Emergency

Medications Prepared by:

LORD VITO CORLEONE U. PUNGTILAN, R.N.
ADENOSINE
(Adenocard, Adenoscan)
CLASS: Antidysrrhythmics, V
ADENOSINE
This medication has a very short life,
normally about 10 seconds. This
means that this medication must be
used immediately.

It is used to treat supraventricular and

atrial tachycardia conditions.
ADENOSINE
A variation of this drug forms chemical
compounds (AMP) and (ATP) adenosine
monophosphate and triphosphate.

While AMP treats shingles and herpes, A TP is

used to treat kidney failure, hypertension, lung
cancer and cystic fibrosis.
ADENOSINE
MECHANISM OF ACTION

PSVT: Slows conduction through AV node and

interrupts AV reentry pathways, which restore normal
sinus symptoms

Stress testing: A2A adenosine receptor agonist;

activation of the A2A adenosine receptor produces
coronary vasodilation and increases coronary blood
flow
ADENOSINE
PHARMACOKINETICS
Half-Life: <10 seconds
Duration: <10 seconds
Onset: 20-30 seconds

METABOLISM
Blood and tissue; deaminated to inosine and
subsequently to hypoxanthine; adenosine also
undergoes phosphorylation to adenosine
monophosphate (AMP) within blood cells
ADENOSINE
METABOLITES
Inosine, hypoxanthine, AMP (inactive)

TOTAL BODY CLEARANCE

30 seconds
ADENOSINE
DOSAGE FORMS AND STRENGTHS

INJECTABLE SOLUTIONS
6mg/2mL prefilled syringe
12mg/4mL prefilled syringe

PREGNANCY CATEGORY

Pregnancy Category: C
Lactation: Potential for serious adverse reactions in nursing
infants; decision to interrupt nursing after administration of
adenosine or not should take into account importance of
drug to mother.
ADENOSINE
PAROXYSMAL SUPRAVENTRCULAR TACHYCARDIA

Indicated for conversion to sinus rhythm of paroxysmal

supraventricular tachycardia (PSVT), including that
associated with accessory bypass tracts (Wolff-Parkinson-
White Syndrome)
Adenocard: 6 mg IVP over 1-3 seconds (maybe given IO)
followed by rapid flush with 20 mL NS, if no conversion
within 1-2 minutes give 12 mg IVP, repeat a second time if
necessary (30 mg total)
ADENOSINE
CONTRAINDICATIONS

1. Hypersensitivity
2. 2nd or 3rd degree AV block (except those on
pacemakers)
3. Sinus node disease, such as sick sinus syndrome or
symptomatic bradycardia (except in patients with a
functioning artificial pacemaker)
4. Adenoscan: Contraindicated in bronchoconstrictive or
bronchospastic lung disease (eg, asthma)
ADENOSINE
CONTRAINDICATIONS

1. Hypersensitivity
2. 2nd or 3rd degree AV block (except those on
pacemakers)
3. Sinus node disease, such as sick sinus syndrome or
symptomatic bradycardia (except in patients with a
functioning artificial pacemaker)
4. Adenoscan: Contraindicated in bronchoconstrictive or
bronchospastic lung disease (eg, asthma)
AMIODARONE
(Pacerone, Cordarone, Nexterone)
CLASS: Antidysrrhythmics, III
AMIODARONE
During a life threatening emergency
crisis where heart disorders are known
to exist, amiodarone can interfere with
a heartbeat, or adversely affect the
heart’s rhythm.

However, it is among one of the most

preferred choice of drugs, for patients
facing blood flow problems of the
heart.
AMIODARONE
Patients are normally administered this
drug in a hospital setting, where their
heart rhythm can be monitored by an
EKG, EGG or electrocardiograph.
Patients with tachycardia experience
faster than normal heart beats, even
during periods of rest, which doctors
consider to be abnormal
AMIODARONE
MECHANISM OF ACTION

Class III antiarrhythmic agent, which inhibits

adrenergic stimulation; affects sodium,
potassium, and calcium channels; markedly
prolongs action potential and repolarization;
decreases AV conduction and sinus node
function
AMIODARONE
ABSORPTION
Bioavailability: 35-65%

Onset (PO): Initial response 2 days to 3 weeks; peak

response takes 1 week to 5 months

Duration (PO): Up to 50 days after discontinuation of

therapy

Peak serum time: 3-7 hours (PO)

Therapeutic range: 0.8-2.8 mcg/mL

Toxicity range: >2-2.5 mcg/mL

AMIODARONE
DOSAGE FORMS AND STRENGTHS

injectable solution
50mg/mL
150mg/100mL (Nexterone)
360mg/200mL (Nexterone)

tablet
100mg
200mg
400mg
AMIODARONE
CONTRAINDICATIONS

1. Hypersensitivity
2. Severe sinus node dysfunction, 2°/3° AV
block or bradycardia causing syncope
(except with functioning artificial
pacemaker), cardiogenic shock
3. Avoid during breastfeeding
AMIODARONE
AMIODARONE
AMIODARONE
EPINEPHRINE
(EpiPen, EpiPen Jr, Auvi-Q, Symjepi, Adrenalin)
CLASS: Alpha/Beta Adrenergic Agonists;
Alpha/Beta Agonists
EPINEPHRINE
This medication helps make breathing
easier for patients suffering with blocked air
passages, such as asthmatic patients, and
patients with lung disorders.

It is also a life-saver for people with severe

allergies or those who experience certain
types of heart conditions.
EPINEPHRINE
MECHANISM OF ACTION

Strong alpha-adrenergic effects, which cause an increase in

cardio output and HR, a decrease in renal perfusion and PVR,
and a variable effect on BP, resulting in systemic
vasoconstriction and increased vascular permeability

Strong beta1- and moderate beta2-adrenergic effects,

resulting in bronchial smooth muscle relaxation

Secondary relaxation effect on smooth muscle of stomach,

intestine, uterus, and urinary bladder
EPINEPHRINE
ABSORPTION
Onset: 5-10 minutes (SC); 1 minute (inhalation)
Duration: 4 hours

METABOLISM
Metabolized by MAO and COMT in adrenergic neuron
Metabolites: Metadrenaline, sulfate conjugates, and hydroxy
derivatives of mandelic acid (inactive)

ELIMINATION
Excretion: Urine
EPINEPHRINE
DOSAGE FORMS AND STRENGTHS

prefilled autoinjector or syringe for SC/IM use

0.3mg/0.3mL (EpiPen, Auvi-Q, Symjepi)

injectable solution
0.1mg/mL (1:10,000)
1mg/mL (1:1000)
EPINEPHRINE
CARDIAC ARREST
1:10,000 solution
IV
Recommended dose: 0.5-1.0 mg (5-10 mL)
During a resuscitation effort, 0.5 mg (5 mL) IV
q5min
Intracardiac
Intracardiac injection if there has not been sufficient
time to establish an IV route
Usual dose ranges from 0.3-0.5 mg (3-5 mL)
EPINEPHRINE
CARDIAC ARREST

Endotracheal Tube

Alternatively, if the patient has been intubated,

epinephrine can be injected via the endotracheal tube
directly into the bronchial tree at the same dosage as
for IV injection

2-2.5 mg q3-5min until IV/IO access established or

spontaneous circulation restored
EPINEPHRINE
HYPOTENSION ASSOCIATED WITH SHOCK

Indicated to increase mean arterial blood pressure in adults

with hypotension associated with septic shock

Recommended dose: 0.05-2 mcg/kg/minute IV infusion;

titrate to desired mean arterial pressure (MAP); may adjust
dose q10-15 min by 0.05-0.2 mcg/kg/minute to achieve
desired blood pressure goal

After hemodynamic stabilization, may wean incrementally

q30min over 12-24 hours
EPINEPHRINE
ANAPHYLAXIS

Indicated in emergency treatment of allergic reactions

(Type I) including anaphylaxis

1:10,000 solution

0.1 mg (0.1mg/mL) IV at rate of 1-4 mcg/min over 5 min

to prevent the need to repeat injections frequently OR
may initiate with infusion at 5-15 mcg/min (with
crystalloid administration)
EPINEPHRINE
1:1000 solution
0.3-0.5 mg (0.3-0.5 mL) of undiluted epinephrine IM/SC once
in anterolateral aspect of the thigh, not to exceed 0.5 mg
(0.5 mL) per injection, repeated every 5-10 minutes as
necessary
Monitor clinically for reaction severity and cardiac effects

Prefilled autoinjector or syringe

0.3 mg (contents of 1 autoinjector) SC/IM once in
anterolateral aspect of the thigh; may repeat dose after 5-15
minutes if symptoms persist
EPINEPHRINE
SYMPTOMATIC BRADYCARDIA

Unresponsive to atropine or pacing: 2-10 mcg//min by IV

infusion or 0.1-0.5 mcg/kg/min (7-35 mcg/min in 70 kg
patient); titrate to patient response
EPINEPHRINE
MYDRIASIS
Induction and maintenance of mydriasis during intraocular
surgery

1:1000 solution

After dilution in an ophthalmic irrigating fluid,

inject intracamerally as a bolus dose of 0.1 mL at
dilution of 1:100,000 to 1:400,000 (10-2.5
mcg/mL)
EPINEPHRINE
CONTRAINDICATIONS

1. There are no contraindications for life-threatening

situations
2. Non-anaphylactic shock
3. Narrow-angle glaucoma
4. Co-administration during general anesthesia with
halogenated hydrocarbons or cyclopropane
5. Labor
6. Situations where vasopressors may be contraindicated,
including thyrotoxicosis, diabetes
7. Maternal blood pressure in excess of 130/80 mm Hg in
hypertension and other cardiovascular disorders
EPINEPHRINE
LACTATION

There is no information regarding presence of epinephrine in

human milk or effects on the breastfed infant or on milk
production.

However, due to poor oral bioavailability and short half-life,

epinephrine exposure is expected to be very low in breastfed
infant.

Epinephrine is first-line medication of choice for treatment

of anaphylaxis; it should be used in same manner for
anaphylaxis in breastfeeding and non-breastfeeding patients.
VASOPRESSIN
(Vasostrict, ADH)
CLASS: Gastrointestinal Agents, Other; Vasopressin-
Related; Antidiuretics, Hormone Analog
VASOPRESSIN
Vasopressin increases the re-absorption of
water, and is used to treat Diabetes
Insipidus.

It is an alternative to epinephrine, and is

often used in the intensive care unit to
support the blood pressure of organ donor
patients.
VASOPRESSIN
Vasopressin increases the re-absorption of water,
and is used to treat Diabetes Insipidus.

It is an alternative to epinephrine, and is often used

in the intensive care unit to support the blood
pressure of organ donor patients.

It can be used in some instances to treat variceal

bleeding, and cardiac arrest.
VASOPRESSIN
MECHANISM OF ACTION

Vasoconstrictor without inotropic or chronotopic

effects; stimulates smooth muscle in GI tract to
cause peristalsis
VASOPRESSIN
ABSORPTION

Bioavailability: Destroyed by trypsin in GI

tract; must be administered parenterally
or intranasally
Onset (antidiuretic activity): IM/SC, 2-8 hr
Onset (pressor activity) IV, 30-60 min

METABOLISM
Metabolized in liver and kidney; rapidly
removed from plasma
VASOPRESSIN
ELIMINATION

Half-life: 10-20 min (parenteral)

Excretion: Urine (5-10%)

VASOPRESSIN
DOSAGE FORMS AND STRENGTHS

injection solution

20 units/mL
VASOPRESSIN
PREGNANCY AND LACTATION

There are no available data on use in pregnant women

to inform a drug associated risk of major birth defects,
miscarriage, or adverse maternal or fetal outcomes;
animal reproduction studies not conducted.
VASOPRESSIN
CONTRAINDICATIONS

Hypersensitivity; multiple dose vial (10 mL) is

contraindicated in patients with known allergy or
hypersensitivity to 8-L-arginine vasopressin or chlorobutanol;
the 1 mL single dose vial does not contain chlorobutanol;
contraindicated only in patients with a known allergy or
hypersensitivity to 8-L-arginine vasopressin
SOTALOL
(Betapace, Betapace AF, Sorine, Sotylize)
CLASS: Antidysrhythmics, II; Antidysrhythmics, III;
Beta-Blockers, Nonselective
SOTALOL
This drug is used to treat life- threatening
issues of the heart.

It is effective in the treatment of patients

suffering from ventricular arrhythmia and
atrial fibrillation or atrial flutter.

Also known as a beta-

blocker, Sotalol effects the impulses of the
nerves in their response to certain parts of
the body.
SOTALOL
MECHANISM OF ACTION

Antiarrhythmic: Class II (beta blockade) and class III

(action potential prolongation) properties

Has adrenoceptor-blocking effect and markedly

prolongs action potential and repolarization
SOTALOL
ABSORPTION
Bioavailability, oral: 90-100%
Onset: IV, 1-2 hr; 5-10 min for ongoing VT
Peak plasma time: 2.5-4 hr (PO)

DISTRIBUTION
Protein bound: None

METABOLISM
None

ELIMINATION
Half-life: Adults, 12 hr; children, 9.5 hr; prolonged in renal
impairment
Excretion: Urine (unchanged)
SOTALOL
DOSAGE FORMS AND STRENGTHS

tablet (Betapace, Betapace AF, Sorine, generic)

80mg
120mg
160mg

oral solution
5mg/mL (Sotylize)

injectable solution
15mg/mL
SOTALOL
ARRHYTHMIAS

Indications

Indicated for treatment of life-threatening ventricular

tachycardia; antiarrhythmic drugs may not enhance
survival in patients with ventricular arrhythmias

Indicated for maintenance of normal sinus rhythm in

patient with highly symptomatic atrial fibrillation/flutter
(AFIB/AFL) who are currently in sinus rhythm
SOTALOL
SOTALOL
CONTRAINDICATIONS

Sinus bradycardia (<50 bpm), sick sinus syndrome or

second or third degree AV block without a pacemaker

Congenital or acquired long QT syndromes, QT interval

>450 ms

Cardiogenic shock, decompensated heart failure

Serum potassium <4 mEq/L

Bronchial asthma or related bronchospastic conditions

Known hypersensitivity to sotalol

PROCAINAMIDE
[Pronestyl (SR)]
CLASS: Antidysrhythmics, Ia
PROCAINAMIDE
This drug is used to treat patients with a life-
threatening heart disorder known as ventricular
tachycardia or an irregular heartbeat.

Procainamide works by blocking some of the

electrical signs in the heart, which can create an
irregular heartbeat.
PROCAINAMIDE
MECHANISM OF ACTION

Class IA (membrane stabilizing) antiarrhythmic agent;

inhibits recovery after repolarization resulting in
decreasing myocardial excitability and conduction velocity

Direct membrane depressant that decreases conduction

velocity, prolongs refractoriness, decreases automaticity
and reduces repolarization abnormalities
PROCAINAMIDE
ABSORPTION
Bioavailability: 75-95%
Peak Plasma Time: 15-60 min (IV/IM)

DISTRIBUTION
Protein Bound: 15-20%
PROCAINAMIDE
METABOLISM

Acetylated in liver to form N-acetylprocainamide

(NAPA) (active); ratio of procainamide/NAPA
depends upon acetylator phenotype and renal
function
Metabolites (active): N-acetylprocainamide (NAPA)
PROCAINAMIDE
ELIMINATION

Half-Life: 2.5-4.7 hr (parent drug), 6-8 hr (NAPA);

increased in renal impairment and geriatrics
Renal Clearance: 150-600 mL/min

Excretion: Urine (30-60%), minimal in bile

Dialyzable: Yes (HD); no (PD)

PROCAINAMIDE
PROCAINAMIDE
PROCAINAMIDE
PROCAINAMIDE
CONTRAINDICATIONS

Hypersensitivity to procainamide or other ingredients

Complete heart block, 2°/3° AV block, SLE, torsade de

pointes
LIDOCAINE
(Lidocaine CV, Lidopen)
CLASS: Antidysrhythmics, Ib
LIDOCAINE
Aside from being effective as an anti-
itching drug, it is used to treat hemorrhoids,
and certain other discomforts of the genital
areas.

Some form of Lidocaine is used as a local

anesthetic during exams, and surgical
procedures, like cystoscopy, and
sigmoidoscopy.
LIDOCAINE
The drug works by numbing the affected
area, and is beneficial for:

1. Causing temporary numbness

2. Reducing or preventing pain following
an insect bite or minor injury
3. Treating hemorrhoids
LIDOCAINE
MECHANISM OF ACTION

Class 1B antidysrhythmic; combines with fast Na channels

and thereby inhibits recovery after repolarization,
resulting in decreasing myocardial excitability and
conduction velocity
LIDOCAINE
ABSORPTION METABOLISM
Bioavailability: 35% (PO) Liver by de-ethylation to form active metabolites
Onset: IV: 45-90 sec Metabolites (active): monoethylglycinexylidide (MEGX)
Duration: 10-20 min and glycinexylidide (GX) (active met)

DISTRIBUTION ELIMINATION
Protein Bound: 60-80% Half-Life: 2.5-8 hr (parent drug), MEGX 2 hr and GX 10 hr
Vd: 1.7 L/kg (metabolites); half-life prolonged with CHF or liver disease
Clearance: less if CHF, shock, digoxin toxicity, geriatric
Excretion: Urine (90%)
LIDOCAINE
DOSAGE FORMS AND STRENGTHS

infusion solution in D5W

100mg/100mL
200mg/100mL
400mg/100mL
800mg/100mL

injectable solution
10mg/mL
20mg/mL
LIDOCAINE
CONTRAINDICATIONS

Hypersensitivity to lidocaine or amide-type local

anesthetic

Adams-Stokes syndrome, SA/AV/intraventricular heart

block in the absence of artificial pacemaker

CHF, cardiogenic shock, 2nd and 3rd degree heart block (if
no pacemaker is present), Wolff-Parkinson-White
Syndrome
LIDOCAINE
PREGNANCY AND LACTATION

Pregnancy Category: B
ATROPINE
(Atropen)
CLASS: Anesthetic Premedication Agents;
Cholinergic, Toxicity Antidotes
ATROPINE
Atropine decreases the production of and
secretion of saliva prior to surgery. Doctors
use this medication to treat stomach
spasms, spasms that occur in the intestine
and other organs.
ATROPINE
In some cases, it is administered to
counteract the effects of other
medications.

Atropine works by preventing the effects

of acetylcholine in the nervous system,
and in the salivary gland, urinary tract and
other tissues.
ATROPINE
MECHANISM OF ACTION

Competitively inhibits action of ACh on autonomic

effectors innervated by postganglionic nerves;
reverses muscarinic effects of cholinergic poisoning
caused by agents with cholinesterase inhibitor
activity by acting as a competitive antagonist of
acetylcholine ast muscarinic receptors; blocks action
of acetylcholiine at parsympathetic sites in secretory
glands, and CNS; inhibits salivation,
tracheobronchial secretions, bradycardia,
hypotension

Antimuscarinic agent
ATROPINE
PHARMACOKINETICS

Half-life: 2-3 hr (>2 years and adults); 7 hr (<2 years);

10 hr (65-75 years)

Peak plasma time: 3 min (IM)

Onset: Rapid (IV/IM)

Bronchodilation: Within 15 min; max within 15 min-

1.5 hr (oral inhalation)

Distribution: Throughout the body; crosses blood

brain barrier
ATROPINE
PHARMACOKINETICS

Absorption: Principally from the upper small intestine

Metabolites: Tropic acid, tropine, and possibly esters of

tropic acid and glucuronide conjugates

Metabolism: Liver via enzymatic hydrolysis

Excretion: Urine (30-50%); small amounts may also be

eliminated in expired air as carbon dioxide and in feces
ATROPINE
DOSAGE FORMS AND STRENGTHS

intramuscular device
0.25mg/0.3mL
0.5mg/0.7mL
1mg/0.7mL
2mg/0.7mL

injectable solution
0.05mg/mL
0.1mg/mL
0.4mg/mL
0.8mg/mL
1mg/mL
ATROPINE
INDICATIONS

1. anesthesia premedication
2. sinus bradycardia (ACLS)
3. bronchospasm
4. Organophosphate or Carbamate
(Cholinesterase Inhibitors) poisoning
ATROPINE
CONTRAINDICATIONS

No absolute contraindications for ACLS

Ineffective in hypothermic bradycardia

Narrow-angle glaucoma, tachycardia,

asthma, GI obstruction, severe
ulcerative colitis, toxic megacolon,
bladder outlet obstruction
NICARDIPINE
(Cardene IV, Cardene SR)
CLASS: Calcium Channel Blockers;
Calcium Channel Blockers, Dihydropyridine
NICARDIPINE
Nicardipine is used to treat high blood
pressure and to control angina (chest pain).
Nicardipine is in a class of medications called
calcium channel blockers.

It lowers blood pressure by relaxing the blood

vessels so the heart does not have to pump as
hard.
NICARDIPINE
MECHANISM OF ACTION

Calcium-channel blocker (dihydropyridine); inhibits

transmembrane influx of extracellular calcium ions
across membranes of myocardial cells and vascular
smooth muscle cells without changing serum calcium
concentrations; this inhibits cardiac and vascular smooth
muscle contraction, thereby dilating main coronary and
systemic arteries

Produces vasodilation and decreases peripheral

resistance
NICARDIPINE
ABSORPTION

Bioavailability: 35%
Onset: PO, 0.5-2 hr; IV, 10-20 min
Duration: Immediate release and IV, 8
hr; extended release, 8-12 hr
Peak plasma time: Immediate release,
0.5-2 hr; extended release, 2-4 hr
NICARDIPINE
DISTRIBUTION
Protein bound: 95%
Vd: 8.3 L/kg

METABOLISM
Metabolized in liver by CYP3A4 (first pass)
Metabolites: Pyridine analogue (inactive)

ELIMINATION
Half-life: 2-4 hr
Dialyzable: HD, no
Total plasma clearance: IV, 0.3-0.9 L/hr/kg; PO, 1.62-7.86
L/hr/kg
Excretion: Urine (60%), feces (35%)
NICARDIPINE
DOSAGE FORMS AND STRENGTHS
capsule
20mg
30mg
capsule, extended release
30mg
45mg
60mg
infusion solution
20mg/200mL
40mg/200mL
injectable solution
2.5mg/mL
NICARDIPINE
PREGNANCY AND LACTATION

Pregnancy category: C

Lactation: Unknown whether drug is

excreted in breast milk; avoid use
NICARDIPINE
CONTRAINDICATIONS

1. Hypersensitivity to nicardipine or other

calcium-channel blockers
2. Advanced aortic stenosis
DOPAMINE
(Intropin)
CLASS: Inotropic Agents
DOPAMINE
Dopamine is a prescription medicine used to
treat the symptoms of low blood pressure, low
cardiac output and improves blood flow to the
kidneys.
DOPAMINE
MECHANISM OF ACTION

Endogenous catecholamine, acting on both

dopaminergic and adrenergic neurons

Low dose stimulates mainly dopaminergic receptors,

producing renal and mesenteric vasodilation; higher
dose stimulates both beta1-adrenergic and dopaminergic
receptors, producing cardiac stimulation and renal
vasodilation; large dose stimulates alpha-adrenergic
receptors
DOPAMINE
ABSORPTION ELIMINATION
Onset: 5 min (adults) Half-life: 2 min
Duration: <10 min Total body clearance: 115 mL/kg/min
Excretion: Urine (80%)
DISTRIBUTION
Vd: 1.8-2.45 L/kg

METABOLISM
Metabolized in liver, kidney, and
plasma by monoamine oxidase and catechol-O-
methyl transferase
Metabolites: Norepinephrine (active),
inactive metabolites
DOPAMINE
DOSAGE FORMS AND STRENGTHS INDICATION

infusion solution, in D5W Treatment of hypotension, low cardiac output,

80mg/100mL poor perfusion of vital organs; used to increase
160mg/100mL mean arterial pressure in septic shock patients
320mg/100mL who remain hypotensive after adequate
volume expansion.
injectable solution
40mg/mL
80mg/mL
160mg/mL
DOPAMINE
DOPAMINE
CONTRAINDICATIONS

Hypersensitivity to dopamine,
pheochromocytoma, ventricular fibrillation,
uncorrected tachyarrhythmias
NOREPINEPHRINE
(Levarterenol, Levophed)
CLASS: Alpha/Beta Adrenergic Agonists
NOREPINEPHRINE
Norepinephrine is a sympathomimetic used in
the control of blood pressure during various
hypotensive states and as an adjunct treatment
during cardiac arrest.
NOREPINEPHRINE
MECHANISM OF ACTION

Strong beta1- and alpha-adrenergic

effects and moderate beta2 effects,
which increase cardiac output and heart
rate, decrease renal perfusion and PVR,
and cause variable BP effects
NOREPINEPHRINE
ABSORPTION ELIMINATION
Onset: 1-2 min Excretion: Urine (84-96%)
Duration: 1-2 min (vasopressor)

METABOLISM
Metabolized by MAO and
catechol-O-methyl transferase (COMT)
in the adrenergic neuron
Metabolites: Normetanephrine,
vanillylmandelic acid (inactive)
NOREPINEPHRINE
DOSAGE FORMS AND STRENGTHS

injectable solution
1mg/mL
NOREPINEPHRINE
NOREPINEPHRINE
CONTRAINDICATIONS

1. Hypersensitivity
2. Patients who are hypotensive from blood volume deficits
except as an emergency measure to maintain coronary and
cerebral artery perfusion until blood volume replacement
therapy can be completed
3. Peripheral vascular thrombosis (except for lifesaving
procedures)
4. Concomitant use with some general anesthetics
cyclopropane (not available in the US), halothane (not
available in the US)
DOBUTAMINE
CLASS: Inotropic Agents
DOBUTAMINE
Dobutamine is a prescription
medicine used to treat the
symptoms of cardiac
decompensation.
DOBUTAMINE
MECHANISM OF ACTION

Strong beta1- and alpha-adrenergic

effects and moderate beta2 effects,
which increase cardiac output and
heart rate, decrease renal perfusion
and PVR, and cause variable BP
effects
DOBUTAMINE
ABSORPTION ELIMINATION
Onset: 1-10 min Half-life: 2 min
Duration: 10 min Clearance: 90 mL/kg/min
Time to peak effect: ~15 min Excretion: Urine

DISTRIBUTION
Vd: 0.2 L/kg

METABOLISM
Metabolized in tissues and liver by
catechol-O-methyl transferase

Metabolites: Glucuronide conjugate, 3-0-

methylated dobutamine (inactive)
DOBUTAMINE
DOSAGE FORMS AND STRENGTHS

infusion solution, in D5W

100mg/100mL
200mg/100mL
400mg/100mL

injectable solution
12.5mg/mL
DOBUTAMINE
CONTRAINDICATIONS

1. Hypersensitivity to drug or
components
2. Idiopathic hypertrophic subaortic
stenosis
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