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7 Cards in this Set
- Front
- Back
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Epinephrine
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Sympathetic Agonist
Naturally occurring catecholamine Potent a- and B-adrenergic stimulant It's effects on B-receptors is more profound EFFECTS: Increased heart rate Increased cardiac contractile force Increased electrical activity in the myocardium Increased systemic vascular resistance Increased automaticity DOSE: Cardiac arrest (adult) -1 mg of 1:10,000 IV every 3-5 minutes -2-2.5 times the IV dose via the ET Severe allergic reactions or asthma (adult) -0.01 mg/kg (0.3-0.5 mg of 1:1,000 SQ -Repeat every 5 to 15 min |
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Norepinephrine
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TRADE NAME: Levophed---Naturally occurring catecholamine--acts on both a- and B-adrenergic receptors--action on a-receptors is more profound
CONTRAINDICATIONS: potent peripheral vasoconstrictor--increases blood pressure in cardiogenic shock and other hypotensive emergencies--tends to constrict the renal and mesenteric blood vessels--reserved for emergencies when dopamine may not be effective INDICATIONS: hypotension (systolic pressure 70 mmHg) refractory to other sympathomimetics--hypotension not related to hypovolemia--Neurogenic shock DOSE: mix 8 mg in 500 mL of D5W (16mcg/mL)----0.5-1.0 mcg per minute titrate to effect----30 mcg per minute max |
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Dopamine
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TRADE NAME: Intropin---Naturally occurring catecholamine--acts on a-, B1, and dopaminergic adrenergic receptors--effects are dose-dependent--chemically related to both epinephrine and norepinephrine and increases blood pressure by acting on both a- and B1-adrenergic receptors--causes a positive inotropic effect on the heart--does not significantly increase myocardial O2 demand
INDICATIONS: increases both the systolic pressure and pulse pressure, but, as a rule, there is usually less effect on the diastolic pressure--hemodynamically significant hypotension (systolic blood pressure of 70 to 100 mmHg)--not resulting from hypovolemia--cardiogenic shock CONTRAINDICATIONS: should not be used as as the sole agent in the management of hypovolemic shock--should not be used in patients with known pheochromocytoma (a tumor of the adrenal gland) PRECAUTIONS: can induce or worsen supraventricular and ventricular dysrhythmias--whenever the dosage of dopamine surpasses 20 ug/kg/min, it functions very much like norepinephrine DOSE: 800 mg diluted in 500 mL of D5W----concentration of 1600 ug/mL----LOW DOSE 2-5 ug/kg/min Dopaminergic Effects (increases perfussion of renal and mesenteric arteries)------MEDIAN DOSE 5-10 ug/kg/min Beta Effects------HIGH DOSE 10-20 ug/kg/min Alpha Effects |
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Isoproterenol
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TRADE NAME: Isuprel---synthetic catecholamine--acts primarily on B-adrenergic receptors--no significant a-receptor stimulating capabilities--primarily acts on heart and lungs--in cardiac emergencies, may be used to increase heart rate in bradycardias that are refractory to atropine
INDICATIONS: bradycardias refractory to atropine--when transcutaneous pacing is unavailable--in denervated hearts (transplants)--in beta blocker overdoses--severe status asthmaticus CONTRINDICATIONS: not used to increase blood pressure in cardiogenic shock--other sympathomimetics, such as dopamine and norepinephine, should be used PRECAUTIONS: patient must be monitored for signs of ventricular irritability--lidocaine should be readily available--significantly increases mycardial oxygen demand DOSES: 1 mg diluted in 500 mL of D5W (2 ug/mL)----titrate until desired heart rate is attained or until signs of ventricular irritability----recommended infusion rate is 2 to 10 ug/min |
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Dobutamine
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TRADE NAME: Dobutrex---synthetic catecholamine--acts primarily on B1-receptors but is a less potent B-agonist than isoproterenol--increases the force of the systolic contraction (positive inotropic effect) with little chronotropic activity--useful in the management of CHF when an increase in heart rate is not desired
INDICATIONS: used for short-term management of congestive heart failure when an increased cardiac output, without an increased cardiac rate, is desired CONTRAINDICATIONS: should not be used as the sole agent in hypovolemin shock unless fluid resuscitation is well under way--to increase cardiac output in severe emergencies, such as cardiogenic shock, dopamine is the preferred agent. PRECAUTIONS: tachycardia and an increase in the systolic blood pressure are common--increases in heart rate of > 10% may induce or exacerbate myocardial ischemia--PVCs can occur--lidocaine should be readily availible INTERACTIONS: may be ineffective when administered to patients taking beta-blockers--patients taking tricyclic antidepressants (TCAs) are at increased risk of hypertension DOSE: 250 mg diluted in 500 mL of D5W-----dosage ranges is between 2 and 20 ug/kg/min |
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SYMPATHOMIMECTICS
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Mimics orginal nuerotransmiters of the sympathetic nervous system
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Vasopressin
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TRADE NAME: Pitressin---hormone; vasopressor--a polypeptide hormone extracted from the posterior pituitaries of animals--possesses pressor and antidiuretic hormone (ADH) properties
MECHANISM OF ACTION: acts as a non-a-adrenergic vasoconstrictor through direct stimulation of smooth muscle receptors--can be used as an alternative to epinephrine during cardiac arrest INDICATIONS: used to increase peripheral vascular resistance during cardiac arrest CONTRAINDICATIONS: chronic nephritis--ischemic heart disease--premature ventricular contractions--advanced arteriosclerosis--when used in cardiac arrest, these contraindications may not apply DOSE: adult dose 40 units IV (single dose only)---Pediatric dose-usage in cardiac arrest not detailed |
