Drug Name

Dosage & Route Shock Adult/Child: IV 2 5 mcg/kg/min increased gradually up to 2050 mcg/kg/min if necessary Renal Failure Adult: IV 25 mcg/kg/min

Action

Indication

Adverse Effects

Contraindication

Nursing Responsibility

DOPAMINE HYDROCHLORIDE (doe'pa-meen) Dopastat, Intropin, Revimine Classifications: AUTONOMIC NERVOUS SYSTEM AGENT; ALPHA- AND BETAADRENERGIC AGONIST (SYMPATHOMIMETIC)

Naturally occurring neurotransmitter and immediate precursor of norepinephrine. Major cardiovascular effects produced by direct action on alpha- and beta-adrenergic receptors and on specific dopaminergic receptors in mesenteric and renal vascular beds.

To correct hemodynamic imbalance in shock syndrome due to MI (cardiogenic shock), trauma, endotoxic septicemia (septic shock), open heart surgery, and CHF.

CV: Hypotension, ectopic beats, tachycardia, anginal pain, palpitation, vasoconstriction (indicated by disproportionate rise in diastolic pressure), cold extremities; less frequent: aberrant conduction, bradycardia, widening of QRS complex, elevated blood pressure. GI: Nausea, vomiting. CNS: Headache. Skin: Necrosis, tissue sloughing with extravasation, gangrene, piloerection. Other: Azotemia, dyspnea, dilated pupils (high doses).

Pheochromocytoma; tachyarrhythmias or ventricular fibrillation. Safe use during pregnancy (category C), lactation, or children is not established.

Assessment & Drug Effects

Monitor blood pressure,

pulse, peripheral pulses, and urinary output at intervals prescribed by physician. Precise measurements are essential for accurate titration of dosage. Report the following indicators promptly to physician for use in decreasing or temporarily suspending dose: Reduced urine flow rate in absence of hypotension; ascending tachycardia; dysrhythmias; disproportionate rise in diastolic pressure (marked decrease in pulse pressure); signs of peripheral ischemia (pallor, cyanosis, mottling, coldness, complaints of tenderness, pain, numbness, or burning sensation). Monitor therapeutic effectiveness. In addition to improvement in vital signs and urine flow, other indices of adequate dosage and perfusion of vital organs include loss of pallor, increase in toe temperature, adequacy of nail bed capillary filling, and reversal of confusion or comatose state.