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Drugs to Improve Cardiac output

Dobutamine (3-20mcg/kg/min)

• MOA: almost exclusively a Beta-1 agonist with no alpha effect, and minimal beta-2 effect
• Effect: inotropic and chronotropic effects on the heart, some decrease in peripheral vascular
resistance and some improvement of AV node conduction
• Use: to improve cardiac output and blood pressure, can be administered peripherally
• Risk: increases myocardial oxygen demand, may increase heart rate excessively

Dopamine (2-20mcg/kg/min)

• MOA: precursor of norepinephrine, stimulates dopaminergic, alpha and beta adrenergic
receptors (little or no beta-2 effect)
• Effect: at low doses (2-5mcg/kg/min) minimal alpha effects, causes more splanchnic dilatation,
improving renal blood flow (a dopaminergic response). At medium doses (5-10mcg/kg/min) beta
effects start to predominate. At high doses (10-20mcg/kg/min) alpha effects more prevalent
• Use: good first line to improve cardiac output when used in mid-range
• Risk: high doses may cause vasoconstiction. Adverse effects on immune function.

Epinephrine (0.01 to 1 mcg/kg/min, or higher in very critical situations, usual dose range in cardiac
patients is 0.03-0.3, in septic patients doses may be higher)

• MOA: potent non-selective beta agonist also an alpha agonist (Beta>alpha)
• Effect: increases inotropic and chronotropic cardiac activity also causes peripheral
vasoconstriction, decreasing peripheral perfusion
• Use: to increase cardiac output and blood pressure, at lowest doses (<0.1mcg/kg/min has
primarily beta-1 effects)
• Risk: can cause profound peripheral vasoconstriction, compromising tissue perfusion. Long
term use downregulates catecholamine receptors, decreasing effect, also increases myocardial
oxygen demand

Acute Pain:

Observe or monitor signs and symptoms associated with pain, such as BP, heart rate, temperature, color
and moisture of skin, restlessness, and ability to focus. Some people deny the experience of pain when it is
present. Attention to associated signs may help the nurse in evaluating pain.

Provide rest periods to facilitate comfort, sleep, and relaxation. The patient’s experiences of pain may
become exaggerated as the result of fatigue. In a cyclic fashion, pain may result in fatigue, which may
result in exaggerated pain and exhaustion. A quiet environment, a darkened room, and a disconnected
phone are all measures geared toward facilitating rest.

Give analgesics as ordered, evaluating effectiveness and observing for any signs and symptoms of
untoward effects. Pain medications are absorbed and metabolized differently by patients, so their
effectiveness must be evaluated from patient to patient. Analgesics may cause side effects that range from
mild to life-threatening.

Decreased cardiac output:

Administer humidified oxygen as ordered. The failing heart may not be able to respond to increased
oxygen demands.