Adrenergic & Cholinergic Medications Flashcards
Adrenergic & Cholinergic Medications
Dopamine Dobutamine Epinephrine Norepinephrine Metoprolol Labetalol Propranolol Esmolol Isoproterenol Phentolamine Benztropine Mesylate
Dopamine
Generic name: Dopamine
Trade name: Intropin
Classification: Adrenergic agonist, vasopressor,
inotropic, sympathomimetic
Indications:
- Shock management
- Sepsis
- Pulmonary edema
- Symptomatic bradycardia
- Beta blocker/Calcium channel blocker overdose
Contraindications:
- Phenochromocytoma
- Tachyarrythmias
- Ventricular fibrillation
- Monoamine oxidase inhibitory use within 14 days
- Allergy to sulphites
Dose:
Adult ‐ initial rate of infusion of 5 mcg/kg/minute
Titrate to effect. Maximum dose of 20
Pediatric ‐ 2‐20 mcg/kg/minute ‐ titrate to effect
Dopamine Additional Info
Increased renal effects range between 2‐5 mcg/kg/min
Increased B 1 effects range between 5‐10 mcg/kg/min
Increased A 1 effects range between 10‐20 mcg/kg/min
400 mg/250 mL normal saline or D5W = 1600 mcg/mL –
Use Baxter Control‐A‐Flo and a 60 drop set
When using the Baxter Control‐A‐Flo, use the closest
approximation of the drip rate on the dial
Dopamine Infusion Chart
You have a septic pt. who is hypotensive. He weighs 70
kg. Start a dopamine infusion starting at 5 mcg/kg/min.
Increase the infusion to 10 mcg/kg/min
Now increase to 15 mcg/kg/min
Dobutamine
Generic name: Dobutamine
Trade name: Dobutrex
Classification: Adrenergic agonist, beta 1 agonist,
inotropic drug, sympathomimetic
Indications:
1. Hypotension with no signs and symptoms of shock with
systolic BP 70‐100 mmHg (after adequate fluid
replacement as required)
2. Hemodynamically significant right
Contraindications: Hypersensitivity,
phenochromocytoma, tachyarrhythmias
Dose: 5‐20 mcg/kg/minute (adult & pediatric)
Add 250 mg into a 250 mL D5W/NS bag = 1000 mcg/mL
Use with caution in patients with sulfite allergy
Epinephrine
Generic name: Epinephrine
Trade name: Adrenalin
Classification: Adrenergic agonist, bronchodilator,
vasopressor, sympathomimetic
Indications:
1. Symptomatic severe bradycardia with hypotension ‐ not
responsive to other therapy
2. Anaphylaxis refractory to other treatments
3. Severe asthma with an allergenic component
4. Beta blocker/ Calcium Channel Blocker Overdose
Epinephrine
Generic name: Epinephrine
Trade name: Adrenalin
Classification: Adrenergic agonist, bronchodilator,
vasopressor, sympathomimetic
Indications:
1. Symptomatic severe bradycardia with hypotension ‐ not
responsive to other therapy
2. Anaphylaxis refractory to other treatments
3. Severe asthma with an allergenic component
4. Beta blocker/ Calcium Channel Blocker Overdose
Contraindications: n/a
Dose:
Start infusion a 1 mcg/min, increase by 1 mcg/min prn
Titrate to systolic BP 90 mmHg or greater
Epi Additional notes
Add 1.5 mg epinephrine 1 mg/mL to 250mL NS or D5W
for a concentration of 6 mcg/mL
Use a 60 gtt (mL/hr = drops/min)
Norepinephrine
Generic name: Norepinephrine
Trade name: Levophed
Classification: Adrenergic agonist, vasopressor,
sympathomimetic
Indications:
- Symptomatic bradycardia
- Shock c hypotension refractory to fluid resuscitation
- Cardiogenic shock c refractory hypotension
Contraindications:
- Hypovolemia
- Profound hypoxia
- Pregnancy
Dose: 0.1 mcg/kg/min IV/IO, titrate to a maximum of 1
mcg/kg/min
Add 16 mg into 250 mL D5W/NS for a concentration of 64
mcg/mL
Isoproterenol
Generic name: Isoproterenol Trade name: Isuprel Classification: B1 and B2 agonist Indications: Immediate control AV heart block (when atropine is ineffective)
Contraindications:
- Hypersensitivity
- Tachycardia caused by digitalis toxicity
- Angina
Dose: 2‐10 mcg/minute IV infusion
Metoprolol
Generic name: Metoprolol
• Trade name: Betaloc, Lopressor
• Classification: Beta 1 selective blocker
• Indications: Symptomatic atrial fibrillation, atrial flutter
(c BP > 80 mmHg)
• Contraindications:
• Hypersensitivity
• 2nd or 3rd degree AV block
• Bradycardia < 50 bpm
• Bronchospastic COPD, reactive airway disease
• Severe heart failure
Dose: 5 mg SIVP, q 5 minutes prn to a total max of 15 mg
• Aim for a HR of 110 bpm
Labetalol
Generic name: Labetalol • Trade name: Trandate • Classification: Alpha 1 B1 & B2 blocker, antihypertensive • Indications: Hypertensive emergencies • Contraindications: 1. Hypersensitivity 2. Severe and prolonged hypotension 3. History of obstructive airway disease 4. Overt heart failure 5. 2°' or 3"' degree AV block 6. Cardiogenic shock 7. Severe bradycardia
Dose: Adult
1. Initially 20‐80 mg IV over 2 minutes
2. Repeat 40‐80 mg IV q 2 minutes to max of 300 mg as
needed
3. Alternatively may give drug as continuous infusion at
0.5 ‐2 mg/minute untildesired response is obtained
Propranlol
Generic name: Propranolol • Trade name: Inderal • Classification: B1 and b 2 blocker • Indications: Management of supraventricular tachycardias • Contraindications: 1. Hypersensitivity 2. Bronchial asthma 3. Sinus bradycardia 4. 2"" or 3'" degree AV block 5. Cardiogenic shock, heart failure (unless secondary to the dysrhythmia)
Dose: Adult 1‐3 mg IV diluted in 50 mL normal saline Do not exceed I mg/min One repeat dose of up to 3 mg may be given in 2 minutes if necessary
Propranlol
Generic name: Propranolol • Trade name: Inderal • Classification: B1 and b 2 blocker • Indications: Management of supraventricular tachycardias • Contraindications: 1. Hypersensitivity 2. Bronchial asthma 3. Sinus bradycardia 4. 2"" or 3'" degree AV block 5. Cardiogenic shock, heart failure (unless secondary to the dysrhythmia)
Dose: Adult 1‐3 mg IV diluted in 50 mL normal saline Do not exceed I mg/min One repeat dose of up to 3 mg may be given in 2 minutes if necessary
Esmolol
Generic name: Esmolol
• Trade name: Brevibloc
• Classification: B1 blocker
• Indications: Treatment of supraventricular tachycardia
• Contraindications: Hypersensitivity
• Dose: Adult ‐ range of 50‐200 mcg/kg/minute
