The document discusses various inotropic agents used to increase the force of cardiac muscle contractions. It describes three main classes of inotropes - cardiac glycosides like digoxin, sympathomimetics like dopamine and dobutamine, and phosphodiesterase inhibitors like amrinone. For each drug, it provides details on mechanisms of action, dosages, administration, indications, contraindications, side effects and nursing considerations. The document provides an in-depth review of inotropic drugs used clinically to enhance cardiac contractility and output.
This document provides an overview of vasopressors and inotropes used in critical care to treat shock. It discusses the different types of shock and principles of resuscitation including fluid administration and optimization of oxygen delivery and consumption. It also reviews the mechanisms of action, indications, and side effects of commonly used vasopressors and inotropes like dopamine, dobutamine, milrinone, levophed, phenylephrine, epinephrine, and vasopressin. Case studies are presented to demonstrate how these agents may be applied based on a patient's hemodynamic status.
Dobutamine and dopamine are commonly used inotropic agents that increase cardiac output by increasing stroke volume, though dopamine can increase afterload at higher doses. Epinephrine and norepinephrine also increase contractility through beta-1 agonism but have greater vasopressor effects. Dobutamine is preferred over dopamine when treating cardiogenic shock due to its more predictable cardiac effects. In septic shock, dobutamine with norepinephrine is recommended to increase cardiac output while maintaining blood pressure, though epinephrine is an alternative. The effects of inotropes on tissue oxygen utilization must also be considered, as agents like dopamine may impair splanchnic perfusion despite increasing cardiac output.
This document discusses coronary artery bypass graft (CABG) surgery. It aims to completely revascularize the heart muscle to relieve symptoms, improve quality of life, and increase life expectancy. CABG surgery is indicated for significant stenosis of the left main coronary artery or other multi-vessel disease. The standard approach is on-pump CABG using cardiopulmonary bypass, though off-pump CABG is also performed. The left internal thoracic artery is the preferred graft for the left anterior descending artery due to its excellent long-term patency rates. Reversed saphenous veins are commonly used for other grafts but have lower patency rates over time. Patient and vessel characteristics help determine surgical candidacy and technique.
This document discusses vasopressor and inotropic agents, including their receptor physiology, pharmacological actions, therapeutic uses, and clinical applications. It provides details on commonly used agents like epinephrine, norepinephrine, dopamine, dobutamine, phenylephrine, vasopressin, and milrinone. It explains their effects on hemodynamics like heart rate, contractility, blood pressure, systemic and pulmonary vascular resistance. It also outlines the advantages and disadvantages as well as indications for use in different shock states and heart conditions.
Bicarbonate use in cardiac arrest and shockSCGH ED CME
This document discusses the use of sodium bicarbonate (NaHCO3) in cardiac arrest and shock. It reviews guidelines from resuscitation councils which recommend against routine use of NaHCO3 in cardiac arrest, except for cases of hyperkalemia or tricyclic overdose. Studies have not found benefits to outcomes from NaHCO3 in cardiac arrest. NaHCO3 is also not recommended for high anion gap acidosis in shock, as it can worsen lactic acidosis. NaHCO3 may be useful for normal anion gap acidosis once the primary cause is corrected. The document concludes there is still a lack of strong evidence supporting NaHCO3 use in many emergency situations due
This document discusses vasoactive agents and their receptor physiology and clinical applications. It begins by outlining the objectives of understanding vasopressor and inotropic receptor physiology and appropriate clinical use. It then provides background on vasopressors, inotropes, and drugs that have both effects. The majority of the document then discusses the receptor physiology and mechanisms of action of various adrenergic, dopaminergic, and vasopressin receptors. It also covers individual drug classifications, effects, indications, and considerations for agents like epinephrine, norepinephrine, dopamine, dobutamine, milrinone, vasopressin, levosimendan, and vasodilators. Studies comparing agents
This document discusses inotropes, which are drugs that increase the force of myocardial contraction. It defines inotropes and discusses their physiological effects and classification. Various endogenous and exogenous inotropic agents are described in detail, including their mechanisms of action, indications, dosages, pharmacokinetics and side effects. Sympathomimetic drugs like epinephrine, norepinephrine and dopamine are discussed as conventional positive inotropic agents.
This document discusses various vasoactive drugs used to treat low blood pressure and cardiac issues in critically ill patients. It begins by explaining the immature heart's limited responsiveness to medications and calcium regulation. It then describes different types of effects that agents can have including increasing blood pressure, contractility, heart rate, and relaxation. The remainder of the document delves into specific drugs, outlining their mechanisms, indications, dosages, and side effects. These include catecholamines like epinephrine, norepinephrine, and dopamine, as well as dobutamine, milrinone, vasopressin, nitroprusside, and nesiritide.
Cardioversion is a procedure that uses electric shock or drugs to convert an abnormal heart rhythm back to normal. There are two main types - electrical cardioversion, which delivers a synchronized electric shock, and pharmacological cardioversion, which uses antiarrhythmic drugs. Electrical cardioversion can be elective or emergency, while pharmacological cardioversion utilizes various classes of drugs like beta blockers, sodium channel blockers, and calcium channel blockers to restore normal rhythm. The document outlines the differences between cardioversion and defibrillation, indications and contraindications for cardioversion, recommendations, procedure steps, complications, and drug options for pharmacological cardioversion.
This document provides an overview of inotropes and vasopressors. It discusses how inotropes such as dobutamine work to increase cardiac contractility as positive inotropes, while drugs like calcium channel blockers act as negative inotropes. Vasopressors like norepinephrine work mainly through alpha receptors to increase blood pressure. The document reviews the mechanisms and indications for various inotropes and vasopressors. It also discusses factors like preload, afterload and contractility that influence cardiac output, and how drugs can be used to optimize these factors in conditions like cardiogenic shock. Monitoring of parameters like blood pressure, cardiac output and central venous pressure is important when using these
This document provides an overview of various cardiac medications, including their classifications, mechanisms of action, indications for use, dosages, and potential adverse effects. It discusses drugs that work on the cardiovascular system like beta blockers, calcium channel blockers, ACE inhibitors, diuretics, inotropes, antiarrhythmics, and anticoagulants. The document also provides a case study example and discusses preparation for cardiac catheterization.
This document discusses vasopressors and inotropes, including their physiology, principles of use, individual drugs, and complications. It describes the adrenergic receptor subtypes and how drugs like norepinephrine, epinephrine, dopamine, dobutamine, vasopressin, and inamrinone/milrinone act on them. Norepinephrine is the first-line treatment for septic shock while dobutamine is preferred for cardiogenic shock. Potential complications include hypoperfusion, dysrhythmias, local effects, hyperglycemia. The document provides dosing guidelines and discusses implications for septic shock management.
Noradrenaline is used to treat hypotension, bronchospasm, and cardiac arrest. It works by causing smooth muscle relaxation in the airways and contraction in the arterioles and increasing cardiac contractability. The document provides formulas for calculating infusion rates of various inotropes like noradrenaline, dopamine, dobutamine, and nitroglycerin based on desired dose, patient weight, and drug concentration. Potential adverse effects include hypertension, bradycardia, and arrhythmias. When administering inotropes, nurses must follow ten rights, continuously monitor blood pressure and ECG, and be aware of drug interactions and precautions.
This document discusses hemodynamic monitoring components used to evaluate the cardiovascular system. It describes how components such as heart rate, blood pressure, cardiac output, stroke volume, central venous pressure and pulmonary artery pressures are measured and used to establish baseline values, evaluate trends, determine dysfunction, and guide interventions. Factors that influence hemodynamics like preload, afterload, contractility and resistance are also explained. Normal ranges for various measurement values are provided.
Hemodynamic monitoring involves measuring and monitoring the factors that influence blood flow and pressure in the body. It is concerned with five main areas: the right heart, lungs, left heart, fluid status, and blood pressures. Normal hemodynamic values include a central venous pressure of 2-6 mmHg, pulmonary artery pressure of 6-15 mmHg, pulmonary capillary wedge pressure of 6-12 mmHg, and a cardiac output of 4-8 L/min. Treatment for different types of shock depends on the underlying cause but may include inotropes, vasopressors, antibiotics, and fluid resuscitation.
The document discusses anaesthetic management of a 55-year-old male with a history of myocardial infarction undergoing gastric surgery, including preoperative evaluation and optimization, intraoperative hemodynamic management and monitoring to balance myocardial oxygen supply and demand, and postoperative care focusing on arrhythmia prevention and pain control. The patient's medications were continued and invasive monitoring was planned intraoperatively to detect any ischemia for prompt intervention.
The term inotropic state is most commonly used in reference to various drugs that affect the strength of contraction of heart muscle (myocardial contractility). However, it can also refer to pathological conditions. For example, enlarged heart muscle (ventricular hypertrophy) can increase inotropic state, whereas dead heart muscle (myocardial infarction) can decrease it.
Dobutamine is a positive inotropic drug that acts directly on cardiac beta-1 receptors to increase myocardial contractility and enhance stroke volume, resulting in increased cardiac output and decreased pulmonary capillary wedge pressure within 1-2 minutes. Common adverse reactions include nausea, headache, respiratory distress, angina, palpitations, tachycardia, hypertension and ventricular ectopic beats. Dobutamine is contraindicated in atrial fibrillation, ventricular arrhythmias and phaeochromocytoma.
CARDIO PLEGIA DELIVERY DR NIKUNJ R SHEKHADA (MBBS,MS GEN SURG,DNB CTS SRDR NIKUNJ SHEKHADA
This document discusses different methods of delivering cardioplegia (chemicals that induce cardiac arrest) during cardiac surgery. It describes:
1. Intracellular and extracellular cardioplegia work by altering ion concentrations to prevent generation of action potentials and induce cardiac arrest.
2. Methods of delivery include antegrade (through coronary arteries), retrograde (through coronary sinus), intermittent, continuous, or a combination.
3. Retrograde delivery has advantages like reaching arteries with blockages, but risks include injury from high pressures in the coronary sinus.
Vasopressors are drugs that induce vasoconstriction and elevate blood pressure. This document discusses the history, physiology, classification, and pharmacology of various vasopressors used in the ICU setting. It describes how vasopressors act on different adrenergic receptors to increase blood pressure by either increasing cardiac output, systemic vascular resistance, or both. The document reviews commonly used vasopressors like norepinephrine, epinephrine, dopamine, phenylephrine, dobutamine, and ephedrine - outlining their indications, mechanisms of action, pharmacokinetics, and adverse effects.
This document provides information on autoimmune hepatitis, including:
- It is a chronic hepatitis of unknown etiology that can progress to cirrhosis. It is characterized by the presence of autoimmune antibodies and evidence of hepatitis.
- The two main types are type 1, associated with ANA/SMA positivity, and type 2, associated with LKM1 positivity.
- Treatment involves immunosuppressive drugs like prednisone, either alone or in combination with azathioprine. The goal is to induce and maintain remission.
- Remission is defined as resolution of symptoms and normalization of liver tests and histology. Treatment is then tapered slowly to maintain remission.
1) The complement system consists of plasma proteins that work together through three activation pathways - classical, lectin, and alternative - to enhance immunity. Deficiencies in complement proteins result in increased risk of infection or autoimmune disease.
2) Evaluation of patients with suspected complement deficiency includes testing for complement protein levels (CH50, AH50), and functional activity. Deficiencies are associated with increased risk of recurrent infections, especially from encapsulated bacteria.
3) Hereditary angioedema is caused by C1-INH deficiency and results in recurrent swelling attacks. It is diagnosed through blood tests showing low C4 and C1-INH levels, and treated by targeting mediators of swelling. Pro
This document summarizes bacterial meningitis. It is an inflammation of the meninges caused by bacteria entering the bloodstream from infections like pneumonia or ear infections. The most common types are pneumococcal, meningococcal, Hib, and listeria. Symptoms include high fever, severe headache, stiff neck, and confusion. Treatment involves intravenous antibiotics and managing complications. Prevention focuses on immunizations, hand washing, and food safety.
Bacterial meningitis is a common central nervous system infection caused by various bacteria. Neisseria meningitidis is a major cause and produces an endotoxin responsible for circulatory collapse. It occurs sporadically or in epidemics, is transmitted via droplets, and prevalence is higher in young children and spleenectomized patients. Clinical presentation includes headache, fever, vomiting, and neck stiffness. Investigations include CSF analysis and blood cultures. Treatment involves antibiotics and supportive care while complications can include neurological deficits if left untreated. Vaccination and chemoprophylaxis can help prevent further spread.
This document provides information about Neisseria meningitidis, the bacteria that causes meningococcal meningitis. It describes the morphological features and virulence factors of N. meningitidis, including its gram-negative diplococcal shape, polysaccharide capsule that allows it to evade the immune system, and pili that enable it to attach to cells in the nasopharynx. The document also outlines the pathogenesis of meningococcal meningitis, noting that the bacteria spread from the nasopharynx via the bloodstream to the meninges, where it can cause inflammation and potentially fatal infection.
Autoimmune hepatitis is a disease where the immune system attacks the liver, causing inflammation. It was originally called the "women's disease" but can affect people of any gender. Symptoms can range from fatigue and joint pain to bruising, abdominal pain, and even life-threatening complications like encephalopathy and coma. Several famous people like Montel Williams, Venus Williams, Kathleen Turner, Toni Braxton, and Missy Elliott suffer silently from various autoimmune diseases and have worked to increase public awareness. Treatment options include traditional therapies as well as holistic approaches, and rates of autoimmune hepatitis are higher in Western Europe than in America.
Autoimmune hepatitis is a chronic inflammatory disease of the liver that results from an autoimmune attack against the liver cells. It was first described in the 1950s under various names before being termed autoimmune hepatitis in 1992. It predominantly affects females and is often diagnosed between ages 40-50. Treatment involves immunosuppressive medications like prednisone and azathioprine to induce remission of symptoms and liver inflammation. Relapses may occur upon withdrawing treatment, requiring retreatment with the same medications.
A 14 year old boy presented with low grade fever, anemia, splenomegaly and polyarthritis of the left ankle, left knee and right middle finger for 6 months. Based on the findings, he was diagnosed with Juvenile Idiopathic Arthritis. Juvenile Idiopathic Arthritis is a chronic autoimmune disease characterized by arthritis in children under 16 years of age lasting more than 6 weeks, for which other causes have been excluded. Treatment involves medications like NSAIDs, DMARDs, corticosteroids and biologics to suppress inflammation and maintain function.
This document provides guidelines for the diagnosis and management of autoimmune hepatitis (AIH) as outlined by the American Association for the Study of Liver Diseases (AASLD) in 2010. It defines AIH as a chronic relapsing hepatitis associated with plasma cell infiltration, hypergammaglobulinemia, and positive autoantibodies. The document discusses the epidemiology, natural history, pathogenesis, clinical presentation, diagnostic criteria, histological features, imaging, and treatment of AIH.
The complement system is an important part of the innate immune system that activates through three pathways - classical, lectin, and alternative. Activation leads to the formation of C3 and C5 convertases that generate inflammatory molecules like C3a and C5a, and opsonins like C3b that promote phagocytosis. It ultimately forms the membrane attack complex that lyses target cells. Complement is tightly regulated to prevent damage to host cells and excessive inflammation. Deficiencies in complement components can increase risk of certain infections.
Bacterial meningitis can be severe and cause long term effects like hearing loss or learning disabilities, while viral meningitis is generally less severe and resolves without treatment. It is important to determine if meningitis is bacterial or viral and, if bacterial, to identify the specific bacteria causing the infection in order to guide treatment and preventative measures. Meningitis is diagnosed through spinal fluid analysis to check for signs of inflammation and look for bacteria. While some forms of bacterial meningitis can be transmitted between people, viruses that cause meningitis are not as contagious.
This document discusses juvenile idiopathic arthritis (JIA), including its definition, signs and symptoms, patterns of onset, and treatment approaches. JIA is the most common rheumatic disease of childhood and can be divided into subtypes based on characteristics. Treatment involves NSAIDs initially and may progress to DMARDs like methotrexate or biological agents if needed. Management of uveitis associated with JIA relies on regular screening by an ophthalmologist and corticosteroid therapy if detected. The goal of JIA treatment is to minimize inflammation, control pain, preserve movement, and promote development.
Describes the complement system components and their activation pathways, the regulation of the complement
system, the effector functions of various complement components,
and the consequences of deficiencies in them.
Dr Sarath Menon presents an approach to diagnosing and classifying hemolytic anemia. Hemolytic anemia results from increased red blood cell destruction and bone marrow compensation. It can be congenital/hereditary or acquired. Classification includes intracorpuscular defects like hemoglobinopathies and enzymopathies, and extracorpuscular factors like mechanical destruction, toxic agents, infections, and autoimmune causes. Diagnosis involves confirming hemolysis and determining the etiology through history, physical exam, peripheral smear, and ancillary lab tests. Common etiologies discussed in detail include sickle cell disease, thalassemia, G6PD deficiency, membrane defects like hereditary spherocytosis, and autoimmune
The complement system consists of three pathways - the classical, lectin, and alternative pathways. The lectin pathway is activated when mannose-binding lectin (MBL) binds to mannose sugars on microbial surfaces. This binding activates MASP-1 and MASP-2, analogous to C1r and C1s in the classical pathway. MASP-1 and MASP-2 then cleave C4 and C2 to form the C3 convertase, which activates the remainder of the complement cascade. The lectin pathway thus provides an antibody-independent mechanism for complement activation in response to microbial pathogens.
This document summarizes various inotropic drugs used to increase cardiac contractility including cardiac glycosides like digoxin, catecholamines like dopamine and dobutamine, phosphodiesterase inhibitors like milrinone, and calcium sensitizers like levosimendan. It provides details on their mechanisms of action, pharmacokinetics, uses, dosages, and side effects. The document focuses on the inotropic and hemodynamic effects of these drugs and their roles in treating low cardiac output states and heart failure.
This document discusses various inotropic agents used to increase the contractility of the heart. It describes the mechanisms and indications for commonly used inotropes including digitalis glycosides like digoxin, sympathomimetics like dopamine and dobutamine, and phosphodiesterase inhibitors like amrinone. It provides dosing guidelines and lists potential adverse effects and nursing considerations for each type of inotrope.
This document discusses various inotropes and vasopressors used to treat low blood pressure. It describes how vasopressors like norepinephrine work by causing vasoconstriction to raise blood pressure, while inotropes like dobutamine increase cardiac contractility. Several catecholamines are discussed in detail, including their mechanisms of action, clinical uses, dosing, and side effects. Dobutamine is an inotrope that increases heart rate and stroke volume but may increase cardiac work. Dopamine has dose-dependent effects including renal and cardiac stimulation. Epinephrine stimulates both alpha and beta receptors to increase blood pressure and heart rate. Norepinephrine is a potent vasop
Dopamine is a chemical precursor of norepinephrine that stimulates alpha, beta, and dopaminergic receptors. At low doses, it causes vasodilation and increased renal blood flow. At intermediate doses, it increases heart rate and cardiac output. At high doses, it increases blood pressure through alpha receptor stimulation. Dobutamine is a synthetic catecholamine that stimulates beta1 and beta2 receptors, causing increased contractility and cardiac output without affecting renal blood flow. Nitroglycerin dilates coronary arteries to improve blood flow and reduces preload, helping to lower blood pressure and myocardial oxygen demand in conditions like hypertension and heart failure.
This document discusses the adrenergic system including adrenoceptor physiology, adrenergic agonists and antagonists. It describes the different types of adrenoceptors (alpha and beta), their locations and responses. It then discusses various adrenergic agonists like epinephrine, norepinephrine, phenylephrine, clonidine and dexmedetomidine and provides their mechanisms of action and dosages. Finally it covers various adrenergic antagonists like phentolamine, labetalol, esmolol, metoprolol and propranolol, describing their receptor selectivities, durations of action and dosages.
This document provides an overview of the pharmacology of various cardiovascular agents, including cholinergic drugs, adrenergic drugs, catecholamines, and vasodilators. It discusses the mechanisms and therapeutic uses of specific drugs from each class, such as neostigmine, phenylephrine, dobutamine, milrinone, and levosimendan. The document also compares the effects and clinical applications of different catecholamines like norepinephrine and epinephrine.
Dopamine and dobutamine are endogenous catecholamines used to increase cardiac output and blood pressure. Dopamine acts through dopamine, adrenergic, and beta receptors. At low doses it increases renal blood flow but at higher doses causes vasoconstriction. Dobutamine is a synthetic catecholamine that directly stimulates beta receptors, increasing contractility and output while causing vasodilation. Both are given by continuous IV infusion and used to treat shock, heart failure, and hypotension. Side effects include arrhythmias for dopamine and hypertension for both.
Emergency medications are used to treat life-threatening conditions and save patients' lives. They work quickly to control symptoms and stabilize vital functions. This document outlines several emergency drugs including adrenaline, noradrenaline, dopamine, dobutamine, nitroglycerin, and others. It describes their mechanisms of action, indications, side effects, and important nursing considerations for safe administration. Understanding these critical care medications is important for emergency treatment of patients.
The document discusses various vasopressor drugs used to treat low blood pressure, including dobutamine, dopamine, epinephrine, and norepinephrine. It describes the mechanisms of action, clinical uses, dosing regimens, and adverse effects of each drug. Key points are that norepinephrine is preferred for septic shock due to fewer side effects, though clinical outcomes are similar across vasopressors. The document provides detailed information on hemodynamic effects and recommendations for use of different vasopressors in various clinical situations.
This document provides guidelines for post-arrest care in pediatric patients. It outlines recommendations for respiratory care to maintain oxygen saturation between 94-99% and use of inotropic drugs like milrinone and epinephrine for cardiac care. It also discusses guidelines for neurological care, ongoing assessment, and treatment of hypotension. Specific recommendations are provided for ventilation, drug therapies including epinephrine, dopamine, norepinephrine and factors influencing outcomes. Targeted temperature management and control of blood glucose are also addressed.
A 28-year-old female presented with palpitations, presyncope and an abnormal ECG strip. The ECG shows a narrow complex tachycardia. Adenosine can be used both diagnostically and therapeutically to help determine if the arrhythmia is dependent on the atrioventricular node by attempting to terminate or cause transient heart block. If the arrhythmia terminates or heart block occurs, it suggests the arrhythmia involves the AV node and is likely a supraventricular tachycardia. If adenosine has no effect, it makes ventricular tachycardia more likely.
Scope: This subject is intended to impart the fundamental knowledge on various aspects
(classification, mechanism of action, therapeutic effects, clinical uses, side effects and
contraindications) of drugs acting on different systems of body and in addition,emphasis
on the basic concepts of bioassay. Objectives: Upon completion of this course the student should be able to
1. Understand the mechanism of drug action and its relevance in the treatment of
different diseases
2. Demonstrate isolation of different organs/tissues from the laboratory animals by
simulated experiments
3. Demonstrate the various receptor actions using isolated tissue preparation
4. Appreciate correlation of pharmacology with related medical sciences
The document summarizes recent trends in the management of heart failure. It discusses the epidemiology and classification of heart failure. The mainstay of treatment involves neurohumoral modulation using ACE inhibitors, ARBs, beta-blockers, and MRAs. Other management principles include preload and afterload reduction, increasing contractility cautiously, and reducing heart rate. Newer drugs like sacubitril/valsartan, dapagliflozin, and vericiguat are improving outcomes, while others like omecamtiv mecarbil and istaroxime are under investigation.
This document discusses vasoconstrictors which are drugs added to local anesthetics to prolong their duration and effectiveness. It classifies vasoconstrictors based on their chemical structure and mode of action. Epinephrine is described as the most commonly used vasoconstrictor due to its direct effects on alpha-1 and beta-2 receptors, which causes vasoconstriction and increased duration of anesthesia. Side effects are also discussed, noting the risks of hypertension, tachycardia and cardiac issues if overused. Maximum safe doses are provided for different local anesthetic solutions containing epinephrine or other vasoconstrictors like norepinephrine and phenylephrine.
The treatment for Mr. Starling's congestive heart failure condition included furosemide to reduce edema, captopril to decrease blood pressure, intravenous fluids to increase blood pressure, and dobutamine to increase contractility. While these treatments provided some improvement, his cardiac output was not improved so he was evaluated for cardiac transplantation. He ultimately received a heart transplant which involved removing his failing heart and implanting a donor heart to treat his end stage heart failure.
This document discusses the hormones adrenaline and noradrenaline. It describes their biosynthesis, mechanisms of action, effects on different organs, clinical uses including anaphylaxis and cardiac arrest, dosages, side effects and comparisons between the two hormones. Adrenaline acts on alpha and beta receptors and has effects like increased heart rate and bronchodilation. Noradrenaline predominantly acts on alpha receptors, causing potent vasoconstriction and increasing blood pressure without bronchodilation. Both are used to treat hypotension but noradrenaline is preferred for septic shock.
THE USE OF INOTROPIC DRUGS IN CARDIAC SURGERYThierry Yunishe
This document provides information on various inotropic drugs used in cardiac surgery, including their indications, mechanisms of action, dosages, and side effects. It discusses sympathomimetic drugs like dopamine, dobutamine, and adrenaline that have positive inotropic effects by stimulating cardiac contraction directly. It also mentions the negative inotrope propranolol and vasopressors like adrenaline and noradrenaline. The aim of using inotropes in cardiac surgery is to optimize cardiac output while using the minimum effective dose to achieve desired outcomes and allow weaning off the drugs.
This document provides information on antihypertensive drugs. It defines hypertension as elevated blood pressure and discusses its classification. The mechanisms involved in hypertension development include increased heart rate, stroke volume, cardiac output, peripheral vascular resistance, and vasoconstriction. Antihypertensive drug classes include those that inhibit the renin-angiotensin-aldosterone system, sympathetic nervous system, calcium channels, and drugs that cause vasodilation or diuresis. Specific drug mechanisms and examples from each class are described along with their advantages and adverse effects in summarizing the pharmacology of antihypertensive treatment options.
Vasoactive drugs act on the heart and circulatory system by affecting adrenergic receptors. They can be classified as vasopressors, inotropes, or vasodilators. Common vasoactive drugs include adrenaline, noradrenaline, dopamine, dobutamine, milrinone, vasopressin, nitroglycerine, and nitroprusside. Each drug has distinct mechanisms of action and indications for use. Careful consideration of dosing and side effects is important when using these powerful cardiovascular medications.
1. A tumour is defined as an abnormal mass of tissue resulting from uncontrolled cell growth that exceeds normal limits. Tumours can be benign or malignant.
2. Benign tumours are usually slow-growing, well-circumscribed masses that compress but do not invade surrounding tissues. Malignant tumours are typically poorly-defined, rapidly growing masses that invade and spread to other areas.
3. Microscopically, benign tumours resemble normal tissue and have normal cell patterns and shapes, while malignant tumours have irregular, abnormal cell patterns and shapes with increased atypical mitosis. Malignant tumours also show a lack of differentiation, invasion of surrounding tissues, and ability to metastasize to
Parkinson's disease is a chronic neurological disorder that affects movement. It is caused by the loss of dopamine-producing neurons in the brain. The main symptoms are tremors, rigidity, bradykinesia, and impaired balance. While the exact cause is unknown, risk factors include genetics, drugs, toxins, and head injuries. There is no cure, but treatment aims to manage symptoms and improve quality of life through medications and sometimes surgery.
The document discusses various nutritional disorders including obesity, starvation, kwashiorkor, marasmus, anorexia nervosa and bulimia nervosa. It defines key terms like calorie and essential nutrients. For each disorder, it describes the etiology, clinical manifestations, pathophysiology, nursing management and prevention. Specifically, it provides details on the signs and symptoms of kwashiorkor and marasmus, how they differ in morphology and nutritional content of foods to prevent protein deficiency. The nursing management of eating disorders focuses on helping clients develop normal eating behaviors and self-image.
Glomerulonephritis is inflammation of the glomerular capillaries in the kidney. It has many causes including primary glomerulonephritis like post-streptococcal glomerulonephritis, rapidly progressive glomerulonephritis, and IgA nephropathy. It can also be caused by systemic diseases like SLE. The document discusses the classification, pathogenesis, clinical features and treatment of various types of glomerulonephritis including acute glomerulonephritis, membranous nephropathy, focal segmental glomerulosclerosis, and chronic glomerulonephritis.
This document discusses colostomy care and procedures. It defines a colostomy as an artificial opening in the large intestine brought to the surface of the abdomen. It then classifies colostomies as either temporary or permanent, and by stoma site or number/type. Common indications for a colostomy include colon cancer, Hirschsprung's disease, and ulcerative colitis. The purpose of colostomy care is to protect the skin, provide drainage, clean and regulate the bowel, and enable patient self-care. Required equipment includes supplies for changing appliances and bags, as well as accessories like filters, tape, soap, and gloves. Colostomy irrigation is defined as introducing a solution through the
This document outlines various teaching methods used in nursing education, including different types of conferences like group, staff, nursing care, and team conferences. It also discusses bedside clinics, nursing rounds, ward teaching programs, ward classes, case studies, assignments, brainstorming, group discussions, demonstrations, process recording, health talks, and laboratory methods. The goal is to take a client and family centered approach to teaching nursing students.
This document provides information about the maxillary lateral incisor tooth. It discusses the tooth's numbering, chronology of development, typical dimensions, and distinguishing anatomical features and traits compared to other teeth. The maxillary lateral incisor is located between the central incisor and canine. It has a rectangular crown shape with rounded mesial and distal outlines and plays a role in functions like shearing food and supporting the lips.
This document discusses the proper arrangement of anterior teeth when placing dentures. It provides guidelines for positioning the maxillary and mandibular central incisors, lateral incisors, and canines. The maxillary teeth should be placed slightly labial to the residual ridge to compensate for bone resorption. Proper overlap and angulation between the upper and lower teeth is also addressed to ensure optimal esthetics, phonetics, and occlusion when moving through excursions. The arrangement is checked in protrusive and lateral movements to confirm the incisal pin follows the guide table without interference.
Evidence-based practice (EBP) began with Cochrane's encouragement to use randomized controlled trials to determine medical intervention effectiveness. EBP integrates the best research evidence, clinical expertise, and patient values and preferences. The 5 steps of EBP are: formulating a question, locating evidence, critically appraising evidence, applying evidence to a patient, and evaluating outcomes. Challenges to EBP include resistance to change and lack of time and skills, while facilitators include support, resources, and training.
Research is defined as a systematic, intensive study directed towards gaining scientific knowledge of a subject. It is an orderly and systematic process based on current issues that begins with clearly defined purposes and emphasizes developing, refining, and expanding professional knowledge through testing theories, finding solutions to problems, and generating empirical evidence. Good research is characterized by being objective, logical, and patiently carried out using valid and reliable tools to collect representative data that is carefully recorded and reported.
This document outlines important qualities for healthcare professionals including strong communication skills, developing good rapport with patients, and knowing how to effectively deliver care. It also emphasizes the importance of continuous learning, applying knowledge in practice, having good teaching abilities, maintaining a healthy lifestyle, and possessing a pleasing personality, empathy, punctuality, team spirit, and mental alertness.
Kidney transplantation involves transplanting a kidney from a living or deceased donor into a patient with end-stage renal disease. There are several indications for kidney transplantation including chronic kidney failure, diabetes, and genetic disorders. Compatibility between donor and recipient is based on blood type and human leukocyte antigens. After transplantation, patients take immunosuppressant drugs to prevent rejection and have improved quality of life compared to dialysis. While transplantation carries risks of infection, rejection and side effects, it provides longer survival than remaining on dialysis.
Professional preparation &training for counsellingJijo G John
The document defines counseling as a helping process where one person gives their time and skills to help a client explore their situation and identify solutions. It discusses the attributes and skills required of an effective counselor, including pre-training attributes like self-awareness, psychological health, and trustworthiness, as well as inter-training skills like active listening, identifying themes, and managing interactions. Finally, it outlines the functions of a counselor as providing advice, reassurance, improving communication, releasing tension, and helping with reorientation.
Physical exercise includes any activity that maintains or improves physical fitness and overall health. It is performed for reasons such as strengthening muscles, cardiovascular health, weight control, and enjoyment. There are three main types of exercise: flexibility, aerobic, and anaerobic. Regular physical exercise provides important health benefits, but excessive exercise without proper rest and nutrition can cause harm and injuries over time.
Nursings fundamental patterns of knowingJijo G John
Carper's (1978) theory outlines four fundamental patterns of knowing in nursing: empirics, ethics, aesthetics, and personal knowing. The theory aimed to formally express nursing knowledge, establish nursing's professional identity, and convey nursing's contributions to healthcare. It also sought to create expert nursing practice. Emancipatory knowing was later added by Chinn and Kramer to recognize social barriers to health and critique the other patterns of knowing. The patterns represent different ways of understanding situations and responding with skilled nursing actions.
The document discusses teaching and lecturing. It defines teaching as activities designed to produce changes in student behavior and notes that teaching is a passion. It provides guidelines for effective lecturing, including maintaining student motivation, summarizing key points, using visual aids and interactions, and managing time. The advantages of lecturing are also presented.
Lung abscess is a localized necrotic lesion in the lung tissue containing pus that forms a cavity. It is generally caused by aspiration of anaerobic bacteria from the GI tract into the lungs. The most common areas affected are the superior segment of the lower lobes and the posterior segment of the upper lobes. Clinical manifestations include cough producing foul-smelling pus, fever, chest pain, and shortness of breath.
Lesson planning ensures teachers have clear objectives for each class, consider goals, content, and evaluation methods, and choose effective teaching methods. It keeps teachers organized and focused, prevents wasted time, provides continuity, and gives teachers confidence in their lessons.
The document outlines the responsibilities of the Indian Nursing Council, which include prescribing the standard nursing curriculum and conditions for admission, establishing examination standards, recognizing qualifications for registration and employment in India and abroad, approving registration of Indian and foreign nurses, inspecting and advising nursing programs and institutions, and maintaining the Indian Nurses Register.
This document discusses the ideal anatomical contacts between the maxillary and mandibular teeth in a Class I occlusion. It explains that the mandibular teeth contacts are positioned one half cusp mesial to their maxillary counterparts. The specific cusp contacts between opposing teeth are described for each tooth group. Guidelines are provided for identifying the tooth and cusp represented by black dots on diagrams. Horizontal determinants of occlusion including ridge and groove direction, balancing and working side interferences, and the effect of distance from the condyles are also outlined.
Views in Odoo - Advanced Views - Pivot View in Odoo 17Celine George
In Odoo, the pivot view is a graphical representation of data that allows users to analyze and summarize large datasets quickly. It's a powerful tool for generating insights from your business data.
The pivot view in Odoo is a valuable tool for analyzing and summarizing large datasets, helping you gain insights into your business operations.
Beyond the Advance Presentation for By the Book 9John Rodzvilla
In June 2020, L.L. McKinney, a Black author of young adult novels, began the #publishingpaidme hashtag to create a discussion on how the publishing industry treats Black authors: “what they’re paid. What the marketing is. How the books are treated. How one Black book not reaching its parameters casts a shadow on all Black books and all Black authors, and that’s not the same for our white counterparts.” (Grady 2020) McKinney’s call resulted in an online discussion across 65,000 tweets between authors of all races and the creation of a Google spreadsheet that collected information on over 2,000 titles.
While the conversation was originally meant to discuss the ethical value of book publishing, it became an economic assessment by authors of how publishers treated authors of color and women authors without a full analysis of the data collected. This paper would present the data collected from relevant tweets and the Google database to show not only the range of advances among participating authors split out by their race, gender, sexual orientation and the genre of their work, but also the publishers’ treatment of their titles in terms of deal announcements and pre-pub attention in industry publications. The paper is based on a multi-year project of cleaning and evaluating the collected data to assess what it reveals about the habits and strategies of American publishers in acquiring and promoting titles from a diverse group of authors across the literary, non-fiction, children’s, mystery, romance, and SFF genres.
Principles of Roods Approach!!!!!!!.pptxibtesaam huma
Principles of Rood’s Approach
Treatment technique used in physiotherapy for neurological patients which aids them to recover and improve quality of life
Facilitatory techniques
Inhibitory techniques
Still I Rise by Maya Angelou
-Table of Contents
● Questions to be Addressed
● Introduction
● About the Author
● Analysis
● Key Literary Devices Used in the Poem
1. Simile
2. Metaphor
3. Repetition
4. Rhetorical Question
5. Structure and Form
6. Imagery
7. Symbolism
● Conclusion
● References
-Questions to be Addressed
1. How does the meaning of the poem evolve as we progress through each stanza?
2. How do similes and metaphors enhance the imagery in "Still I Rise"?
3. What effect does the repetition of certain phrases have on the overall tone of the poem?
4. How does Maya Angelou use symbolism to convey her message of resilience and empowerment?
Satta Matka Dpboss Kalyan Matka Results Kalyan ChartMohit Tripathi
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The membership Module in the Odoo 17 ERPCeline George
Some business organizations give membership to their customers to ensure the long term relationship with those customers. If the customer is a member of the business then they get special offers and other benefits. The membership module in odoo 17 is helpful to manage everything related to the membership of multiple customers.
Join educators from the US and worldwide at this year’s conference, themed “Strategies for Proficiency & Acquisition,” to learn from top experts in world language teaching.
No, it's not a robot: prompt writing for investigative journalismPaul Bradshaw
How to use generative AI tools like ChatGPT and Gemini to generate story ideas for investigations, identify potential sources, and help with coding and writing.
A talk from the Centre for Investigative Journalism Summer School, July 2024
Credit limit improvement system in odoo 17Celine George
In Odoo 17, confirmed and uninvoiced sales orders are now factored into a partner's total receivables. As a result, the credit limit warning system now considers this updated calculation, leading to more accurate and effective credit management.
Slide Presentation from a Doctoral Virtual Open House presented on June 30, 2024 by staff and faculty of Capitol Technology University
Covers degrees offered, program details, tuition, financial aid and the application process.
The Jewish Trinity : Sabbath,Shekinah and Sanctuary 4.pdfJackieSparrow3
we may assume that God created the cosmos to be his great temple, in which he rested after his creative work. Nevertheless, his special revelatory presence did not fill the entire earth yet, since it was his intention that his human vice-regent, whom he installed in the garden sanctuary, would extend worldwide the boundaries of that sanctuary and of God’s presence. Adam, of course, disobeyed this mandate, so that humanity no longer enjoyed God’s presence in the little localized garden. Consequently, the entire earth became infected with sin and idolatry in a way it had not been previously before the fall, while yet in its still imperfect newly created state. Therefore, the various expressions about God being unable to inhabit earthly structures are best understood, at least in part, by realizing that the old order and sanctuary have been tainted with sin and must be cleansed and recreated before God’s Shekinah presence, formerly limited to heaven and the holy of holies, can dwell universally throughout creation
How to Configure Time Off Types in Odoo 17Celine George
Now we can take look into how to configure time off types in odoo 17 through this slide. Time-off types are used to grant or request different types of leave. Only then the authorities will have a clear view or a clear understanding of what kind of leave the employee is taking.
2. INTRODUCTION
An inotrope is an agent, which increases or decreases
the force or energy of muscular contractions.
In 1785 the first inotrope-Digitalis was discovered &
used for CCF.
As science advanced, other inotropes were developed
which were more potent and have different chemical
properties and physiological effects.
All inotropes are successful because they increase the
myocardial contractility of the heart.
By enhancing myocardial contractility, cardiac output, the
amount of blood ejected by the heart with each beat,
will also increase.
4. CARDIAC GLYCOSIDES
The first line of inotropes include all
digitalis derivatives
Digitalis Glycosides have
A direct effect on cardiac muscle and the
conduction system.
An indirect effect on the cardiovascular
system regulated by the
autonomic nervous system which is
responsible for the effect on the sino-
atrial (SA) and atrioventricular (AV)
nodes.
5. The result of these direct and indirect
effects are: -
An increase in force and velocity of
myocardial contractility (positive
inotrope effect).
Slowing of heart rate (negative
chronographic effect).
Decreased conduction velocity through
the AV node.
6. DIGOXIN
Digoxin is the most commonly prescribed cardiac
glycoside
Convenient pharmacokinetics,
Alternative routes of administration
Widespread availability of serum drug level
measurement.
DIGOXIN ADMINISTRATION
Digoxin can be administered intravenously
or orally.
IV injection should be carried out over 15
minutes to avoid vasoconstriction
responses.
Intramuscular Digoxin is absorbed
unpredictably, causing local pain, and is not
recommended.
7. DIGOXIN LOADING DOSE
Loading doses of Digoxin range from 10 –
15mg/kg.
Digoxin can be given orally, but with a slower
onset of action and peak effect.
DIGOXIN MAINTENANCE DOSE :-
Initial therapy of Digoxin is usually started at
0.125 to 0.375mg/day.
NOTE: DRAW A SERUM DIGOXIN LEVEL AT
LEST SIX HOURS AFTER THE LAST DOSE!
8. SIDE EFFECTS ASSOCIATED WITH
TOXICITY:-
GASTROINTESTINAL : Anorexia, nausea,
vomiting, diarrhea Rare: abdominal
pain, hemorrhagic necrosis of the
intestines.
CNS : visual disturbances, (blurred or
yellow vision), headache, weakness,
dizziness, apathy and psychosis.
OTHER : Skin rash, gynecomastia
9. SYMPATHOMIMETICS (ADRENERGIC)
Sympathomemetic drugs exert
potent inotropic effects by
stimulating beta (B1 and B2), alpha
(A1 and A2) and dopaminergic
receptors in the myocardium, blood
vessels, and sympathetic nervous
system.
10. ALPHA 1 (A1):
A1 receptors are in vascular smooth muscle &
also in the myocardium, which mediate positive
inotropic and negative chronotropic effects.
Stimulation of A1 receptors leads to
vasoconstriction.
ALPHA 2 (A2):-
A2 receptors are located in large blood vessels.
Stimulation of A2 receptors mediates arterial and
venous vasoconstriction.
11. BETA 1 (B1):-
Beta 1 receptors increase heart rate and myocardial
contractility.
BETA 2 (B2):-
Beta 2 receptors enhance vasodilation; relax
bronchial, uterine and gastrointestinal smooth
muscle
DOPAMINERGIC: Related to the effect of
dopamine.
12. DOPAMINE (INTROPIN)
(200mg/5ml ampule).
A chemical precursor of epinephrine.
Possessing alpha and beta and dopaminergic
receptor – simulating actions.
The specific effects are related to the dose
delivered.
13. LOW DOSE
0.5- 2mcg/kg/minute (Dopaminergic effect).
Vasodilation of renal and mesenteric arteries.
Promote blood flow and increased GFR
(glomerular filtration rates in patients who
become resistant to diuretics).
Urine output may increase without significant
effect on blood pressure or heart rate.
14. INTERMEDIATE DOSE
2 to 10 mcg/kg/minute
Beta-adrenergic receptor activity is
increased in the heart.
Partial antagonism of alpha –
adrenergic receptors will mediate
vasoconstriction.
Modest increase in systemic vascular
resistance increases cardiac output
& CVP
15. DOPAMINE ADMINISTRATION
CONCENTRATIONS
Remove 5ml from 100ml 5% Glucose ,add
200 mg Dopamine, final concentration
2000mcg/ml.
OR
Make the concentration half with 50 ml
of 5% Dextrose.
16. Indication:-
Renal protection.
Hypotention/haemodynamic
compromise due to MI, trauma,
sepsis, CCF.
Increases mesenteric flow in
mesenteric ischaemia.
Contraindication: -
Pregnancy.
Phaeochromocytoma.
Tachyarrhythmias.
Occlusive vascular disease.
17. WARNING:
Correct hypovolaemia prior to administration.
Do not infuse peripherally.
Extravasations can cause severe tissue necrosis.
Monitor the patient carefully for decreased
circulation in the extremities.
If extravasates into tissues-
The infusion should be immediately stopped.
Infiltrate with 0-15ml 0.9% Sodium Chloride
containing 5-10mg Phentolalmine.
Regitine is then administered SQ in the four
90°quadrants around the site of extravasations.
18. ADVERSE EFFECTS:
Tachycardia
Supraventricular tachycardia
Ventricular arrhythmias
Pulmonary congestion
Nausea
Vomiting
Headache.
Increased myocardial oxygen demand.
Hypotension when used concomitantly
with dilantin
19. DOBUTAMINE (Dobutrex)
(250mg in 20ml ampule)
• Drug class:-
Catecholamine.
• Mechanism of action:-
Chemically related to dopamine.
Synthetic catecholamine.
Stimulates Beta 1 and Alpha-adrenergic
receptors.
Increases myocardial contractility, stoke volume
and cardiac output.
Decreases preload and afterload (Vasodilatation)
Produces mild chronotropic, hypotensive and
arrhythmogenic effects.
Increase renal and mesenteric blood flow by
increasing cardiac output.
Does not affect renal blood flow like dopamine.
20. • Initial dose: -
2 to 3 mcg/kg/minute.
• Usual dose: -
2.5 to 10 mcg/kg/minute.
• Desired effects include:
1. Increased cardiac output
2. Increased stroke volume
This dose will not increase heart rate
or cause vasoconstriction.
21. Maximum dose: -
20 mcg/kg/minute.
Dobutamine administration
concentrations: -
Infusion pump: 500 mg per 250 cc
normal saline
Syringe pump: 250 mg (20cc) in
total 50 cc normal
saline (5 mg per cc)
22. • Contraindication:-
Idiopathic hypertrophic subaortic
stenosis.
• Nursing implication: -
Monitor for hypertension, tachycardia, chest
pain, and premature ventricular contractions.
Monitor cardiac output, pulmonary artery
pressure ECG
Correct hypovolemia before treating with this
drug.
Patient with aterial fibrillation should be
digitalized before giving this drug to prevent
ventricular tachycardia.
23. Warning: -
Increasing the rate past 20
mcg/kg/minute could be detrimental
because myocardial oxygen
consumption can cause tachycardias.
Adverse effects:-
Tachycardia
Arrhythmias
Blood pressure fluctuation
Myocardial ischemia
Headache
Nausea
Tremors
Hypokalemia
24. NOREPHINEPHRINE (LEVOPHED)
Drug class: -
Catecholamine.
Endogenous catecholamine released from nerve cells,
synthesized by adrenal medulla.
Metabolized mainly by the liver.
Mechanism of action: -
Potent alpha – receptor antagonist, leads to arterial and
venous constriction.
Minimal effect on beta 2 receptors.
Increases myocardial contractility due to its beta 1
adrenergic effects.
Effective in septic shock and neuroginic shock after
adequate hydration.
Increases blood flow to the major organs including the
kidneys and helps in increases urine output.
25. Initial dose: -
0.5 mcg/minute to 1 mcg/minute
Titrate to desired effect
Average dose:-
2 to 12 mcg/minute
Doses greater than 30 mcg/minute
might be required during shock.
Norepinephrine administration
concentration:-
Infusion pump: 4 mg per 250 c crystalloid
(16 mcg/cc)
26. Contraindications:-
Hypovolemic and cardiogenic shock
(because potent vasoconstriction is
already occurring).
Pregnancy.
Hypoxia.
Hypovolemia secondary to fluid
deficit.
Caution with hypertension and
hyperthyroidism.
27. Nursing implication:-
Extravasations produces ischemic
necrosis and sloughing of superficial
tissues.
Use of a central line is recommended
due to the risk of extravasations into
surrounding tissue.
Rebound hypotension occurs if it is
discontinued abruptly.
Its use should be temporary.
Monitor for bradycardia or
arrhythmias.
28. EPINEPHRINE
• Drug class: -
Catecholamine.
Endogenous catecholamine, produced,
stored, and released by the adrenal medulla.
Mainly eliminated via kidneys.
• Mechanism of action: -
Stimulation of alpha and beta-adrenergic
receptors causes vasoconstriction.
Increases heart contractility and rate.
Causes bronchodilation.
Antagonizes histamine effect.
29. • Dosage: -
Initial dose 0.5-1mg IV.
Or
1.5-3mg via ETT.
Maintain drip of 1-4 mcg/minute.
Titrate to BP.
Common contraindication: -
Hypertension.
Pheochromocytoma.
Caution with heart failure angina and
hyperthyroidism.
31. ISOPROTERENOL (ISUPREL)
Has nearly pure beta-adrenergic receptor activity.
Increase heart rate and contractility and cause
peripheral vasodilation.
Used for temporary control of symptomatic
bradycardia.
Initial drug of choice for heart transplant.
Increases myocardial oxygen requirements and the
possibility of inducing or exacerbating myocardial
ischemia is present.
The risk of arrhythmias is also increased.
It is not the first treatment of choice for
bradycardias.
• Atropine, epinephrine or pacing should
be initiated first.
32. DOSE: -
Initial dose of 2 mcg/minute
Titrate dose to a maximum of 10 mcg/min.
or heart rate is 60 or greater.
Decrease the rate if blood pressure is
>120/60
Decrease rate if PVC’s or Ventricular
tachycardia is noted.
Isoporterenol administration
concentration: -
1 mg in 250 cc crystalloid (4 mcg/cc).
33. Adverse effects: -
Arrhythmias.
Ventricular tachycardia.
Ventricular fibrillation.
Warning :-
May exacerbate tachyarrhythmias
due to digitalis toxicity.
May precipitate hypokalemia.
34. PHOSPHODIESTERASE INHIBITORS
Powerful positive inotropic agents.
The action is not fully understood.
Inhibits phosphodiesterase, an enzyme that degrades
(CAMP)
Cyclic Adenosine Monophosphate.
There is no effect on alpha or beta-receptors.
Increase contractile force and velocity of relaxation of
cardiac muscle.
Increasing cardiac output without increasing myocardial
oxygen consumption.
They cause vasodilation and a decrease in SVR (systemic
vascular resistance) and PVR (Pulmonary vascular
resistance & in afterload (resistance to ventricular
ejection)
35. AMRINONE (INOCOR)
Has a hemodynamic effect similar to Dobutamine.
Increase cardiac output and decrease pulmonary
vascular resistance.
It should be used with caution in patients with
ischemic heart disease because it can exacerbate
ischemia.
It should be considered for use in patients with severe
congestive heart disease, which is no longer
responsive to other inotropes, diuretics, and
vasodilators.
It is also used after aorto-coronary bypass surgery.
It is recommended that the lowest dose that produce
the desired hemodynamic effect to be used.
36. LOADING DOSE:
0.5 TO 0.75 mg/kg given over 2-3 min. IV
DO NOT EXCEED 1 mg/kg.
Maintenance dose: -
5 to 10 mcg/kg/min
Maximum dose:-
10mg/kg/24hours.
Doses higher than 15 mcg/kg/minute
can produce tachycardia
37. NEVER DILUTE WITH DEXTROSE !
---Chemical reaction occurs
Syringe pump: Use Straight Solution
Concentration 5 mg/cc
Adverse reaction: -
Thrombocytopenia occurs in 10% of all
patients seen 48 – 72 hours after
infusion and resolves when drug is
discontinued.
Gastrointestinal upset
Myalgia
Fever
Hepatic dysfunction
Ventricular irritability
38. Nursing implication: -
Monitor for arrhythmias, hypotension,
thrombocytopenia & hepatotoxicity.
Monitor cardiac output, pulmonary
artery pressure and heart rate.
Effects last for 2 hours after drip is
discontinued.
The loading dose may be given over 2 to
5 minutes, but to prevent Hypotension
it is recommended the loading dose be
given over 10 to 15 minutes.
39. MILRINONE (Primacor)
Milrinone is about 10 fold more potent
than Amrinone.
A positive inotropic agent that
increases cardiac output and decreases
systemic vascular resistance.
Because of its vasodilating effect,
Milrinone is not generally associated
with an increase in myocardial oxygen
demand.
Milrinone can be diluted in dextrose or
saline solution.
40. LOADING DOSE:-
50 mcg/kg given IV over 10 minutes
MAINTENANCE DOSE:-
0.375 to 0.75 mcg/kg/minute
Warning; -
DOSES TO HIGH CAN CAUSE
HYPOTENSION AND TACHYCARDIA.
41. MILRINONE IS INCOMPATIBLE
WITH LASIX!
ADVERSE EFFECTS:
Supraventricular tachycardia
Ventricular arrhythmias
Ventricular ectopy
Increased ventricular rate in atrial
fibrillation/flutter
Headache
Hypokalemia
Tremors
Thrombocytopenia
42. EASY FORMULAS FOR DRUG CALCULATIONS FOR
INFUSION PUMPS
TO DETERMINE DESIRED RATE:-
(Remember 1 mg = 1000 mcg)
(Desired mcg) X kg. X 60 ÷ mcg/cc (in solution)
Example:- Give Dopamine 5 mcg/kg/min to a patient who
weights 65 kg.
5 X 65 X 60 ÷ (800 mg in 500 cc)
(5 mcg) X (65 kg) X 60 ÷ (800 mg ÷ 500 cc = 1.6 mg. X 1000)
= 1600 mcg
19500 ÷ 1600 = 12.18 cc
Example: Give Dopamine 2.5 mcg/kg/min to a patient who
weight 55 KG.
2.5 X 55 X 60 ÷ 1600
(2.5 mcg) X (55 kg) X 60 ÷ 1600 = 5.15 cc
43. TO DETERMINE MCG/KG/CC INFUSING:
Example: You have a patient that weighs 85 kg
who has a dopamine drip infusion at 8cc per
hour and you want to determine how many
mcg/kg/min the patient is receiving. The
dopamine is mixed at 1600 mcg per cc.
MCG/CC X RATE ÷ 60 ÷ KG
1600 X 8 ÷ 60 ÷ 85 = 2.5 mcg/kg/minute
Example : You have a patient that weighs 102 kg
who has a Dobutamine drip infusing at 12 cc
per hour and you want to determine how many
mcg/kg/min the patient is receiving. The
Dobutamine is mixed at 500 mg in 250 cc = 2000
mcg per cc.
(500 mg ÷ 250 = 2 X 1000 = 2000)
44. CONCLUSION
Inotropes are very effective drugs when
administered properly.
Patients receiving inotropes should be
monitored closely including blood pressure,
cardiac monitoring, intake and output, and
laboratory tests that have been ordered by the
physician.
Knowledge of desired effects and side effects is
critical to the administration of inotropes.
45. CONCLUSION
Cont…
A thorough grasp of the pharmacology of
inotropes is crucial to understand the rationale
for drug therapy of heart failure.
Inotropes continue to improve through scientific
research.
Oral forms of inotropes are now being
investigated to manage congestive heart failure
at home.
46. BIBLIOGRAPHY
ACLS, Emergency Cardiovascular Care Program,
American Heart Association, 1997-1998, pp. 7.3-
7.4, 8.3-8.8.
Braunwald; Heart Disease, 1998, W. B. Saunders
Company, pp. 9468-9470, 9477-9481, 9492-9502.
Critical Care Nursing-Diagnosis and
Management, Second Edition. L. Thelan, et al.
Mosby-Year Book, Inc. 1994. pp 346-347
Physician’s Desk Reference, 1997, pp. 1116-1118.