Pharm Exam 2: Medications for Shock and Hypotension

Alpha 1 receptors act on...

arterioles and veins (vasoconstriction)

Beta 1 receptors act on...

cardiac tissue (increasing heart rate, contractility, conduction)

Beta-2 receptors act on...

lungs (bronchodilation, vasodilation)

Give IV fluids and norepinephrine for

Hypovolemic shock

Give dobutamine and norepinephrine for...

cardiogenic shock

Give norepinephrine, epinephrine, and vasopressin for...

distributive shock

Treat cause, give norepinephrine for...

obstructive shock

What type of agonist is epinephrine?

Alpha and beta

Administration concerns for epinephrine (3)

Monitor ECG for arrhythmias

Incompatible with alkaline solutions

Use a central line to prevent tissue necrosis

What are the three backup meds given for anaphylactic shock (along with epi)?

Antihistamines

Histamine 2 blockers

Corticosteroids

What type of agonist is norepinephrine?

Alpha-1 agonist (so vasoconstriction)

What is the first-line vasopressor for sepsis?

Norepinephrine

Administration guidelines for norepinephrine

MUST use central line to prevent peripheral extravasation

Continuous BP monitoring

What are three contraindications for norepinephrine?

1) Uncorrected hypovolemia

2) Pheochromocytoma

3) V. fib

A patient took WHAT type of drug within 14 days and should avoid norepinephrine?

MAO inhibitors

What do you give if a patient has extravasation from norepinephrine?

phentolamine infiltration

Dopamine: low-dose effect (2-5 mcg/kg)

renal vasodilation and increased urine output

Dopamine: moderate-dose effect (5-10 mcg/kg)

increased cardiac contractility and cardiac output

Dopamine: high-dose effect (>10 mcg/kg)

vasoconstriction, increased BP

What med do you NOT mix with dopamine?

Bicarbonate

What is the action of dobutamine?

increased myocardial contractility without significant increase in HR. Improves cardiac output and stroke volume.

Does dobutamine have alpha effects?

NOPE.

What do you titrate dobutamine to?

cardiac output

What are four contraindications to dobutamine?

1) IHSS

2) Pheochromoctyoma

3) Unprotected tachyarrhythmias

4) Ventricular arrhythmias

What is the action of phenylephrine?

Alpha 1 agonist - vasoconstriction

What are three indications for phenylephrine?

Hypotension

V. tach

Narrow angle glaucoma

What are four adverse effects of phenylephrine?

-Reflex bradycardia

-Hypertension

-Tissue necrosis

-Reduced organ perfusion