GENERIC NAME: Epinephrine

BRAND NAME: Adrenalin, EpiPen, EpiPen Jr.

CLASSIFICATION:

- Pharmacotherapeutic: sympathomimetic (alpha-, beta-adrenergic agonist).

- Clinical: Antiglaucoma, bronchodilator, cardiac stimulant, antiallergic, antihemorrhagic,
priapism reversal agent.
USES:

- Treatment of allergic reactions.

- Treatment of hypotension associated with septic shock.
- Added to local anesthetics to decrease systemic absorption and increase duration of
activity.
PRECAUTIONS:

- Contraindications: Hypersensitivity to Epinephrine.

note: There are no absolute contraindications with injectable Epinephrine in a life-
threatening situation.
- Cautions: Elderly, diabetes mellitus, hypertension, Parkinson’s disease, thyroid disease,
cerebrovascular or cardiovascular disease, concurrent use of tricyclic antidepressants.
History of prostate enlargement, urinary retention.
ACTIONS: Stimulates alpha-adrenergic receptors, beta1- adrenergic receptors, beta2-
adrenergic receptors.
PHARMACOKINETICS:
Well absorbed after parenteral administration; minimally absorbed after inhalation. Metabolized
in liver, other tissues, sympathetic nerve endings. Excreted in urine. Ophthalmic form may be
systemically.
SIDE EFFECTS:

- Frequent
Systematic: Tachycardia, palpitations, anxiety.
Ophthalmic: Headache, eye irritation, watering of eyes.
- Occasional
Systemic: Dizziness, lightheadedness, facial flushing, headache, diaphoresis, increased
B/P, nausea, trembling, insomnia, vomiting, fatigue.
Ophtalmic: Blurred/decreased vision, eye pain.
- Rare
Systemic: Chest discomfort/ pain, arrhythmias, bronchospasm, dry mouth/throat.
ADVERSE EFFECTS/TOXIC REACTIONS

- Excessive doses may cause acute hypertension, arrhythmias.

- Prolonged/excessive use may result in metabolic acidosis due to increased serum lactic
acid.
 - Metabolic acidosis may cause disorientation, fatigue, hyperventilation, headache,
nausea, vomiting, diarrhea.
INTERACTIONS:

- May decrease effects of beta blockers.

- May decrease effects of beta blockersmay increase risk of cardiac arrhythmias.
- May increase vasoconstriction.
- may increase cardiovascular effects.

NURSING CONSIDERATIONS:

- INTERVENTION/EVALUATION:
- Monitor changes of B/P, HR.
- Assess lung sounds for rhonchi, wheezing, rales.
- Monitor ABGs. In cardiac arrest, adhere
- to ACLS protocols.

- PATIENT/FAMILY TEACHING:
- Avoid excessive use of caffeine.
- Report any new symptoms of tachycardia, shortness of breath, dizziness immediately
GENERIC NAME: Norepinephrine
BRAND NAME: Norepin, Levophed
CLASSIFICATION:
- Pharmacotherapeutic: Alpha, beta agonist.
- Clinical: Vasopressor.
USES: Treatment of severe hypotension, cardiogenic shock, septic shock persisting after
adequate fluid volume replacement.
PRECAUTIONS:
- Contraindications: Hypersensitivity to norepinephrine, hypotension related to
hypovolemia, mesenteric/ peripheral vascular thrombosis.
- Cautions: Concurrent use of MAOIs.
ACTIONS: Stimulates beta1-adrenergic receptors, alpha-adrenergic receptors, increasing
contractility, heart rate and producing vasoconstriction. Increases systemic B/P, coronary blood
flow.
PHARMACOKINETICS: Localized in sympathetic tissue. Metabolized in liver. Primarily
excreted in urine.
SIDE EFFECTS:
- Norepinephrine produces less pronounced, less frequent side effects than
EPINEPHrine.
- Occasional: Anxiety, bradycardia, palpitations.
- Rare: Nausea, anginal pain, shortness of breath, fever.
ADVERSE EFFETS/TOXIC REACTIONS:
- Extravasation may produce tissue necrosis, sloughing.
- Overdose manifested as severe hypertension with violent headache
- Arrhythmias, photophobia, retrosternal or pharyngeal pain, pallor, diaphoresis, vomiting.
INTERACTIONS:
- MAOIs may prolong hypertension.
- may increase tachycardic effect.
NURSING CONSIDERATIONS:
- BASELINE ASSESSMENT:
- Assess ECG, B/P continuously (be alert for sudden drop in B/P). Be alert to pt complaint
of headache.

- INTERVENTION/EVALUATION:
- Monitor IV flow rate diligently.
- Assess for extravasation.
- Assess nailbed capillary refill.
- Monitor I&O.
GENERIC NAME: Dopamine
BRAND NAME: Intropin
CLASSIFICATION:
- Pharmacotherapeutic: Sympathomimetic (adrenergic agonist).
- Clinical: Cardiac stimulant, vasopressor.
USES: Adjunct in treatment of shock, persisting after adequate fluid volume replacement
PRECAUTIONS:
- Contraindications: Hypersensitivity to dopa mine, sulfites. Pheochromocytoma, ven
tricular fibrillation. Uncorrected tachyarrhythmias
- Cautions: Ischemic heart disease, occlusive vascular disease, hypovolemia, recent use
of MAOIs, ventricular arrhythmias, post-MI.
ACTIONS: Stimulates adrenergic and dopaminergic receptors. Effects are dose dependent.
Lower dosage stimulates dopaminergic receptors, Higher doses stimulate both dopaminergic
and beta1- adrenergic receptors,
PHARMACOKINETICS: Widely distributed. Does not cross blood-brain barrier. Metabolized in
liver, kidneys, plasma. Primarily excreted in urine. Not removed by hemodialysis. Half-life of 2
min.
SIDE EFFECTS:
- Frequent: Headache, arrhythmias, tachycardia, anginal pain, palpitations, vaso
constriction, hypotension, nausea, vomi ting, dyspnea.
- Occasional: Piloerection, bradycardia, widening of QRS complex.
ADVERSE EFFETS/TOXIC REACTIONS: High doses may produce ventricular arrhythmias,
tachycardia. Pts with occlusive vascular disease are at high risk for gangrene. Tissue necrosis
with sloughing may occur with extravasation of IV solution.
INTERACTIONS: Ergot derivatives, MAOIs may increase hypertensive effects.
NURSING CONSIDERATIONS:
- BASELINE ASSESSMENT:
- Pt must be on continuous cardiac monitoring.
- Assess patency of IV access.

- INTERVENTION/EVALUATION:
- Continuously monitor for cardiac arrhythmias.
- Measure urinary output frequently.
- If extravasation occurs, immediately infiltrate affected tissue with 10–15 mL 0.9% NaCl
solution containing 5–10 mg phentolamine mesylate.
- Be alert to excessive vasoconstriction, slow or temporarily stop infusion, notify physician
GENERIC NAME: Dobutamine
BRAND NAME:
CLASSIFICATION:
- Pharmacotherapeutic
- Clinical
USES:
PRECAUTIONS:
- Contraindications
- Cautions
ACTIONS:
PHARMACOKINETICS:
SIDE EFFECTS:
- Frequent
- Occasional
- Rare
ADVERSE EFFETS/TOXIC REACTIONS:
INTERACTIONS:
NURSING CONSIDERATIONS:
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