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- Adrenergic Dopaminergic Catecholamine
Dopamine Mechanism of Action:
- Naturally occurring catecholamine that is the chemical precursor of norepinephrine. Is generally dose dependant on its effects.
- 1-2 μg/kg/min--dopaminergic receptors--dilation of renal, mesenteric, and cerebral arteries
- 2-10 μg/kg/min--beta receptors--inotropic, chronotropic
- 10-20 μg/kg/min--alpha & beta--vasoconstriction of renal, mesenteric, and peripheral arteries and veins
- >20 μg/kg/min--Mimics pure alpha effects similar, to norepinepherine like effects. It is occasionally used at this range in-hospital.
- Cardiogenic Shock
- Cardiogenic Shock w/ Pulmonary Edema (CHF)
- Hypovolemic Shock / Hypotension (after fluid resuscitation)
- Neurogenic Shock
- Septic Shock
- Women on oxytocin
- Uncorrected hypovolemia
- Patients with known pheochromocytoma
- MAOIs,TCAs, other cardiac stimulants, vasopressors, will cause increased heart rate, and SV dysrhythmias
- Will precipitate in basic, alkaline solutions
- May cause necrosis, sloughing at infusion site
- Pregnancy (C)
Dopamine Dosage Adults:
- 2-20 μg/kg/min, occasionally up to 50 μg/kg/min, generally not exceeding 20 μg/kg/min without medical control guidance.
- Titrated to effect, run through a large vein.
- Generally add two vials 200 mg to 250 ml NS, yielding 1600 μg/ml, although some alternative methods exist
Dopamine Dosage Pediatrics:
- 2-20 μg/kg/min, with 10 μg/kg/min is a reasonable starting dose, titrated to effect, generally not exceeding 20 μg/kg/min.
- Add 6 mg x weight in kg diluted to 100 ml, to create drip.
- 1gtt/min (cc/hr) equals 1 μg/kg/min.
Dopamine Side Effects:
- Nausea & Vomiting
- Angina, AMI
- Tachycardia, Including ventricular fibrillation, ventricular tachycardia
- Potentiating effects--TCAs, MAOIs, bretylium
- Precipitates in Alkaline Solutions
- Dopamine may cause hypotension when used concomitantly with phenytoin (Dilantin)
- Can cause tissue necrosis and sloughing. Take care to avoid infiltration, use central intravenous access or the large veins of the arm
- Titrate dosage to patient’s hemodynamic response