GENERIC NAME Dopamine

BRAND NAME Intropin

CLASSIFICATI ON Catecholamines , inotropic agents, vasopre ssors

DOSAGE/ ROUTE Important- This is a potent drug: It must be diluted before administration to the patient. Adult: IV- The recommended initial dose is 1-5 mcg/kg/min, up to 5-10 mcg/kg/min according to patient's response. IV infusion Initial dose of 0.5 to 1 mcg/kg/min; titrate every few min to desired response. Usual dosage is 2 to 20 mcg/kg/min, with rates up to 40 mcg/kg/min rarely used

INDICATION This medication is an adrenergic and dopaminergic cardiac stimulant, prescribed for heart failure. It increases the pumping strength of the heart.

CONTRAINDICATION Contraindicated in patients with pheochromocytoma, uncorrected tachyarrhythmias or ventricular fibrillation and hypersensitivity.

ADVERSE REACTION nausea, vomiting, tachycardia, ectopic beats, palpitation, anginal pain, hypotension, vasoconstriction, bradycardia, hypertension, dyspnea, headache, widened QRS complexes, azotemia.

NURSING CONSIDERATION Monitor vital signs , and ECG during infusion, watch for dsyarrythmias and ischemia also monitor, PCWP,CVP, CO2, and urinary output Monitor for possible adverse reaction Assess for heart failure: dyspnea, neck vain distention, Assess for oxygenation and perfusion deficit Before starting therapy, give a plasma volume to correct hypovolemia and cardiac glycoside Continuously monitor ECG, blood pressure, pulmonary artery wedge pressure, cardiac output and urine output

Dobutamiine

Dobutrex

Vasopressors

Treatment of cardiac decompensation caused by organic heart disease or cardiac surgical procedures

Nitroglycerin

Nitrostat

Nitrates

IV Initial dose, 5 mcg/min delivered through an infusion pump. Increase by 5mcg/min-increments every 35 min as needed. If no response at 20 mcg/min, increase increments to 1020 mcg/min. Once a partial BP response is obtained, reduce dose and lengthen dosage intervals; continually monitor response and titrate carefully

IV Treatment of perioperative hypertension; control of CHF in the setting of acute MI; treatment of angina pectoris in patients not responding to sublingual nitroglycerin and beta-blockers; induction of intraoperative hypotension.

Idiopathic hypertrophic subaortic stenosis; hypersensitivity to any component of the product; Dobutamine with dextrose should not be administered simultaneously with blood through the same infusion set because of the possibility of pseudoagglutination of red cells. Contraindicated with allergy to nitrates, severe anemia, early MI, head trauma, cerebral hemorrhage, hypertrophic cardiomyopathy, pregnancy, lactation

CNS: headache CV: hypertension, increased heart rate

Adverse effects CNS: Headache, apprehension, restlessness, weakness, vertigo, dizziness, faintness CV: Tachycardia, retrosternal discomfort, palpitations, hypotension, syncope, collapse, orthostatic hypotension, angina Dermatologic: Rash, exfoliative dermatitis, cutaneous vasodilation with flushing, pallor, perspiration, cold sweat, contact dermatitis transdermal preparations,

Assessment History: Allergy to nitrates, severe anemia, early MI, head trauma, cerebral hemorrhage, hypertrophic cardiomyopathy, hepatic or renal disease, hypotension or hypovolemia, increased intracranial pressure, constrictive pericarditis, pericardial tamponade, low ventricular filling pressure or low PCWP, pregnancy, lactation. Physical: Skin color, temperature, lesions; orientation, reflexes, affect; P, BP, orthostatic BP, baseline ECG, peripheral perfusion; R, adventitious sounds; liver

topical allergic reactionstopical nitroglycerin ointment GI: Nausea, vomiting, incontinence of urine and feces, abdominal pain Local: Local burning sensation at the point of dissolution (sublingual) Other: Ethanol intoxication with highdose IV use (alcohol in diluent) Furosemide Lasix Loop diuretic 20 mg, 40 mg, 80 mg tablets; 10 mg/mL, 40 mg/5 mL oral solution; 10 mg/mL injection

evaluation, normal output; liver and renal function tests (IV); CBC, Hgb

Oral, IV: Edema associated with CHF, cirrhosis, renal disease

Severe sodium and water depletion, hypersensitivity to sulphonamides and furosemide, hypokalaemia, hyponatraemia, precomatose states associated with liver cirrhosis, anuria or renal failure. Addisons disease.

Fluid and electrolyte imbalance. Rashes, photosensitivity, nausea, diarrhoea, blurred vision, dizziness, headache, hypotension. Bone marrow depression (rare), hepatic dysfunction. Hyperglycaemia, glycosuria, ototoxicity. Potentially Fatal: Rarely, sudden death and cardiac arrest. Hypokalaemia and magnesium depletion can cause cardiac arrhythmias.

Assessment & Drug Effects Observe patients receiving parenteral drug carefully; closely monitor BP and vital signs. Sudden death from cardiac arrest has been reported. Monitor BP during periods of diuresis and through period of dosage adjustment. Observe older adults closely during period of brisk diuresis. Sudden alteration in fluid and electrolyte balance may precipitate significant adverse reactions. Report symptoms to physician. Lab tests: Obtain frequent blood count, serum and urine electrolytes, CO2, BUN, blood sugar, and uric acid values during first few months of therapy and periodically thereafter. Monitor for S&S of hypokalemia . Monitor I&O ratio and pattern. Report decrease or unusual increase in output. Excessive diuresis

can result in dehydration and hypovolemia, circulatory collapse, and hypotension. Weigh patient daily under standard conditions. Monitor urine and blood glucose & HbA1C closely in diabetics and patients with decompensated hepatic cirrhosis. Drug may cause hyperglycemia. Note: Excessive dehydration is most likely to occur in older adults, those with chronic cardiac disease on prolonged salt restriction, or those receiving sympatholytic agents.