Term
Norepinephrine (Levophed)
Mechanisms of Action |
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Definition
•Endogenous catecholamine
•Potent alpha-adrenergic receptor stimulation
•Increases myocardial contractility due to weaker beta-1 effects
•Arterial and venous vasoconstriction from potent alpha stimulation
•Increased SVR (afterload) increases blood pressure and may diminish cardiac output.
•Due to an increase in myocardial oxygen demand, may worsen myocardial ischemia, especially if coronary vasoconstriction is induced by coronary alpha receptor stimulation. |
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Term
Norepinephrine (Levophed)
Indications |
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Definition
•Hemodynamically significant hypotension refractory to other sympathomimetics
•Cardiogenic shock
•Used more often with low SVR states (e.g., sepsis) than in MI-related hypotension |
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Term
Norepinephrine (Levophed)
ContraIndications |
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Definition
•Hypotension due to hypovolemia (may be used as a temporary agent until volume can be replaced)
•Profound hypoxemia or hypercarbia
•Mesenteric or peripheral vascular thrombosis
•Pre-existing hypertension
•Use with caution in patients with heart disease and/or hyperthyroidism. |
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Term
Norepinephrine (Levophed)
Precautions |
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Definition
•Taper infusion off slowly to prevent severe hypotension.
•Extravasation causes tissue necrosis and sloughing (use phentolamine (regitine), 5 - 10 mg diluted in 15 ml of 0.9% NSS to minimize damage).
•Avoid mixing with sodium bicarbonate (forms a precipitate). |
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Term
Norepinephrine (Levophed)
Dosages |
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Definition
•Start at 0.5 - 1.0 mcg/min
•Titrate to desired effect (SBP of 90 - 100 mmHg); up to 30 mcg/min
•Adult dosage commonly 2 - 12 mcg/min
•Mix 4 ml ampule (1 mg/ml) in 500 ml D5W or 0.9% NSS to make 8 mcg/ml |
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Term
Phenylephrine (Neo-synephrine)
Medication Classifications |
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Definition
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Term
Phenylephrine (Neo-synephrine)
Mechanisms of Action |
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Definition
•Potent direct-acting sympathomimetic (synthetic) with strong alpha-adrenergic and weak beta-adrenergic cardiac stimulant properties
•Elevates systolic and diastolic pressures due to peripheral arteriolar constriction.
•Constricts capacitance vessels and increases venous return.
•Cardiac output is slightly decreased due to the increase in afterload.
•Coronary blood flow is increased.
•Rise in blood pressure may cause reflex bradycardia due to aortic baroreceptor stimulation.
•Produces little or no CNS stimulation |
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Term
Phenylephrine (Neo-synephrine)
Indications |
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Definition
•Hypotension from shock, shock-like states, or drug-induced shock
•To overcome PSVT
•During anesthesia to maintain adequate level of blood pressure and prolong anesthesia drug’s effects |
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Term
Phenylephrine (Neo-synephrine)
Precautions |
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Definition
•Use vein of antecubital fossa or central line to prevent extravasation.
•Avoid getting medication on hands and then rubbing eyes (may cause aniscoria, blurred vision, and compromised depth perception).
•Monitor BP and CVP every 2 - 5 minutes. |
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Term
Phenylephrine (Neo-synephrine)
Contra-indications |
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Definition
•Severe coronary disease or hypertension
•Hypotension due to hypovolemia
•Ventricular tachycardia
•Cautious use in thyroid dysfunction, diabetes mellitus, myocardial disease, bradycardia, or cerebral atherosclerosis |
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Term
Phenylephrine (Neo-synephrine)
Dosages |
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Definition
•Titrate 0.1 - 0.18 mg/min until BP stabilizes, then 0.04 - 0.06 mg/min for maintenance infusion.
•Dilute 10 mg in 500 ml D5W or 0.9% NSS to make 0.02 mg/ml concentration. |
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Term
Norepinephrine (Levophed)
Medication Classifications |
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Definition
•Vasopressor
•Sympathomimetic |
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Term
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Definition
Norepinephrine
Phenylephrine
Dopamine
Dobutamine
Vasopressin(antidiuretic, Hemostatic) |
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Term
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Definition
Nitroglycerin
Morphine sulfate(narcotic Analgesic)
Sodium nitroprusside
Hydralazine
Inamrinone(inotropic agent)
Milrinone(inotropic agent) |
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Term
Dopamine (Inotropin)
Medication Classifications |
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Definition
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Term
Dopamine (Inotropin)
Mechanism of action low and mid dose |
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Definition
•Chemical precursor of norepinephrine
•Low doses = dopaminergic receptor stimulation
•Vasodilation of renal, mesenteric, and cerebral arteries
•Urine output increased, while heart rate and blood pressure are usually unchanged
•Mid-range doses = beta-1 adrenergic receptor stimulation with weak alpha-stimulation
•Increased cardiac output due to increased heart rate and contractility
•Small increase in SVR
•Weaker alpha-1 at this dose antagonized by beta-1 stimulation |
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Term
Dopamine (Inotropin)
Mechanism of action high dose |
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Definition
•High doses = alpha-adrenergic receptor stimulation
•Renal, mesenteric, and peripheral vasoconstriction
•Increase in SVR and preload
•Doses above 20 mcg/kg/min produce alpha stimulation similar to norepinephrine
•Increases myocardial work without compensatory increase in coronary blood flow |
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Term
Dopamine (Inotropin)
Indications |
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Definition
•Cardiogenic shock
•Hemodynamically significant hypotension, in absence of hypovolemia (systolic blood pressure [SBP] < 70 mmHg)
•CHF, in combination with other agents (such as sodium nitroprusside) |
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Term
Dopamine (Inotropin)
Precautions |
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Definition
•Excessive vasoconstriction at high doses
•Can compromise circulation to the extremities in some patients (monitor peripheral pulses, color, and temperature).
•Will increase heart rate and may cause supraventricular or ventricular arrhythmias.
•Increased myocardial workload without increase in coronary perfusion can cause or worsen ischemia.
•Taper infusion carefully to avoid acute hypotension.
•Monoamine oxidase (MAO) inhibitors may potentiate effects of dopamine. |
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Term
Dopamine (Inotropin)
ContraIndications |
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Definition
•Cardiogenic shock
•Uncorrected tachyarrhythmias
•Ventricular fibrillation
•Hemodynamically significant hypotension, in presence of hypovolemia (SBP < 70 mmHg) |
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Term
Dopamine (Ionotropin)
Dosage |
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Definition
•Low dose: 2 - 5 mcg/kg/min
•Mid-range dose: 5 - 10 mcg/kg/min
•High dose: > 10 mcg/kg/min
•Titrate dosage to desired hemodynamic effect, using data from right heart catheterization as measure of effects.
•Dilute 400 mg in 250 ml D5W for concentration of 1600 mcg/ml. |
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Term
Hydralazine (Apresoline)
Medication Classifications |
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Definition
•Anti-hypertensive
•Direct vasodilator |
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Term
Hydralazine (Apresoline)
Mechanisms of Action |
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Definition
•Non-nitrate vasodilator and antihypertensive
•Reduces blood pressure mainly by direct effects on vascular smooth muscles of the arterioles, resulting in vasodilation
•Little effect on venous-capacitance vessels
•Diastolic response often greater than systolic
•Vasodilation reduces afterload and substantially improves cardiac output, as well as renal and cerebral perfusion.
•Hypotensive effect may be limited by sympathetic reflexes (increases in heart rate, stroke volume, and cardiac output). |
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Term
Hydralazine (Apresoline)
Indications |
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Definition
•Moderate to severe hypertension, including acute hypertensive emergency
•Pregnancy-induced hypertension and preeclampsia
•May be used in conjunction with cardiac glycosides or other vasodilators in short-term treatment of CHF
•Unexplained pulmonary hypertension |
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Term
Hydralazine (Apresoline)
Contraindications |
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Definition
•Coronary artery disease or MI
•Pre-existing hypotension
•Persistent tachycardia
•Advanced renal impairment
•Mitral valve disease |
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Term
Hydralazine (Apresoline)
Precautions |
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Definition
•Taper drug slowly to avoid sudden possible rise in blood pressure.
•Blood dyscrasia resulting in decrease in hemoglobin and hematocrit
•Obtain baseline and periodic BUN, creatinine, uric acid, serum potassium, blood glucose, and CBC; also obtain ECG.
•Use with caution if used concomitantly with beta-adrenergic blockers.
•Tartrazine may be contained in some products; may cause allergic-type reaction in patients who also have aspirin hypersensitivity. |
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Term
Hydralazine (Apresoline)
Adverse reactions |
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Definition
•Headache and dizziness
•Palpitations and tachycardia
•Drug-induced hypotension
•Angina
•Nausea and vomiting, diarrhea, anorexia
•Decreased hematocrit and hemoglobin levels
•Hypersensitivity reactions: rash, urticaria, fever, chills, arthralgia, hepatitis, eosinophilia |
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Term
Hydralazine (Apresoline)
Dosages |
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Definition
•Hypertension in adults:
•: 10 - 50 mg QID
•Intravenous: 5 - 40 mg slow IV push over 1 - 2 minutes, may repeat every 4 - 6 hours as needed
•Hypertension in geriatrics: start with 10 mg PO BID or TID and titrate as needed |
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Term
Inamrinone
Medication Classification |
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Definition
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Term
Inamrinone
Mechanism of Action |
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Definition
*Phosphodiesterase inhibitor; noncatecholamine inotropic agent
* Formerly called amrinone
* Inhibits peak IIIcyclic AMP isoemzyme in cardiac and vascular muscle, resulting in direct inotropic effect and drect arterial vasodilation; effects are linked to inhibition of phosphodiesterase
*Drug acts slightly different than digitalis and beta adrenergic stimulants
* Rapid acting potent inotropic and vasodilator
*Cardiac output increases and SVR and preload decrease at dosages of 2-15 mcg/kg/min
*higher dosage produces tachycardia
*Hemodynamic effects are similar to dobutamine |
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Term
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Definition
*Severe CHF refractory to diuretics, vasodilators, and conventional inotropic agents
Additive to digitalis and catechoamine therapy
* Promotion of hemodynamic improvements in patients with CHF from ischemic heart disease |
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Term
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Definition
*Clear yellow in appearance
*Store at room temperature and protect from light
* May increase or induce myocardial ischemia
* Do not mix with furosemide(LAsix)or dextrose containing solutions
* Adjust dosage frequently to achieve desired effect at the lowest possible dosage |
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Term
Inamrinone
Contra indications |
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Definition
*Hypersensitivity to inamrinone or bisulfites
*pre-existing hypotension
*presence of uncorrected aortic or pulmonic valve obstruction
*Right ventricular outflow tract or left ventricular outflow tract obstruction
*Patients with uncorrected hypokalemia or dehydration |
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Term
Inamrinone
Adverse Reactions |
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Definition
-Nausea and vomiting
-Thrombocytopenia due to hepatotoxicity
-Dose-dependent Tachydysrhythmias, ventricular irritability, hypotension
-Muscular stiffness, myalgias, tenderness, and localized inflammatory reaction at site of infusion
-Hypersensitivity reaction (Itching) may occur with long term use
-Fever |
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Term
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Definition
-IV
-Loading dose: 0.75 mcg/kg over 2-5 min.
-Infusion @5-10 mcg/kg/min, titrated to desired effect
-Adjust frequently to achieve optimal effects at lowest possible dose
-Mix 20 ml ampule of 100mg(5mg/ml) with 0.9% NS for 1-3mg/ml concentration |
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Term
Digitalis
Medication Classification |
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Definition
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Term
Digitalis
Mechanism of Action |
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Definition
-Cardiac Glycoside
-mild positive inotropic effect due to increased calcium in the sarcoplasmic reticulum, increasing contractility
-Vasoconstriction of coronary and mesenteric arteries is due to increased calcium levels; increases SVR via increased vascular tone
-since digitalis effects are caused by increased calcium concentrations,betablockers have no effects on positive inotropic activity
-Slows AV nodeal conduction by lengthening the refractory period
-Increaes aortic root baroreceptor sensitivity
-Results i reduction in heart rate due to increased arterial pressure
-High doses cause increased and potentionally dangerous adrenergic activity(binds to muscle as well as in the plasma |
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Term
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Definition
-Effective control of ventricular response in atrial tachydysrhythmias without adversely affecting contractility
-Calcium channel blockers may supplant digitalis as drug of choice for atrial fibrillation
-If the BP is high, use calcium channel blocker
-If the BP is normal or low , use digitalis
-May convert PSVT to normal sinus rhythm
- Congestive heart failure |
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Term
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Definition
-Toxicity occurs i 20% of all patients
-Toxicity and overdose treated with Digibind
-Hypokalemia
-Hypokalemia sensitizes the myocardium to digitalis
-May alter onset and rate of positive inotropic effects
-Hyperkalemia possible with massive digitalis overdose
-Causes massive coronary vasoconstriction
-May induce or worsen ischemia |
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Term
Digitalis
Contra indications |
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Definition
-Ventricular tachycardia or ventricular fibrillation
-Acute myocardial infarction
-High degree AV blocks
-Digitalis intoxication
-WPW syndrome
-use with cautin if at all |
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Term
Digitalis
Adverse Reactions |
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Definition
-Increases slope of phase 4 of action potential
-May induce delayed after depolarizations
-Results in ectopy
-Alters the ECG
-Increases the PR interval
-Depresses the ST Segment, scooped appearance
-Flattens or inverts t waves
-Shortens the QT Interval |
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Term
Digitalis
Adverse reactions |
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Definition
-Slows impulse tranmission throught hte ventricular conduction system
-Wide range of Cardiac Arrhythmias
-Extra cardiac side effects
-Anorexia
-Nausea and Vomiting
-Diarrhea
-Fatigue
-Mental status Change
-Blurred vision
-Yellow-green hue to visual spectrum
-Presence of Halos around lights |
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Term
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Definition
•Loading dose: 10 - 15 mcg/kg
•IV effects in 5 - 30 minutes and peaks in 1.5 - 3.0 hours
•Maintenance dosing dependent on body size and renal function (monitor creatinine clearance)
•Normal therapeutic range is 0.5 - 2.0 ng/ml.
•Also available in oral preparations (0.125, 0.25, and 0.50 mg tablets) |
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Term
Furosemide (Lasix)
Medication Classification |
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Definition
•Antihypertensive
•Diuretic |
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Term
Milrinone (Primacor)
Medication Classification |
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Definition
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Term
Milrinone (Primacor)
Mechanism of Action |
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Definition
| Phosphodiestrerase inhibitor; noncatecholamine inotropic agent |
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Term
Milrinone (Primacor)
Indications |
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Definition
-short term treatment of CHF refractory to diuretics or digitalis
-TO increase cardiac output and to reduce pulmonary capillary wedge pressure and SVR without increasing myocardial oxygen demand
-Chronic heart failure with decompensation |
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Term
Milrinone (Primacor)
Precautions |
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Definition
-Use cautously in patients with atrial flutter ar fibrillation due to shortening of AV nodal conduction time and poential for increased ventricular response
-Avoid infusion in same IV line as Furosemide
-Monitor Vial Signs, Cardiac monitor, I&Os, renal function, and platelet level
-Expect dose reduction as cardiac output and urinary output improve |
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Term
Milrinone (Primacor)
Contra Indications |
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Definition
-Hypersenitivity to the drug
-Severe aortic and pulmonary valvular stenosis
-Hypertrophic cardiomyopathy
-Acute MI
-Hypotension |
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Term
Milrinone (Primacor)
Adverse Reactions |
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Definition
-Headache
-Ventricular ectopy. ventricular tachycardia, v-fib
-Hypotension
-Chest pain and cardiac ischemia
-Thrombocytopenia
-Local tissue discomfort or necrosis |
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Term
Milrinone (Primacor)
Dosage |
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Definition
-Inital loading dose; 50mcg/kg slow push over 10 min
-Continuous infusion: .375 -.75 mcg/kg/min
-Titrate dose to desired effect
-Commonly used concomitantly with digitali and diuretics
-with renal impairment max dose is 1.13 mg/kg/day |
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Term
Furosemide (Lasix)
Mechanism of action |
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Definition
-Diuretic
-Inhibits the reabsorbtion or sodium and chloride in the Kidneys
-Decreases reanl vascular resistance; increases reanl blood flow and urine output |
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Term
Furosemide (Lasix)
Indications |
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Definition
Edema asociated with CHF, cirrhosis of the liver, and ranal disease
-Initiation of rapid diuresis in acute pulmonary edema
-Volume overload
-Mild impairment of renal function |
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Term
Furosemide (Lasix)
Precautions |
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Definition
-Observe for signs of electolyte disturbances
-Digitalis may exacerbate metabolic effect of hypokalemia |
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Term
Furosemide (Lasix)
Contra Indications |
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Definition
-Anuria(Renal failure)
-Hypersensitivity to sulfonamides
-Chronic metabolic alkalosis or hyper kalemia
-hypotension or dehydration |
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Term
Furosemide (Lasix)
Adverse reactions |
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Definition
-Electrolyte depeletion: hypokalemia, hyponatremia
-dehydration, hypotension
-Vascular thrombosis or embolism
-Hypergycemia
-Nausea, vomiting, diarrhea, cramping
-rash urticaria, leukopenia, anemia |
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Term
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Definition
IV or Oral
IV - 20-80 mg in increment of 20mg
oral- 20 -40 mg initially titrate to desired effect |
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