Sympathomimetic medications: Nursing pharmacology

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Notes

Notes





SYMPATHOMIMETIC MEDICATIONS, PART 1/2
DRUG NAME
dobutamine
dopamine
CLASS
Sympathomimetics
β1-agonist
β1- and α-agonist
MECHANISM of ACTION
Stimulates β1-adrenergic receptors → increases contractility and cardiac output
Stimulates β1-adrenergic receptors → increases contractility and cardiac output

Stimulates β1- and α-receptors → vasoconstriction → increases blood pressure
INDICATIONS
  • Cardiac decompensation
  • Unlabeled: cardiogenic shock in children
  • Shock
  • Hypotension
  • Unlabeled: bradycardia
  • Cardiac arrest
ROUTE(S) of ADMINISTRATION
  • IV
  • IV
SIDE EFFECTS
  • CV: palpitations, tachycardia, hypertension, angina, arrhythmias
  • GI: nausea, vomiting
  • CNS: cerebral hemorrhage
  • Dopamine, epinephrine, norepinephrine: extravasation (boxed warning), tissue necrosis, sloughing, gangrene
  • Epinephrine: hyperglycemia (clients with diabetes)
CONTRAINDICATIONS & CAUTIONS
  • Pregnancy and breastfeeding
  • Elderly clients
  • Hypertension or coronary artery disease
  • Dobutamine
    • hypertrophic cardiomyopathy with outflow tract obstruction
  • Norepinephrine:
    • hypovolemia, mesenteric or peripheral thrombosis
  • Dopamine: 
    • tachyarrhythmias, ventricular fibrillation, pheochromocytoma, hypovolemia
  • Isoproterenol: 
    • tachyarrhythmias, angina pectoris, cardiac glycoside toxicity
  • Epinephrine:
    • closed-angle glaucoma, non-anaphylactic shock

Drug interactions:
  • Dobutamine: COMT inhibitors
  • Dopamine, epinephrine, norepinephrine: MAO inhibitors, TCAs
  • Combining sympathomimetic medications


SYMPATHOMIMETIC MEDICATIONS, PART 2/2
DRUG NAME
epinephrine (Adrenalin,
Adrenaclick, Epipen)

norepinephrine (Levophed)
isoproterenol (Isuprel)
CLASS
Sympathomimetics
Bronchodilator Nonselective adrenergic agonist
Nonselective
adrenergic agonist
Nonselective beta-adrenergic agonist
MECHANISM of ACTION
Stimulates β1- and β2-agonist →
bronchodilation, cardiac and CNS stimulation
Stimulates β-receptors in heart → increases contractility, heart rate, and cardiac output

Stimulates β1- and α-receptors → vasoconstriction → increases blood pressure

Stimulates β1- and β2-agonist →
bronchodilation, cardiac and CNS stimulation
INDICATIONS
  • Acute asthmatic attacks
  • Bronchospasm
  • Anaphylaxis, allergic reactions
  • Cardiac arrest
  • Shock
  • Acute hypotension
  • Shock
  • Episodes of heart block
  • Cardiac arrest, CPR
  • Bronchospasm occurring during anesthesia
  • Shock, congestive heart failure
ROUTE(S) of ADMINISTRATION
  • IV
  • IM
  • INH
  • ET tube
  • IV
  • IV
  • IM
SIDE EFFECTS
  • CV: palpitations, tachycardia, hypertension, angina, arrhythmias
  • GI: nausea, vomiting
  • CNS: cerebral hemorrhage
  • Dopamine, epinephrine, norepinephrine: extravasation (boxed warning), tissue necrosis, sloughing, gangrene
  • Epinephrine: hyperglycemia (clients with diabetes)
CONTRA-INDICATIONS & CAUTIONS
  • Pregnancy and breastfeeding
  • Elderly clients
  • Hypertension or coronary artery disease
  • Dobutamine
    • hypertrophic cardiomyopathy with outflow tract obstruction
  • Norepinephrine:
    • hypovolemia, mesenteric or peripheral thrombosis
  • Dopamine: 
    • tachyarrhythmias, ventricular fibrillation, pheochromocytoma, hypovolemia
  • Isoproterenol: 
    • tachyarrhythmias, angina pectoris, cardiac glycoside toxicity
  • Epinephrine:
    • closed-angle glaucoma, non-anaphylactic shock

Drug interactions:
  • Dobutamine: COMT inhibitors
  • Dopamine, epinephrine, norepinephrine: MAO inhibitors, TCAs
  • Combining sympathomimetic medications
NURSING CONSIDERATIONS for
SYMPATHOMIMETIC MEDICATIONS
ASSESSMENT & MONITORING

Assessment and monitoring - norepinephrine

Assessment
  • Weight
  • Orientation, LOC
  • Hemodynamic status
  • Respiratory status 

Intervention and monitoring
  • Administer via central line
  • Low dose titrated based on client’s response

Monitoring
  • Hemodynamic status
  • Intake and output
  • LOC
  • Side effects
    • Paresthesias, cool extremities
    • Extravasation
      • Stop infusion
      • Notify health care provider
      • Administer phentolamine mesylate subcutaneously
  • Evaluate for the therapeutic response of blood pressure stabilization.
CLIENT EDUCATION
  • Purpose of medication: increase their blood pressure
  • Administered as a continuous infusion, adjusted as needed

Transcript

Sympathomimetics are medications that mimic the effect of endogenous catecholamines, like norepinephrine and epinephrine. As a result, these medications activate the sympathetic nervous system, which in turn triggers the fight or flight response, ultimately increasing the heart rate and blood pressure, as well as slowing down digestion. This response maximizes blood flow to the muscles and brain.

Now, sympathomimetic medications include dobutamine, dopamine, norepinephrine, epinephrine, and isoproterenol. All of them are administered intravenously, while isoproterenol can also be given intramuscularly, and epinephrine can also be administered intramuscularly, as well as through endotracheal tube or inhalation.

Once administered, sympathomimetic medications act by stimulating adrenergic receptors. Now, there are two main groups of adrenergic receptors: the alpha receptors, and beta receptors. Alpha adrenergic receptors are mainly located on the walls of blood vessels of the skin, as well as the gastrointestinal and genitourinary systems, and when stimulated, they cause vasoconstriction and decreased blood flow to these tissues.

On the other hand, beta receptors have two main subtypes: beta-1 and beta-2. Beta-1 adrenergic receptors are mainly located in the heart, and when activated, they increase the heart rate and contractility, which helps pump out more blood. On the other hand, beta-2 adrenergic receptors are found on smooth muscle cells in the walls of blood vessels supplying skeletal muscles and the brain, so their activation leads to vasodilation and increased blood flow to these tissues; and in the lungs, they cause bronchodilation.

Summary

Sympathomimetic medications are drugs that mimic the effects of the sympathetic nervous system. They work by mimicking the effect of endogenous catecholamines, like norepinephrine and epinephrine, and can be used to treat conditions such as cardiac decompensation, shock, anaphylaxis, bronchospasm, and bradycardia post-cardiac arrest. Some common examples of sympathomimetic medications include dobutamine, dopamine, norepinephrine, epinephrine, and isoproterenol.

Once administered, these medications stimulate two types of adrenergic receptors, alpha, and beta. With alpha-adrenergic receptor stimulation, vasoconstriction occurs, whereas stimulation of beta-1 adrenergic receptors causes increased heart rate and contractility, and stimulation of beta-2 adrenergic receptors causes vasodilation and bronchodilation.

Common side effects of sympathomimetics include gastrointestinal disturbances, hypertension, and arrhythmias. Nursing considerations for clients receiving sympathomimetics include monitoring their hemodynamic status; titrating doses as needed; monitoring for side effects; and assessing for the desired therapeutic response. Client education is focused on what to expect during treatment.

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