Generic Name Vasopressin

Brand Name Vasostrict

Drug Classification Antidiuretics, Hormone Analog, Gastrointestinal

Agents
Dosage Vasodilatory Shock
 0.01-0.04 unit/minute intravenously (IV)
Mode of action With its antidiuretic effect, vasopressin is a
major player in the control of body fluid balance.
Renal vasopressin V2-receptors, which are
connected to adenylyl cyclase and the
production of cAMP, mediate this effect.
Vasopressin can also constrict blood vessels
and raise blood pressure.12 This effect is
brought on by vascular V1-receptors, which, in
contrast to renal receptors, are linked to
phospholipase C and elevated intracellular
Ca2+ concentration.
Indication Vasopressin is used to raise blood pressure in
adults experiencing vasodilatory shock who are
resistant to fluid and catecholamine
administration.
Contraindication  a migraine headache
 high blood pressure
 coronary artery disease
 heart failure
 asthma
 an accumulation of toxins in the blood due
to kidney failure called uremia
 seizures

Side Effect/ Adverse Significant: Reversible diabetes insipidus

Reaction (following discontinuation of treatment), water
 intoxication; extravasation; decreased cardiac
output.
Blood and lymphatic system disorders:
Decreased platelet count, intractable bleeding.
Cardiac disorders: Angina, cardiac arrest, atrial
fibrillation, bradycardia, myocardial ischaemia,
right heart failure.
Gastrointestinal disorders: Nausea, vomiting,
diarrhoea, flatulence, abdominal pain,
mesenteric ischaemia.
General disorders and admin site conditions:
Non-cardiac chest pain.
Immune system disorders: Hypersensitivity,
anaphylaxis.
Investigations: Increased serum bilirubin
Metabolism and nutrition disorders:
Hyponatraemia.
Nervous system disorders: Headache, vertigo,
tremor.
Renal and urinary disorders: Fluid retention,
acute renal insufficiency.
Respiratory, thoracic and mediastinal disorders:
Bronchospasm.
Skin and subcutaneous tissue disorders:
Gangrene, hyperhidrosis, urticaria, ischaemic
lesions.
Vascular disorders: Hypertension, pallor,
peripheral ischaemia, haemorrhagic shock.
Drug interaction  Enhanced therapeutic effect with
indometacin specifically on cardiac index
and systemic vascular resistance.
 Enhanced effect on mean arterial blood
pressure with ganglionic blocking agents
(e.g. mecamylamine).
 Increased pressor and antidiuretic effects
with drugs suspected of causing SIADH
(e.g. TCAs, SSRIs, carbamazepine,
haloperidol, chlorpropamide, methyldopa,
 enalapril, clofibrate, fludrocortisone, urea,
pentamidine, ifosfamide, cyclophosphamide,
vincristine, felbamate).
 Decreased pressor and antidiuretic effects
with drugs suspected of causing diabetes
insipidus (e.g. clozapine, lithium, foscarnet,
demeclocycline, heparin, alcohol,
norepinephrine).
Nursing Responsibilities Monitor I&O closely, restrict intake as necessary
to prevent water intoxication.
Weigh daily if indicated.
Check B/P, pulse frequently. Monitor serum
electrolytes, Hgb, Hct, urine specific gravity.
Evaluate injection site for erythema, pain,
abscess.
Report side effects to physician for dose
reduction.
Be alert for early signs of water intoxication
(drowsiness, listlessness, headache, seizures).
Observe for evidence of GI bleeding.
Withhold medication, report immediately any
chest pain, allergic symptoms.
During therapy, monitor the patient's alertness
and orientation frequently.
R: Lethargy and confusion associated with
headache may indicate the onset of water
intoxication, which, while slow to develop, can
result to convulsions and terminal coma.

Generic Name Levosimendan

Brand Name Simdax
Drug Classification Calcium Sensitizer
Dosage Acute decompensated cardiac failure
 Adult: Loading dose: 6-12 mcg/kg via
infusion over 10 minutes in situations where
conventional therapy is insufficient and
inotropic support is considered appropriate.
Maintenance dose: 0.1 mcg/kg/min via
continuous infusion; may be reduced to 0.05
mcg/kg/min if significant hypotension or
tachycardia occur, or increased to 0.2
mcg/kg/min if the initial dose is tolerated and
an increased haemodynamic effect is
required. The dose and duration of
treatment are tailored to the patient's clinical
condition and response. Patients taking IV
vasodilators and/or inotropes should reduce
the loading dose to 6 mcg/kg over 10
minutes.
Mode of action Levosimendan works in two ways: (1) it
sensitizes troponin C to calcium in a calcium-
dependent manner, increasing the effects of
calcium on cardiac myofilaments during systole
and improving contraction at a low energy cost.
(2) During diastole, sensitization is reduced due
to a decrease in calcium concentration, which
does not worsen diastolic relaxation but, on the
contrary, improves it. Because levosimendan,
unlike other inotropic agents, does not cause
diastolic calcium overload, it also does not
cause cardiac myocyte dysfunction, arrhythmia,
or an increase in energy consumption.
Indication For short term treatment of acutely
decompensated severe chronic heart failure
(CHF). It is also being researched for
use/treatment in heart disease.
Contraindication Levosimendan is not recommended for patients
who have moderate-to-severe kidney
impairment, severe liver impairment, severe
ventricular filling or outflow obstruction, very low
blood pressure and fast heart rate, and/or a
history of torsades de pointes.

Side Effect/ Adverse Significant: Hypokalaemia, decreased Hb and

Reaction haematocrit, ventricular tachycardia, atrial
 fibrillation, ventricular extrasystoles,
hypotension.
Cardiac disorders: Myocardial ischaemia,
cardiac failure.
Gastrointestinal disorders: Diarrhoea,
constipation, nausea, vomiting.
Nervous system disorders: Headache,
dizziness.
Psychiatric disorders: Insomnia.
Drug interaction  Other IV vasoactive agents increase the risk
of hypotension.
 Drugs primarily metabolized by CYP2C8
may be exposed to greater risk (e.g.
loperamide, pioglitazone, repaglinide,
enzalutamide).
 Concurrent use with isosorbide mononitrate
may increase orthostatic hypotension.
Nursing Responsibilities
GENERAL SURVEY

Client J.S. has an endomorph body built. She was conscious an disoriented due to pain. The
vital signs of the patient were as follows:

Temperature 34.5

Heart rate 110 bpm

Pulse rate 108 bpm

Blood pressure 80/70 mmHg

Respiratory rate 25 cpm

O2 saturation 95%

SKIN AND NAILS

The patient has uniform senile skin color, the texture is smooth and cool to touch. The skin
turgor of the patient is good as it return immediately to its original state after being assessed
through pinching. The patient has a capillary refill of <3 seconds. Fingernails were clean and
well trimmed with slightly pallor appearance. No clubbing or spooned shaped nails were
noted. Peripheral edema noted on both feet noted.

HEAD

The patient has a normocephalic head with no nodules and masses can be seen. It is

symmetrical without deformities, lumps, or tenderness. Scalp free of

lesion, infestation, lumps or tenderness and hair is in good distribution. Black and

white thin hair noted. Her facial features are asymmetrical, there’s no masses, paralysis

or edema noted.

EYES

Eyes are equally round. Eyebrows are aligned and symmetrical in movement. Lids
are symmetrical. Lacrimal duct is normal with no signs of swelling, excessive tearing, or
dryness. Conjunctiva is pinkish with no signs of lesion. No signs of edema, sunken or
discoloration in the periorbital region. Sclera is anicteric. Pupils are black, isocoric
and are brisk. Extraocular movements are normal. Pupils are dilated, equally round, and
reactive to light and accommodation.
EARS

The ears has no tags and the color appearance matches with the rest of the skin. Symmetric
and in line with lateral canthus of the eyes. Auricles are symmetrical with normal elasticity
and quick recoil. There are no visible foreign bodies, redness, discharges, or abnormalities of
either ear, which both are positioned centrally and in proportion to the head. External canal
is normal with no signs of impacted cerumen, discharge such as foul smelling, serous,
purulent or mucoid and hearing acuity is normal.

NOSE

The patient’s nose is symmetrical and patent with nasal septum intact and at the midline.
There were no purulent discharges noted. There were no further unusualities found.

MOUTH

Lips of the patient were asymmetrical, slightly pale in color, dry and no cracks noted

with no signs of lesions.

PHARYNX

There were no purulent discharges noted upon assessment. There were no

further unusualities found upon assessment.

NECK

Trachea is located at midline. Lymph nodes were palpable but not enlarged. No

signs of irritation and redness over the skin. Head movements were coordinated and no

discomforts expressed, he was able to move the head freely. Jugular vein is

distended, but muscle strength is decreased.

THORAX

Upon auscultation, wheezing were heard from both the right and left lobe,

with moderate labored breathing.

HEART

Heart sounds were diminished from the patient.No murmurs can be heard upon
auscultation.

ABDOMEN

Skin of the abdomen is intact, with no striae, scars, or lesions. The contour is flat.

Abdomen was round, soft, and not distended with normal bowel sounds.

GENITO - URINARY SYSTEM

Pubic hair growth is normally distributed as described by the patient. No bloody or foul-
smelling discharges, noted. However, urine output was 15-20 cc/hr. Urine has amber color
appearance.

NEUROLOGICAL ASSESSMENT

The patient is conscious and aware of her name. She is disoriented with regards to
the day and the place. Furthermore, the patient had some difficulty understanding during
the assessment due to the pain she was feeling. However, there are instances when she is
confused, but she has no issue recalling her name and how many children she has. The
patient's speech was spontaneous and coherent. GCS scores are as follows:

Component Score

Eye 4

Verbal 5

Motor 6

Total Score: 15