Sympathomimetic medications: Nursing pharmacology

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SYMPATHOMIMETIC MEDICATIONS, PART 1/2
DRUG NAME	dobutamine	dopamine
CLASS	Sympathomimetics
CLASS	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
CLASS	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

Content Reviewers

Lisa Miklush, PhD, RNC, CNS,Antonella Melani, MD,Gabrielle Proper, RN, BScN, MN

Contributors

Victoria S. Recalde, MD,Evan Debevec-McKenney,Jung Hee Lee, MScBMC

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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Sympathomimetic medications: Nursing pharmacology

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