ICU Topics > Common Medications
Common Medications
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Medications: Quick Reference for Therapy Decisions
| Drug Class | Common Examples | Therapy Implication |
|---|---|---|
| Paralytics | Nimbex, Vecuronium | HOLD — absolute contraindication to mobility |
| Barbiturates (burst suppression) | Pentobarbital, Propofol (high dose) | HOLD — absolute contraindication to mobility |
| Thrombolytics | tPA | HOLD — bed rest 8–24 hrs post-procedure |
| Vasopressors | Levophed, Vasopressin, Dopamine | HOLD if doses increasing, MAP <60, or >2 pressors active |
| Sedatives | Propofol, Precedex, Versed | MODIFY — assess arousal and ability to follow commands before proceeding |
| Benzodiazepines | Ativan, Versed, Valium | MODIFY — cognition impaired; monitor vitals and respiratory status |
| Opioids | Morphine, Fentanyl, Dilaudid | MODIFY — monitor sedation level, hypotension, respiratory rate |
| Anticoagulants | Heparin, Lovenox, Warfarin | MODIFY — bleeding risk; correlate with INR and platelet values |
| Antipsychotics | Haldol, Seroquel, Geodon | MODIFY — monitor drowsiness, dizziness, fall risk |
| Insulin Drip | Regular insulin | MODIFY — check glucose before session; hypoglycemia risk during activity |
| Antiarrhythmics | Amiodarone, Adenosine | MONITOR — limit strenuous activity; monitor HR to parameter |
| Anticonvulsants | Keppra, Depakote, Cerebyx | MONITOR — seizure precautions; assess cognitive status |
| Beta Blockers | Metoprolol, Labetalol | MONITOR — HR may not reflect true exertion level; watch for bradycardia |
| Calcium Channel Blockers | Diltiazem, Nicardipine | MONITOR — bradycardia possible; monitor vitals |
| Diuretics | Lasix, Mannitol | MONITOR — hypotension possible; patient may need to urinate during session |
| Hyperosmolar Therapy | Hypertonic saline, Mannitol | MONITOR — used to manage ICP; factor ICP status into activity decisions |
| Steroids | Solu-Medrol, Dexamethasone | MONITOR — may mask infection signs; monitor glucose during activity |
| Neuro-Stimulants | Amantadine, Ritalin, Provigil | MONITOR — therapy timing may matter; coordinate with dosing schedule |
| IVIG / PLEX | IVIG, Plasmapheresis | MONITOR — coordinate timing with infusion; monitor for fatigue and hypotension |
Antiarrhythmics
Purpose: Convert irregular heart rhythm to normal sinus rhythm; prevent relapse into arrhythmia
Common Examples: Amiodarone (Cordarone), Adenosine (Adenocard)
Therapy Considerations: Limit strenuous activity. Monitor HR and maintain rate within the recommended parameter. Bradycardia and hypotension are possible.
Anticoagulants
Purpose: Prevent blood clot formation by interfering with the coagulation cascade.
Common Examples: Unfractionated heparin (IV drip), Enoxaparin (Lovenox), Warfarin (Coumadin), Apixaban (Eliquis), Rivaroxaban (Xarelto)
Therapy Considerations: Anticoagulation increases bleeding risk — correlate with INR and platelet values before therapy. Patients on therapeutic anticoagulation (not just prophylactic dosing) warrant closer monitoring during activity. Avoid high-resistance activities or those with high fall risk. Heparin drip patients may have an arterial line or femoral access — apply those precautions as well.
Anticonvulsants
Purpose: Reduce electrical activity in the brain to prevent or treat seizures.
Common Examples: Fosphenytoin (Cerebyx), Levetiracetam (Keppra), Sodium Valproate (Depakote), Lacosamide (Vimpat)
Therapy Considerations: Seizure precautions apply. Assess cognitive status before and during the session. Some anticonvulsants cause drowsiness or dizziness — monitor fall risk.
Antihypertensive
Basic Purpose: Reduce brain damage caused by bleeding from a burst blood vessel; prevent vasospasm
Conditions Treated: Subarachnoid hemorrhage
Common Examples: Nimodipine, Nicardipine, Varapamil
*Nicardipine is often used to help maintain a patient’s BP within goal*
Antipsychotics
Purpose: Restore neurotransmitter balance in the brain. Used for behavioral management without sedation.
Common Examples: Quetiapine (Seroquel), Haloperidol (Haldol), Ziprasidone (Geodon)
Therapy Considerations: Can cause drowsiness, dizziness, and lightheadedness. Fall risk is elevated. Assess arousal and balance before any out-of-bed activity.
Barbituates
Purpose: Central nervous system depressant used for sedation, seizure management, and ICP reduction.
Common Examples: Phenobarbital (Luminal), Pentobarbital
Therapy Considerations: Burst suppression induced by barbiturates (or high-dose Propofol) is an absolute contraindication to mobility. Tend to heighten pain intensity and awareness. High potential for physiological and psychological dependence. Monitor cardiovascular status.
Benzodiazepines
Purpose: Central nervous system depressant; promotes sedation, muscle relaxation, and amnesia.
Common Examples: Lorazepam (Ativan), Midazolam (Versed), Diazepam (Valium)
Therapy Considerations: Cognition will be impaired — assess ability to follow commands before proceeding. Monitor for hypotension and decreased respiratory drive. Versed is the #1 delirium-causing medication and is associated with longer ventilation times and longer ICU stays. High potential for physiological and psychological dependence.
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Purpose: continuous infusion used for anesthesia, sedation, and severe agitation. Generally not advised as first-line sedative, but appropriate in some situations:
Seizure management
EtOH withdrawal
Fall back option if Propofol or Precedex are contributing to hypotension or bradycardia
Onset: 1-3min
Duration: 30-60min.
Versed produces unpredictable awakening and time to extubation when infusions continue longer than 48-72 hours
Dosage:
Initial: 0.01-0.05 mg/kg;
Maintenance: 0.02 mg/kg/hr
Max: 2-10mg/hr.
Concerns: Use of versed is associated with longer ventilation times and longer LOS in ICU. It is the #1 delirium-causing medication.
Side Effects that may impact mobility: Excessive somnolence (1.6%), Cardiac arrest, Involuntary movement, Apnea (15.4%)
Beta Blockers
Purpose: Decrease heart rate by blocking adrenergic receptors.
Common Examples: Atenolol, Metoprolol (Lopressor), Labetalol, Propranolol
Therapy Considerations: Heart rate may not accurately reflect true exertion level — do not rely on HR alone to guide intensity. Monitor for bradycardia and hypotension throughout the session.
Calcium Channel Blockers - General
Purpose: Decrease muscle contractility and slow electrical conduction in the heart.
Common Examples: Diltiazem (Cardizem)
Therapy Considerations: Monitor for bradycardia and hypotension. Vitals should be checked before and after activity.
Calcium Channel Blockers - Neurological
Purpose: Reduce brain damage caused by bleeding from a ruptured blood vessel; prevent cerebral vasospasm.
Common Examples: Nimodipine, Nicardipine, Verapamil
**Nicardipine is commonly used to maintain BP within a prescribed goal range in the neuro ICU.
Therapy Considerations: Monitor BP closely. Nicardipine is often titrated to a BP target — activity that causes significant BP fluctuation should be done cautiously and vitals monitored throughout.
Corticosteroids
Purpose: Reduce inflammation and suppress immune response. Used in a wide range of ICU conditions.
Common Examples: Methylprednisolone (Solu-Medrol), Dexamethasone (Decadron), Hydrocortisone
Therapy Considerations: Steroids can mask signs of infection and impair wound healing — note skin integrity during positioning and ADLs. Prolonged use causes muscle weakness and increases fracture risk. Monitor glucose levels during therapy as steroids commonly cause hyperglycemia. In spinal cord injury, high-dose steroids are sometimes used acutely — confirm precautions with the team.
Diuretics
Purpose: Increase urine output to reduce fluid volume and manage edema.
Common Examples: Furosemide (Lasix), Mannitol, Bumetanide (Bumex), Torsemide (Demadex)
Therapy Considerations: Hypotension is possible — monitor vitals. Be prepared for the patient to need to urinate during or immediately after activity. Electrolyte imbalances (particularly potassium) may occur with prolonged use.
Hyperosmolar Therapy
Purpose: Decrease brain volume and CSF volume by reducing water content; used to manage cerebral edema and elevated ICP.
Common Examples: Hypertonic saline (3%, 23%), Mannitol (20%, 25%)
Therapy Considerations: Used specifically to manage ICP — activity decisions should account for current ICP status. Monitor for hypotension, electrolyte imbalances, and dizziness. Both agents are osmotic diuretics; patient may have increased urination.
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Purpose: decreases the water and Na reabsorption in the renal tubule causing a reduction in ICP and cerebral edema. Decreases blood viscosity, plasma expansion, and cerebral O2 delivery, causing cerebral vasoconstriction. Osmotic gradient across blood-brain barrier moves fluid from the parenchyma into the intravascular space. Works as an osmotic diuretic, moving fluid from intracellular space to extracellular diuretic effect
Onset of action: 15-30 min
Duration: 1.5-6 hours
Dosing: Effect is dose dependent; 0.25-2 g/kg/dose
Side effects: hyponatremia, AKI, tachycardia, hypotension with hypovolemia
Other side effects that may affect mobility: chest pain, peripheral edema, dizziness, HA
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Purpose: Uses an osmotic gradient to shift fluid from intracellular space to interstitial and intravascular space to manage cerebral edema. Can be bolus or continuous infusion. Rapid onset, usually see effects in 5 minutes, can last 12 hours
Adverse side effects: electrolyte imbalances, Metabolic acidosis, Acute kidney injury (AKI), Coagulopathies, Hypotension
Immunoglobulin Infusion (IVIG)
Purpose: Provides antibodies to support immune function.
Common Examples: IVIG
Therapy Considerations: Coordinate therapy timing with the infusion schedule. Monitor for hypotension or adverse reactions during or following infusion. Fatigue is common.
Insulin Drip
Purpose: Manages blood glucose in critically ill patients with hyperglycemia or diabetes. Continuous insulin infusions are common in the ICU.
Common Examples: Regular insulin (IV continuous infusion)
Therapy Considerations: Check blood glucose before initiating therapy — hypoglycemia can present as altered mental status, confusion, or weakness that may be mistaken for neurological changes. If the patient is hypoglycemic, do not begin or continue therapy; notify nursing immediately. Activity increases glucose utilization and can cause glucose to drop during the session. Coordinate with nursing if a long or high-exertion session is planned.
Neuro-Stimulants
Purpose: Boost dopamine levels in the brain to increase alertness and improve arousal.
Common Examples: Amantadine, Modafinil (Provigil/Nuvigil), Bromocriptine, Methylphenidate (Ritalin), Levodopa
Therapy Considerations: Therapy timing may matter — coordinate sessions around dosing schedule for maximum benefit. Amantadine has the strongest evidence but can increase depression risk and lower seizure threshold. Bromocriptine may also help with sympathetic storming.
Opioids
Purpose: Analgesic; manage moderate to severe pain. Available in oral, patch, and IV forms.
Common Examples: Morphine, Fentanyl, Hydromorphone (Dilaudid), Oxycodone, Methadone
Therapy Considerations: Monitor sedation level, hypotension, and respiratory rate before and during activity. Gastric hypomobility is common — note bowel status. Fentanyl must be weaned slowly; withdrawal presents as tachycardia, hypertension, and diaphoresis.
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Onset of action: Oral IR 30-60min, ER 90min. IV 2min
Duration of action: Oral IR 3-4hrs, ER 12hrs. IV 2-4hrs.
Concerns: Respiratory depression, nausea, constipation, marked hypotension, accumulation in severe liver failure, accumulation of toxic metabolites in renal failure, neuroexcitation (seizures)
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Dosage: 2-100 mcg/kg dependent on pain level, size/weight, and desired level of analgesia/anesthesia
Onset of Action: 7-8 min (bolus)
Duration of Action: 30-60 for bolus but elimination half-life is 2 hours and when used as part of long-term sedation may take longer as it is fat soluble
Concerns: Respiratory depression, nausea, constipation, bradycardia, hypotension, skeletal muscle rigidity at high bolus doses (> 100-200 mcg), accumulation in severe hepatic failure, confusion, somnolence
*Has to be weaned slowly. The symptoms of withdrawal are tachycardia, hypertension and diaphoresis. Also important to keep in mind the high likelihood of bowel slowing.
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Onset of action: PO 30min. IV 1-2min.
Duration of action: PO 4hrs. IV ~2hrs.
Concerns: Respiratory depression, bradycardia, hypotension, nausea, constipation
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Onset of action: IR 30-60min; ER variable.
Duration of action: IR 3-4hrs; ER 12hrs
Side Effects/Concerns: Respiratory depression, nausea, constipation, hypotension, bradycardia, drug-drug interactions
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Onset of action: PO ~1hr. IV 30min
Duration of action: 4-8hrs
Side Effects/Concerns: Respiratory depression, nausea, constipation, extremely long half-life (up to 150 hrs but that is not same as duration of action), QTc prolongation and risk of arrhythmias, serotonin syndrome
Paralytics / Neuromuscular Blocking Agents
Purpose: Induce chemical paralysis by blocking neuromuscular transmission; used to facilitate intubation and improve ventilator synchrony.
Common Examples: Cisatracurium (Nimbex), Vecuronium (Norcuron), Rocuronium (Zemuron), Pancuronium (Pavulon)
Therapy Considerations: Medically paralyzed patients are an absolute contraindication to mobility. The patient cannot communicate and will have little to no muscle tone. If splinting or PROM is appropriate, protect joints from hyperextension, subluxation, or impingement, and avoid overstretching muscles. Monitor for unrecognizable signs of distress, skin breakdown, and hemodynamic changes.
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Dosage: 0.03 mg/kg every 40-50 minutes OR 0.03 mg/kg every 50-60 minutes OR maintenance infusing 3 mcg/kg/minute. Reduce to 1-2 mcg/kg/minute as needed
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Dosage: 0.01-0.012 mg/kg/min for continuous infusion
Plasmapheresis (PLEX)
Purpose: Filters and exchanges plasma to remove harmful antibodies or toxins from the blood.
Common Examples: PLEX (plasmapheresis)
Therapy Considerations: Coordinate therapy timing with the procedure schedule — patients are often fatigued following PLEX. Monitor vitals and activity tolerance. Vascular access for PLEX may limit mobility on the involved side.
Sedatives
Purpose: CNS depressant used to reduce anxiety, promote sedation, and facilitate mechanical ventilation. Some agents also suppress seizures or provide analgesic properties.
Common Examples: Dexmedetomidine (Precedex), Propofol (Diprivan), Ketamine
**Propofol is only administered to mechanically ventilated patients to ensure airway protection.
Therapy Considerations: Assess arousal and ability to follow commands before proceeding. Consider whether the dose can be safely reduced for therapy — consult with the team. Consider a medical hold if the patient is obtunded and sedation cannot be safely reduced.
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Purpose: Sedation and adjuvant analgesic without respiratory depression.
Has been shown to increase the amount of ICU days without delirium.
Creates light to moderate sedation and has support to preserve the sleep/wake cycle.
Patient is usually more awake vs other sedatives. Not recommended for deep sedation
Good to use as part of the weaning process from propofol as patients are weaned from the vent. Important to know that 10-15% of patients do not respond at all, for unknown reasons.
Onset: 10-15min
Duration of Effect: 1-2 hrs. Patients may be easily roused, able to follow commands, and may fall back quickly into deeper sedation once the rousing stimulus is removed.
Dosage: initial loading dose: 1 mcg/kg over 10 minutes. Maintenance 0.2-.07 mcg/kg/hr. Can’t really be given in bolus because of the risk for bradycardia.
Side Effects: initial bolus injection is associated with vasoconstrictive effects, causing bradycardia and HTN. Continuous infusion is associated with hypotension secondary to vasodilation caused by central sympatholysis. A-fib and tachycardia also reported
Other Side Effects that may affect mobility: Apnea, Bronchospasm
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Purpose: Primary medication used on Neuro ICU. Rapid wean off effect. Can be decreased for neuro checks.
Onset: 10 seconds
Duration of Effect: 5-20 min. Fat-soluble, so resources vary on wake-up times based on time under sedation and level of Propofol delivered. Leaves the CNS first, so does stop working fairly fast. Patients may be more aroused very quickly once the infusion is turned off or down.
Light sedation <48 hours: 3-10 min
Light sedation <72 hours: less than 35 min
Deep sedation 24 hours: 25 hours
Deep sedation 7-14 days: 3 days
Dosage: Range 5-80mg/kg/min. In a healthy younger adult (<55 y/o): 6-12 mg/kg/hr. Geratric or debilitated: 3-6 mg/kg/hr
Low: 0-30mg/kg/min
Moderate: 30-50 mg/kg/min
High: 50-80 mg/kg/min
Precautions: Consider dose and ability to follow commands. Can the patient tolerate a lower dose? If can decrease, should have a quick impact/change in arousal.
Side Effects: dystonia or choreiform movements; bradycardia, hypotension, decreased cardiac output, hyperlipidemia, apnea, decreased respiratory drive, respiratory acidosis, Propofol infusion syndrome. May also decrease systemic vascular resistance, myocardial blood flow, cerebral blood flow, ICP, and oxygen consumption.
Pulmonary Side Effects: Respiratory depressant, frequently producing apnea that may persist for longer than 60 seconds, may produce significant decreases in respiratory rate, minute volume, tidal volume, mean inspiratory flow rate, and functional residual capacity
Additional Concerns: Hypertriglyceridemia may result from prolonged administration and can cause pancreatitis. Propofol causes amnesia so weaning can result in fear and anxiety. It is prepared in a lipid emulsion so it does contain about 100 calories in every bottle.
Propofol Infusion Syndrome
Rare and poorly understood. Thought to be due to biomedical changes caused by propofol and underlying conditions in the critically ill
Risk factors: hypoxia, severe neurological injury, sepsis, use of vasoconstrictors, steroids, inotropes, and/or prolonged infusions or Propofol >5mg/kg/hr for > 48 hrs.
Symptoms: severe metabolic acidosis, hyperkalemia, lipemia, rhabdomyolysis, hepatomegaly and elevated liver enzymes, renal failure, EKG changes, and heart failure
Treatment: stop using Propofol and supportive care
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Purpose: Part of multimodal pain management and used more often to take pressure off of nation opioid shortage. Higher doses help to decrease other sedative requirements and lower doses help to decrease other opioid requirements.
Onset of action: IV 30 seconds. IM 3-4min.
Duration of action: IV 5-10min. IM 12-25min.
Side Effects: Hypertension, tachycardia, dissociative anesthetic at higher doses, hallucinations, apnea with rapid administration of large bolus doses, nausea
Thrombolytics
Purpose: Break down existing blood clots to restore blood flow.
Common Examples: Tissue Plasminogen Activator (tPA)
Therapy Considerations: Patients are typically on bed rest for 8–24 hours post-procedure due to the presence of the femoral sheath and increased bleeding risk associated with tPA. Confirm restrictions with the medical team — timing may be facility-specific.
Vasopressors & Inotropes
Purpose: Vasopressors cause peripheral vasoconstriction to increase blood pressure. Inotropes increase cardiac contractility to improve cardiac output. Several agents have both properties.
Common Examples: Norepinephrine (Levophed), Epinephrine, Dopamine (Intropin), Phenylephrine (Neo-Synephrine), Vasopressin, Dobutamine, Milrinone
Therapy Considerations: Used in critical situations to stabilize hemodynamics. Monitor vitals closely and limit activity involving orthostatic stress. Hold or modify therapy when doses are increasing, MAP <60 mmHg, or patient is on more than 2 vasopressors simultaneously. Consult the attending physician for specific restrictions.
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Indication: Hypotension. Causes peripheral vasoconstriction, inotropic stimulation of the heart, and coronary artery vasodilation. Preferred initial agent to treat septic shock.
For about 90% of patients, this is the first choice pressor.
Dose:
Low: 0.03 mcg/kg/min
Moderate: 0.2 mcg/kg/min
High: 0.5 mcg/kg/min
Hemodynamic Effects: Mild increase or no impact on HR
Other Side Effects that may affect mobility: Tissue necrosis, confusion, headache, tremor, anxiety, restlessness
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Indication: Most often used for the treatment of anaphylaxis, second-line agent in septic shock, and management of hypotension s/p CABG.
It may not be a good sign, clinically, if this is being used.
Dose:
Low: 0.2 μg/kg/min
Moderate: 0.8 μg/kg/min
High: 2 μg/kg/min
Hemodynamic Effects: Increased CO, with decreased SVR and variable effects on the MAP. May cause increased HR, dysrhythmias, HTN, V-Fib.
Other Side Effects that may affect mobility: Asthenia, dizziness, headache, tremor, difficulty breathing/pulmonary edema, cerebral hemorrhage
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Indication: Most often used to treat hypotension due to sepsis or cardiac failure
Dose Determines Hemodynamic Effects:
Low: 1-2 mcg/kg/min
Selective vasodilation in renal, mesenteric, cerebral, coronary beds. No impact on HR. Possible hypotension
Moderate: 5-10 mcg/kg/min
Increases CO (increase SV with variable effects on HR but likely increased HR)
High: >10 mcg/kg/min
Vasoconstriction with an increased systemic vascular resistance (increased HR)
Other side effects that may affect mobility: dyspnea, HA
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Indication: Hypotension in hyperdynamic sepsis, neurologic disorders, anesthesia-induced hypotension. Results in vasoconstriction with minimal cardiac inotropy or chronotropy.
Dose:
Low = 0.5 mcg/kg/min
Moderate = 2
High = 5
Hemodynamic Effects: severe bradycardia, V-Tach
Other Side Effects that may affect mobility: HA, metabolic acidosis, restlessness
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Indication: Vasodilatory shock/septic shock. Vasopressin may be used in patients with refractory shock despite adequate fluid resuscitation with the use of high-dose norepinephrine and dopamine.
Most notorious for causing distal tissue necrosis.
Dose:
Low: 1.2 unit/hr
High: 2.4 unit/hr
Hemodynamic Effects: decreased HR, arrhythmias, cardiac arrest, CO, angina, myocardial ischemia, and peripheral constriction
References
Clark, K. (2017). Intensive Care Unit. In H. Smith-Gabai & S. E. Holm (Eds.), Occupational Therapy in Acute Care (2nd ed., pp. 115–135). AOTA Press. https://library.aota.org/OT_in_Acute_Care_2e/134?highlightText=intensive%20care%20unit
Detwiller, M., & Williams, M. (2021, March 4). Medications in the ICU [PowerPoint slides]. Inpatient Rehabilitation Department, Brigham & Women’s Hospital.
Inpatient Rehabilitation Department. (2021). ICU medications [Fact sheet]. Beth Israel Deaconess Medical Center.