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DOPAMINE
Dopamine is used to manage certain conditions such as hypotension, shock ( associated wit MI, trauma, renal failure,, Heart surgery, persisting after adequate fluid volume replacement)
OFF LABEL: Symptomatic bradycardia or heart attack unresponsive to atropine or cardiac pacing.
Action
Stimulates adrenergic receptors. Effects are dose-dependent. Lower dosage stimulates dopaminergic receptors, causing renal vasodilation. Higher doses stimulate both dopaminergic and beta1-adrenergic receptors, causing vasoconstriction, Increased BP
Therapeutic Effects: Low dosage (1-3 mcg/kg/min): increase the renal blood flow, urinary flow sodium excretion. Low to moderate dosage (4-10 mcg/kg/min): Increase myocardial contractility, cardiac output and stroke volume. High dosage (greater than 10 mcg/kg/min): Increase peripheral resistance, renal vasoconstriction, B.P
Pharmacokinetics
- Routes: IV
- Onset: 1-2 min
- Peak: N/A
- Duration: Less than 10 min
- Widely distributed.
- Does not cross blood-brain barrier.
- Metabolized in liver, kidney, plasma.
- Primarily excreted in urine.
- Not removed by haemodialysis.
Half-life: 2 min
Precautions
Contraindications
- Pheochromocytoma
- Ventricular fibrillation
- Ischemic heart disease
- Occlusive vascular disease
- Hypovolemia
- Ventricular arrhythmias
- Post MI
Pregnancy/Lactation
- Unknown if drug crosses placenta or is distributed in breast milk. Pregnancy category C
- Recommended close hemodynamic monitoring
- No age-related precautions noted.
Drug: May have increased effects with vasoconstrictive agents, Vasopressors.
Herbal: None significant
Food: None known
Lab Values: None significant
Administration
Blood volume depletion must be corrected before administering dopamine
IV
Reconstitution
- Available prediluted in 250 or 500 ml D5W or dilute in 250-500ml 0.9% NaCl, D5W, or lactated Ringer's to maximum concentration of 3,200 mcg/ml.
- Administer into large vein to prevent extravasation.
- Use infusion pump to control flow rate
- Titrate drug to desired hemodynamic, renal response
- Do not use solutions darker than slightly yellow or discolored to yellow, brown, pink to purple.
- Stable for 24 hrs after dilution.
- Acyclovir
- Amphotericin B
- Cefepime
- Furosemide
- Insulin
- Sodium bicarbonate
Effects of dopamine are dose-dependent. Titrate to desired response.
Acute hypotension, shock
- Adults and Elderly: IV infusion initially, 1-5 mcg/kg/min up to 20 mcg/kg/min. Maximum: 50 mcg/kg/min. Titrate to desired response.
- Children: Initially, 1-5 mcg/kg/min. Increase in 5-10 mcg/kg/min. Maximum: 50 mcg/kg/min. Neonates: 1-20 mcg/kg/min. Titrate to desired response.
Side effects
Frequent
- Headache.
- Arrhythmias.
- Tachycardia.
- Anginal pain.
- Palpitations.
- Vasoconstriction.
- Nausea.
- Hypotension.
- Dyspnoea.
- Piloerection.
- Bradycardia.
- Widening of QRS complex.
Adverse Effects
High dose may produce ventricular arrhythmias. Patients with occlusive vascular disease are high risk for further compromise of circulation to extremities, which may result in gangrene. Tissue necrosis with sloughing may occur with extravasation of IV solution.
Nursing Consideration
Patient must be continuous cardiac monitoring. Determine weight for dosage calculation. Obtain initial B.P, heart rate, respiration.
Nursing interventions
- Continuously monitor for cardiac arrhythmias.
- Measures urinary output frequently.
- Monitor B.P, heart rate, respiration 15 min during administration.
- Assess cardiac output, pulmonary wedge pressure or central venous pressure frequently.
- Assess peripheral circulation
- Immediately notify physician of decreased urinary output, cardiac arrhythmias, significant changes in B.P, heart rate.
- Taper dosage before discontinuing.
- Be alert to excessive vasoconstriction.
Dopamine pdf download
Dopamine PPT file download
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