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DOPAMINE (Intropin®)

CLASS:

  • Catecholamine / Sympathomimetic

  • Adrenergic Agonist

ACTIONS:

  • Dose dependent sympathomimetic

  • At lower drip rates of 1-2 ug/kg/min, stimulate dopaminergic receptors to produce cerebral, renal, and mesenteric vasodilation

  • At drip rates of 2-10 ug/kg/min, B1 effects predominate (predominantly inotropic effect) with alpha effect beginning (vasoconstriction)

  • At drip rates 10 -20ug/kg/min, alpha effects predominate with renal, mesenteric, and peripheral arterial, and venous vasoconstriction with marked increase in SVR (systemic vascular resistance)

  • At drip rates > 20ug/kg/min alpha effects similar to norepinephrine predominate with marked peripheral vasoconstriction and tachycardia

INDICATIONS:

  • Cardiogenic shock

  • Other types of shock after adequate fluid resuscitation

  • Symptomatic bradycardia unresponsive to Atropine or external pacemaker

CONTRAINDICATIONS:

  • Hypovolemia BEFORE fluid resuscitation

  • Patients taking monamine oxidase inhibitors

  • Pheochromocytoma (can precipitate hypertensive crisis) = tumor in the adrenal glands

  • Uncorrected tachyarrhythmias

STANDARD PREP:

  • 400 mg /250 cc (pre-mixed)

DOSAGE/ROUTE:

  • See Hawaii S.O. - Bradycardia., Acute Pulmonary Edema. 2.5-20 mcg/kg/min

SIDE EFFECTS:

  • Tachyarrhythmias

  • Hypotension

  • precipitate myocardial ischemia

  • Tissue necrosis with extravasation (infiltration)

  • Headache, N/V, angina

  • Bradycardia

  • Widening of QRS complex

PRECAUTIONS:

  • Beta blockers – may decrease the effects of dopamine

  • Stop infusion if diastolic pressure rises > 90 mm Hg

  • Incompatible with NaHCO3 since alkaline environment may inactivate dopamine

  • Avoid extravasation which will cause tissue necrosis and tissue sloughing. Inform ER RN or MD since local injection of Regitine will be required.