Nursing School - Medications: Adrenergic Agonist - Overview/Agents Used to Treat Shock,
Cardiac Arrest, and Anaphylaxis
actions of medications:
-sympathetic nervous system stimulation: improve circulation and preserver blood flow
to the vital organs
-a1 (alpha) receptor activation -> peripheral blood vessels constrict and bp
increases -> forcing blood to the vital organs
-B1 receptor activation -> HR increases and heart will contract more strongly
-dopamine receptor activation -> dose dependent; low dose= increases blood flow
to the organs; high dose: stimulated beta 1 receptors
-milrinone -> does not affect the ANS receptors
medications that stimulation a1 receptors (alpha 1 receptors): constrict the peripheral blood
vessels or snake them smaller -> BP increases
-norepinephrine (Levophed) -> strong vasoconstrictor
-beta stimulation effect ->increase HR and contractility
-phenylephrine (Neo-Synephrine)
-use:
- treatment hypotension, drug reaction, or shock
-precautions and contraindications:
-shock due to blood volume decrease hypovolemic shock
-blood clots
-medication interaction
-adverse reactions:
-hypertension; headache; anxiety (b/c constricting blood vessels)
-reflex bradycardia
-cardiac dysrhythmias
-tissue necrosis w/ extravasation
-specific nursing actions:
-assess fluid status
-frequent monitoring bp
-frequent monitoring infusion site
-infuse into large vein
-inject phentolamine w/ infiltration
-medications that stimulate beta 1 receptors:
-epinephrine (Adrenalin) -> beta1 and 2 stimulant ; use for clients w/ atrial ventricular
block; cardiac arrest, anaphylaxis [DILATES THE BRONCHIOLES]
-isoproterenol (Isuprel) [DILATES THE BRONCHIOLES]
-dobutamine
-use:
-atrioventricular block; anaphylaxis
-cardiac arrest; heart failure
-precautions and contraindications:
-cardiac dysrhythmias (tachy and ventricular dysrhythmias) -> these meds will make
them worse; corn allergy
-pregnancy and lactation
-med interactions (MAOI and tricyclics are difficult to give other meds)
-adverse effects:
-hypertension; headache; anxiety
-reflex bradycardia
-cardiac dysrhythmias
-tissue necrosis w/ extravasation
-nursing action:
-assess fluid status
-frequent monitoring bp
-frequent monitoring infusion site
-infuse into large vein
-inject phentolamine w/ infiltration
meds that stimulate dopamine receptors:
-stimulation of dopamine receptors:
-dopamine -> hr and contractility will increase
-lower dose = increase perfusion to vital organs esp kidneys
-higher dose= causes vasoconstriction and can reduce blood flow to
kidneys and other vital organs
-use: treats:
-renal failure (lower doses)
-shock (higher doses)
-heart failure (higher doses)
-precautions and contraindications:
-tachycardia; dysrhythmias
-corn or corn product allergies
-pregnancy lactation
-adverse effects:
-cardiac dysrhythmias
-change in bp
-anxiety
-decrease urine output
-priority nursing action:
-begin slowly; taper dose (10 mcg per kilo per min) -> any higher will make it beta effect
vs kidney affects
-evaluate response
-milrinone:
-use: increase cardiac contractility; improves left ventricular function; dilates the armies
-short term treatment for acute compensated heart failure
-will have signs of severe heart failure, SOB, decreased mental function,
decreased urinary output
-precautions and contraindications:
-structural heart defects (ex. pulmonary valve disease)
-pregnancy and lactation
-renal dysfunction
-adverse effects:
-ventricular dysrhythmias
-angina
-headaches
-priority nursing actions:
-loading dose; taper dose
-monitor effects
-analgesics
-assessment:
-age, renal & liver impairment, vital signs, ecg, hemodynamic monitoring, mental
status, urine output, skin perfusion, increased myocardial oxygen demand, infusion site,
electrolyte (hypokalemia and hypomagnesemia -> increase risk of dysrhythmias), oxygenation
and acid base status, medication interactions
Implementations:
-bonus, titration of infusion, infusion pump, large vein or central line, do not mix, length
of administration (milrinone 5 days end date)