Dopamine (Intropin)

Question 1

Classification

Answer 1

Sympathomimetic, adrenergic agonist, inotropic, vasopressor

Question 2

Mechanism of Action

Answer 2

• Stimulates alpha & beta adrenergic receptors
• At moderate doses (2-10 mcg/kg/min), dopamine stimulates beta 1 receptors, increaseing inotropy and cardiac output while maintaining dopaminergic-induced vasodilatory effects.
• At high doses (10-20 mcg/kg/min), alpha adrenergic agonism predominates causing increased peripheral vascular resistance and vasoconstriction.

Question 3

Indications

Answer 3

• Hypotension & decreased cardiac output associated with cardiogenic shock & septic shock
• Hypotension after ROSC following cardiac arrest
• Symptomatic bradycardia unresponsive to atropine

Question 4

Contraindications

Answer 4

• Hypovolemic shock (correct with volume fluid replacement before giving dopamine)
• Pheochromocytoma
• VF, VT, or other ventricular arrythmias
• Known sensitivity (including sulfites)

Question 5

Adverse Effects

Answer 5

• Tachycardia, arrythmias
• Skin & soft tissue necrosis
• Severe hypertension from excessive vasoconstriction
• Angina
• Dyspnea, headache, nausea, vomiting

Question 6

Administration

Answer 6

• Adult: 2-20 mcg/kg/min IV/IO infussion
  
  • Cardiac dose is usually 5-10 mcg/kg/min
  • Vasopressor dose is usually 10-20 mcg/kg/min
  • Little benefit with doses over 20 mcg/kg/min
• Pediatrics: Same as adult dosing

Question 7

Special Considerations

Answer 7

• Half life is 2 minutes.