Positive inotropic drugs like adrenaline and noradrenaline increase myocardial contractility and cardiac output. Adrenaline acts on beta-1, beta-2, and alpha-1 receptors to increase heart rate, contractility, and blood pressure. It is used in low cardiac output states, shock, and bronchodilation. Noradrenaline is a potent vasoconstrictor that raises blood pressure through alpha-1 receptor activation with less tachycardia than adrenaline. Both drugs require close hemodynamic and ECG monitoring due to risks of hypertension, arrhythmias, and other side effects.

1. Positive Inotropic Drugs
-Definition:
The definition of a positive
inotrope is an agent that will
increase myocardial
contractility by increasing the
velocity and force of myocardial
fiber shortening

2. Adrenaline (Epinephrine)
Pharmacologic class
Sympathomimetic (direct acting)
Action:
Adrenaline acts on beta 1,beta 2, and
alpha 1 receptors

3. Action
CVS: Increased heart rate and force of contraction
produce an increase in cardiac output. Systolic
blood pressure (SBP) rises
RES: Bronchial smooth muscle is relaxed resulting
in bronchodilatation through effect of b2
metabolic: Adrenaline mobilizes glucose from
glycogen and raises blood sugar. Pupillary dilation
(mydriasis) occurs.

4. -Low cardiac output states
-During cardiac arrest
-Allergic reactions (anaphylactic shock)
-local anesthetic
-Bronchodilator for a cute severe asthma
attack
-Septic shock
Indications

5. Contraindications
- Dilated Cardiomyopathy
- Parkinson Symptoms
- Closed Angle Glaucoma
- High Blood Pressure
- Heart Attack
- Angina
- Sinus Tachycardia
- Abnormal Heart Rhythm
-- shock
-- during general anesthesia
-- Overactive Thyroid Gland
- Diabetes
- Bleeding causing Blood Pressure or Heart Problems

6. Adverse reactions
CNS: nervousness, anxiety, tremors, vertigo, headache,
disorientation, agitation, drowsiness, fear, dizziness,
cerebral hemorrhage, cerebrovascular accident (CVA).
CV: palpitations, widened pulse pressure, hypertension
, tachycardia, angina, ECG changes, ventricular
fibrillation

7. Adverse reactions Cont.’
GI: nausea, vomiting
GU: decreased urinary output,
urinary retention, dysuria
Respiratory: dyspnea
Skin: urticaria, pallor, diaphoresis,
Other: hemorrhage at injection site

8. Nursing care of Adrenaline
•Do not use a peripheral vein (risk of extravasation)
•Give via a central vein via accurate infusion pump
• Dilute with normal saline or (Ds 5%)
• Continuous hemodynamics monitoring
• Do not connect to CVP lumen used for monitoring
central venous pressure
• Assess urine output carefully

9.  Check blood pressure every 2 minutes until desired pressure is
achieved.
 glucose level frequently and manage for hyperglycemia.
• Don't discontinue drug abruptly.
 Recheck every 5 minutes for duration
of infusion.
 Maintain continuous ECG monitoring
 Assess Peripheral circulation
 Use coloured sticker for labels of drug
Be aware that headache may signal extreme hypertension and
overdose

10. CON. Nursing Care
-Monitor infusion site for extravasation.
-peripheral vascular insufficiency (decreased
Watch for signs and symptoms of peripheral
vascular insufficiency (decreased capillary
refill, pale to cyanotic to black skin color).
-Never leave patient unattended during
infusion
-Use coloured sticker for lables of drug data

11. Nor adrenaline (Nor epinephrine)
Levophed
Noradrenaline (norepinephrine) is a substance released naturally
by the nerve cells
vasopressor (a drug that raises the blood
pressure because of its ability to constrict blood vessels)
Pharmacologic class
Sympathomimetic
Actions : potent vasoconstrictor
acts mainly on alpha 1 receptors with few effects on β1
receptors
Increases blood pressure by vasoconstriction. Less likely to
cause tachycardia than adrenaline.

12. Indications:
-Acute hypotensive states such as septic shock
where peripheral vasodilation occurs.
-Severe cardiogenic shock
- Neurogenic shock
- spinal anesthesia, blood transfusion.
-Myocardial Infarction
- Hemodynamically significant hypotension (SBP
< 70 mm Hg) with low total peripheral resistance.

13. Contraindications
- High Blood Pressure
- Blood Clot, Blockage or Closing Off of Blood
Vessels.
-Excess Amount of Carbon Dioxide in the
Blood.
-- Decreased Oxygen In The Tissues Or Blood.
- Decreased Blood Volume

14. Side effects
 CNS: headache, anxiety, insomnia, tremors
 CV: bradycardia, severe hypertension,
 arrhythmias
 Skin: irritation with extravasation,
 necrosis
 Respiratory: respiratory difficulty
 Metabolic :hyperglycemia
 Nursing care such as adrenaline **Peripheral
circulation

15. Nursing Care
- beginning Monitor blood pressure every 2 minutes
from the
of therapy until the desired blood pressure is achieved,
then monitor the blood pressure and pulse rate at
frequent intervals, usually every 5 to 15 minutes, during
the administration of these drugs.
-Inspect site of administration for any infiltration,
extravasation.