| Question | Answer |
| What class is epinephrine (1:10,000) | Sympathomimetic, vasopressor, bronchodilator |
| What are the mechanisms of action for epinephrine (1:10,000) | 1.) Beta stimulation leads to increased inortropic, chronotropic, and dromotropic effects. Increased CO. Increased myocardail oxygen requirements. |
| What are the MAO for epinephrine (1:10,000) | 2.) Beta 2 stimulation leads to peripheral vasodilation and bronchodilation |
| What are the MAO for epinephrine (1:10,000) | 3.) Alpha 1 stimulation leads to peripheral vasoconstriction, increased SVR, Makes heart more susceptible to countershock, increased afterload |
| What are the MAO for epinephrine (1:10,000) | 4.) Inhibits histamine release (stops degranulation) during anaphylactic reactions |
| What are the indications for epinephrine (1:10,000) | 1.) Asystole
2.) Vfib, pulseless Vtach
3.) PEA
4.) Severe anaphylaxis |
| What are the contraindications for epinephrine (1:10,000) | 1.) Hypersensitivity
2.) Patients with underlying cardiovascular disease
3.) Tachyarrhythmias
4.)Hypovolemic shock
5.) Not with alkaline drugs |
| What are the CNS side effects for epinephrine (1:10,000) | Anxiety, dizziness, headache, restlessness, SUBARACHNOID HEMORRHAGE, tremors, weakness |
| What are the cardiovascular side effects for epinephrine (1:10,000) | Anginal pain, DYSRHYTHMIAS, hypertension, PALPITATIONS, ischemia |
| What are the GI/GU side effects for epinephrine (1:10,000) | nausea (c), vomiting (c), urinary retention |
| What are the respiratory side effects for epinephrine (1:10,000) | dyspnea |
| What are the skin side effects for epinephrine (1:10,000) | pallor, coldness, necrosis, urticaria |
| What are the eye side effects for epinephrine (1:10,000) | pupil dilation |
| What are the precautions for epinephrine (1:10,000) | 1.) increased myocardial workload may lead to ischemia, infarction |
| What are the precautions for epinephrine (1:10,000) | 2.) Hypersensitivity (may have increased airway resistance due to sulfites in the preparation) |
| What are the precautions for epinephrine (1:10,000) | 3.) Use cautiously in patients with:
-heart disease
-diabetes
-hypertension
-given along with other sympathomimetics or with phosphodiesterase inhibitors (caffeine, amiophylline, dipyridamole, erectile dysfuntion meds) |
| What are the precautions for epinephrine (1:10,000) | 4.) Deactivated with sodium bicarbonate/lasix (alkaline solutions) |
| What are the precautions for epinephrine (1:10,000) | 5.) Patients on MOA inhibitors (marplan, nardil, parnate) potentiates the effects |
| How is epinephrine (1:10,000) supplied | 1mg/10mL = 1:10,000 prefilled syringe |
| How is epinephrine (1:10,000) administered | IVP, IO, ET |
| How is epinephrine (1:10,000) given (dose) - cardiac arrest | 1mg (1:10,000) IVP or IO
Followed by a 20mL flush
Raise the patients arm for 10-20 seconds
Repeat every 3-5 minutes |
| How is epinephrine (1:10,000) given (dose) - anaphylaxis | 0.1mg (1mL) SIVP (1:10,000) over 5 minutes
repeat in 5-15 minutes PRN |
| What is dopamine class | Sympathomimetic, vasopressor |
| What are the MAO for dopamine | catecholamine that stimulates dopaminergic, beta, and alpha adrenergic receptors (dose dependent)
Naturally occuring precursor of norepinephrine |
| What is the MAO for dopamine (low dose) | Low doses (dopaminergic stimulation) leads to : (0.5 to 2mcg/kg/min) - NOT used in the field
-Renal, mesenteric, cerebral, coronary vasodilation
-Increased urinary output |
| What is the MAO for dopamine (intermediate dose) | Intermediate doses (beta 1 stimulation) leads to: (2 to 10mcg/kg/min)
-positive inotropic, chronotropic, dromotropic effects
-increased cardiac output
-increased myocardial oxygen requirements |
| What is the MAO for dopamine (high dose) | High doses (alpha 1 stimulation) leads to peripheral vasoconstriction: (10 to 20mcg/kg/min)
-Arterial and venous vasoconstriction (vasopressor)
-Increased SVR
-Vasoconstriction to renal, mesenteric, and coronary vessels
-Increased afterload |
| What are the indications for dopamine | cardiogenic shock, neurogenic shock, septic shock, hypotension that occurs after ROSC, symptomatic bradycardia (refractory, not responding to oxygen, atropine, or pacing), symptomatic heart blocks (2nd type 2 and 3rd), severe CHF |
| What are the contraindications for dopamine | not used first line for hypovolemic shock, tachyarrhythmias or vfib, patients with pheochromocytoma (catecholamine producing tumor on adrenal gland), known hypersensitivity, not with alkaline solutions |
| What are the CNS side effects for dopamine | headache (c), anxiety |
| What are the cardiovascular side effects for dopamine | Anginal pain (c), tachycardia (c), ectopic beats (c), palpitations (c), vasoconstriction (c), aberrant conduction, hypertension (rise in diastolic pressure) |
| What are the eyes side effects for dopamine | Dilated pupils (in high doses) |
| What are the respiratory side effects for dopamine | dyspnea (c) |
| What are the GI effects for dopamine | nausea (c), vomiting (c) |
| What are the skin side effects for dopamine | gangrene (high doses for a long time), necrosis, tissue sloughing with extravasation |
| What are the precautions for dopamine | 1.) May cause increased workload on the heart |
| What are the precautions for dopamine | 2.) Hypoxia, hypercarbia, acidosis reduce drug effectiveness |
| What are the precautions for dopamine | 3.) Tissue necrosis if it infiltrates |
| What are the precautions for dopamine | 4.) High doses may cause pradoxical hypotension because the increased SVR = decrease in stroke volume and cardiac output |
| What are the precautions for dopamine | 5.) Discontinue use gradually |
| What are the precautions for dopamine | 6.) Deactivated with sodium bicarbonate/lasix (alkaline solutions) |
| What are the precautions for dopamine | 7.) Patients on MAO inihibitors (Marplan, Nardil, Parnate) potentiates the effects |
| What are the precautions for dopamine | 8.) Beta blockers may blunt the inotropic effects |
| What are the precautions for dopamine | 9.) When given with phenytoin (dilatnin) - hypotension, bradycardia, and seizures may develop |
| What are the precautions for dopamine | 10.) Given along with other sympathomimetics or with phosphyodiesterase inhibitors (caffeine, amiophylline, dipyridamole, erectile dysfunction meds) may exacerbate dysrhythmia respons |
| How is dopamine supplied | -200mg/5mL
-400mg/5mL
-800mg/5mL
READ LABEL CAREFULLY |
| How is dopamine given | Administered: titrate intravenous infusion (IV infusion, piggyback) |
| How is dopamine prepared | 200, 400, 800mg in 250-500mL
Beta dose range: 2-10mcg/kg/mi (start at 2-5)
Alpha dose range: 10-20mcg/kg/min (start at 10-15mcg/kg/min |
| What other name does dopamine go by | intropin |
| What class is norepinephrine | sympathomimetic, agonist, vasopressor |
| What is the MAO of norepinephrine | Alpha 1 stimulation leads to peripheral vasoconstriction:
-arterial/venous vasoconstriction
-increased SVR
-Increased afterload could result in increased back pressure on the heat leading to increased workload and O2 requirements |
| What is the MAO of norepinephrine | Beta 1 stimulation leads to positive inotropic, chronotropic, and dromotropic effects, increased myocardial O2 requirements, increased cardiac output
PREDOMINATELY ALPHA 1 STIMULATION DRUG |
| What are the indications for norepinephrine | Use if other vasopressors aren't workikng - severe hypotension <70mmHg, drug of last resort
-cardiogenic shock
-neurogenic shock
-septic shock
-poison/drug induced hypotension
-blood pressure support after resuscitation from cardiac arrect |
| What are the contraindications for norepinephrine | 1.) hypotension due to hypovolomia (need appropriate fluid replacement first)
2.) profound hypoxia
3.) profound hypercarbia
4.) hypertension
5.) hypersensitivity |
| What are the CNS side effects for norepinephrine | headache (c), restlessness, tremor, dizziness, anxiety |
| What are the cardiovascular side effects for norepinephrine | reflex bradycardia, DYSRHYTHMIAS, CHEST PAIN, hypertension, palpitations, tachycardia, decreased cardiac output |
| What are the GI side effects for norepinephrine | nausea (c), vomiting (c), organ ischemia |
| What are the GU side effects for norepinephrine | oliguria, renal failure, organ ischemia |
| What are the respiratory side effects for norepinephrine | distress, dyspnea, apnea |
| What are the eyes side effects for norepinephrine | photophobia |
| What are the skin side effects for norepinephrine | diaphoresis, gangrene, necrosis (with infiltration) |
| What are the precautions for norepinephrine | 1.) Increases myocardial workload and O2 consumption
2.) If it infiltrates it can cause tissue necrosis
3.) May contribute to hypoxia due to pulmonary vasoconstriction |
| What are the precautions for norepinephrine | 4.) Use cautiously with:
-cardiogenic shock
-acute MI
-CHF
-in the presence of hypoxia,hypercarbia, acidosis
-MAO inhibitor therapy within 14 days (Marplan, Nardil, Parnate)
-beta adrenergic antagnosists blunt the beta 1 effects |
| How is norepinephrine supplied | 4mg/4mL |
| How is norepinephrine administered | administered IV infusion (piggyback) |
| How is norepinephrine given (dose) | Mix: 4mg/250mL or 8mg/500mL in D5W
Dosage range: 0.1 to 0.5mcg/kg/min
Titrate to systolic BP 90-110mmHg
Higher doses may be needed for poison/drug induced hypotension
CONSTANTLY ASSESS HEMODYNAMIC STATUS |
| What other name is norepinephrine have | Levophed (leave em dead) |
| What class is propranolol | non-selective beta-adrenergic blocker (beta 1 and beta 2), sympatholytic, antihypertensive, antianginal |
| What are the MOA of propranolol | Blocks beta 1 receptors leading to:
-depressed automaticity at the SA node
-decreased AV node and intraventricular conduction
-decreased heart rate and force of contraction
-decreased myocardial O2 consumption
-decreased BP |
| What are the MOA of propranolol | Block beta 2 receptors leading to:
-possible bronchoconstriction |
| What are the MOA of propranolol | Decreases renin release from the kidneys (blocks beta 1 receptors in kidneys)
-vasodilation |
| What are the indications of propranolol | Stable supraventricular tachyarrythmias (refractory to other therapies - vagal maneuver and adenosine) -HR 150 and above |
| What are the indications of propranolol | To prevent recurrent Vtach - HR 150 and above |
| What are the indications of propranolol | Stable Afib/Aflutter with RVR - HR 150 and above |
| What are the indications of propranolol | Stable MAT - HR 150 and above
to prevent angina
to treat hypertension |
| What are the contraindications of propranolol | asthma/COPD
bradycardia/heart blocks (second and third degree)
CHF patients
cardiogenic shock
any patient with depressed cardiac function
cocaine intoxication |
| What are the CNS side effects of propranolol | depression, dizziness (c), drowsiness, fatigue (c), hallucinations, insomnia, lethargy (c) |
| What are the cardiovascular side effects of propranolol | bradycardia, CHF, cold extremities, postural hypotension, profound hypotension, 2ND OR 3RD HEART BLOCKS, vasodilation |
| What are the GI side effects of propranolol | diarrhea, dry mouth, nausea (c), vomiting |
| What are the eyes/ears side effecs of propranolol | dry/burning eyes, visual disturbances |
| What are the metabolic side effects of propranolol | hypoglycemia |
| What are the respiratory side effects of propranolol | BRONCHOSPASMS, dyspnea, wheezing |
| What are the precautions of propranolol | -DM
-renal/hepatic disease
-peripheral vascular disease
-history of systemic sting reaction (anaphylactic reactions)
-may mask the symptoms of hypoglycemia
-myasthenia gravis |
| How is propranolol administered | 1mg/1mL |
| What is the dose for propranolol? | Initial dose: 1-3mg SIVP (1mg/min) - May dilute in 10-30mL
Subsequent dose: May repeat dose in 2 minutes
Total dose: 5mg |
| What is the other name for propranolol | inderol |
| What do you give in toxic cases of propranolol | IV calcium may restore BP in toxic cases
IV glucagon - exerts positive inotropic action on the heart and decreased renal vascular resistance
Effects may also be reversed with NE, dopamine, or epi
Atropine should be available |
