Top Medications Given in the ICU
As a new ICU nurse, it’s important to be familiar with the common ICU medications that are given to patients under intensive care. Here are some of the top medications you are likely to encounter in your unit:
Sedatives are drugs that are used in the ICU to enable patients to endure certain procedures or remain calm. When administered, patients slowly close their eyes and appear to be sleeping. Medical professionals are then able to do certain invasive things that the patient would be unable to tolerate otherwise.
Some common sedatives used in the ICU include:
- Propofol – ventilator always required
These medications are often administered by an ICU nurse as a drip. The physician will order the medication and the ICU nurse will give it in a patient’s vein through a normal IV catheter or a central venous catheter.
It’s extremely important to note that these medications do not help patients sleep, nor do they control pain. In fact, they actually disrupt sleep cycles, and extended use can cause extreme sleep deprivation. However, this easily goes unnoticed because the patients appear to be calm and relaxed. Extended use of sedatives is associated with poor outcomes (specifically delirium) and they should only be used for short periods.
Patients who are on ventilators are often given Propofol for “tube tolerance,” which essentially means to make them more comfortable having a tube in their mouth that helps them breathe and to reduce agitation and anxiety. However, studies have shown that as much as 81% of intubated patients develop delirium and mechanical ventilation alone is not an automatic indicator for sedation. One of the top causes for agitation is delirium itself, so it doesn’t make a lot of sense to treat delirium with deliriogenic medications (that are likely the cause of the delirium!)
Pain is a common symptom for many ICU patients. Pain medications are used to help manage pain and keep patients comfortable. Please note, sedatives are not the same as pain medications.
Some common pain medications used in the ICU include:
These medications can be given as one-time doses or in the form of a drip for more extreme cases. As of the time of this writing, IV opioids are the first-line drug class for non-neuropathic pain and should be administered when assessed with a pain score. Non-opioids are often given in conjunction with opioids to decrease the amount of opioid use.
A great tool for all ICU nurses to be aware of is something called the ABCDEF bundle. It’s a strategy to improve outcomes in the ICU. The “C” of the ABCEDF bundle is Choice of Analgesic and gets into the specifics of the latest evidence around ICU pain control. Click here and click on C Element to check it out.
As many of you are aware, there needs to be care and consideration with the administration of opioids due to concerns for respiratory depression, but also delirium, long-term substance use disorder, and many other complications. However, many patients in the ICU setting experience very real and intense pain that must be adequately addressed, therefore tools like the ABCDEF bundle are extremely helpful in guiding clinicians to the best choice for the patient.
Vasopressors are one of the common ICU medications that are used to increase blood pressure in patients with hypotension. While the choice of drug depends on the cause and situation at hand, often physicians will order that patients get IV fluids first before starting vasopressors. (Ensuring there’s enough water in the tubes before attempting to clamp the tubes down!)
Some common vasopressors used in the ICU include:
These medications are very potent and can cause many complications. Therefore, they are only used when absolutely necessary. They should be given in a central venous catheter. The ICU nurse will have a blood pressure goal ordered by the physician, often a mean arterial pressure (MAP) above 65. The nurse will initiate the drip at the starting dose and titrate it up or down depending on how the patient responds.
Patients who require these may also have an arterial line in place for very close blood pressure monitoring, or will have their blood pressure taken with a regular blood pressure cuff (non-invasive blood pressure, or NIBP) as often as every 5-15 minutes. It is the responsibility of the nurse to ensure these pressures are being taken, and that they are evaluating them, responding promptly and appropriately, and also documenting any changes.
Antibiotics are used to treat infections in the ICU. Patients may present to the ICU with an active infection, or they may acquire one while in the ICU. Patients in the ICU are at increased risk for infections due to the use of invasive devices such as central venous and urinary catheters, ventilators, and any other invasive devices.
Some common antibiotic medications used in the ICU include:
The key to antibiotics in the ICU is to ensure they are given at the correct time. If it is ordered to be given every 6, 8, 12, or 24 hours, it needs to be given as close to that timeframe as possible. When the medication is administered, the levels of it in the patient’s circulation increase. We want to maintain that level to optimize the impact of the drug.
You may also be required to draw labs to check the level of the antibiotic in the blood to evaluate if it needs to be adjusted. For example, if giving vancomycin, you may need to draw both peak and trough specimens. A peak is the highest concentration of of a medication and would be drawn 1-2 hours after the infusion is complete. A trough is assessing when the drug is at its lowest concentration in the bloodstream and therefore is drawn at the end of a dosing interval (for example, 30 minutes before the next dose is due).
Common ICU Medications: Final Thoughts
As a new intensive care nurse, it’s important to be familiar with the common medications used in the ICU. This list is not exhaustive, but it should give you a good starting point for your learning. If you enjoyed this post and want to take a free mini-course on ICU drips for beginners, click here.
More Resources for New ICU Nurses
- New ICU Nurse Master List
- Sepsis Protocol for Nurses
- Advice for New ICU Nurses
- Top Tips for New Grads in ICU
Trying to build your confidence as a new ICU nurse?
Breakthrough ICU from FreshRN is a 6-week, online course specifically crafted for brand new ICU nurses who want to get ahead of the game. So that instead of merely surviving orientation, they’re confidently thriving all the way through. With Breakthrough ICU, it’s like we took all of the highlighted info from the nursing textbooks, mixed in our own experience, wisdom, and expertise, and packaged it in a way that it’s tangible, easy to digest and understand, and can be applied to your very next shift. You can start your ICU journey with your head held high (but not too high!) and your heart calm.