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GENERIC NAME:

Dopamine Hydrochloride

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BRAND NAMES:

Dopamine, Dopastat, Intropin, Revimine

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DRUG CLASSIFICATION:

Autonomic Nervous System Agent; Alpha- and Beta-adrenergic agonist (Sympathomimetic)

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MECHANISM OF ACTION:

Neurotransmitter occurring naturally and norepinephrine's immediate precursor. Major cardiovascular effects produced in the mesenteric and renal vascular beds through direct action on the alpha and beta adrenergic receptors and on the dopaminergic receptors. A positive myocardial inotropic effect increases heart output by increasing systemic and pulse pressure, and little or no diastolic pressure effects. Improves circulation in the renal vascular bed by reducing the vascular resistance and thus the rates of glomerular filtration and urinary performance are increased.

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STOCK DOSAGE:

200 mg/5 mL Vial (40 mg/mL)

400 mg/5 mL Vial (80 mg/mL)

800 mg/5 mL Vial (160 mg/mL)

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INDICATION:

Dopamine HCl is indicated in myocardial infarction, trauma, endotoxic septicemia, open-heart surgery, kidney failure, and chronic cardiac decompensation as in congestive failure in the correction of hemodynamic imbalances present in shock syndrome. Patients in whom physiological parameters such as urine flow, myocardial function, and blood pressure have not experienced a profound deterioration are most likely to respond to dopamine HCl appropriately. The shorter the time between onset and symptoms, and start of volume correction therapy and dopamine HCl is indicated by multiclinic trials, the better the prognosis. Where appropriate, a proper plasma or entire blood expander should restore blood volume before dopamine HCl is administered.

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CONTRAINDICATIONS:

Contraindicated to patient with pheochromocytoma and tachyarrhythmias or ventricular fibrillation. Safe use during pregnancy (category C), lactation, or children is not established.

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SIDE EFFECTS/ADVERSE REACTIONS:

Cardiovascular System: Ventricular arrhythmia, atrial fibrillation, ectopic beats, tachycardia, anginal pain, palpitation, cardiac conduction abnormalities, widened QRS complex, bradycardia, hypotension, hypertension, vasoconstriction

Respiratory System: Dyspnea

Gastrointestinal System: Nausea and vomiting

Metabolic/Nutritional System: Azotemia

Central Nervous System: Headache and anxiety

Dermatological System: Piloerection

Other: Gangrene of the extremities has occurred when high doses were administered for prolonged periods or in patients with occlusive vascular disease receiving low doses of dopamine HCl.

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NURSING INTERVENTIONS:

· Monitor patient’s blood pressure, pulse, peripheral pulses, and urinary output at intervals prescribed by physician.

· Report the following indicators promptly to physician: Reduced urine flow rate in absence of hypotension; ascending tachycardia; dysrhythmias; disproportionate rise in diastolic pressure; signs of peripheral ischemia such as pallor, cyanosis, mottling, coldness, complaints of tenderness, pain, numbness, or burning sensation.

· Monitor therapeutic effectiveness.

· Medication must be diluted before administration to the patient.

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GENERIC NAME:

Norepinephrine Bitartrate

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BRAND NAME:

Levarterenol, Levophed, Noradrenaline

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DRUG CLASSIFICATION:

Alpha/Beta Adrenergic Agonists

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MECHANISM OF ACTION:

The sympathomimetic amine directly acts identical to body norepinephrine catecholamine. It affects alpha-adrenergic receptors directly and predominantly; little effect on beta receptors but on the heart (beta1 recipient). Vasoconstriction and heart stimulation; also strong resistance and blood vessel ability restriction.

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STOCK DOSAGE:

4 mg/4 mL (1 mg/mL)

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INDICATION:

It increases blood pressure in severe acute hypotension adult patients. The subsequent inotropic stimulation and vasoconstriction of the heart lead to increased systolic and diastolic blood pressure, myocardial oxygenation, blood circulation of the coronary artery, and cardiac work. It also contributes to the restoration of BP in certain high blood pressure conditions, including shock, sympathy, pheochromocytomectomy, spinal anesthesia, poliomyelitis, IM, septicemia, blood transfusion and drug reactions. Also as a supplement in heart arrest treatment.

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CONTRAINDICATIONS:

Contraindicated to patient who use as sole therapy in hypovolemic states, except as temporary emergency measure; mesenteric or peripheral vascular thrombosis; profound hypoxia or hypercarbia; use during cyclopropane or halothane anesthesia; pregnancy (category D), lactation.

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SIDE EFFECTS/ADVERSE REACTIONS:

Cardiovascular System: Hypertension and bradycardia
Nervous system disorders: Anxiety and headache
Respiratory disorders: Respiratory difficulty and pulmonary edema.

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NURSING INTERVENTIONS:

· Monitor constantly while patient is receiving norepinephrine. Take baseline BP and pulse before start of therapy, then q2min from initiation of drug until stabilization occurs at desired level, then every 5 min during drug administration.

· Adjust flow rate to maintain BP at low normal (usually 80–100 mm Hg systolic) in normotensive patients. In previously hypertensive patients, systolic is generally maintained no higher than 40 mm Hg below preexisting systolic level.

· Observe carefully and record mental status, skin temperature of extremities, and color of earlobes, lips, nail beds in addition to vital signs.

· Monitor I&O. Report decrease in urinary output or change in I&O ratio.

· Be alert to patient's complaints of headache, vomiting, palpitation, arrhythmias, chest pain, photophobia, and blurred vision as possible symptoms of overdosage. Reflex bradycardia may occur as a result of rise in BP.

· Continue to monitor vital signs and observe patient closely after cessation of therapy for clinical sign of circulatory inadequacy.

· Store the medication at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). Store in original carton until time of administration to protect from light. Discard unused portion.