The document provides an overview of various adrenergic medications, including epinephrine, norepinephrine, isoproterenol, dobutamine, and dopamine, detailing their classifications, mechanisms of action, indications, routes of administration, and side effects. It outlines contraindications, cautions, and drug interactions for each medication and emphasizes the importance of proper assessment and monitoring during their use. Client education focuses on the purpose of these medications, particularly in managing blood pressure through continuous infusion.

24. DRUG NAME epinephrine (Adrenalin) norepinephrine isoproterenol
dobutamine
dopamine
CLASS
Bronchodilator Nonselective
adrenergic agonist
Nonselective
adrenergic agonist
Nonselective beta-
adrenergic agonist
β1-agonist
β1- and α-agonist
MECHANISM
of ACTION
Stimulates β1- and β2-
agonist →
bronchodilation, cardiac and
CNS stimulation
Stimulates β-receptors
and α-receptors →
increases contractility,
heart rate, and cardiac
output, increases blood
pressure
Stimulates β1- and β2-
agonist →
bronchodilation,
cardiac and CNS
stimulation
Stimulates β1-
adrenergic receptors
→ increases
contractility and
cardiac output
Stimulates β1-
adrenergic receptors
→ increases
contractility and
cardiac output
Stimulates β1- and
α-receptors →
vasoconstriction →
increases blood
pressure
INDICATIONS
•Acute asthmatic attacks
•Bronchospasm
•Anaphylaxis, allergic
reactions
•Cardiac arrest
•Shock
•Acute hypotension
•Shock
•Episodes of heart
block
•Cardiac arrest, CPR
•Bronchospasm
occurring during
anesthesia
•Shock, congestive
heart failure
•Cardiac
decompensation
•Unlabeled: cardiog
enic shock in
children
•Shock
•Hypotension
•Unlabeled:
bradycardia
•Cardiac arrest
ROA IV, IM, INH, ET tube IV IV,IM IV IV

25. SIDE EFFECTS
•CV: palpitations, tachycardia, hypertension, angina, arrhythmias
•GI: nausea, vomiting
•CNS: cerebral hemorrhage
•Dopamine, epinephrine, norepinephrine: extravasation (boxed warning), tissue necrosis, sloughing,
gangrene
•Epinephrine: hyperglycemia (clients with diabetes)
CONTRA-
INDICATIONS &
CAUTIONS
•Pregnancy and breastfeeding
•Elderly clients
•Hypertension or coronary artery disease
•Dobutamine: hypertrophic cardiomyopathy with outflow tract obstruction
•Norepinephrine: hypovolemia, mesenteric or peripheral thrombosis
•Dopamine: tachyarrhythmias, ventricular fibrillation, pheochromocytoma, hypovolemia
•Isoproterenol: tachyarrhythmias, angina pectoris, cardiac glycoside toxicity
•Epinephrine:closed-angle glaucoma, non-anaphylactic shock
Drug interactions:
Dobutamine: COMT inhibitors
•Dopamine, epinephrine, norepinephrine: MAO inhibitors, TCAs
•Combining sympathomimetic medications

26. SYMPATHOMIMETIC MEDICATIONS
ASSESSMENT &
MONITORING
Norepinephrine
Weight
•Orientation, LOC
•Hemodynamic status
•Respiratory status
Intervention and monitoring
Administer via central line
•Low dose titrated based on client’s response
Monitoring
Hemodynamic status
•Intake and output
•LOC
•Side effects
• Paresthesias, cool extremities
• Extravasation
• Stop infusion
• Notify health care provider
• Administer phentolamine mesylate subcutaneously
•Evaluate for the therapeutic response of blood pressure stabilization.
CLIENT EDUCATION
•Purpose of medication: increase their blood pressure
•Administered as a continuous infusion, adjusted as needed