Adrenergic Drugs Flashcards
Dobutamine
Chemical Classification
Catecholamine
Dobutamine
Mechanism of Action
Causes increased contractility, increased cardiac output without marked increase in heart rate by acting on Beta1-receptors in heart; minor alpha and beta2 effects
Dobutamine
Uses
Cardiac decompensation due to organic heart disease or cardiac surgery
Dobutamine
Contraindications
Hypersensitivity, idiopathic hypertrophic subaortic stenosis
Dobutamine
Side Effects
CNS: Anxiety, headache, dizziness, fatigue
CV: palpitations, tachycardia, hyper/hypotension, PVCs, angina
ENDO: hypokalemia
GI: heartburn, nausea, vomiting
MS: muscle cramps (leg)
RESP: dyspnea
Dobutamine
Nursing Considerations
ASSESS:
- HYPOVOLEMIA; if present, correct first; administer cardiac glycoside before DOBUTamine
- OXYGENATION/PERFUSION DEFICIT: check BP, chest pain, dizziness, loss of consciousness
- HEART FAILURE: S3 gallop, dyspnea, neck venous distention, bibasilar crackles in patients with CHF, cardiomyopathy, palpate peripheral pulses; report if extremities become cold or mottled or if peripheral pulses decrease
- ECG during administration continuously; if BP increases, product is decreased; CVP or PCWP, cardiac output during inf; report changes
- Serum electrolytes, urine output
- SULFITE SENSITIVITY, which may be life threatening
Dobutamine
Overdose Treatment
Administer a Beta1-adrenergic blocker; reduce IV or discontinue, ensure oxygenation/ventilation; for severe tachydysrhythmias (ventricular), give lidocaine or propranolol
Dopamine
Functional Classification
Adrenergic
Dopamine
Chemical Classification
Catecholamine
Dopamine
Mechanism of Action
Causes increased cardiac output; acts on beta1- and alpha-receptors, causing vasoconstriction in blood vessels; low dose causes renal and mesenteric vasodilation; beta1 stimulation produces inotropic effects with increased cardiac output
Dopamine
Uses
Shock, increased perfusion, hypotension, cardiogenic/septic shock
Dopamine
Contraindications
Hypersensitivity, ventricular fibrillation, tachydysrhythmias, pheochromocytoma, hypovolemia
Dopamine
Side Effects
CNS: Headache, anxiety
CV: Palpitations, Tachycardia, Hypertension, Ectopic Beats, Angina, Wide QRS Complex, peripheral vasoconstriction, hypotension
GI: Nausea, Vomiting, Diarrhea
INTEG: necrosis, tissue sloughing with extravasation, GANGRENE
RESP: dyspnea
Dopamine
Nursing Considerations
ASSESS:
- Hypovolemia; if present, correct first
- OXYGENATION/PERFUSION DEFICIT: check BP, chest pain, dizziness, loss of consciousness
- HEART FAILURE: S3 gallop, dyspnea, neck venous distention, bibasilar crackles in patients with CHF, cardiomyopathy, palpate peripheral pulses
- I&O ratio: if urine output decreases without decrease in BP, product may need to be reduced
- ECG during administration continuously; if BP increases, product should be decreased; PCWP, CVP during inf
- BP, pulse q5min
- Paresthesias and coldness of extremities; peripheral blood flow may decrease
- Inj site: tissue sloughing; if this occurs, administer phentolamine mixed with NS
Dopamine
Overdose Treatment
Discontinue IV, may give a short-acting alpha-adrenergic blocker
Epinephrine
Functional Classification
Bronchodilator nonselective adrenergic agonist, vasopressor
Epinephrine
Chemical Classification
Catecholamine
Epinephrine
Mechanism of Action
Beta1- and Beta2-agonist causing increased levels of cAMP, thereby producing bronchodilation, cardiac, and CNS stimulation; high doses cause vasoconstriction via alpha-receptors; low doses can cause vasodilation via Beta2-vascular receptors
Epinephrine
Uses
Acute asthmatic attacks, hemostasis, bronchospasm, anaphylaxis, allergic reactions, cardiac arrest, adjunct in anesthesia, shock
Epinephrine
Contraindications
Hypersensitivity to sympathomimetics, closed-angle glaucoma, nonanaphylactic shock during general anesthesia
Epinephrine
Side Effects
CNS: Tremors, Anxiety, insomnia, headache, Dizziness, confusion, hallucinations, CEREBRAL HEMORRHAGE, weakness, drowsiness
CV: Palpitations, Tachycardia, hypertension, Dysrhythmias, increased T wave
GI: Anorexia, Nausea, Vomiting
MISC: sweating, dry eyes
RESP: Dyspnea
Epinephrine
Nursing Considerations
ASSESS:
- ASTHMA: auscultate lungs, pulse, BP, respirations, sputum (color, character); monitor pulmonary function studies before and during treatment
- ECG during administration continuously; if BP increases, decrease dose; BP, pulse q5min after parenteral route; CVP, ISVR, PCWP during inf if possible; inadvertent high arterial BP can result in angina, aortic rupture, cerebral hemorrhage
- Inj site: tissue sloughing; administer phentolamine with NS
- SULFITE SENSITIVITY; may be life-threatening
- Cardiac status, I&O; blood glucose in diabetes
- ALLERGIC REACTIONS, BRONCHOSPASMS: withhold dose, notify prescriber
Epinephrine
Overdose Treatment
Administer alpha-blocker and beta-blocker
Norepinephrine (Levophed)
Functional Classification
Adrenergic
Norepinephrine (Levophed)
Chemical Classification
Catecholamine
Norepinephrine (Levophed)
Mechanism of Action
Causes increased contractility and heart rate by acting on beta-receptors in heart; also acts on alpha-receptors, thereby causing vasoconstriction in blood vessels; BP is elevated, coronary blood flow improves, and cardiac output increases
Norepinephrine (Levophed)
Uses
Acute hypotension, shock
Norepinephrine (Levophed)
Contraindications
Hypersensitivity to this product or cyclopropane/halothane anesthesia; ventricular fibrillation, tachydysrhythmias, pheochromocytoma, hypotension, hypovolemia
Norepinephrine (Levophed)
Side Effects
CNS: Headache, anxiety, dizziness, insomnia, restlessness, tremor, CEREBRAL HEMORRHAGE
CV: Palpitations, Tachycardia, Hypertension, Ectopic Beats, Angina
GI: Nausea, Vomiting
GU: decreased urine output
INTEG: necrosis, tissue sloughing with extravasation, GANGRENE
RESP: dyspnea
SYST: ANAPHYLAXIS
Norepinephrine (Levophed)
Nursing Considerations
ASSESS:
- I&O ratio; notify prescriber if output <30ml/hr
- BP, pulse q2-3min after parenteral route, ECG during administration continuously; if BP increases, product is decreased, CVP or PWP during inf if possible
- Paresthesias and coldness of extremities; peripheral blood flow may decrease
- EXTRAVASATION: inj site: tissue sloughing
- sulfite sensitivity, which may be life-threatening
Norepinephrine (Levophed)
Overdose Treatment
Administer fluids, electrolyte replacement
Dobutamine
Functional Classification
Adrenergic direct-acting Beta1-agonist, cardiac stimulant
