Commonly Used Drips Flashcards
Also releases norepinephrine from nerve terminals, which itself stimulates alpha-1 ad beta-1 receptors
Dopamine
Generally used to augment BP and cardiac output in patients with cardiogenic shock
Dopamine
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
Dopamine
Dopamine preparation
1 amp contains 200 mg dopamine
Sample dopamine order
Dopamine drip: 200 mg dopamine (1amp) + 250cc D5W to run for ___ cc/hr
Dopamine factor
13.3 for 1 amp dopamine in 250cc D5W
Dopamine effect at 1-2 mcg/kg/min
Renal vasodilation. Vasodilation of splanchnic and renal vasculature
MOA: activates DA1 and DA2 receptors
Dopamine effect at 2-4 mcg/kg/min
Inotropic. Increase in cardiac output with little or no change in heart rate or systemic vascular resistance
MOA: activates b-1 receptors
Dopamine effect at >= 5 mcg/kg/min
Vasoconstrictor. Vasonconstriction leads to increase in SVE, LV filling pressures and heart rate
MOA: effects on a1-receptor overwhelm the dopaminergic receptors
Dobutamine effect at at low doses (2.5 mcg/kg/min)
Minimal positive chronotropic activity
Dobutamine effect at higher doses (> 2.5 mcg/kg/min)
Moderate chronotropic activity
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
True
A potent vasoconstrictor and inotropic stimulant that is recommended for pressure support in septic shock
Noradrenaline/norepinephrine
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
True
Norepinephrine starting dose
2-4 mcg/min
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
False: it is unlikely that a further increase will be beneficial
Norepinephrine factor
Norepineprine drip: 2mg norepinephrine (1 amp) + 250 cc D5W (factor used: 0.133)
A sulfated polysaccharide and is usually isolated from mammalian tissues rich in mast cells
Heparin
Acts as an anticoagulant by activating antithrombin (AT III) and accelerating the rate at which antithrombin inhibits clotting enzymes, particularly thrombin and factor Xa
Heparin
Usual heparin formulation
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)
Usual Heparin dose indicated for myocardial infarction
Dose: “60-12”. 60 units/kg IV. Push as loading then start IV drip at at 12 units/kg/hr
Usual heparin dose indicated for deep vein thrombosis or pulmonary embolism
Dose: “80-18”. 80 units/kg IV Push then start IV drip at 18 units/kg/hr
What are the usual protocols in adjusting heparin drips
Heparin Raschke’s Protocol and Mayo Clinic Protocol
How to adjust heparin drip based on PT/aPTT
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.
