Cardiac: Sympathomimetics (Sympathetic Agonists) Flashcards
Epinephrine 1:10,000 (1mg/10mL)
Onset: less than 2 min
Peak Effects: less than 5 min
Duration: 5-10 min
Half-life: 5 minutes
MOA: acts on alpha-1 and beta-1 receptors, but primarily beta. Causes: increased HR, increased cardiac contractile force, increased electrical activity in the myocardium, increased systemic vascular resistance, increased BP, increased automaticity, and vasoconstriction.
Class: sympathetic agonist
Description: is a naturally occurring catecholamine with alpha and beta stimulant effects
Indications: cardiac arrest (asystole, ventricular fibrillation, pulseless ventricular tachycardia, and PEA); symptomatic bradycardia refractory to atropine
Contraindications: pts who do not require extensive cardiopulmonary efforts; not for use in hypovolemia
Precautions: protect from light. Can be deactivated by Sodium Bicarbonate. Effects can be intensified in pts taking antidepressants.
Side effects: palpitations, anxiety, tremors, headache, dizziness, N/V, increases myocardial oxygen demand, myocardial ischemia.
Adult dosage: 1.0mg of a 1mg/10ml solution every 3-5 minutes
Peds dosage: 0.01mg/kg or 0.1ml/kg every 3-5 minutes
Epinephrine Push Dose Pressor 10mcg/ml
To make: expel 1cc from a 10cc saline flush, and draw up 1 ml of epinephrine 1:10,000. Shake well.
Onset: less than 2 min
Peak Effects: less than 5 min
Duration: 5-10 min
Half-life: 5 minutes
MOA: acts on alpha-1 and beta-1 receptors, but primarily beta. Causes: increased HR, increased cardiac contractile force, increased electrical activity in the myocardium, increased systemic vascular resistance, increased BP, increased automaticity, and vasoconstriction.
Class: sympathetic agonist
Description: a naturally occurring catecholamine with alpha and beta stimulant effects
Indications: management of shock when the BP is in imminent danger of hemodynamic collapse to increase MAP
Contraindications: not for use in pts who do not requires extensive cardiopulmonary resuscitation efforts; not for use in hypovolemia
Precautions: protect from light. Can be deactivated by Sodium Bicarbonate. Effects can be intensified in pts taking antidepressants.
Side effects: palpitations, anxiety, tremors, headache, dizziness, N/V, increases myocardial oxygen demand, myocardial ischemia.
Dosage: 5-20mcg (0.5-2ml) every 1-5 minutes
Epinephrine Drip
Onset: less than 2 min
Peak Effects: less than 5 min
Duration: 5-10 min
Half-life: 5 minutes
MOA: acts on alpha-1 and beta-1 receptors, but primarily beta. Causes: increased HR, increased cardiac contractile force, increased electrical activity in the myocardium, increased systemic vascular resistance, increased BP, increased automaticity, and vasoconstriction.
Class: sympathetic agonist
Description: a naturally occurring catecholamine with alpha and beta stimulant effects
Indications: management of shock when the BP is in imminent danger of hemodynamic collapse to increase MAP
Contraindications: not for use in pts who do not requires extensive cardiopulmonary resuscitation efforts; not for use in hypovolemia
Precautions: protect from light. Can be deactivated by Sodium Bicarbonate. Effects can be intensified in pts taking antidepressants.
Side effects: palpitations, anxiety, tremors, headache, dizziness, N/V, increases myocardial oxygen demand, myocardial ischemia.
Dosage: 2-10mcg/min
Norepinephrine (Levophed)
Onset: immediate
Peak effects: less than 1 minute
Duration: 1-2 minutes
Half-life: 3 minutes
MOA: acts on alpha adrenergic receptors; a potent peripheral vasoconstrictor; increases myocardial oxygen demand
Class: sympathetic agonist
Description: a naturally occurring catecholamine. Acts on both alpha and beta adrenergic receptors; action on alpha receptors is more profound
Indications: hypotension (systolic BP less than 70mmHg) not related to hypovolemia
Contraindications: should not be given to pts who are hypotensive from hypovolemia
Precautions: can cause local tissue necrosis if it extravasates. Typically induces renal and mesenteric vasoconstriction
Side effects: anxiety, tremors, headache, dizziness, N/V, bradycardia (as a reflex response to increased peripheral vasoconstriction), increases myocardial oxygen demand
Interactions: can be deactivated by sodium bicarbonate and other alkaline solutions. Concomitant admin with beta-blockers can result in extremely high BP
Dosage: 0.1-0.5mcg/kg/min (max of 30mcg/min)
. for 16mcg/ml: put 8mg in a 500ml bag of D5W
OR
put 4mg in 250ml bag of D5W
NOTE: MUST be given ONLY in diluted IV infusions
Phenylephrine (Neo-Synephrine)
Onset: immediate
Peak effects: less than 1 minute
Duration: 15-20 minutes
Half-life: 2 minutes
MOA: a potent synthetic catecholamine that acts primarily on alpha adrenergic receptors. Acts primarily on the vascular smooth muscle heart and lungs to increase peripheral vascular resistance and BP. Reduces mucosal swelling and edema, when used topically on mucosal membranes
Class: sympathetic agonist
Indications: to increase BP in shock (systolic less than 70mmHg), in particular in cases where peripheral vascular resistance is reduced, such as septic shock and spinal shock.
Contraindications: not to be used to increase BP in cardiogenic shock
Precautions: causes tissue sloughing at injection site
Side effects: nervousness, headache, blurred vision, lacrimation, urinary retention, rebound nasal congestion, tremors, arrhythmias, angina, N/V
Interactions: can be deactivated by sodium bicarbonate and other alkaline solutions. Should be used with caution in pts with digitalis toxicity because it can aggravate tachyarrhythmias
Dosage: 100-180mcg/min (0.5-2mcg/kg/min)
Maintenance dosage: 46-60mcg/min
NOTE: should ONLY be piggybacked
Phenylephrine (Neo-Synephrine) Push Dose Pressor
Onset: immediate
Peak effects: less than 1 minute
Duration: 15-20 minutes
Half-life: 2 minutes
MOA: a potent synthetic catecholamine that acts primarily on alpha adrenergic receptors. Acts primarily on the vascular smooth muscle heart and lungs to increase peripheral vascular resistance and BP. Reduces mucosal swelling and edema, when used topically on mucosal membranes
Class: sympathetic agonist
Indications: to increase BP in shock with MAP below 45mmHg, in particular in cases where peripheral vascular resistance is reduced, such as septic shock and spinal shock.
Contraindications: not to be used to increase BP in cardiogenic shock
Precautions: causes tissue sloughing at injection site
Side effects: nervousness, headache, blurred vision, lacrimation, urinary retention, rebound nasal congestion, tremors, arrhythmias, angina, N/V
Interactions: can be deactivated by sodium bicarbonate and other alkaline solutions. Should be used with caution in pts with digitalis toxicity because it can aggravate tachyarrhythmias
Dosage: 50-100mcg (0.5-2ml) every 1-5 minutes
To make: draw up 1ml of a 10mg/ml phenylephrine vial, and inject into a 100 ml bag of NS (this gives you a concentration of 100mcg/ml)
Dopamine (Intropin)
Onset: less than 5 minutes
Peak effects: 5-8 minutes
Duration: less than 10 minutes
Half-life: 2 minutes
MOA: used to treat hypotension in cardiogenic shock. increases BP by acting on both alpha and beta-1 adrenergic receptors. Effects on beta-1 receptors causes a positive inotropic effect on the heart. Does not increase myocardial oxygen demand as much as epinephrine and does not have the same amount of chronotropic effects. Acts on alpha-adrenergic receptors, causing peripheral vasoconstriction. Increases both systolic BP and the pulse pressure (usually less effect on the diastolic pressure)
Class: sympathetic agonist
Description: a naturally occurring catecholamine that is a chemical precursor of norepinephrine. Acts on alpha, beta-1, and dopaminergic adrenergic receptors. The effects on adrenergic receptors is dose dependent. A “Bad Ass Drug”
Indications: symptomatic bradycardia refractory to atropine, significant hypotension (systolic 70-100mmHg) in cardiogenic shock
Contraindications: should not be used as a sole agent in managing hypovolemic shock, unless unable to manage with a fluid bolus, pts with known pheochromocytoma (adrenal gland tumor), tachyarrhythmias, ventricular fibrillation
Precautions: increases HR, can induce or worsen SVT and ventricular arrhythmias, When dose goes over 20mcg/kg/min, alpha effects are predominate
Side effects: nervousness, headache, arrhythmias, palpitations, chest pain, dyspnea, N/V
Interactions: Can be deactivated by sodium bicarbonate and other alkaline solutions. Dose should be reduced in pts taking MAOIs. Can cause hypotension when used with phenytoin (Dilantin)
Dosage: 2-10mcg/kg/min, titrated to effect
To make: put 800mg in 500ml of D5W for a concentration of 1600mcg/ml
OR
put 400mg in 250ml of D5W for a concentration of 1600mcg/ml
Dobutamine (Dobutrex)
Onset: 2-10 minutes
Peak effects: 10-20 minutes
Duration: varies
Half-life: 2 minutes
MOA: increases force of the systolic contraction (positive inotropic effect) with little chronotropic activity; is useful in managing CHF, when an increase in HR is not wanted
Class: sympathetic agonist
Description: synthetic catecholamine that acts primarily on beta-1 adrenergic receptors
Indications: short-term management of CHF when an increased cardiac output that does not increase HR is desired
Contraindications: should not be used as the sole agent in hypovolemic shock, unless unable to manage with fluid bolus; in cardiogenic shock, dopamine is preferred
Precautions: tachycardia and increase in systolic BP is common. increases in HR more than 10% may induce or exacerbate myocardial ischemia. PVCs can occur
Side effects: nervousness, headache, HTN, arrhythmias, palpitations, chest pain, dyspnea, N/V
Interactions: may be ineffective when administered to pts taking beta blockers, because they block the beta-receptors dobutamine acts on. Pts taking TCAs have an increased risk of HTN
Vasopressin (Pitressin): ADH
Onset: variable
Peak effects: variable
Duration: 30-60 min
Half-life: 10-20 min
MOA: in higher doses, it acts as a non-alpha-adrenergic vasoconstrictor through direct stimulation of smooth muscle receptors. It can be used as an alternative to epinephrine during CPR
Class: hormone; vasopressor
Description: polypeptide hormone extracted from the posterior pituitaries of animals. Has pressor and antidiuretic hormone (ADH) properties
Indications: to increase peripheral vascular resistance during CPR instead of epinephrine
Contraindications: chronic nephritis, ischemic heart disease, PVCs, advanced arteriosclerosis
Precautions: epilepsy, migraine, asthma, heart failure, angina
Side effects: blanching of the skin, abdominal cramps, nausea, HTN, bradycardia, minor arrhythmias
Route: IV/IO
Dosage (only in adults): 40 units (single dose only). Can replace first or second dose of epinephrine in cardiac arrest
