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MECHANISM OF ACTION Stimulates dopamine1 (D1) and dopamine2 (D2) postsynaptic receptors. D1 receptors mediate vasodilation in renal, mesenteric, coronary, and cerebral blood vessels. D2 receptors inhibit norepinephrine release. In higher doses, dopamine also stimulates alpha1 and alpha2 receptors, causing vascular smooth-muscle contraction. At doses of 0.5 to 3 mcg/kg/min, this naturally occurring catecholamine mainly affects dopaminergic receptors in renal, mesenteric, coronary, and cerebral vessels, resulting in vasodilation, increased renal blood flow, improved GFR, and increased urine output. At doses of 2 to 10

CONTRAIN -DICATION Pheochromo cytoma, uncorrected ventricular fibrillation, ventricular tachycardia, and other tachyarrhyth mias

dopamine hydrochloride Class and Category Chemical class: Catecholamine Therapeutic class: Cardiac stimulant, vasopressor

To correct hypotension thats unresponsive to adequate fluid volume replacement or occurs as part of shock syndrome caused by bacteremia, chronic cardiac decompensation, drug overdose, MI, open-heart surgery, renal failure, trauma, or other major systemic illnesses; to improve low cardiac output

SIDE-EFFECT / ADVERSE EFFECT CNS: Headache CV: Angina, bradycardia, hypertension, hypotension, palpitations, peripheral vasoconstriction, sinus tachycardia, ventricular arrhythmias GI: Nausea, vomiting RESP: Dyspnea SKIN: Extravasation with tissue necrosis


If possible, avoid giving dopamine to patients with occlusive vascular disease, such as atherosclerosis, Buergers disease, diabetic endarteritis, or Raynauds disease, because of risk of decreased peripheral circulation. Use drug cautiously in patients with cardiac disease, particularly coronary artery disease, because dopamine increases myocardial oxygen demand. Also use drug cautiously in patients allergic to sulfites, which are contained in some forms of dopamine. Inspect parenteral solution for particles and discoloration before administration. Dilute dopamine concentrate with a compatible I.V. solution before administering. Typical dilution is 400 mg in 250 ml to yield 1.6 mg/ml. Dont exceed 3.2 mg/ml. If patient has hypovolemia, ensure adequate fluid resuscitation before giving drug. Give drug by I.V. infusion using an infusion pump. WARNING When infusion rate exceeds 20 mcg/kg/min, monitor patient for excessive vasoconstriction and loss of renal vasodilating effects. Avoid using an infusion rate above 50 mcg/kg/min. If you must infuse more than 20 mcg/kg/ min of dopamine to maintain blood pressure, expect to infuse norepinephrine as prescribed. To avoid extravasation and tissue necrosis, administer infusion through a central catheter. If you must give drug via peripheral line, inspect site often for signs of extravasation and necrosis. If you detect

mcg/kg/ min, dopamine stimulates beta1adrenergic receptors, increasing cardiac output while maintaining dopaminergicinduced vasodilation. At doses of 10 mcg/kg/min or more, alpha-adrenergic agonism takes over, causing increased peripheral vascular resistance and renal vasoconstriction.

such signs, start a new I.V. line for dopamine infusion, discontinue previous I.V. line, and notify prescriber immediately. If drug extravasates, expect to give 5 to 10 mg phentolamine diluted in 10 to 15 mlnormal saline solution, as prescribed. Phentolamine infiltrates directly into area to antagonize vasoconstriction and minimize sloughing and tissue necrosis. Titrate dopamine gradually to minimize hypotension, especially after a high infusion rate. Monitor blood pressure continuously with an intra-arterial line, as indicated. Place patient on continuous ECG monitoring, and assess heart rate and rhythm for arrhythmias. Monitor patients hemodynamic parameters, such as central venous pressure, pulmonary artery wedge pressure, and cardiac output, as indicated, to assess effectiveness of dopamine therapy. Monitor urine output hourly as appropriate to assess patient for improved renal blood flow. PATIENT TEACHING Explain the need for frequent hemodynamic monitoring.