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The Ups and Downs of Drug Titration

Kitty Garrett Level: Beginner

Content Description

Therapeutic interventions for critically ill patients often include the administration of several potent intravenous medication infusions. Nurses are expected to juggle these intravenous drips to optimize physiologic response and patient outcomes. The purpose of this presentation is to clarify the nurse's role in the administration of commonly prescribed continuous IV infusions. Actions and dosages of several classes of commonly prescribed drips will be reviewed. Practical information will be presented regarding which drugs need titration, which ones don't, what to titrate to, and tips on how to titrate. Adverse drug reactions will be addressed. The distinction between guideline-based titration and judgment-based titration will be made. Emphasis will be placed on patient safety issues to include the 2009 JCAHO National Patient Safety Goals. Case studies will be presented with learner participation.

j. analgesics k. volume expanders l. diuretics m. anticoagulants n. activated protein C o. electrolytes 4. Continuous Infusion Titration a. Titrated drugs b. Titrate to what? c. Nontitrated drugs d. Titration units e. Recommended dosages f. Urgency of titration g. Fixed versus true titration Practical Information - Factors to Consider a. Expected physiologic response b. Frequency of vital signs c. Adverse effects/what to do d. Half-life of drug e. Volume status of patient f. Drug interactions g. Weight-based dosing h. Other patient conditions Practical Information - Resources/Tools a. Drug titration charts b. Compatibility charts c. Smart IV infusion pumps d. Bedside monitors e. Electronic tools / PDAs f. Calculation formulas Case Studies Summary


Learning Outcomes

At the end of this session the attendee will be able to: 1. Describe the primary action and dosing regimen for the most commonly prescribed intravenous drips in critical care 2. Identify clinical, laboratory and hemodynamic parameters needed for appropriate titration of 6-8 classes of drugs used in critical care 3. Provide feedback into case studies to demonstrate knowledge of appropriate drug titration


Summary of Key Points

1. Introduction a. Definition of titration b. Back to the basics c. Nurse's role in IV drug administration Patient Safety a. 5 rights b. JCAHO National Patient Safety Goals c. Technology tools d. Safety tips Pharmacology Review a. vasopressors b. vasodilators c. positive inotropes d. anti-arrhythmics e. chronotropes f. insulin g. heparin h. sedatives i. neuromuscular blockers 7. 8.



JCAHO 2009 National Patient Safety Goals. Available at: NationalPatient SafetyGoals/. Accessed November 25, 2008. Gahart, BL and Nazareno AR. 2008 Intravenous Medications (24th Ed). Mosby/Elsevier, Philadelphia, 2008. High Alert Medication List. Institute for Safe Medication Practices. Available at: Accessed November 25, 2008. Mosby's Critical Care Drug Reference. Mosby/Elsevier, St. Louis, 2008. Wiegand, DJLM and Carlson, KK. AACN Procedure Manual for Critical Care. (5th Ed). Elsevier/Saunders, St. Louis, 2005.




The Ups and Downs of Drug Titration

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