Dexmedetomidine

Name /bks_53161_deglins_md_disk/dexmedetomidine 02/12/2014 01:21PM Plate # 0-Composite pg 1 # 1
1 Interactions
Drug-Drug: Sedation is enhanced by anesthetics, other sedative/hypnotics, PDF Page #1
dexmedetomidine (dex-me-de-to-mi-deen) and opioid analgesics.
Precedex Drug-Natural Products: Concomitant use of kava-kava, valerian, skullcap,
Classification chamomile, or hops canqCNS depression.
Therapeutic: sedative/hypnotics Route/Dosage
Pregnancy Category C
ICU Sedation
Indications IV (Adults): Loading infusion— 1 mcg/kg over 10 min followed by maintenance
Sedation of initially intubated and mechanically ventilated patients during treatment infusion of 0.2– 0.7 mcg/kg/hr for maximum of 24 hr; rate is adjusted to achieve de-
in an intensive care setting; should not be used for ⬎24 hr. Sedation of non-intubated sired level of sedation.
patients before and/or during surgical and other procedures. IV (Children): Loading infusion-0.5– 1 mcg/kg followed by maintenance infu-
sionof 0.2– 1 mcg/kg/hr. Children ⬍ 1 yr may require higher end of infusion rate.
Action
Acts as a relatively selective alpha-adrenergic agonist with sedative properties. Ther- Procedural Sedation
apeutic Effects: Sedation. IV (Adults): Loading infusion— 1 mcg/kg (0.5 mcg/kg for ophthalmic surgery or
patients ⬎65 yr) over 10 min followed by maintenance infusion of 0.6 mcg/kg/hr;
Pharmacokinetics
rate is adjusted to achieve desired level of sedation (usual range 0.2– 1 mcg/kg/hr)
Absorption: IV administration results in complete bioavailability.
(maintenance infusion of 0.7 mcg/kg/hr recommended for fiberoptic intubation un-
Distribution: Unknown.
til endotracheal tube secured).
Protein Binding: 94%.
Metabolism and Excretion: Mostly metabolized by the liver, some metabolism NURSING IMPLICATIONS
by P450 enzyme system. Metabolites are mostly excreted in urine.
Half-life: 2 hr. Assessment
● Assess level of sedation throughout therapy. Dose is adjusted based on level of se-
TIME/ACTION PROFILE (sedation) dation.
ROUTE ONSET PEAK DURATION ● Monitor ECG and BP continuously throughout therapy. May cause hypo-
IV rapid unknown unknown tension, bradycardia, and sinus arrest.
● Toxicity and Overdose: Atropine IV may be used to modify the vagal tone.
Contraindications/Precautions
Contraindicated in: Hypersensitivity. Potential Nursing Diagnoses
Use Cautiously in: Hepatic impairment (lower doses may be required); Ad- Anxiety (Indications)
vanced heart block; Severe left ventricular dysfunction; Geri:qrisk of bradycardia Implementation
and hypotension (consider dosep); OB, Lactation, Pedi: Safety not established.
● Dexmedetomidine should be administered only in intensive care settings with con-
Adverse Reactions/Side Effects tinuous monitoring.
Resp: hypoxia. CV: BRADYCARDIA, SINUS ARREST, hypotension, transient hyperten- ● A loading dose may not be required when converting patient from another seda-
sion. GI: dry mouth, nausea, vomiting. Hemat: anemia. Misc: fever. tive.
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.
Name /bks_53161_deglins_md_disk/dexmedetomidine 02/12/2014 01:21PM Plate # 0-Composite pg 2 # 2
2 sodium acetate, sodium bicarbonate, sodium phosphates, succinylcholine, sufen-

tanil, tacrolimus, teniposide, theophylline, thiopental, thiotepa, ticarcillin/clavu-
● Continuous Infusion: Diluent: To prepare infusion, withdraw 2 mL of dexme- lanate, tigecycline, tirofiban, tobramycin, topotecan, trimrthoprim/sulfamethox- PDF Page #2
detomidine and add to 48 mL of 0.9 NaCl for a total of 50 mL. Concentration: 4 azole, vancomycin, vasopressin, vecuronium, verapamil, vinblastine, vincristine,
mcg/mL. Shake gently. Solution should be clear; do not administer solutions that vinorelbine, voriconazole, zidovudine, zoledronic acid.
are discolored or contain particulate matter. Ampules and vials are for single use ● Y-Site Incompatibility: amphotericin B colloidal, amphotericin B lipid com-
only. Rate: Administer loading infusion over 10 minutes, followed by mainte- plex, blood, diazepam, irinotecan, pantoprazole, plasma, phenytoin.
nance infusion of 0.2– 0.7 mcg/kg/hr for ICU sedation and 0.2– 1.0 mcg/kg/hr
for procedural sedation. Adjust dose to achieve desired level of sedation. Adminis- Patient/Family Teaching
ter via infusion pump to ensure accurate rate. ● Explain to patient and family the purpose of the medication.
● Y-Site Compatibility: 0.9% NaCl, 20% mannitol, acyclovir, alfentanil, allopuri-
nol, amifostine, amikacin, aminophylline, amiodarone, amphotericin B liposome, Evaluation/Desired Outcomes
ampicillin, ampicillin/sulbactam, anidulafungin, argatroban, atracurium, atro- ● Sedation for up to 24 hr.
pine, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenor- Why was this drug prescribed for your patient?
phine, busulfan, butorphanol, calcium chloride, calcium gluconate, carboplatin,
carmustine, caspofungin, cefazolin, cefepime, cefoperazone, cefotaxime, cefote-
tan, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, chlorpromazine, ciprofloxa-
cin, cisatracurium, cisplatin, clindamycin, cyclophosphamide, cyclosporine, cy-
tarabine, dacarbazine, dactinomycin, daptomycin, daunorubicin hydrochloride,
D5W, dexamethasone, dexrazoxane, digoxin, diltiazem, diphenhydramine, dobu-
tamine, docetaxel, dolasetron, dopamine, doxacurium, doxorubicin hydrochlo-
ride, doxycycline, droperidol, enalaprilat, ephedrine, epinephrine, ertapenem,
erythromycin, esmolol, etomidate, etoposide, etoposide phosphate, famotidine,
fenoldopam, fentanyl, fluconazole, fludarabine, fluorouracil, foscarnet, fospheny-
toin, furosemide, gancyclovir, gemcitabine, gentamicin, glycopyrrolate, granise-
tron, haloperidol, heparin, hydrocortisone, hydromorphone, idarubicin, ifosfam-
ide, imipenem/cilastatin, insulin, isoproterenol, ketorolac, labetalol, leucovorin,
levofloxacin, levorphanol, lidocaine, linezolid, lorazepam, magnesium sulfate,
mannitol, mechlorethamine, meperidine, meropenem, mesna, methohexital,
methotrexate, methylprednisolone, metoclopramide, metoprolol, metronidazole,
midazolam, milrinone, mitomycin, mitoxantrone, morphine, mycophenolate, nal-
buphine, naloxone, nesiritide, nicardipine, nitroglycerin, nitroprusside, norepi-
nephrine, octreotide, ondansetron, oxaliplatin, oxytocin, paclitaxel, palonose-
tron, pancuronium, pemetrexed, pentamidine, pentobarbital, phenobarbital,
phenylephrine, piperacillin/tazobactam, plasma substitute, potassium acetate, po-
tassium chloride, potassium phosphate, prochlorperazine, promethazine, propo-
fol, propranolol, quinapristin/dalfopristin, ranitidine, remifentanil, rocuronium,
䉷 2015 F.A. Davis Company

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Name /bks_53161_deglins_md_disk/dexmedetomidine 02/12/2014 01:21PM Plate # 0-Composite pg 1 # 1

2 sodium acetate, sodium bicarbonate, sodium phosphates, succinylcholine, sufen-

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