Vasopressors

Question 1

**Uses for Levophed? **
List 3 uses
1)
2)
3)

Answer 1

** Uses for Levophed? **

It is used for
1. severe hypotension,
2. shock, or
3. bradycardia

Question 2

Receptor Action: Epinephrine
Description?

Answer 2

Receptor Action: Epinephrine
It is a vasopressor and sympathomimetic drug that increases coronary perfusion

Question 3

**Uses for Dobutamine? **
List 2 uses
1)
2)

Answer 3

** Uses for Dobutamine? **

Dobutamine is used for
1. cardiogenic shock and
2. associated hypotension

Question 4

Receptor Action: Dobutamine
Description?

Answer 4

Receptor Action: Dobutamine
Dobutamine is an adrenergic agonist and first-line inotropic

It acts like a chemical balloon pump that reduces afterload but increases the rate and cardiac contractility.

It increases cardiac output and mild vasodilation.

Question 5

**Uses for Vasopressin? **
List 2 uses
1).
2).
3).
4).

Answer 5

** Uses for Vasopressin? **
Treats
1. PEA and
2. VF.
3. AHA/ACLS guidelines recommend Vasopressin 40 units one time only to replace the first or second dose of Epinephrine.

4. Vasopressin is used in patients with refractory shock despite marked fluid resuscitation and catecholamines such as norepinephrine and dopamine.

Question 6

** Uses for Epinephrine? **
List 5 uses
1).
2).
3).
4).
5).
6).

Answer 6

** Uses for Epinephrine? **

Is used for
1. profound refractory hypotension,
2. ventricular fibrillation,
3. Ventricular Tachycardia (VT),
4. Pulseless Electrical Activity (PEA) and
5. asystole.
6. It is the first drug of choice for cardiac arrest.

Question 7

Uses for Dopamine?
1).
2).
3).
4).
5).
6).

Answer 7

**Uses for Dopamine?

Dopamine is an adrenergic agonist for
1. central hypotension,
2. heart failure, and
3. increased renal and
4. mesenteric perfusion without hypovolemia
5. If the etiology of the shock is unknown, then dopamine is a good first-line drug of choice
6. In shock and Sepsis it will augment cardiac performance and renal perfusion.

Question 8

Dosing Levophed

1) On clinical round the resident asked how should Levophed be titrated. Answer?

2) Later the nurse called how many ml/hr should the pump be set for 5mg/min. Answer?

3) What would you recommend to the provider for reversal of Levophed

Answer 8

Dosing Levophed
4mg/250mls
1) Usual Dose 2-12mcg/min ,

Titrate Q3-5 mins.

2) Conversion factor = x 3.75

5mg/min = 5 x3.75 = 18.75 ml/hr

3) Phentolamine

Question 9

Receptor Action: Dopamine
Description?

Answer 9

Receptor Action: Dopamine
Dopamine It is a positive inotrope with vasoconstrictive actions. It tends to exhibit beta-agonist in low doses. In higher doses, it acts more like an alpha agonist. It will increase cardiac output and heart rate.
It will augment cardiac performance and renal perfusion in shock and sepsis.

Question 10

Dosing Epinephrine

1) What is the usual dose for Epinephrine?
Answer

2) What clinical endpoint in titration would the nurse measure. Answer

3) If an order has 10mcg/min, what is the drip rate in ml/hr?

Answer 10

Dosing Epinephrine
1MG/250ML
1) 1 - 4 mcg/min

2) Titrate Q1-2 mcg Q 20mins
Until Hemodynamically Stable. Keep patient on cardiac monitor, Caution MI in high doses

3) Conversion factor = x 15
10mcg/min = 10 x 15 = 150 ml/hr

Question 11

Dosing Dobutamine

1) Advise on how to dose Dobutamine. Answer?

2) 6 hrs after the start of infusion, the titration order was to increase dose to 7mcg/kg/min. Weight 90kg. Advise nursing on drip rate and monitoring. Answer?

Answer 11

Dobutamine
Weight based Dosing 70kg
500mg/250ml or 2000mcg/ml
1) Starting at 1-2mcg/kg/min,

Titrate Q5 mins, monitor vital signs
Maximum dose = 40mcg

2) Conversion factor = x 0.03

7mg/min = 7 x0.03x90 = 18.9 or 19 ml/hr.
If hypotension is noted after infusion, stop the infusion, and address fluid volume losses.

Question 12

Dosing Dopamine

1) What rate should provider start Dopamine.
Answer?

2) Maximum dose?. Answer?

Answer 12

Dopamine
Weight based Dosing 70kg
400mg/250ml
1) Starting dose 5mcg/min
Usual Dose 2-20mcg/min ,

2) Conversion factor = x 0.0375

5mg/min = 5 x70x0.0375 = 13.13 ml/hr

Question 13

Dosing Vasopressin

1) A Pharmacist Intern asked you for guidiance on how to dose Vasopressin - mg/kg/min or mcg/min. Patient weighs 80kg. Answer?

2) What dosing precautions if any would you provide and why? Answer?

Answer 13

Vasopressin
Units/mins dosing (not weight based)
20 units/100ml D5W or NS
1) Starting at 0.01 units/min

Usual dose 0.01 - 0.04 unit/min

2) Stopping drip MUST TITRATE DOWN - 0.01 unit/min

Rapid rebound hypotension is a frequent reaction to the abrupt discontinuation of the drip.

3) Doses > 0.04unit/min may lead to cardiac arrest

Question 14

Caution Levophed
What precaution for social history when starting Levophed?

Answer 14

Caution Levophed
Cocaine use

Question 15

Receptor Action: Levophed
Description?

Answer 15

Receptor Action: Levophed
Levophed (Norepinephrine) is a potent alpha/beta-agonist causing vasoconstriction and increased blood pressure

Question 16

Caution Dopamine
The next day after starting a patient on Dopamine, the nurse reported on Clinic round, what are the possible assessments and monitoring for Dopamine?

Answer 16

Caution Dopamine
1. Cardiac monitoring - can cause significant tachycardia
2. It can also increase renal perfusion. Monitoring urine is essential. Urine output Q1hr.
3. It can also cause vasoconstriction, limb ischemia, and
4. widened QRS complex.
5. Sulfite allergy

Question 17

Caution DoBUTAMINE
The nurse urgently called Pharmacy to report severe hypotension after infusion. What action is the appropriate steps?

Answer 17

Caution DoBUTAMINE
If hypotension is noted after infusion, stop the infusion, and address fluid volume losses.

This drug will cause hypotension in the presence of hypovolemia

Question 18

Caution Vasopressin
Please inform the Intern about the potential precautions or side effect to Vasopressin dosing? Answer “A.A.C.M.N.P”
1).
2).
3).
4).
5).

Answer 18

Caution Vasopressin
Doses > 0.04 can cause cardiac arrest

It can cause adverse reactions of
1. arrhythmias,
2. cardiac arrest,
3. angina,
4. myocardial ischemia, and
5. peripheral constriction.
6. Monitor for HypoNatremia

These reactions are usually seen in doses > 0.04 units/minute. Doses greater than 0.04 units/min may lead to cardiac arrest.

**Must titrate down to stop drip - titrate down slowly by 0.01 unit/minute

Question 19

Caution Epinephrine
What precaution for dose monitoring of Epinephrine?
1).
2).
3).
4).
5).
6).

Answer 19

Caution Epinephrine
Dose carefully
1. high dose poses risk of MI post recusitation
2. Keep patient on Cardiac Monitor
3. Do not give with alkaline solutions
4. Metabolic dysf., Metabolic acidosis
5. Decrease urine output,
6. hyperglycemia

Question 20

DD Interaction: Levophed
The medical resident asked you to screen patient profile before starting Levophed. What would you identify?
1).
2).

.

Answer 20

DD Interaction: Levophed
1) Avoid MAOIs
2) Avoid in Hypovolemia

Question 21

Receptor Action: Vasopressin
Description?
Metabolism sites?

Answer 21

Receptor Action: Vasopressin
Vasopressin is an antidiuretic hormone. It has unlabeled use in septic shock.

Its two primary functions are to retain water in the body and constrict blood vessels, thereby increasing blood pressure, increasing systemic vascular resistance, and decreasing heart rate.

Metabolized by kidneys/liver

Question 22

**Uses for Nipride? **
List 2 uses
1).
2).
3).

Answer 22

** Uses for Nipride? **

Nipride (sodium nitroprusside) is indicated for
1. hypertensive crisis,
2. acute pulmonary edema, and
3. congestive heart failure.

Question 23

Dosing Nipride

1) How should Nitroprusside dosing be titrated. Answer?

2) Advise on titrations if treating Hypertensive Crises. BP 210/90., Pt. weight 80kg. current dose 7mcg. Answer?

3) A nurse is concerned about Reversal for Nipride, please advise.

Answer 23

Dosing Niprideweight base **
50mg/250mls or 200mcg/ml
1). Usual dose:
0.3-10mcg/min

Titrating:
Q5-10 mins
slowly titrated until MAP decreases 5-10mmHg

Max. dose:
40

2). If treating a patient for a hypertensive crisis, MAP should be reduced by no more than 25% over the first hour.
In this scenario, target BP no greater than 157.
Conversion factor 0.3
Dose 0.3 x7mcgx80kg/min = 168ml/hr.

3) It acts quickly and is reversed quickly.

Question 24

Caution Nipride
Nurse noticed Mr. Jones altered mental status, and patient was complaining wanting Nipride to be stopped. How do you respond and what labs are you recommending to evaluate clinical status of this patient?

Answer 24

Caution Nipride
1) Nipride cannot be stopped abruptly, which may cause rebound hypertension and seizures
2) Nipride is cyanide toxic; signs and symptoms of toxicity possibly being that of altered blood ph and mental status changes. Monitor serum ph.
3) **To prevent cyanide toxicity, thiocyanate levels must be monitored.

Question 25

Receptor Action: Nipride
Description?

Answer 25

Receptor Action: Nipride
Nipride decreases Afterload.

Question 26

**Uses for Nipride? **
List 2 uses
1).
2).
3).

Answer 26

** Uses for Nipride? **

Nipride (sodium nitroprusside) is indicated for
1. hypertensive crisis,
2. acute pulmonary edema, and
3. congestive heart failure.