Medications II

Venodilators such as nitrates (preload) and hydralazine (afterload) treat HTN, heart failure and angina. 

Inotropes can assist a failing heart. Examples include:

• Noradrenaline
• Generalised vasoconstriction
• Increased systemic vascular resistance
• Dopamine
• In low doses due to side effects
• Digoxin
• Cardiac glycoside with mild inotropic effects that helps control AF by slowing and strengthening HR, but may cause other arrhythmias with hypoxia.

In patients with tachycardia, inotropes may cause myocardial ischaemia and reduce oxygen delivery.

Amiodarone, which can cause pulmonary fibrosis (Goldschlager et al, 2000) is an anti-arrhythmic drug commonly used on ITU.

Nitric oxide is a pulmonary vasodilator that dilates vessels next to ventilated alveoli therefpre:

• Reducing shunt
• Reducing V/Q mismatch
• Benefiting 50% of patients in respiratory failure.

Patients should not be removed from NO for physio.

Sedatives (minimal = anxiolytics) include:

• Diazepam or midazolam
• Propofol which stabilises HR and BP
• Chlormethiazole which can increase bronchial secretions

Alfentanil is a short-acting intravenous analgesic.