Dobutamine normal dosage

0.5 - 20 mcg/kg/min IV or IO; Not to exceed 40mcg/kg/min. Heart Failure patients should not exceed 20mcg/kg/min.

Phenylephrine: mechanism of action

Potent, alpha-adrenergic agonist. no beta-adrenergic activity; produces syst. art. vasoconstriction. Incr in systemic vasc resistance result in dose dep inc in syst and dias blood pressure and reductions in HR & cardiac output esp in pts w/heart failure.

Dopamine (Intropin) dosage

2 - 20 mcg/kg/min, max 50. If dosages >20 to 30 mcg/kg/minute are needed, a more direct-acting vasopressor may be more beneficial (ie, epinephrine, norepinephrine).

Perfuse kidneys (low dosage), vasopressor, chronotrop, inotrop

If dopamine is raised to >=20mcg/min and the desired effect is not achieved, what is recommended?

A more direct vasopressor (ie. epinephrine, norepinephrine)

Dopamine: low dose range and purpose

1 to 5 mcg/kg/minute, results in increased renal blood flow and urine output

Dopamine: intermediate dose range and purpose

5 to 10 mcg/kg/minute, results in increased renal blood flow, heart rate, cardiac contractility, and cardiac output

Dopamine: high dose range and purpose

>10 mcg/kg/minute, alpha-adrenergic effects begin to predominate, resulting in vasoconstriction, increased blood pressure, in addition to increased heart rate, cardiac contractility, and cardiac output due to beta-adrenergic effects.

Dopamine: Mechanism of action

lower doses are dopaminergic stimulating - renal and mesenteric vasodilation, higher doses also are both dopaminergic and beta1-adrenergic stimulating and produce cardiac stimulation and renal vasodilation; large doses stimulate alpha-adrenergic receptors

Norepinephrine: Mechanism of action

Stimulates beta1-adrenergic receptors and alpha-adrenergic receptors causing increased contractility and heart rate as well as vasoconstriction; alpha effects (vasoconstriction) are greater than beta effects (inotropic and chronotropic effects)

Dobutamine: Mechanism of action

Dobutamine stimulates myocardial beta1-adrenergic receptors resulting in increased contractility and heart rate. Some vasodilation in addition to the inotropic and chronotropic action.

40. Heart failure patients not to exceed 20

100 to 180 mcg/minute, or alternatively, 0.5 mcg/kg/minute; titrate to desired response.

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Vasoactive Drips

Question	Answer
Dobutamine normal dosage	0.5 - 20 mcg/kg/min IV or IO; Not to exceed 40mcg/kg/min. Heart Failure patients should not exceed 20mcg/kg/min.
Levophed (Norepinephrine) dosage	(IBW) 15 - 25 mcg/min
Phenylephrine: mechanism of action	Potent, alpha-adrenergic agonist. no beta-adrenergic activity; produces syst. art. vasoconstriction. Incr in systemic vasc resistance result in dose dep inc in syst and dias blood pressure and reductions in HR & cardiac output esp in pts w/heart failure.
Epinephrine dosage	1 - 8 mcg/min
Dopamine (Intropin) dosage	2 - 20 mcg/kg/min, max 50. If dosages >20 to 30 mcg/kg/minute are needed, a more direct-acting vasopressor may be more beneficial (ie, epinephrine, norepinephrine).
Digoxin (Lanoxin) dosage
Nitroglycerin (Tridil) dosage	5 - 200 mcg/min
Dobutamine purpose	+ Inotrop
Dopamine purpose	Perfuse kidneys (low dosage), vasopressor, chronotrop, inotrop
If dopamine is raised to >=20mcg/min and the desired effect is not achieved, what is recommended?	A more direct vasopressor (ie. epinephrine, norepinephrine)
Dopamine: low dose range and purpose	1 to 5 mcg/kg/minute, results in increased renal blood flow and urine output
Dopamine: intermediate dose range and purpose	5 to 10 mcg/kg/minute, results in increased renal blood flow, heart rate, cardiac contractility, and cardiac output
Dopamine: high dose range and purpose	>10 mcg/kg/minute, alpha-adrenergic effects begin to predominate, resulting in vasoconstriction, increased blood pressure, in addition to increased heart rate, cardiac contractility, and cardiac output due to beta-adrenergic effects.
Dopamine: Mechanism of action	lower doses are dopaminergic stimulating - renal and mesenteric vasodilation, higher doses also are both dopaminergic and beta1-adrenergic stimulating and produce cardiac stimulation and renal vasodilation; large doses stimulate alpha-adrenergic receptors
Norepinephrine: Mechanism of action	Stimulates beta1-adrenergic receptors and alpha-adrenergic receptors causing increased contractility and heart rate as well as vasoconstriction; alpha effects (vasoconstriction) are greater than beta effects (inotropic and chronotropic effects)
Dobutamine: Mechanism of action	Dobutamine stimulates myocardial beta1-adrenergic receptors resulting in increased contractility and heart rate. Some vasodilation in addition to the inotropic and chronotropic action.
Dopamine max dose	50mcg/kg/min
Dobutamine max dose	40. Heart failure patients not to exceed 20
Phenylephrine dosage	100 to 180 mcg/minute, or alternatively, 0.5 mcg/kg/minute; titrate to desired response.

Created by: mwillis

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