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INTRODUCTION

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dexmedetomidine (deks-med-e-toe-mi-deen)

Precedex

Classification

Therapeutic: sedative/hypnotics

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Indications
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Sedation of initially intubated and mechanically ventilated patients during treatment in an intensive care setting; should not be used for >24 hr.

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Action
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Acts as a relatively selective alpha-adrenergic agonist with sedative properties. Therapeutic Effects: Sedation.

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Adverse Reactions/Side Effects
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Resp: hypoxia. CV: BRADYCARDIA, SINUS ARREST, hypotension, transient hypertension. GI: nausea, vomiting. Hemat: anemia. Misc: fever.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Assess heart rate, ECG, and heart sounds (See Appendices G, H). Report slow heart rate (bradycardia) or symptoms of other arrhythmias, including palpitations, chest discomfort, fainting, and fatigue/weakness.

  • Assess blood pressure (BP) and compare to normal values (See Appendix F). Report changes in BP, either a problematic decrease in BP (hypotension) or a sustained increase in BP (hypertension).

  • Monitor signs of low oxygen levels (hypoxia) or anemia, including pallor and cyanosis. Monitor pulse oximetry to quantify suspected problems with mechanical ventilation or blood delivery to tissues.

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Patient/Client-Related Instruction
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  • Instruct patient or family/caregivers to report other troublesome side effects such as severe or prolonged fever or GI problems (nausea, vomiting).

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Pharmacokinetics
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Absorption: IV administration results in complete bioavailability.

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Distribution: Unknown.

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Protein Binding: 94%.

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Metabolism and Excretion: Mostly metabolized by the liver, some metabolism by P450 enzyme system. Metabolites are mostly excreted in urine.

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Half-life: 2 hr.

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TIME/ACTION PROFILE (sedation)

ROUTE ONSET PEAK DURATION
IV rapid unknown unknown

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity.

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Use Cautiously in: Hepatic impairment (lower doses may be required); Advanced heart block; Geriatric patients (increased risk of bradycardia and hypotension in patients ≥65 yr; Pregnancy, lactation or children (safety not established).

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Interactions
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Drug-Drug: Sedation is enhanced by anesthetics, other sedative/hypnotics, and opioid analgesics.

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Drug-Natural: Concomitant use of kava, valerian, skullcap, chamomile, or hops can ↑ CNS depression.

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Route/Dosage
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IV (Adults): Loading infusion—1 mcg/kg over 10 min followed by maintenance infusion of 0.2–0.7 mcg/kg/hr for maximum of 24 hr; rate is adjusted to achieve desired level of sedation.

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Availability
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Injection: 100 mcg/mL in 2-mL ampules and vials.

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