Pediatric Shock Part 9 Medications
Medications
· Inotropic agents
· Vasopressors
· Vasodilators
· Inodilators
Epinephrine
· Acts directly on adrenergic receptors
· Low dose cause increased myocardial contractility, heart rate, pulse pressure, and SBP
· Higher doses produce increased SBP and DBP pressures and a narrowing of the pulse pressure.
Epinephrine Indications
· Inadequate cardiac output
· Hypotension
· Symptomatic bradycardia
· Pulseless arrest
· Septic shock
Dosages
0.1-1mcg/kg/min infusion
Wide variety of response so the nurse should titrate it according to the patient’s response.
Mix 0.6 x body weight (kg) equals mg to add to sufficient fluid to create a total volume of 100ml.
1ml/hr delivers 0.1mcg/kg/min
Precautions
· Preferably use a central line
· Can cause local ischemia if infiltration occurs
· Inactivated by alkaline solutions
· May cause peripheral ischemia and necrosis if administered in peripheral line
· May aggravate myocardial ischemia and increase myocardial oxygen demand
Norepinephrine
· At clinical doses vasoconstrictive properties predominate
· When used in combination with Dopamine or Dobutamine, it has been shown to increase splanic and renal artery perfusion
Norepinephrine indications
· Hypotension, especially due to vasodilation
· Inadequate cardiac output
· Spinal shock
· Alpha adrenergic overdoses: Tricyclic overdose and neuroleptic agents
Dosages
· 0.1-2mcg/kg/min infusion
· Wide variety of response so the nurse should titrate it according to the patient’s response.
· Mix 0.6 x body weight (kg) equals mg to add to sufficient fluid to create a total volume of 100ml.
· 1ml/hr delivers 0.1mcg/kg/min
Precautions
· Hypertension
· Organ ischemia
· Distal extremity ischemia
· Infuse via a secure central line
· Extravasation can result in local tissue necrosis
Dopamine
· Lower dose lead to increased renal and splanchnic, coronary, and cerebral blood flow
· Higher dose lead to peripheral vasoconstriction and heart rate.
· Wide variety in patient responses
Indications
· Inadequate cardiac output
· Hypotension
· Need to increase renal and splanchnic blood flow
Precautions
· May produce tachycardia which may aggravate myocardial ischemia
· Deliver through a secure large bore peripheral cath
· Higher does should be delivered via a central line
· Avoid mixing with alkaline solutions
Dobutamine
· Increases cardiac contractility
· Increases heart rate
· Produces mild vasodilation of the peripheral vascular bed
Indications
· Myocardial dysfunction
· Inadequate cardiac output, especially in patients with increased pulmonary vascular resistance
Dosages
· 2-20mcg/kg/min infusion
· Preparation: 6 x body wt (kg) equals amount in mg to be added to sufficient diluent to create a total volume of 100ml
· 1ml/hr delivers 1mcg/kg/min
Precautions
· Tachycardia
· Tachydysrrhythmias
· Hypertension
· N&V
· Local tissue necrosis due to extravasation
Sodium Nipride
· Vasodilator that reduces vascular tone
· It improves myocardial function by reducing peripheral vascular resistance
Indications
· Hypertensive emergencies
· Inadequate cardiac output due to high peripheral vascular resistance
· Cadiogenic shock
Precautions
· Monitor BP closely
· Hypotension is the most common side effect
· Monitor thiocyanide levels if used for more than 2-3 days
Milrinone
An inodilator that increases myocardial contractility and produces peripheral and vascular bed vasodilation
Indications
· Inadequate cardiac output due to increased peripheral vasoconstriction
· Cardiogenic shock
· Septic shock
Dosages
· Loading dose of 50-75mcg/kg over 10-60 minutes
· Continuous infusion of 0.5-0.75mcg/kg/min IV/IO
Precautions
· Monitor for hypotension during loading dose
· Long half-life
· Thrombocytopenia may occur
Inamrinone
· Loading dose of 0.75 to 1mg/kg over 5 minutes. May repeat x 2 for total loading dose of 3mg
· Continuous infusion of 5-10mcg/kg/min
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