Common Medication in ICU

1. Bronchodilators

Short-Acting Beta-Agonists (SABAs)

Albuterol (Salbutamol)

  • Use: Relieves acute bronchospasm in asthma and COPD.
  • Mechanism of Action: Stimulates beta-2 adrenergic receptors in the bronchial smooth muscle, leading to bronchodilation.
  • Side Effects: Tachycardia, palpitations, tremors, headache, and hypokalemia.
  • Contraindications: Hypersensitivity to albuterol or its components.

Long-Acting Beta-Agonists (LABAs)

Salmeterol

  • Use: Long-term control of asthma and COPD.
  • Mechanism of Action: Stimulates beta-2 adrenergic receptors, leading to prolonged bronchodilation.
  • Side Effects: Tachycardia, palpitations, headache, muscle cramps, and paradoxical bronchospasm.
  • Contraindications: Acute episodes of asthma or COPD, hypersensitivity.

Formoterol

  • Use: Maintenance treatment of asthma and COPD.
  • Mechanism of Action: Stimulates beta-2 adrenergic receptors, causing bronchodilation with a rapid onset and long duration.
  • Side Effects: Tremor, headache, palpitations, muscle cramps, and throat irritation.
  • Contraindications: Hypersensitivity to formoterol.

Anticholinergics

Ipratropium Bromide

  • Use: Relieves bronchospasm, often used with albuterol.
  • Mechanism of Action: Blocks muscarinic receptors in the bronchial smooth muscle, leading to bronchodilation.
  • Side Effects: Dry mouth, cough, headache, dizziness, and blurred vision.
  • Contraindications: Hypersensitivity to ipratropium, atropine, or their derivatives.

Tiotropium

  • Use: Long-term maintenance treatment of COPD.
  • Mechanism of Action: Blocks muscarinic receptors, leading to prolonged bronchodilation.
  • Side Effects: Dry mouth, constipation, urinary retention, and upper respiratory tract infection.
  • Contraindications: Hypersensitivity to tiotropium or its components.

Methylxanthines

Theophylline

  • Use: Long-term control of asthma and COPD.
  • Mechanism of Action: Inhibits phosphodiesterase, leading to increased cAMP levels and bronchodilation.
  • Side Effects: Nausea, vomiting, diarrhea, insomnia, tremors, and arrhythmias.
  • Contraindications: Active peptic ulcer disease, seizure disorders, and hyperthyroidism.

2. Corticosteroids

Systemic Corticosteroids

Methylprednisolone (Solu-Medrol)

  • Use: Reduces inflammation in severe asthma, COPD exacerbations, and ARDS.
  • Mechanism of Action: Suppresses inflammatory and immune responses by inhibiting multiple inflammatory cytokines.
  • Side Effects: Hyperglycemia, increased risk of infection, osteoporosis, muscle weakness, and adrenal suppression.
  • Contraindications: Systemic fungal infections and hypersensitivity to the drug.

Dexamethasone

  • Use: Reduces inflammation and is used in conditions like severe asthma and ARDS.
  • Mechanism of Action: Suppresses inflammatory responses by binding to glucocorticoid receptors and inhibiting pro-inflammatory gene expression.
  • Side Effects: Hyperglycemia, adrenal suppression, osteoporosis, increased infection risk.
  • Contraindications: Systemic fungal infections and hypersensitivity to the drug.

Inhaled Corticosteroids (ICS)

Fluticasone

  • Use: Long-term control of asthma and COPD.
  • Mechanism of Action: Reduces airway inflammation by inhibiting multiple inflammatory cytokines.
  • Side Effects: Oral candidiasis (thrush), hoarseness, cough, and adrenal suppression.
  • Contraindications: Hypersensitivity to fluticasone.

Budesonide

  • Use: Maintenance treatment of asthma and COPD.
  • Mechanism of Action: Suppresses inflammation in the airways by inhibiting multiple inflammatory pathways.
  • Side Effects: Oral candidiasis, hoarseness, cough, and adrenal suppression.
  • Contraindications: Hypersensitivity to budesonide.

3. Antibiotics

Broad-Spectrum Antibiotics

Piperacillin/Tazobactam (Zosyn)

  • Use: Severe bacterial infections, including pneumonia.
  • Mechanism of Action: Piperacillin inhibits bacterial cell wall synthesis, and tazobactam inhibits beta-lactamase enzymes, enhancing piperacillin’s effect.
  • Side Effects: Allergic reactions, gastrointestinal upset, elevated liver enzymes.
  • Contraindications: Hypersensitivity to penicillins or beta-lactamase inhibitors.

Ceftriaxone

  • Use: Community-acquired pneumonia and other severe infections.
  • Mechanism of Action: Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins.
  • Side Effects: Diarrhea, rash, allergic reactions, and elevated liver enzymes.
  • Contraindications: Hypersensitivity to cephalosporins.

Macrolides

Azithromycin

  • Use: Treats bacterial infections such as community-acquired pneumonia.
  • Mechanism of Action: Inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit.
  • Side Effects: Nausea, vomiting, diarrhea, and QT prolongation.
  • Contraindications: Hypersensitivity to macrolide antibiotics and history of cholestatic jaundice with prior use.

Fluoroquinolones

Levofloxacin

  • Use: Severe or complicated respiratory infections, including hospital-acquired pneumonia.
  • Mechanism of Action: Inhibits bacterial DNA gyrase and topoisomerase IV, preventing DNA replication and transcription.
  • Side Effects: Tendonitis, QT prolongation, gastrointestinal upset, and CNS effects (e.g., headache, dizziness).
  • Contraindications: Hypersensitivity to fluoroquinolones, history of tendon disorders related to quinolone use.

4. Mucolytics

N-Acetylcysteine (Mucomyst)

  • Use: Breaks down mucus in conditions like COPD, cystic fibrosis, and bronchitis.
  • Mechanism of Action: Breaks disulfide bonds in mucus, reducing viscosity and facilitating clearance.
  • Side Effects: Nausea, vomiting, rash, and potential for bronchospasm.
  • Contraindications: Hypersensitivity to acetylcysteine.

Dornase Alfa (Pulmozyme)

  • Use: Reduces mucus viscosity in cystic fibrosis.
  • Mechanism of Action: Cleaves extracellular DNA in mucus, reducing viscosity.
  • Side Effects: Voice alteration, pharyngitis, rash, and chest pain.
  • Contraindications: Hypersensitivity to dornase alfa.

Carbocisteine

  • Use: Breaks down and thins mucus, making it easier to clear.
  • Mechanism of Action: Reduces the viscosity of mucus by breaking the mucin disulfide bonds.
  • Side Effects: Gastrointestinal upset, rash, and possible allergic reactions.
  • Contraindications: Active peptic ulcer disease and hypersensitivity to the drug.

Erdosteine

  • Use: Reduces mucus production and improves mucus properties.
  • Mechanism of Action: Opens disulfide bonds in mucus, decreasing its viscosity.
  • Side Effects: Nausea, vomiting, and possible allergic reactions.
  • Contraindications: Severe liver disease and hypersensitivity.

Ambroxol

  • Use: Enhances mucus clearance and reduces viscosity.
  • Mechanism of Action: Stimulates synthesis and release of surfactant and increases mucociliary transport.
  • Side Effects: Gastrointestinal upset, rash, and rare allergic reactions.
  • Contraindications: Hypersensitivity to ambroxol.

5. Sedatives and Analgesics

Midazolam

  • Use: Provides sedation for mechanically ventilated patients.
  • Mechanism of Action: Enhances the effect of GABA at the GABA-A receptor, inducing sedation and amnesia.
  • Side Effects: Respiratory depression, hypotension, and prolonged sedation.
  • Contraindications: Acute narrow-angle glaucoma, severe respiratory depression, and hypersensitivity.

Fentanyl

  • Use: Provides pain relief and sedation.
  • Mechanism of Action: Binds to opioid receptors, particularly mu receptors, inhibiting ascending pain pathways.
  • Side Effects: Respiratory depression, constipation, hypotension, and bradycardia.
  • Contraindications: Severe respiratory depression, acute or severe asthma, and hypersensitivity.

6. Neuromuscular Blockers

Vecuronium

  • Use: Facilitates mechanical ventilation by inducing muscle paralysis.
  • Mechanism of Action: Blocks acetylcholine at the neuromuscular junction, inhibiting muscle contraction.
  • Side Effects: Prolonged paralysis, bradycardia, and hypotension.
  • Contraindications: Hypersensitivity to vecuronium.

Cisatracurium

  • Use: Muscle relaxation during mechanical ventilation and surgery.
  • Mechanism of Action: Binds competitively to nicotinic receptors on the motor endplate, blocking acetylcholine and causing muscle relaxation.
  • Side Effects: Bradycardia, hypotension, and prolonged neuromuscular blockade.
  • Contraindications: Hypersensitivity to cisatracurium or other bis-benzylisoquinolinium agents.

7. Mast Cell Stabilizers

Cromolyn Sodium

  • Use: Prevents asthma attacks and allergic rhinitis.
  • Mechanism of Action: Inhibits the release of histamine and other mediators from mast cells.
  • Side Effects: Cough, throat irritation, and dry mouth.
  • Contraindications: Hypersensitivity to cromolyn sodium.

8. Leukotriene Receptor Antagonists

Montelukast (Singulair)

  • Use: Long-term control of asthma and prevention of exercise-induced bronchoconstriction.
  • Mechanism of Action: Blocks leukotriene receptors, reducing bronchoconstriction, inflammation, and mucus production.
  • Side Effects: Headache, gastrointestinal upset, and neuropsychiatric effects (e.g., agitation, depression).
  • Contraindications: Hypersensitivity to montelukast.

Inhalers

Metered-Dose Inhalers (MDIs)

  • Mechanism of Action: Deliver a specific amount of medication to the lungs in the form of a short burst of aerosolized medicine that is inhaled by the patient.
  • Common Medications: Albuterol, fluticasone, and salmeterol.

Dry Powder Inhalers (DPIs)

  • Mechanism of Action: Deliver medication in the form of a dry powder directly to the lungs.
  • Common Medications: Formoterol, budesonide, and tiotropium.

Summary

This list covers the major classes of respiratory medications used in the ICU, their uses, mechanisms of action, side effects, contraindications, and includes details about inhalers. Each category is crucial for managing different aspects of respiratory conditions, ensuring comprehensive patient care.