Dopamine (Intropin)

Question 1

Class (2)

Answer 1

• Catecholamine

- Sympathomimetic

Question 2

Actions (5)

Answer 2

• Dose dependent sympathomimetic
• At lower drip rates of 1-2 ug/kg/min, stimulate dopaminergic receptors to produce cerebral, renal, and mesenteric vasodilation
• At drip rates of 2-10 ug/kg/min, B1 effects predominate (inotropic effect) with alpha effect beginning (vasoconstriction)
• At drip rates 10-20 ug/kg/min, alpha effects predominate with renal, mesenteric, and peripheral arterial, and venous vasoconstriction with marked increase in SVR (systemic vascular resistance)
• At drip rates >20 ug/kg/min, alpha effects similar to Norepi predominate with marked peripheral vasoconstriction and tachycardia

Question 3

Indications (3)

Answer 3

• Cardiogenic shock
• Other types of shock after adequate fluid resuscitation
• Symptomatic bradycardia unresponsive to Atropine or external pacemaker

Question 4

Dosage/Route

Answer 4

• Bradycardia SO: 5 mcg/kg/min and increase gradually up to 20 mcg/kg/min to maintain BP of 100-110 mmHg systolic
• Pulmonary Edema/CHF SO: 5-20 mcg/kg/min via automatic IV infusion pump to maintain BP of 100-110 mmHg

Question 5

Standard Prep

Answer 5

400 mg/250 cc

Question 6

Contraindications (4)

Answer 6

• Hypovolemia BEFORE fluid resuscitation
• Pts taking MAOIs
• Pheochromocytoma (can precipitate hypertensive crisis)
• Uncorrected tachyarrhythmias

Question 7

Side Effects (3)

Answer 7

• Tachyarrhthymias
• HTN
• Precipitate myocardial ischemia
• Tissue necrosis with extravasation (infiltration)

Question 8

Precautions (4)

Answer 8

• Monitor VS and EKG
• Stop infusion if diastolic pressure rises >90 mmHg
• Incompatible with NaHCO3 since alkaline environment may inactivate Dopamine
• Avoid extravasation which will cause tissue necrosis and tissue sloughing–inform ER RN or MD since local injection of Regitine will be required