
But just for a stunt—
Guess me: one dose, out like a race.
Etomidate
A patient’s heart races, their pressure is steep,
I’m chosen to slow it, their rate now deep.
But give me in asthma...caution, beware,
I may block the breath that isn’t there
Caetgory and example
Beta Blockers
Labetalol, Carteolol
Define anticoagulant vs antiplatelet and provide an example for each:
Anticoagulants: Medications that interfere with the clotting cascade, preventing the formation or growth of fibrin clots.
Heparin or Coumadin/Warfarin
Antiplatelets: Medications that prevent platelets from sticking together (aggregation) and forming a platelet plug in the early stages of clot formation.
Asprin or Clopidogrel (Plavix)
A messenger bursting with zing,
Used when airways close up in a fling.
It makes hearts race and hypotension fear,
And in codes brings new cheer —
Adrenal alarm: up goes everything.
Epinephrine
Give me 3 drugs, including their classification, used in an RSI
Sedatives: Etomidate, Ketamine, Propofol, Versed
Analgesics: Fentanyl, Dilaudid, Morphine
Paralytics: Succinylcholine, Vecuronium, Rocuronium, Nimbex
I slip through the GABA-bound door,
Bring calm, yet they demand for more.
I fade anxious fight,
Steal memories light,
Short-acting, but strong to the core.
Versed
I do not charm GABA to weave my spell,
Yet still I bring silence where chaos fell.
Through medullary whispers I quiet the storm,
But brady and hypo are part of my form.
Category and example
Alpha 2 agonists
Precedex
Besides respiratory depression, anem two common side effects from narcotic use
Hemodynamic compromise and decreased bowel mobility