Dexmedetomidine (Precedex) - Critical Care Medications

Рет қаралды 54,932

Күн бұрын

A medication review focused on Dexmedetomidine.
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0:00 Intro
2:02 History and Therapeutic Actions
4:59 Indications/Contraindications
7:02 Adverse Effects
8:11 Concentrations/Dosing/Pharmacokinetics
9:47 Nursing considerations
11:40 Wrap Up
#ICUAdvantage #Precedex #Medications

Пікірлер: 97

@ICUAdvantage Жыл бұрын

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@paigeaspinwall5835 Жыл бұрын

I am excited! I completed the CCRN Academy review & passed. I enjoy ICU Advantage and really excited for you to share this with us! Can't wait to get started!

@megancummings7546 Жыл бұрын

This is so exciting!!! Congratulations Eddie!

@ICUAdvantage Жыл бұрын

@@paigeaspinwall5835 Way to go Paige!! Excited to officially open things up and be able to provide CEs for all this education. As always, thank you so much for all your support! Really glad to know you will be a part of this and are excited for it.

@ICUAdvantage Жыл бұрын

@@megancummings7546 Thanks so much Megan! Very excited for this.

@jordanschmidt9772 Жыл бұрын

I once had a patient on this. On 0.4 mcg/kg/min, he was snowed. But on 0.3 he was wide awake and agitated. Such a strange medication. Either works wonderfully or is just frustrating, in practice. Great video!

@ICUAdvantage Жыл бұрын

Haha, exactly! Exactly why I have a love hate relationship with it. When its good its great, otherwise, I feel like Im better off infusing saline.

@kimberlyelmer9472 Жыл бұрын

We have a frequent return LVAD patient who loves the recreational drugs outside the hospital. She's wild and awake maxed on fentanyl and prop, but add a bit of dex and she's comatose. So weird.

@jaecaflanagan-simpson8270 7 күн бұрын

Did you try .35?! Lol j/k

@bianca_1005 Жыл бұрын

Dexdor! (Here in Italy it's the brand name) When I began working in cardio ICU coming from a big ward full of patients with delirium this drug was a MIRACLE to me... No more running after granny who's ripping off her CVC/catheter, you name it...while another one tries to ace the diving championship jumping head first from the bed and another two gramps are escaping 😂 The most frequent side effect we observe is bradycardia, followed by hypotension. We use it in agitated patients whose devices do not have to be tampered with (e.g. Swan Ganz, arterial lines, or if they need a CPAP helmet but tear it off). Or in case of small procedures. As you say, the dosing and rate is decided by the facility. We have a protocol in place. Thank you, clear and concise as always 🔝

@ICUAdvantage Жыл бұрын

Haha oh the stories we come across in healthcare! People have NO idea! Thanks so much for sharing Bianca. I've had mixed success with it, but have found at facilities that allow for larger doses, that it can be more effective. Sometimes, some people just don't respond. Agreed that Brady and hypotension are the most common and often the biggest reason to stop using it.

@Aligatortubtub Жыл бұрын

You are an incredible instructor. I learn so much from every single video you post and truly appreciate all your hard work.

@ICUAdvantage Жыл бұрын

Wow, thank you so much for this Ali! Glad you have enjoyed the videos and found them helpful!

@kristinamidolo7681 Жыл бұрын

Absolutely loving your video's - so helpful to a new ICU nurse

@phil.curious Жыл бұрын

Thank you so much for the videos on the different drugs. Just started to work with Milrinon and Dex. as soon as your videos came out. Perfect timing. Highly appreciate it!

@ICUAdvantage Жыл бұрын

Haha awesome! I love it when the timing works out like this Phil!

@Sound0ne 27 күн бұрын

I just completed a study with Yale research unit. As a fentanyl addict, Dexmedetomidine along with low tapering doses of methadone got me through a 7 day withdrawal period. Now that I’m home, symptoms are weak enough to deal with using ibuprofen and CBD. Excited to see where this drug takes us in the OUD crisis

@happynurse8706 Жыл бұрын

I've used this medication many times works excellent in the situations I've needed very good for detox patients

@ICUAdvantage Жыл бұрын

Yeah I've found when it works, it works great.

@Blinn2330 Жыл бұрын

Here since what feels like day 1 and you always produce excellent content. Keep it up. Big fan of Precedex!

@ICUAdvantage Жыл бұрын

Right on! Thanks for the support all this time. Glad you enjoyed it!

@giogarcia4053 Жыл бұрын

Another great video! Precedex is a fantastic med when it works, we use it often on our post op CABG patient until we can extubate or even with low tolerance to bipap because it’s very useful for anxious intubated patients most of the time and doesn’t have too much of a effect on our hemodynamics most of the time. Although some patients have a really good tolerance to it and require more sedation/pain relief.

@ICUAdvantage Жыл бұрын

Whole heartedly agree! When it works, it works magic. And that fact that it doesn't cause respiratory depression makes it possible to use in so many situations we wouldn't normally be able to. Thanks so much for your support!

@justin.fairchild Жыл бұрын

We use this in most all of our post op heart patients when they come up from surgery. It works well in conjunction with pain control.

@ICUAdvantage Жыл бұрын

Agreed! We typically would just use analgesics in recovery when possible, but if some sedation or anxiety control was needed, this was typically our goto.

@MegaMrskatie Жыл бұрын

This was helpful. Thank you

@shanekaervin6733 Жыл бұрын

Thank you for creating this video! It is very helpful

@ICUAdvantage Жыл бұрын

Great to hear this Shaneka! Glad you liked it.

@AaaAaa-hb9be 10 ай бұрын

Very common drug used in veterinary medicine! We also routinely use an antidote, atipamezole.

@jongjincoleman4386 2 ай бұрын

Great learning ICU learning tool!!!

@ChaseWatkins. Жыл бұрын

Have used intranasal for pediatric patients in the ED, works well.

@ICUAdvantage Жыл бұрын

Nice. Hadn't heard of that way. Thanks for sharing that Chase!

@shanepis Жыл бұрын

My preceptor and myself (I am new to practice nurse this past December) got floated from ICU stepdown to ICU and we had a pt on this drip while alert on HFNC. It kept them calm so they would put their O2 demand up. It went well. Thank you as always for teaching this stuff. I am hoping in some time to move from stepdown to ICU.

@brycekallenbach8042 Жыл бұрын

You will find that it works or it doesn't. When it does work, it is mostly effective for 24hrs. Even then, bradycardia is common in my experience.

@nygeek6471 Жыл бұрын

It’s very hit or miss. It’s also prone to nasty hemodynamic effects. It can also decrease RBC count. Definitely not to be used outside of an ICU setting

@ICUAdvantage Жыл бұрын

Agreed with others. Very love hate relationship. When it works, its great and perfect for what is needed. Other times, no matter how high you go, it seems to be no better than saline. Glad to hear it helped in your situation and hope to hear from you again when you get into the ICU!

@nygeek6471 Жыл бұрын

@@ICUAdvantage totally agree with the sometimes it feels like it’s just saline, other times it works. Sometimes your patients hemoglobin is dropping when they’re on it for too long. Other times they go into arrhythmias. Overall I’m not a fan of precedex at high doses for long periods of time. I feel like I can get more from low dose prop with less side effects

@ICUAdvantage Жыл бұрын

@@nygeek6471 Yeah if intubated I will 100% take prop 99/100 times.

@zakilivoali2504 9 ай бұрын

Great stuff

@skyfiraprimafilla9824 11 ай бұрын

Thank. You. ❤❤

@sharonmason8985 Жыл бұрын

We use this med for sedation in kids who are I &V and used for several days along side with fentanyl

@ICUAdvantage Жыл бұрын

Whats I&V?

@beckyp8914 Жыл бұрын

I have found that this drug always works. I’ve been using it for years on my patients in the ICU and has been a life savor for my patients and my sanity. I can’t think of a time where it has totally failed me. ❤️ Precedex… thanks for informative video.

@alecfairfield2745 4 ай бұрын

In the PICU we love Precedex

@ICUAdvantage 4 ай бұрын

It really is great when it works, and doesn't cause those issues :)

@Ingitadhikary Жыл бұрын

can we have a detail vedios on hypo or hyper natremia , kalemia etc

@F1rst0raft Жыл бұрын

I love precedex!

@ICUAdvantage Жыл бұрын

It is a good one! 😂 Life of Darnelle

@rezgatchi726 Жыл бұрын

Thank you very much😭 I just started working in Cardiac Care ICU looking after patients post MVR, CABG. My patient was on this drip together with Noreadrenaline, Dobutamine and Propofol. Thank you your videos are indeed very helpful. It lessens my anxiety and boosts my confidence. God bless you!💜💜💜

@ICUAdvantage Жыл бұрын

Hey Rez! Thanks so much for taking the time to drop a comment. ❤ Really glad to hear the videos are helpful for you and help to take the edge off. I know it can be stressful at times so truly happy to know they are helping you out.

@rezgatchi726 Жыл бұрын

@@ICUAdvantage im picking up extra shifts and saving up so I can purchase ICU advantage Academy. I want to take this skill in a new level. My goal is to be CCRN certified. 🙏🏻✨

@ICUAdvantage Жыл бұрын

@@rezgatchi726 You got this Rez! You definately are doing the right things by growing your knowledge base and making you a better practitioner.

@kaseydunn8694 Жыл бұрын

Wouldn’t benzos and propofol potentiate/activate GABA receptors, not inhibit it?

@allyu274 11 ай бұрын

Can precedex drop blood pressure less common than it does heart rate? The NP I worked with tried to tell me it doesn’t affect blood pressure, even though this patient is sensitive to sedation already.

@camerynjewell9299 27 күн бұрын

Hi Eddie, would you say that hypocalcemia/magnesia is a common side effect from Precedex?

@chikazulu102 Жыл бұрын

For continuous sedation if you using propofol how many milligrams per kg in adults

@stratoleft Жыл бұрын

I need it for my cats.

@USA__WILL Жыл бұрын

My favor ICU med ! Prop is a close second

@ICUAdvantage Жыл бұрын

It is a goodie! I will say I like my prop more tho 😉

@nygeek6471 Жыл бұрын

@@ICUAdvantage I have to agree prop is much more consistent and reliable

@javierorozco4260 Жыл бұрын

Do you recommend the membership to any ED nurses or is this more for the ICU?

@ICUAdvantage Жыл бұрын

Yeah definitely helpful in the ED as well. Some topics may not apply, but most do. As for the Academy (I’m assuming that’s the membership you’re referring to) that basically has all the benefits of all KZfaq/Patreon membership tiers, plus, most importantly, you’ll be able to get CEs for watching these video lessons I put together.

@MsDwayne67 Жыл бұрын

So because of the blocking of norepinephrine would that be one of the causations of hypotension? Sorry if it is a dumb question

@MsDwayne67 Жыл бұрын

Our parameters are start at 0.2 mcg to max of 1.5 mcg

@08MordSith Жыл бұрын

Can you explain more about it's use in alcohol withdrawal?

@ICUAdvantage Жыл бұрын

GABA receptors are involved as a binding site for ethanol. In the same ways that benzos bind to GABA receptors to produce inhibitory action, Dex also influences the inhibition of GABA neurons, helping to prevent withdrawal symptoms and DTs. That along with the sedation without respiratory depression can be helpful in managing severe alcohol withdrawal that normally has required over sedation with benzos, and thus a prolonged ICU stay.

@08MordSith Жыл бұрын

@@ICUAdvantage precedex does not hit GABA. We're having challenges with sedating etoh patients with precedex without hitting GABA causing seizures.

@ICUAdvantage Жыл бұрын

@@08MordSith Correct about not hitting GABA. It effects upstream with same inhibition of GABA neurons without direct binding like beznos and prop. My experience tho has been with it as an adjunct with typical benzo treatment. Helps prevent high dose benzo drips and can help with reduced dosing of Bezos based on CIWA.

@08MordSith Жыл бұрын

@@ICUAdvantage respectfully disagree, unless they have GABA coverage via benzos or phenobarbital, precedex should not be used

@ICUAdvantage Жыл бұрын

@@08MordSith I think there’s a misunderstanding. That how I’ve known it used; as an adjunct with benzos. Not used alone.

@carleebusardo2885 6 ай бұрын

Would it make sense to use precedex and Levophed (norepinephrine) at the same time?

@jasminefrias6521 3 ай бұрын

Oh 100%, all the time. Levophed’s action on beta actually helps counteract the bradycardia that’s most commonly seen with precedex.

@ingothitrust5248 Жыл бұрын

There is a very odd and specific cohort of patients for whom this medication works reasonably well for. Just from experience and observation, 9/10 this med doesn't do diddly squat.

@agentpaper1163 2 ай бұрын

Sometimes, I wanna take dexmed for myself 😵‍💫😵‍💫😵‍💫

@AT-yj8gl Жыл бұрын

Eddie can you PLEASE make a series for Med Surg nurses wanting to transition to critical care? There's such a learning curve and barely any of it was covered in school. If you make it and choose to put it behind a reasonably priced pay wall, I'll pay!

@ICUAdvantage Жыл бұрын

Hey there! So I do have plans eventually to do like an ICU Bootcamp type of course, but honestly with my time commitments right now, probably won't be any time soon for that.

@AT-yj8gl Жыл бұрын

@ICUAdvantage ofc I get that sir. ill be on the lookout when you do drop if I haven't transitioned by then. meanwhile do you have any other creators you recommend on KZfaq to help with that?

@ICUAdvantage Жыл бұрын

@@AT-yj8gl I can't think of anyone that has any content specifically covering anything like that.

@caynofficial Жыл бұрын

at my ICU we use 8mcg/ml concentration. however standard is the mixture with glucose which I dont really understand, can someone explain?!

@ICUAdvantage Жыл бұрын

Oh interesting. What is the total dose and volume in a bag?

@caynofficial Жыл бұрын

@@ICUAdvantage as far as I remember its 2000mcg at 250 glucose, we call it the BIG dexdor infusor^^ but honestly it works pretty well and we need less volume over the day which is benefitial to the patients in most cases.

@nygeek6471 Жыл бұрын

3:46 don’t benzos and propofol activate, rather than inhibit GABA receptors? GABA agonists sedate. 4:53 isn’t the hypotension from the activation of alpha 2 receptors on peripheral vasculature like colonidine

@ICUAdvantage Жыл бұрын

So for the GABA section I definite said that weird. Basically what I was trying to state is that the impacted neurons would be inhibited. Which yes the activation and potentiation of GABA receptors increases inhibitory effects of GABA. As for the hypotensive/bradycardic effects of both Dex and Clonidine, it seems to be that both work in brain stem by inhibiting norepi release at neuronal junction preventing activation of sympathetic response thus vasoconstriction and bradycardia can result.

@nygeek6471 Жыл бұрын

@@ICUAdvantage gotcha. I think the bradycardia is from norepinephrine inhibition to the vagus nerve, and alpha 2 agonism is from activation at peripheral vasculature (activating alpha 2 receptors vasodilators arteries.) Double checked and the second part is what I’m getting on UpToDate, the 1st part about the vagus nerve from an attending about why precedex causes bradycardia but clonidine causes tachycardia (no baroreceptor reflex with precedex like with clonidine)

@ICUAdvantage Жыл бұрын

@@nygeek6471 Interesting you mention about the vagus nerve. Looking around now specifically for that I do so a couple things talking about increasing vagal activity via Ach, but still most seem to point to the central inhibition of sympathetic activation as the primary driver of Brady/hypotension with a2 agonists. That is an interesting point about the reflexive tachycardia and I'll have to look into it more as to why we wouldn't still have potential for baroreceptor reflex with Dex.

@nygeek6471 Жыл бұрын

@@ICUAdvantage thanks! Love the pharm/patho. P.s. ach is the parasympathetic signaling pathway in the CNS, it cascades from GABA like norepi cascades from glutamate. This is why anticholnerigcs increase heart rate via inhibiting the vagus nerve (and heart transplant patients don’t have vagal innervation hence why atropine won’t work in them)

@michaelburatovich3199 Жыл бұрын

What’s the advantage of dexmedetomidine over midazolam for anxious patients?

@ICUAdvantage Жыл бұрын

So response will vary patient to patient, but big advantage is lack of respiratory depression

@michaelburatovich3199 Жыл бұрын

@@ICUAdvantage plus midazolam has a serious hangover effect-it makes the patient drunk when they wake up.

@ICUAdvantage Жыл бұрын

@@michaelburatovich3199 For sure. I mean theres more advantages, especially with delirium and whatnot, but the resp depression I think is the biggest.