sympathomymetics Flashcards
trade name of albuterol
proventil
ventolin
MOA of albuterol
beta 2 agonist
: Relaxes bronchial smooth muscle by action on beta 2 receptors in the lungs
use of albuterol
Treatment or prevention of bronchospasm in patients with reversible obstructive airway disease;
prevention of exercise-induced bronchospasm.
dose of albuterol
Nebulization solution: 2.5 mg 3-4 times daily as needed;
Quick relief: 1.25-5 mg every 4 to 8 hours as needed (Hold puffer over end of ETT tube making the best seal you can and give 6 puffs)
onset of albuterol
10 minutes
peak effect of albuterol
: 0.5-2 hours
duration of albuterol
Nebulization/oral inhalation: 3-4 hours;
Oral: 4-6 hours
Metabolism: albuterol
Hepatic to an inactive sulfate
Half-life elimination: albuterol
Inhalation: 3.8 hours; Oral: 3.7-5 hours
Excretion: albuterol
Urine (30% as unchanged drug)
Contraindications: albuterol
Hypersensitivity to albuterol or any component of the formulation
Adverse Reactions: albuterol CV
Angina pectoris, atrial fibrillation, cardiac arrhythmia, chest discomfort, chest pain, extrasystoles, flushing, hypertension, hypotension, palpitations, supraventricular tachycardia, tachycardia,
Adverse Reactions: albuterol Central nervous system
stimulation, dizziness, drowsiness, headache, insomnia, irritability, migraine, nervousness, nightmares, restlessness, seizure, vertigo,
Adverse Reactions: albuterol Derm, GI/ GU
Diaphoresis, skin rash, urticarial, Hyperglycemia, hypokalemia, lactic acidosis, Diarrhea, dysgeusia, dyspepsia, gastroenteritis, nausea, vomiting, xerostomia, Difficulty in micturition, Lymphadenopathy, Anaphylaxis, angioedema, hypersensitivity reaction, Pain at injection site, Muscle cramps, musculoskeletal pain, tremor, weakness, Otitis media,
adverse reactions: albuterol pulmonary
Bronchospasm, cough, epistaxis, exacerbation of asthma, laryngitis, oropharyngeal edema, oropharyngeal irritation, pharyngitis, rhinitis, upper respiratory tract inflammation, viral upper respiratory tract infection
trade name dobutamine
dobutrex
how is dobutatmine supplied?
1000mg/250mL
MOA dobutamine
Stimulates beta1-adrenergic receptors, causing increased contractility and heart rate, with little effect on beta2- or alpha-receptors.
use of dobutamine
short-term management of patients with cardiac decompensation. Positive inotropic agent for use in myocardial dysfunction related to sepsis; stress echocardiography.
Dose: Dobutamine Infusion Initial Dose
Cardiac decompensation: I.V. infusion:
0.5-1 mcg/kg/minute
may also initiate at higher doses (eg, 2.5 mcg/kg/minute) depending on severity of decompensation with titration to desired response (Leier, 1977).
Dose: Dobutamine InfusionMaintenance dose:
2-20 mcg/kg/minute.
Note: In patients with heart failure, lower doses are preferred to minimize adverse effects
max dose of dobutamine
Maximum dose: 40 mcg/kg/minute
Onset of action: dobutamine
Half-life elimination:
I.V.: 1-10 minutes
Peak effect: dobutamine
10-20 minutes
Metabolism: dobutamine
In tissues and hepatically to inactive metabolites
half-life elimination dobutamine
2 minutes
Excretion: Dobutamine
Urine (as metabolites)
Adverse Reactions: CV
Increased heart rate, increased blood pressure, increased ventricular ectopic activity, hypotension, premature ventricular beats (5%, dose related), anginal pain (1% to 3%), nonspecific chest pain (1% to 3%), palpitation (1% to 3%),
Adverse Reactions Dobutamine- other
Fever (1% to 3%), headache (1% to 3%), paresthesia, Slight decrease in serum potassium, Nausea (1% to 3%), Thrombocytopenia (isolated cases), Phlebitis, local inflammatory changes and pain from infiltration, cutaneous necrosis (isolated cases), Mild leg cramps, Dyspnea (1% to 3%)
Contraindications: Dobutamine
Hypersensitivity to dobutamine or sulfites (some contain sodium metabisulfate), or any component of the formulation; idiopathic hypertrophic sub aortic stenosis (IHSS)
usual adult con
250 mg in 500 mL (concentration: 500 mcg/mL),
500 mg in 250 mL (concentration: 2000 mcg/mL),
1000 mg in 250 mL (concentration: 4000 mcg/mL) of D5W or NS
trade name of Dopamine
Dopamine
how is dopamine supplied
(400mg/250mL)
MOA of dopamine
low
medium
high dose
Stimulates both adrenergic and dopaminergic receptors,
lower doses are mainly dopaminergic stimulating and produce renal and mesenteric vasodilation,
medium doses also are both dopaminergic and beta1-adrenergic stimulating and produce cardiac stimulation and renal vasodilation
large doses stimulate alpha-adrenergic receptors.
low dose of dopamine and its effect
Low-dose: 1-5 mcg/kg/minute, increased renal blood flow and urine output
medium dose of dopamine and its effect
Intermediate-dose: 5-15 mcg/kg/minute, increased renal blood flow, heart rate, cardiac contractility, and cardiac output
high dose of dopamine and its effect
High-dose: >15 mcg/kg/minute, alpha-adrenergic effects begin to predominate, vasoconstriction, increased blood pressure
dopamine dose in heart failure
Inotropic support in advanced heart failure: I.V. infusion: 5-15 mcg/kg/minute; lower doses are preferred
onset dopamine
Onset of action: Adults: Within 5 minutes
duration of action dopamine
Duration: Adults:
metabolism of dopamine
Metabolism: Renal, hepatic, plasma; 75% to inactive metabolites by monoamine oxidase and 25% to norepinephrine
half life of dopamine
Half-life elimination: ~2 minutes
excretion of dopamine
Excretion: Urine (as metabolites)
AE Dopamine
Adverse Reactions: Angina pectoris, atrial fibrillation, bradycardia, ectopic beats, hypertension, hypotension, palpitations, tachycardia, vasoconstriction, ventricular arrhythmia, ventricular conduction, widened QRS complex on ECG,
Anxiety, headache, Gangrene (high dose), piloerection, Increased serum glucose (usually not above normal limits), Nausea, vomiting, Azotemia, Increased intraocular pressure, mydriasis, Polyuria, Dyspnea, Tissue necrosis
contraindications dopamine
Contraindications: Hypersensitivity to sulfites (commercial preparation contains sodium bisulfite); pheochromocytoma; ventricular fibrillation
trade name epinephrine
Adrenalin
MOA of epinephrine
Stimulates alpha-, beta1-, and beta2-adrenergic receptors resulting in relaxation of smooth muscle of the bronchial tree, cardiac stimulation (increasing myocardial oxygen consumption), and dilation of skeletal muscle vasculature; small doses can cause vasodilation via beta2-vascular receptors; large doses may produce constriction of skeletal and vascular smooth muscle.
use: Epinephrine
Treatment of type I allergic reactions including anaphylactic reactions.
Treatment of bronchospasm associated with bronchial asthma.
Ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) unresponsive to initial defibrillatory shocks; pulseless electrical activity; asystole; hypotension/shock unresponsive to volume resuscitation;
symptomatic bradycardia unresponsive to atropine or pacing; inotropic support; acute severe asthma with respiratory failure unresponsive to inhaled beta-agonist; croup.
dose of epinephrine systole:
I.V., I.O.: 1 mg every 3 to 5 minutes until return of spontaneous circulation;
if this approach fails, higher doses of epinephrine (up to 0.2 mg/kg) have been used for treatment of specific problems (eg, beta-blocker or calcium channel blocker overdose)
endotracheal epinephrine dose
how to prepare
special precautions
2 to 2.5 mg every 3 to 5 minutes until I.V./I.O access established or return of spontaneous circulation;
dilute in 5 to 10 mL NS or sterile water. Note: Absorption may be greater with sterile water. May cause false-negative reading with exhaled CO2 detectors; use second method to confirm tube placement if CO2 is not detected
epinephrine dose with bradycardia
Bradycardia (symptomatic; unresponsive to atropine or pacing): I.V. infusion: 2 to 10 mcg/minute or
0.1 to 0.5 mcg/kg/minute (7 to 35 mcg/minute in a 70 kg patient); titrate to desired effect
IV dosing epinephrine w/ bronchoconstriction
I.V.: 0.1 mg (1:10,000 [0.1 mg/mL] solution) over 5 minutes; may infuse at 1 to 4 mcg/minute to prevent the need to repeat injections frequently or may initiate with an infusion at 5 to 15 mcg/minute (with crystalloid administration).
In general, I.V. administration should only be done in patients who are profoundly hypotensive or are in cardiopulmonary arrest refractory to volume resuscitation and several epinephrine injections
onset of epinephrine
immediate
1 minute inhaled
Metabolism of Epinephrine
Metabolism: Taken up into the adrenergic neuron and metabolized by monoamine oxidase and catechol-o-methyltransferase; circulating drug hepatically metabolized
excretion of epinephrine
Excretion: Urine (as inactive metabolites, metanephrine, and sulfate and hydroxy derivatives of mandelic acid, small amounts as unchanged drug)
adverse reactions: Epi
Adverse Reactions: Angina, cardiac arrhythmia, chest pain, flushing, hypertension, pallor, palpitation, sudden death, tachycardia (parenteral), vasoconstriction, ventricular ectopy, ventricular fibrillation, Anxiety (transient), apprehensiveness, cerebral hemorrhage, dizziness, headache, insomnia, lightheadedness, nervousness, restlessness, Dry throat, loss of appetite, nausea, vomiting, xerostomia, Acute urinary retention in patients with bladder outflow obstruction, Tremor, weakness, Allergic lid reaction, burning, corneal endothelial damage (intraocular use), eye pain, ocular irritation, precipitation of or exacerbation of narrow-angle glaucoma, transient stinging, Dyspnea, pulmonary edema, Diaphoresis
Contraindications: Epi
Oral inhalation (OTC labeling): Concurrent use or within 2 weeks of MAO inhibitors
ephedrine trade name
ephedrine
Ephedrine MOA
Mechanism and use: Releases tissue stores of norepinephrine and thereby produces an alpha- and beta-adrenergic stimulation; longer-acting and less potent than epinephrine.
Ephedrine use
Treatment of anesthesia-induced hypotension.
Dose: ephedrine
I.V.: 5 to 25 mg/dose slow I.V. push repeated after 5 to 10 minutes as needed to maintain blood pressure
Metabolism: ephedrine
Minimally hepatic; metabolites include p-hydroxyephedrine, p-hydroxynorephedrine, norephedrine
Half-life elimination: ephedrine
2.5 to 3.6 hours
Excretion: ephedrine
Urine (60% to 77% as unchanged drug) within 24 hours
Adverse reactions: ephedrine
Adverse Reactions: Arrhythmias, chest pain, elevation or depression of blood pressure, hypertension, palpitation, tachycardia, unusual pallor,
Agitation, anxiety, apprehension, CNS stimulating effects, dizziness, excitation, fear, headache hyperactivity, insomnia, irritability, nervousness, restlessness, tension,
Anorexia, GI upset, nausea, vomiting, xerostomia, Painful urination, Trembling, tremor (more common in the elderly), weakness,
Dyspnea, Diaphoresis increased
Contraindications: Ephedrine
Hypersensitivity to ephedrine or any component of the formulation; angle-closure glaucoma; concurrent use of other sympathomimetic agents
trade name of Isoproterenol
Isuprel
how is Isoproterenol supplied?
0.2 mg/mL
what is the MOA of Isoproterenol
Mechanism Stimulates beta1- and beta2-receptors resulting in relaxation of bronchial, GI, and uterine smooth muscle, increased heart rate and contractility, vasodilation of peripheral vasculature.
Isoproterenol uses
Mild or transient episodes of heart block that do not require electric shock or pacemaker therapy;
serious episodes of heart block and Adams-Stokes attacks (except when caused by ventricular tachycardia or fibrillation)
; cardiac arrest until electric shock or pacemaker therapy is available;
bronchospasm during anesthesia; adjunct to fluid and electrolyte replacement therapy and other drugs and procedures in the treatment of hypovolemic or septic shock and low cardiac output states (eg, decompensated heart failure, cardiogenic shock)
dose Isoproterenol
Dose: Bradyarrhythmias, AV nodal block, or refractory torsade de pointes: Continuous I.V. infusion: Usual range: 2-10 mcg/minute; titrate to patient response
onset of Isoproterenol
immediate
duration Isoproterenol
I.V.: 10-15 minutes
