Adrenergic Drugs Chapter 18

Question 1

dobutamine uses

Answer 1

therapeutic: inotropics
Pharmacologic: adrenergics

Question 2

dobutamine side effects

Answer 2

Side effects: CV: pertension, incr HR, premature ventricular contractions

Question 3

dobutamine interactions

Answer 3

Interactions: D/D: use with nitroprusside may have a synergistic effect on incr cardiac output beta blockers may negate the effect of dobutamine incr risk of arrythmias or hypertension with some anesthetic (cyclopopane, halothane) MAOI, oxytocics or tricyclic antidepressants

Question 4

dobutamine dose

Answer 4

Dosage:IV (adults and children) 2.5-15 mcg/kg/min titrate to response (up to 40 mcg/kg/min)
IV neonates: 2-15 mcg/kg/min

Question 5

dobutamine nursing implications

Answer 5

NI: A: monitor bp, HR , ECG, pulmonary capillary wedge pressure cardiac output, cvp, and urinary output continously during the administration. rpt sign changes in vs or arrythmias. consult physician for parameters for pulse, bp or ecg changes for adjusting dose or discontinuing medication.
palpate peripheral pulses and assess appearance of extremeties routinely t/o dobutamine admin. notify physician if quality of pulse deteriorates or if extremeites become cold or mottled
Lab considerations: monitor K concentrations during therapy may cause hypokalemia
monitor electrolytes, BUN, creatinine, and prothrombin time weekly during prolonged therapy
Toxicity: If O/d occurs, reduction or discontinuation of therapy is the only treatment necessary because of the duration of dobutamine

Question 6

dopamine use

Answer 6

Therapeutic: inotropics, vasopressors
Pharmacologic: adrenergics

Question 7

dopamine side effects

Answer 7

Side effects: CV: arrythmias, hypotension EENT: mydriasis (high dose)

Question 8

dopamine interactions

Answer 8

Interactions: D/D use with MAOI, ergot alkaloids(ergotamine), doxapram or some antidepressants result in severe hypertension and bradycardia Use with general anesthesics may result in arrythmias Beta blockers may antagonzie cardiac effects.

Question 9

dopamine dose

Answer 9

Dosages: IV Adults: dopamiergic (renal vasodilation) effects 1-5 mc/kg/min beta adrenergic (cardiac stimulation) effects 5-15 mcg/kg/min alpha adrenergic (increased peripheral vascular resistance) effects >15 mcg/kg/min; infusion rate may be increased as needed.
IV Children and infants: 1-20 mcg/kg/min, depending on desired response (1-5 mcg/kg/min has been used to improve renal blood flow)
IV neonates: 1-20 mcg/kg/min

Question 10

dopamine nursing implications

Answer 10

NI: A: monitor BP, HR, PP, ECG, PCWP, cardiac output, CVP and urinary output continuously during administration. Report significant changes in VS or arrhythmias. consult physician for parameters for pulse, bp or ecg changes for adjusting dose or discontinuing medication.
monitor urine output frequently dur. admin. report decr. promptly.
palpate peri pulses and assess appearance of extremities routinely during admin. Notify Dr. if quality of pulse deteriorates or if extremities become cold or mottled.
If hypotension occurs, admin. rate should be incr. if hypotension continues more potent vasconstriction (Nor-epi) may be administered

Question 11

epinephrine

Answer 11

Therapeutic: antiashtmatics, bronchodilators, vasopressors
Pharmacologic: adrenergics

Question 12

epinephrine

Answer 12

Side Effects: CNS: Nervousness, restlessness, tremor CV: angina, arrythmias, hypertension, tachycardia

Question 13

epinephrine

Answer 13

Interactions: D/D: concurrent use with other adrenergic agents will have additive adrenergic effects Use with MAOI may lead to hypertensive crisis. Beta blockers may negate therapeutic effect. Tricyclic antidepressants enhance pressor response to epinephine.
D/Natural: use with caffeine containing herbs (cola nut, guarana, mate, tea, coffee) incr stimulant effect

Question 14

norepinephrine

Answer 14

Therapeutic: vasopressors

Question 15

norepinephrine

Answer 15

Side Effects: CNS: anxiety, dizziness, headache, insomnia, restlessness, tremor, weakness RESP: dyspnea CV arrythmias, bradycardia, chest pain, hypertension GU decreased urine output, renal failure ENDO: hyupergylcemia F&E metabolic acidosis Local: Phlebitis at IV site Misc fever

Question 16

norepinephrine

Answer 16

Interactions: D/D: use with cyclopoprane or halothane anesthia, cardia glycosides doxapram or local use of cocaine may result in incr. myocardial irritability. use with MAOI methyldopa, doxapram, or tricyclic anti depressants may result in severe hypertension. Alpha-adrenergic blockers can prevent pressor response. Beta blockers may exaggerate hypertension or block cardiac stimulation. Concurrent use with ergot alkaloids (ergotamine, ergonovine, methylergonovine or oxytocin) may result in enhanced vasoconstriction and hypertension.

Question 17

norepinephrine

Answer 17

NI: A: monitor BP every 2-3 min until stabilized and every 5 in thereafter. Systolic BP is usually maintained at 80-100 mm Hg or 30-40 mmHg below the previously existing systolic pressure in previously hypertensive pts. Consult physician for parameters. Continue to monitor BP frequently for hypotension following discontinuation of norephinephrine.
ECG should be monitored continuously CVP, intra-arterial pressure, pulmonary artery diastolic pressure, PCWP, and cardiac output may also be monitored.
Monitor urine output and notify HC Prof if it deccreases to <30-ml/hr
Assess IV site frequently throughout infusion. A large vein should be used to minimize risk of extravasation which may cause tissue necrosis. Phentolamine 5-10 mg may be added to each liter of solution to prevent sloughing of tissue in extravasation. If extravasation occurs, the site should be infiltrated promptly with 10-15 ml of 0.9% NaCl solution containing 5-10 mg of phentolamine to prevent necrosis and sloughing. If prolonged therapy is required or if blanching along the course of the vein occurs, change injection sites to provide relief from vasoconstriction.
Toxicity and O/D: if O/D occurs, discontinue norepinephrine and administer fluid and electrolyte repl. therapy. An alpha-adrenergic blocking agent (phentolamine 5-10 mg) may be administered iV to treat hypertension.