Commonly Used Drips

Question 0

Also releases norepinephrine from nerve terminals, which itself stimulates alpha-1 ad beta-1 receptors

Answer 0

Dopamine

Question 1

Generally used to augment BP and cardiac output in patients with cardiogenic shock

Answer 1

Dopamine

Question 2

Usually started at an infusion rate of 2-5 mcg/kg/min and dose is increased every 2-5 min to amax of 20-50 mcg/kg/min

Answer 2

Dopamine

Question 3

Dopamine preparation

Answer 3

1 amp contains 200 mg dopamine

Question 4

Sample dopamine order

Answer 4

Dopamine drip: 200 mg dopamine (1amp) + 250cc D5W to run for ___ cc/hr

Question 5

Dopamine factor

Answer 5

13.3 for 1 amp dopamine in 250cc D5W

Question 6

Dopamine effect at 1-2 mcg/kg/min

Answer 6

Renal vasodilation. Vasodilation of splanchnic and renal vasculature

MOA: activates DA1 and DA2 receptors

Question 7

Dopamine effect at 2-4 mcg/kg/min

Answer 7

Inotropic. Increase in cardiac output with little or no change in heart rate or systemic vascular resistance

MOA: activates b-1 receptors

Question 8

Dopamine effect at >= 5 mcg/kg/min

Answer 8

Vasoconstrictor. Vasonconstriction leads to increase in SVE, LV filling pressures and heart rate

MOA: effects on a1-receptor overwhelm the dopaminergic receptors

Question 9

Dobutamine effect at at low doses (2.5 mcg/kg/min)

Answer 9

Minimal positive chronotropic activity

Question 10

Dobutamine effect at higher doses (> 2.5 mcg/kg/min)

Answer 10

Moderate chronotropic activity

Question 11

True or False: dobutamine is usually given at 10 mcg/kg/min, however its vasodilatory effects at this dose precludes its use in patients where vasoconstrictive effect is needed

Answer 11

True

Question 12

A potent vasoconstrictor and inotropic stimulant that is recommended for pressure support in septic shock

Answer 12

Noradrenaline/norepinephrine

Question 13

True or False: despite the non-significant improvement in survival compared to patients given with dopamine, the relatively safer profile of norepinephrine makes it a good initial vasopressor therapy

Answer 13

True

Question 14

Norepinephrine starting dose

Answer 14

2-4 mcg/min

Question 15

True or False: if systemic perfusion or systolic pressure cannot be maintained at >90 mmHg with a dose of dose of 15 mcg/min norepineprine, it is likely that a further increase will be beneficial

Answer 15

False: it is unlikely that a further increase will be beneficial

Question 16

Norepinephrine factor

Answer 16

Norepineprine drip: 2mg norepinephrine (1 amp) + 250 cc D5W (factor used: 0.133)

Question 17

A sulfated polysaccharide and is usually isolated from mammalian tissues rich in mast cells

Answer 17

Heparin

Question 18

Acts as an anticoagulant by activating antithrombin (AT III) and accelerating the rate at which antithrombin inhibits clotting enzymes, particularly thrombin and factor Xa

Answer 18

Heparin

Question 19

Usual heparin formulation

Answer 19

Heparin drip: 10,000 units of unfractionated heparin in enough PNSS to make 100 cc in a soluset (concentration of 10,000 units/100 cc or 100units/cc)

Question 20

Usual Heparin dose indicated for myocardial infarction

Answer 20

Dose: “60-12”. 60 units/kg IV. Push as loading then start IV drip at at 12 units/kg/hr

Question 21

Usual heparin dose indicated for deep vein thrombosis or pulmonary embolism

Answer 21

Dose: “80-18”. 80 units/kg IV Push then start IV drip at 18 units/kg/hr

Question 22

What are the usual protocols in adjusting heparin drips

Answer 22

Heparin Raschke’s Protocol and Mayo Clinic Protocol

Question 23

How to adjust heparin drip based on PT/aPTT

Answer 23

aPTT is ideally monitored q6 hr and IV drip adjusted accordingly to reach target aPTT of 1.5x - 2.5x (use the Raschke’s) that of control to 46-70 seconds (use the Mayo Clinic). Refer to the protocols for the adjustment.