Common Medications

Common Medications

Medications in the ICU can be confusing, even for us! No only are there a lot of different kinds of medications, but there are multiple different medicines within each class. And if that weren’t enough, one of the most confusing things about some of these medicines is that they have multiple names. It can be confusing if one doctor tells you your child is getting acetaminophen, but the nurse calls it Tylenol. It’s really the same thing! If you find yourself getting confused about what medicines your child is receiving, and it sounds like it may have changed, just ask!

Pain Control: Some of the most commonly used medications in the pediatric ICU are those used to keep your loved one relaxed and pain-free. Surprisingly, the most frequently used medication for pain control is regular old Tylenol. We can also use ibuprofen in some cases, but it is less frequently used. After Tylenol, the next most commonly used pain medicines are narcotics, such as morphine, fentanyl, or hydromorphone. These are very powerful pain medications that can also have a calming effect. These medicines are great not only because they are strong, but also because the dosing can be very flexible…they can be given via IV or by mouth, and they can be given continuously, on a scheduled basis every few hours, or just when your child needs a little boost.

Sedation: One class of medicines used for their calming effect are called benzodiazepines, but we’ll just refer to them as “benzo’s.” The two most common ones are midazolam and lorazepam (also known as Versed and and Ativan). These are primarily used to cause relaxation and sedation, and don’t have any effect on pain control. Just like the narcotics, they can be given via IV or by mouth. A third medication that is commonly used and that you should know about is called dexmedetomidine, but we usually refer to it by the name Precedex (press-uh-dex). This medication is only given as a continuous infusion through the IV, but can have a very nice calming effect.

Heart Rate and Blood Pressure: The medicines used to increase the heart rate, increase how strong the heart contracts, or to support the blood pressure are all given through a continuous infusion. The most common are dopamine, epinephrine, norepinephrine, and milrinone. They all work in slightly different ways, but overall the effect is the same…to help the heart and blood vessels pump blood out the other organs. There are, of course, also medications that can lower your heart rate or blood pressure but they aren’t used in kids as often as in adults.

Fluids: It’s very important for all people to be well-hydrated, but it’s especially important for sick kiddos. Fluids can be given many ways, and usually it’s directly into the vein through an IV. If your child needs a large amount of fluid quickly, you’ll hear the team ask for a “fluid bolus.” This just means to give a certain amount quickly. Otherwise, you might hear that your child is on “maintenance fluids.” This is also fluid that goes through the IV, but is given continuously at a much slower rate. It’s purpose is to keep your child hydrated during a time when they can’t or shouldn’t be drinking enough by mouth. It’s important to get good nutrition, however, so your team will want to start giving fluid or formula in the stomach as soon as possible. Once your child is getting enough this way, either through a feeding tube or a bottle, the fluids through the IV can be turned off.

Urine: Sometimes, instead of being dehydrated, the child will have too much fluid in their body. You might notice that their eyelids or hands look puffy. In this case, the team might order a medication to help your child pee that extra fluid out. The most common medication used for this purpose is called “Lasix.”

Antibiotics: Infection is one of biggest reasons that babies and kids need to come to the PICU. Initially, the team is often worried that the infection is caused by a bacteria, and will put your child on antibiotics. There are a TON of antibiotics, and they work in many different ways. Trust me, that part is way too boring. What you should know, however, is that often times the team will stop the antibiotics when they are convinced the infection is from a virus. This usually occurs after about 48 hours, when all the tests and cultures haven’t shown anything worrisome. Antibiotics don’t work for viral infections, which is why they can be stopped safely while your child’s body is given time to fight the virus.