Adrenergic Agonists (5-vasopressors; 5-bronchodilators)

Question 1

Epinephrine

Vasopressor

Answer 1

Brand Name: Epinephrine

Classification: Sympathetic agonist

Action: α and β adrenergic agonist (β effects more pronounced although dose-related)

Indications: Cardiac arrest, symptomatic bradycardia, Normovolemic hypotension, Allergies/anaphylaxis, Severe bronchospasm

Contraindications: Few in the emergency setting

Dose: 0.3-1.0 mg

Routes: IV, IO, IM, SQ, ET, inhaled

Adverse Effects: Palpitations, anxiety, tremulousness, headache, dizziness, hypertension, Can worsen cardiac ischemia

Other: Two preparations are commonly available 1:1,000 (1mg/mL) 1:10,000 (1mg/10mL)

Question 2

Norepinephrine

Vasopressor

Answer 2

Brand Name: Levophed

Classification: Sympathetic agonist

Action: α and β adrenergic agonist (α effects more pronounced)

Indications: Normovolemic hypotension, Septic Shock, Cardiogenic shock

Contraindications: Should not be used in hypovolemia until volume replacement has occurred

Dose: 0.1-0.5 mcg/kg/min (titrate to effect)

Routes: IV

Adverse Effects: Palpitations, Anxiety, Tremulousness, Headache, Dizziness, Hypertension, Can worsen cardiac ischemia, reflex bradycardia

Other: Extravasation can cause localized tissue damage. Best administered through a central line

Question 3

Dopamine

Vasopressor

Answer 3

Brand Name: Intropin

Classification: Sympathetic agonist

Action: α and β adrenergic agonist

Indications: Normovolemic hypotension, Symptomatic bradycardia, Septic shock, Cardiogenic Shock

Contraindications: Should not be used in hypovolemia until volume replacement has occured

Dose: 2-20 mcg/kg/min (titrated to effect)

Routes: IV

Adverse Effects: Palpitations, Anxiety, Tremulousness, Headache, Dizziness, Hypertension, Can worsen cardiac ischemia, Reflex bradycardia

Other: Extravasation can cause localized tissue damage. Best administered through central line. Proposed renal benefit has been disproven

Question 4

Dobutamine

Vasopressor

Answer 4

Brand Name: Dobutrex

Classification: Synthetic sympathetic agonist

Action: A and B adrenergic agonist (inotropic properties more pronounced that chronotropic properties)

Indications: Congestive Heart Failure (CHF)

Contraindications: Hypovolemia

Dose: 2-20mcg/kg/min (titrate to effect)

Routes: IV

Adverse: Palpatations, anxiety, tremulousness, headache, dizziness, hypertension, can worsen cardiac ischemia, reflex bradycardia

Other: Extravasation can cause localized tissue damage, best administered through central line, other agents preferred in cardiogenic shock

Question 5

Phenylephrine

Vasopressor

Answer 5

Brand Name: Neo-Synephrine

Classification: Sympathetic agonist

Action: Almost a pure α agonist causing vasoconstriction

Indications: Normovolemic hypotension, Septic Shock, Spinal Shock

Contraindications: Avoid in cardiogenic shock

Dose: 100-180 mcg/min (0.5-2.0 mcg/kg/min and titrate to effect)

Routes: IV

Adverse Effects: Palpitations, Anxiety, Tremulousness, Headache, Dizziness, Can worsen cardiac ischemia, Reflex bradycardia

Other: can be applied to nasal mucosa to shrink tissues prior to nasal procedures

Question 6

Albuterol

Bronchodilator

Answer 6

Brand Name: Ventolin, Proventil

Classification: β agonist

Action: β agonist with preference for β2 adrenergic receptors.

Indications: Bronchospasm, Allergies/anaphylaxis, Hyperkalemia

Contraindications: Hypersensitivity

Dose: 2.5 mg (SVN) 90 mcg (MDI)

Routes: Inhalation

Adverse Effects: Palpitations, Anxiety, Tremulousness, Headache, Dizziness, Tachycardia

Other: Patient’s heart rate and SpO2 should be monitored during treatment

Question 7

Levalbuterol

Bronchodilator

Answer 7

Brand Name: Xopenex

Classification: B agonist

Action: B agonist with preference for B2 adrenergic receptors. It is a racemic isomer of albuterol

Indications: Bronchospasms, allergies/anaphylaxis, hyperkalemia

Contraindications: Hypersensitivity

Dose: 0.63mc (SVN)

Routes: Inhalation

Adverse: Palpitations, anxiety, tremulousness, headache, dizziness, tachycardia

Other: The pts heart rate and SpO2 should be monitored during treatment

Question 8

Metaproterenol

Bronchodilator

Answer 8

Brand Name: Alupent

Classification: B Agonist

Action: B Agonist with preference for B2 adrenergic receptors

Indications: Bronchospasm, allergies/anaphylaxis, hyperkalemia

Contraindications: Hypersensitivity

Dose: 0.2-0.3ml of solution containing 15mg/ml (SVN); 0.65mg (MDI)

Routes: Inhalation

Adverse: Palpitations, anxiety, tremulousness, headache, dizziness, tachycardia

Other: The pts heart rate and SpO2 should be monitored during treatment

Question 9

Terbutaline

Answer 9

Brand Name: Brethine

Classification: B Agonist

Action: Relatively nonselective B agonist

Indications: Bronchospasm, allergies/anaphylaxis, hyperkalemia, preterm labor

Contraindications: hypersensitivity

Dose: 0.25mg

Routes: Inhalation, SQ

Adverse: Palpitations, anxiety, tremulousness, headache, dizziness, tachycardia

Other: The pts heart rate and SpO2 should be monitored during treatment

Question 10

Racemic Epinephrine

Bronchodilator

Answer 10

Brand Name: S2

Classification: Sympathetic Agonist

Action: Relatively nonselective B agonist. It is a mix of both racemic isomers of epinephrine

Indications: Croup

Contraindications: Hypersensitivity

Dose: 0.25-0.75ml of a 2.5% solution

Routes: Inhalation

Adverse: Palpitations, anxiety, tremulousness, headache, dizziness, tachycardia

Other: The pts heart rate and SpO2 should be monitored during treatment