ICU Medications

 Vasopressors & Inotropes

• Norepinephrine (Levophed)

  • Use: First-line pressor in septic shock.

  • MOA: α1 agonist → vasoconstriction; mild β1 → ↑HR/contractility.

  • Fun fact: Nurses call it “Leave-em-dead” because if you need a lot, the patient is very sick.

• Epinephrine

  • Use: Anaphylaxis, cardiac arrest, refractory shock.

  • MOA: Strong α + β agonist.

  • Fun fact: It’s literally adrenaline, same hormone your body makes when you’re scared.

• Dopamine

  • Use: Historically shock, now rare.

  • MOA: Dose-dependent: low = renal vasodilation, medium = β1, high = α1.

  • Fun fact: At low dose it was thought to "save kidneys," but studies said nope.

• Phenylephrine

  • Use: Hypotension (esp. tachycardic patients).

  • MOA: Pure α1 agonist → vasoconstriction.

  • Fun fact: It’s the same drug family as nasal decongestant sprays!

• Vasopressin

  • Use: Adjunct in septic shock.

  • MOA: V1 receptor → vasoconstriction (independent of adrenergic receptors).

  • Fun fact: It’s your body’s anti-diuretic hormone (ADH) in IV form.

• Dobutamine

  • Use: Cardiogenic shock, heart failure.

  • MOA: Mostly β1 agonist → ↑contractility.

  • Fun fact: Think “DO BUTamine = DO BUT squeeze the heart.”

Sedatives & Hypnotics

• Propofol

  • Use: Sedation, induction.

  • MOA: Potentiates GABA.

  • Fun fact: Looks like milk → nicknamed “Milk of Amnesia.”

• Midazolam (Versed)

  • Use: Sedation, amnesia.

  • MOA: Benzodiazepine, GABA-A agonist.

  • Fun fact: “Versed” = very relaxed and well-versed in forgetting things.

• Dexmedetomidine (Precedex)

  • Use: Sedation without respiratory depression.

  • MOA: α2 agonist (like clonidine).

  • Fun fact: Sedates so well, patients look like they’re in “natural sleep.”

• Ketamine

  • Use: Induction, analgesia, sedation.

  • MOA: NMDA antagonist.

  • Fun fact: Causes “dissociation” → some patients have wild hallucinations (dream-like).

Analgesics

• Fentanyl

  • Use: Pain, sedation.

  • MOA: Potent μ-opioid agonist.

  • Fun fact: 100x stronger than morphine! (tiny doses pack a punch).

• Morphine

  • Use: Pain, preload reduction in cardiogenic pulmonary edema.

  • MOA: μ-opioid agonist, histamine release.

  • Fun fact: Named after Morpheus, the Greek god of dreams.

• Hydromorphone (Dilaudid)

  • Use: Pain control.

  • MOA: μ-opioid agonist.

  • Fun fact: Up to 7x stronger than morphine, but smoother onset.

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  1. Paralytics (Neuromuscular Blockers)

• Succinylcholine

  • Use: Rapid sequence intubation (RSI).

  • MOA: Depolarizing NMBA.

  • Fun fact: Causes muscle fasciculations → patients twitch before they freeze.

• Rocuronium (Roc)

  • Use: Intubation, paralysis in ICU.

  • MOA: Non-depolarizing NMBA.

  • Fun fact: Fast-acting, sometimes nicknamed “Rock-et fuel.”

• Cisatracurium

  • Use: Long-term paralysis in ARDS.

  • MOA: Non-depolarizing NMBA.

  • Fun fact: Broken down by Hofmann elimination → no need for kidneys/liver!

Diuretics

• Furosemide (Lasix)

  • Use: Fluid overload, CHF, pulmonary edema.

  • MOA: Loop diuretic (Na-K-2Cl blocker).

  • Fun fact: “Lasix” = lasts six hours.

• Mannitol

  • Use: Cerebral edema, ↑ICP.

  • MOA: Osmotic diuretic.

  • Fun fact: Made from sugar alcohol → it literally pulls water like candy.

Antiarrhythmics

• Amiodarone

  • Use: A-fib, VT/VF arrest.

  • MOA: K+ channel blocker (Class III, but “dirty” blocks everything).

  • Fun fact: Turns skin blue-gray after long-term use → “Smurf drug.”

• Lidocaine

  • Use: Ventricular arrhythmias.

  • MOA: Na+ channel blocker.

  • Fun fact: Same drug dentists use to numb your teeth.

Anticoagulants & Reversal

• Heparin

  • Use: Prevent clots, DVT prophylaxis.

  • MOA: Potentiates antithrombin III.

  • Fun fact: Comes from pig intestines! 🐖

• Protamine

  • Use: Reverses heparin.

  • MOA: Positively charged, binds negatively charged heparin.

  • Fun fact: Originally made from salmon sperm. 🐟

 Miscellaneous ICU Essentials

• Insulin drip → keeps blood sugar tight; too much = patient goes on a “sweat ride.”

• Sodium Bicarbonate → “code drug” for acidosis; basically IV baking soda.

• Calcium gluconate → stabilizes cardiac cells in hyperkalemia; “shock shield” for the heart.

• Magnesium sulfate → for torsades; fun fact: also used in pregnancy seizures.