Vasoactive Drugs

nicardipine (Cardene) side effects

long offset of action can be problematic in hemodyanically unstable patients.

nitroglycerin

a smooth muscle relaxant and vasodilator. reduces myocardial oxygen consumption, preload, and after load by reducing systolic, diastolic, and mean blood pressure. decreases central venous pressures, LVEDP, and SVR. low doses 30-50mcg/min produce venous dilation, high dose (150-500) produce arteriolar dilation. onset 1-2 min lasts 3-5 min

phenylephrine hydrochloride (Neo-Synephrine)

a sympathomimetic. primarilly acts on alpha1 receptors. potent long lasting vasoconstriction which lead to an increase in SVR. has no direct cardiac effects.

propofol side effects

apnea, bradycardia, hypotension. urine may turn green

vasopressin

a synthetic arginine vasopressin. contracts vascular smooth muscle and stimulates the release of vasoconstrictive calcium. at lower concentrations stimulates V2 receptors leading to an antidiuretic effect

Dobutamine (Dobutrex)

a synthetic catecholamine related to dopamine. inotropic agent using beta stimulation. increases cardiac output, improves stroke volume with minimal increase in heart rate and blood pressure. decreases peripheral vascular resistance. most effective only for a few hours. may improve atrioventricular conduction.

dopamine side effects

aberrant conduction, tachycardia, vasoconstriction and widened QRS complex.

nitroglycerin nursing considerations

abrupt discontinuation of NTG can cause coronary vasospasm monitor rhythm and bp very short acting use cautiously with inferior wall MI. these patients may be very preload dependent

nicardipine (Cardene) nursing considerations

advantages over nitroprusside - produces more stable bp control. it is not a vasodilator so it does not reduce preload and does not produce reflex tachycardia. does not produce coronary steal syndrome. increase ventilation/perfusion mismatch and can produce hypoxemia

Amiodarone

an anti arrhythmic agent. decreases episodes of VT/VF by increasing threshold. it prolongs the duration of action potential in cardiac fibers, depresses conduction velocity, slows conduction and prolongs refractoriness at the AV node.

norepinephrine bitartrate (Levophed) side effects

anxiety, arrhythmias, chest pain, decreased cardiac output, gangrene has been reported.

nitroprusside (Nipride)

a potent rapid acting anti-hypertensive agent. produces peripheral vasodilation through direct action on smooth muscles of the blood vessels. lower diastolic bp.

vasopressin side effects

brady arrhythmia, tachyarrhythmia, and hyponatremia

phenylephrine hydrochloride (Neo-Synephrine) side effects

bradycardia, headache, tingling of extremity, ventricular tachycardia. can cause hypo-perfusion to tissues and end organs.

nicardipine (Cardene)

calcium channel blocker inhibits influx of calcium ions into the cardiac and smooth muscles. causes coronary and peripheral blood vessels to dilate and relax. reduces SVR and reduces bp. lack negative inotropic effect, minimal increase in heart rate and no effect on AV conduction.

epi nursing considerations

correct hypovolemia prior to admin monitor HR BP ECG monitor serum potassium and glucose while drip is infusing.

nitroprusside (Nipride) nursing consideration

cyanide toxicity can occur with doses less than average effective dose. may be rapid serious and lethal. - measure thiocynate levels daily metheomoglobinemia may begin to occur within 16 hours with larger doses never allow systolic bp to fall below 60 continuously monitor bp monitor acid/base balance and venous oxygen concentration

Amiocaproic acid (Amicar) nursing considerations

do not use in present of disseminated intravascular coagulation do not use if evidence of intravascular clotting process tranexamic acid (TXA) has similar properties and benefits as this drug

epinephrine side effects

do not use with isoproterenol. when given to rapidly may cause bradycardia followed by tachycardia. headache, hypertension, tachycardia, weakness and death.

norepinephrine bitartrate (Levophed) nursing consideration

doses greater than .2mcg/kg/min reduces visceral and peripheral blood flow, frequently producing a metabolic acidosis do not use for hypotension related to blood loss unless an emergency should not be given in the same IV as whole blood monitor bp - avoid HTN observe for hypovolemia and replace fluids may cause decreased perfusion to skin and cause tissue necrosis. assess for cyanosis, decreased cap refill and peripheral pulses

nitroglycerin use

drug of choice for unstable angina, or CHF with acute MI. used in short term to prevent spasm of internal mammary arteries postoperatively.

epinephrine use

first line drug for borderline cardiac output. helpful with hypertrophied hearts recovering after carioplegic arrest. helps stimulate the sinus node when intrinsic heart rate is slow. bronchospasm responds well to epi, treatment of anaphylaxis and protamine reaction., and used for cardiac resuscitation.

Amiocaproic acid (Amicar) side effects

generally well tolerated. thrombocytopenia, dysrhythmia, and thrombus formation

milrinone (Primacor) side effects

hypotension, VT, SVT

Amiodarone side effects

hypotension, agranulocytosis, angioedema, arrhythmias

nitroglycerin side effects

hypoxia due to drug inhibits pulmonary artery constriction, which increases blood flow to poorly oxygenates areas of the lungs. lightheadedness, headache, hypotension and tachycardia

dobutamine side effects

increase ventricular ectopy, myocardial ischemia, angina pain and hypotension

Dopamine (Intropin)

increases cardiac output with minimal increase in myocardial oxygen consumption. dilates renal and mesenteric blood vessels at doses lower than those required to elevate systolic blood pressure. doses over 10mcg/kg/min may cause peripheral vasoconstriction and increase pulmonary occlusive pressure.

norepinephrine bitartrate (Levophed) use

indicated for patients with marginally low cardiac output and with low blood pressure cause by low SVR. if the cardiac index is less than 2.0L/min/m2 another inotrope should be used prior to the addition of levo. used when phenylephrine has little effect on blood pressure. it has been used as an inotrope in conjunction with a vasodilator such as nitroprusside to counteract its alpha effects.

Amiocaproic acid (Amicar)

inhibits fibronlysis. inhibits plasminogen activator substance, inhibits plasmin activity. increases fibrinogen activity in clot formation, onset prompt only last about 3 hours.

nitroprusside (Nipride) side effects

it can decrease bp very quickly, which can lead to irreversible ischemia and death.

phenylephrine hydrochloride (Neo-Synephrine) nursing considerations

may cause a reflex decrease in heart rate ensure patient has adequate volume resuscitation prior to administering causes an increase in myocardial oxygen consumption and may make metabolic acidosis worse

vasopressin nursing considerations

may produce vasospasm in ITA grafts (bypass) induces intestinal and gastric mucosa vasoconsitriction does not provide any inotropic support should be used in conjunction with other vasopressors

demerol

narcotic analgesic. treats postoperative shivering. can cause dizziness, flushing, side effects related to histamine release.

milrinone (Primacor) nursing considerations

not to safe or effects for use over 48 hours use cautiously with renal impairment monitor BP, urine output, renal función, fluid and lytes, aggressive replacement of K and Mag reduce or stop rate if excessive drop in bp

phenylephrine hydrochloride (Neo-Synephrine) indication

only indicated to increase the SVR when hypotension coexists with a satisfactory cardiac index (greater than 2.2). should be used to maintain a systemic blood pressure around 100-110. greater pressures should be avoided to reduce the adverse effects on the myocardium related to elevated SVR

milrinone (Primacor)

positive inotropic action with vasodilator activity. it increases the amount of calcium moving into the cardiac cells, resulting in a more forceful contraction. reduces after load and preload by direct relaxant effect on vascular smooth muscle. improves cardiac output without significantly increasing heart rate or myocardial demand. decreases pulmonary capillary wedge pressure, peripheral resistance, diastolic BP and mean BP.

vasopressin use

pt with vasodilatory shock. may be beneficial in patients with low SVR and pulmonary hypertension. does not significantly alter PA pressures.

propofol

sedative hypnotic agent. rapid onset of action, high metabolic clearance. prolong infusion (over 10 das) will result in drug accumulation in the tissues and increase time to awakening. tubing changed every 12 hours

dobutamine uses

short term inotropic support in cardiac decompensation from depressed contractility. (organic heart disease or cardiac surgical procedures)

milrinone (Primacor) use

short term management of pt with decompensated heart failure. causes a decrease in SVR and PVR, useful for patients with RV failure. generally a second line medication for persistent low cardiac output despite catecholamines.

nicardipine (Cardene) use

short term treatment of hypertension

epinephrine

sympathomimetic drug stimulates alpha and beta adrenergic receptors. it is a potent cardiac stimulant. strengthens myocardial contraction, increases cardiac rate, increases myocardial and cerebral blood flow during CPR, relaxant of smooth muscle especially bronchial, decrease blood flow supply to the abdomen and increases blood supply to the smooth muscles. elevates systolic and lower diastolic blood pressure.

norepinephrine bitartrate (Levophed)

sympathomimetic drug which causes peripheral vasoconstriction and inotropic stimulation of the heart; it also dilates coronary arteries.

nitroprusside (Nipride) use

to control systemic hypertension when SVR is high. to improve myocardial function when SVR is high.

Amiocaproic acid (Amicar) use

treatment of fibrinolytic bleeding associated with surgical complications following heart surgery

Amiodarone nursing considerations

use a .22 micron filter because it bubbles monitor for QT prolongation may cause pro arrhythmia. monitor for bradycardia long term use; monitor liver enzymes and thyroid function, pulmonary status and have regular ophthalmic exams

nursing considerations for dobutamine

use in extreme caution in MI precipitous hypotension may occur correct hypovolemia and acidosis prior to imitating. monitor HR, ectopy activity, bp and urine output dobutamine is most useful when cardiac output is marginal and there is mild elevation in SVR. moderate pulmonary vasodilator and may improve right ventricle function synergistic effect in improving cardiac output when use with milrinone

propofol use

used for over short period of time in the post operative period. in cabg pt, this drug is used to keep them sedated until they are hemodynamically stable, typically the first two hours postoperative. most pts awaken 20 min after termination of infusion, allowing for rapid extubation.

Amiodarone use

used prophylacticly to reduce the incidence of postoperative atrial fibrillation. used for the treatment of VT/VF, conversion of a fib, and treatment of choice in SVT.

dopamine uses

used to treat hypotension resulting from shock second choice after atropine for treatment of symptomatic bradycardia