| Drug and Dosage | Use | Action | Assessment: Side Effects |
|---|
| Alpha and Beta Agonists |
| Epinephrine (Adrenalin)—Subcu or IM 0.1–1 mg in 1:1000 solution; IV—intracardiac 1:10,000 solution; ophthalmic 1:1000–1:50,000 solution | Asystole, bronchospasm, anaphylaxis, glaucoma | Stimulates pacemaker cells; inhibits histamine and mediates bronchial relaxation; ↓ intraocular pressure | Ventricular arrhythmias, fear, anxiety, anginal pain, decreased renal blood flow, burning of eyes, headache |
| NURSING IMPLICATIONS: Use TB syringe for greater accuracy; massaging injection site hastens action; repeated injections may cause tissue necrosis; avoid injection in buttocks because bacteria in area may lead to gas gangrene; may make mucous plugs in lungs more difficult to dislodge |
| Norepinephrine (Levophed)—IV 8–12 mcg/min titrated to desired response | Acute hypotension, cardiogenic shock | Increases rate and strength of heartbeat; increases vasoconstriction | Palpitations, pallor, headache, hypertension; anxiety, insomnia; dilated pupils, nausea, vomiting; glycosuria, tissue sloughing |
| NURSING IMPLICATIONS: Observe vital signs, mentation, skin temperature, and color (earlobes, lips, nailbeds); tissue necrosis occurs with infiltration; antidote is phentolamine 5–10 mg in 10–15 mL normal saline |
| Beta Agonists |
| Dobutamine (Dobutrex)—IV 1.5–10 mcg/kg/min | Acute heart failure | Stimulates cardiac contractile force (positive inotropy); fewer changes in heart rate than dopamine or isoproterenol | Tachycardia, arrhythmias |
| NURSING IMPLICATIONS: Mix with 5% dextrose; do not dilute until ready to use; protect from light; administer with infusion pump; check vital signs constantly; extravasation can produce tissue necrosis; see Norepinephrine |
| Dopamine (Inotropin)—IV 1–5 mcg/kg/min titrated to desired response; gradually increase in 1- to 4-mcg/kg/min increments at 10- to 30-min intervals; must maintain at 20 mcg/kg/min or less | Acute heart failure | ↑Cardiac contractility; ↑ renal blood flow | Ectopic beats; nausea, vomiting; tachycardia, anginal pain, dyspnea, hypotension |
| NURSING IMPLICATIONS: Monitor vital signs, urine output, and signs of peripheral ischemia; will cause tissue sloughing if infiltration occurs |
| isoproterenol (Isuprel)—sublingual 10–15 mg; IV 0.5–5.0 mcg/min in solution | Cardiogenic shock, heart block, bronchospasm—asthma, emphysema | ↑Cardiac contractility; facilitates atrioventricular (AV) conduction and pacemaker automaticity | Tachyarrhythmias, hypotension, headache, flushing of skin; nausea; tremor; dizziness |
| NURSING IMPLICATIONS: Monitor vital signs, ECG; oral inhalation solutions must not be injected |