Meds For Shock Flashcards
Medications to improve contractility and examples
Positive inotropes:
dobutamine (Dobutrex)
dopamine (Intropin)
What are each of the ranges of dopamine used for?
Low dose = renal dose
Mid range = to increase squeeze of heart
High dose = alpha - vasoconstrict
Why are drugs that improve preload given?
For volume resuscitation (to improve volume)
Types of drugs given to improve preload and examples
Vasopressors:
norepinephrine (Levophed)
dopamine (Intropin)
phenylephrine (Neo-synephrine)
Vasopressin
Which type of patient should not have vasopressors and why?
Hypovolemic patients - so all types of shock except distributive shock: septic, anaphylactic, neurogenic
Need to replace fluid volume first
For distributive shock, the problem is vasodilation, so need to treat that first
Meds given for shock that reduce preload, and examples
Diuretics: furosemide
Vasodilators:
NTG
nitroprusside (Nipride)
Morphine (yes, it’s also a vasodilator)
Meds given to reduce afterload for shock
Nitroprusside
Meds given to increase afterload and examples
Dopamine (in high doses)
Norepinephrine (Levophed)
Epinephrine (Adrenalin)
Phenylephrine (Neo-Synephrine)
Action of Intropin (dopamine)
Increase contractility
Explain the doses of Intropin (dopamine) in depth
< 3 mcg/kg/min - stimulates Dopaminergic receptors producing renal, mesenteric, coronary, and cerebral vessel dilation, increasing urinary output
3-10 mcg/kg/min - stimulates beta1 receptors, producing increase in cardiac output
> 10 mcg/kg/min - stimulates alpha receptors producing vasoconstriction of pulmonary and systemic vessels, causing increased afterload
Side effects of intropin (dopamine)
Increased HR
Increased myocardial oxygen needs, resulting in angina and arrhythmias
Nursing considerations of intropin (dopamine)
Monitor HR closely, for chest pain and arrhythmias
Infuse through stable IV line to prevent infiltration
If infiltrates - infuse Regitine ASAP
Action of dobutamine (Dobutrex)
Increase contractility: Stimulates beta1 receptors with weak stimulation of beta2 receptors
Vasodilation
Reduces filling pressures and pulmonary interstitial edema
Reduces systemic vascular resistance
Side effects of dobutamine (Dobutrex)
Increased HR
Increased myocardial oxygen needs, resulting in angina or arrhythmias
Decreased BP
Nursing considerations for dobutamine (Dobutrex)
Monitor HR 7 BR closely
Monitor for chest pain and arrhythmias
Action of furosemide (lasix)
Decrease preload
Increases elimination of sodium and water, thus reducing vascular volume
SE of furosemide (lasix)
Electrolyte imbalances
Nursing considerations for furosemide (lasix)
Monitor electrolytes and BP
Provide moisturizer for lips
Action of nitroglycerin
Dilates veins and arteries
Decreases preload and afterload
Decreases cardiac workload and oxygen needs
SE of nitroglycerin
Hypotension
HA
Palpitations
Nasal congestion
Tolerance for nitrates
Nursing considerations for nitroglycerin
Monitor BP, rhythm, dizziness, orthostatic hypotension
Can be used in pts who cannot take ACE inhibitors
Use extreme caution if SBP < 90 mmHg and with RVI
Patient must be supine during administration
Action of Nitroprusside
Dilates veins and arteries
Decreases preload and afterload
Decreases cardiac workload and oxygen needs
SE of nitroprusside
Hypotension
HA
Palpitations
Nasal congestion
Tolerance for nitrates
Hypoxemia (nitride induced intra pulmonary Thiocyanate toxicity)
Nursing considerations for nitroprusside
Monitor BP, rhythm, dizziness, orthostatic hypotension
Can be used in pts who cannot take ACE inhibitors
Use extreme caution if SBP < 90 mmHg and with RVI
Patient must be supine during administration
Monitor for Thiocyanate toxicity (Metabolic acidosis, Confusion, Hyperreflexia, Seizures)
Daily levels if used > 72 hours
Action of norepinephrine (Levophed)
Stimulates alpha receptors to cause vasoconstriction
SE of norepinephrine (Levophed)
Hypertension
Ventricular dysrhythmias
Chest pain
HA
Anxiety
Nursing considerations for norepinephrine (Levophed)
Continuous ECG monitoring (watch for vent. dysrhythmias)
Monitor for chest pain, VS hourly
Report severe elevations in BP
*Tissue necrosis can occur in high doses or prolonged administration or extravasation
Monitor peripheral pulses hourly and report change in strength of pulses
Treat extravasating with phentolamine (Regitine)
Action of Phenylephrine (Neosynephrine)
Stimulates alpha receptors to cause vasoconstriction
SE of Phenylephrine (Neosynephrine
HTN
Ventricular dysrhythmias
Chest pain
HA
Anxiety
Nursing considerations for Phenylephrine (Neosynephrine)
Continuous ECG monitoring (watch for ventricular dysrhythmias)
Monitor for chest pain routinely, VS hourly
Report severe elevations in BP
