Week 8 - Cardio Vascular Drug (1) PDF

PHARMACOLOGICAL MANAGEMENT UTILIZING THE NURSING PROCESS ON THE CARDIOVASCULAR MEDICATIONS At the end of the session, the student will be able to: Determine the therapeutic actions Determine the indication of the drug Identify the pharmacokinetics of the drug Identify the co...

PHARMACOLOGICAL MANAGEMENT UTILIZING THE NURSING PROCESS ON THE CARDIOVASCULAR MEDICATIONS At the end of the session, the student will be able to: Determine the therapeutic actions Determine the indication of the drug Identify the pharmacokinetics of the drug Identify the contraindications and cautions Determine the adverse effects of the drug Explain the drug interactions. Identify antidotes for over-dosage. Determine the nursing considerations when giving the drug What’s wrong with my Heart? ANATOMY OF THE HEART Impulse Conduction and the ECG Sinoatrial node AV node Bundle of His Bundle Branches RAAS SYSTEM Where do broken heart goes? NURSING CONSIDERATIONS P ressure (blood) monitor R ise slowly to reduce orthostatic hypotension E ating must be considered (diet) S tay on medications S kipping or stopping is no-no U ndesirable responses R emind to exercise, ↓ alcohol coke E liminate smoking; educate ACE INHIBITOR DRUGS: - pril benazepril (Lotension); captopril (Capoten); enalapril (Vasotec): fosinopril (Monopril); lisinopril (Prinivil, Zestril); moexipril (Univisac); perindopril (Aceon); quinapril (Accuprill); ramipril (Altace); trandolapril (Mavil) ACE INHIBITOR ACTION: Suppresses renin-angiotensin- aldosterone system; blocks conversion of angiotensin I to angiotensin II (a potent vasoconstrictor). INDICATIONS: Hypertension, adjunction therapy for CHF, reduces development of serve heart failure following MI in clients with impaired left ventricular function; prevents kidney failure in type II diabetes. ACE INHIBITOR UNDESIRABLE EFFECTS: Gastric irritation, headache, dizziness, tachycardia, angioedema, cough, maculopapular rash, pruritis, infection, hyperkalemia OTHER SPECIFIC INFORMATION: Probenecid elimination of ace inhibitors, NSAIDs may cause hypotensive effects with other antihypertensives as well as it may occur with potassium-sparing diuretics, potassium supplements, or potassium containing salt substitutes. ACE INHIBITOR INTERVENTION: 1. Obtain baseline and monitor serum/urine protein, BUN ,creatinine, glucose, CBC with differential, potassium and sodium levels 2. Advise rest coz 1st dose syncope may occur in those with CHF. 3. Provide mouth care; alteration in taste may occur. ACE INHIBITOR INTERVENTION: 4. Report any signs of infection, bruising or bleeding 5. Do not give with foods especially Captopril , moexipril, quinapril and Ramipril, it will have reduced absorption but other ACE inhibitors are not affected by food. 6. Instruct not to use potassium supplements or any food or substance containing a large amount of potassium low-sodium milk, salt substitutes, etc. ANGIOTENSIN II RECEPTOR BLOCKERS (ARBS) DRUGS: candesartan (Atacand); eprosartan - sartan (teveten); irbesartan (Avapro); losartan (Cozaar); telmesartan (Micardis); valsartan (Diovan) ANGIOTENSIN II RECEPTOR BLOCKERS (ARBS) ACTION: Blocks the binding of angiotensin II to the AT, receptor found in many tissues (i.e. adrenal, vascular smooth muscle). This blocks the vasoconstriction effect of the renin- angiotensin system as well as the release of aldosterone resulting in a decreased BP. INDICATION: Hypertension. Used alone or with other anti - hypertensive. ANGIOTENSIN II RECEPTOR BLOCKERS (ARBS) OTHER SPECIFIC INFORMATION: Phenobarbital may ↓ effects. INTERVENTIONS: 1. Monitor renal function tests. 2. Monitor BP and apical HR prior to each dose and on a regular basis. If hypotension occurs, place client in the supine position with feet slightly elevated. 3. Maintain hydration. 4. Administer without regard to meals. 5. Assess for signs of upper respiratory infection, cough and diarrhea. BETA BLOCKERS DRUGS: cardioselective (Beta I receptors); - olol acebutolol (sectral), atenolol (therabloc), betaxolol (Kerlone), bisoprolol (Zebeta), esmolol (Brevibloc), metoprolol (Cardiosel, Toprol XL), nebivolol (Nebilet) Nonselective (Beta 1 and 2 receptors); carteolol (Cartol); carvedilol (Carvid); labetalol (Normodyne); nadolol (Corgard); penbutolol (Levotol); pindolol (Visken); propranolol (Inderal); sotal (Betapace); timolol (Blocadren) BETA BLOCKERS ACTION: Binds to beta 1 (cardiac) and or beta 2 (lungs) adrenergic receptor sites that prevents the release of catecholamine. ↓ in contractility, ↓ renin release, ↓ in the sympathetic output. INDICATIONS: Hypertension, angina, MI, migraine headaches, situational anxiety, thyrotoxic storm/crisis, upper GI bleed, familial (essential) tremors, and assist in treatment of dysrrhythmias. BETA BLOCKERS OTHER SPECIFIC INFORMATION: Anticholinergics ↑ absorption. Antacids ↓ absorption. ↑ risk for bradycardia when used concurrently with cardiac glycosides and calcium channel blockers. ↑ hypotensive effects when given with diuretics. Sudden discontinuing may cause refractory hypertension. Do not give to a patient with COPD and Asthma. BETA BLOCKERS UNDESIRABLE EFFECT S B radycardia L ipidemia ibido brOnchospasm C HF onduction abnormalities K onstriction perpheral vascular E xhaustion motional depression R educes recognition of hypoglycemia BETA BLOCKERS INTERVENTIONS: 1. Monitor blood sugar closely in clients with diabetes. Monitor triglyceride and cholesterol level (LDL). 2. Monitor BP and pulse prior to administering. If pulse is < 60 or SBP < 90, withhold and notify provider of health care. 3. Monitor any change in the cardiac rhythm of any signs of CHF. 4. Report dizziness CALCIUM CHANNEL BLOCKERS DRUGS: amplodipine (Amvasc, Norvasc); - difine bepridil (Vascor); diltiazem (Cardizem); felodipine (Plendil) SR; isradipine (DynaCirc) SR; nicardipine (Cardene) SR; nifedipine (Procardia) SR; nimodipine (Nimotop); nisoldipine (Sular); verapamil (Isoptin, Calan) CALCIUM CHANNEL BLOCKERS ACTION: Blocks calcium access to the cells causing a ↓ in contractility, ↓ arteriolar constriction, ↓ PVR, and ↓ in BP INDICATION: Hypertension; vasospastic angina; classic chronic stable angina atrial fibrillation or flutter migraine headaches. Nimodipine is selective for cerebral arteries. Bepridil prevents coronary artery spasm making it an agent for chronic stable angina. These 2 medications are not indicated for hypertension. CALCIUM CHANNEL BLOCKERS OTHER SPECIFIC INFORMATION: Beta-adrenergic blockers may ↑ cardiac depression when given with calcium channel blockers. ↑ Serum levels of digoxin, carbamazepine and quinidine result when given with calcium channel blockers, cimetidine or ranitidine. Antidote for CCB Toxicity: Glucagon – hypoglycemia Insulin - hyperglycemia CALCIUM CHANNEL BLOCKERS INTERVENTIONS: 1. Monitor hepatic and renal function studies. Monitor ECG and avoid giving when heart blocks are present. 2. During bepridil therapy, periodic K+ levels may be required. Have emergency equipment available with IV with administration. 3. Protect drug from light and moisture. 4. Position client to decrease peripheral edema. 5. Do not crush or chew VASODILATORS DRUGS: hydralazine (Apresoline); minoxidil (Loniten) ACTION: Direct relaxation of vascular smooth muscle, producing vasodilation or arterioles which decreases after load. VASODILATORS INDICATION: Hypertension UNDESIRABLE EFFECTS: Headache, dizziness; anorexia, nausea, vomiting, diarrhea; palpitations, tachycardia, hypotension, occasional postural hypotension; edema and/or weight gain (drugs can cause sodium and water retention); flushing nasal congestion. Lupus-like reaction (fever, facial rash, muscle and joint ache, splenomegaly). VASODILATORS OTHER SPECIFIC INFORMATION: ↑ hypotensive effects with antihypertensives, beta blockers and diuretics. INTERVENTIONS: 1. Monitor BP, heart rate, daily weight, CBC, renal function tests, urinalysis. 2. Take with meals for nausea eat unsalted crackers or dry toast.  ANTI HYPOTENSIVE AGENTS DRUGS: (Sympathomimetic Drugs) Dobutamine, Dopamine, Ephedrine, Epinephrine, Isoproterenol, Metaraminol. ACTION: Activates alpha receptors in arteries and veins to produce an increase in vascular tone and an increase in BP. INDICATION: Symptomatic treatment of orthostatic hypotension in patients whose lives are impaired by the disorder and who have not had a response to any other therapy; Severe hypotension and shock.  ANTI HYPOTENSIVE AGENTS OTHER SPECIFIC INFORMATION: Risk of ↑ effects and toxicity of cardiac glycosides, beta blockers, alpha adrenergic agents, and corticosteroids if taken with hypotensive agents. INTERVENTION/EDUCATION : 1. Monitor BP and HR. 2. Monitor known visual problems. 3. Encourage to void before taking a dose. ANTI – ARRHYTHMIC AGENTS ANTI – ARRHYTHMIC AGENTS SODIUM CHANNEL BLOCKERS Class 1a; disopyramide (Norpace), moricizine (Ethmozine), procainamide (Pronestyl), quinidine (Quinaglute): Class 1b; lidocaine (Xylocaine), mexiletine (Mexitil): Class 1c; flecainide (Tambocor), propafenone (Rythmol). ANTI – ARRHYTHMIC AGENTS POTASSIUM CHANNEL CLOCKERS Class III amiodarone ( Cordarone), Bretylium, Ibutilide (Corvert), dofetilide (Tikosyn), sotalol (Betapace, Betapace AF). ANTI – ARRHYTHMIC AGENTS DRUGS: Class IV amplodipine (Amvasc, Norvasc); bepridil (Vascor); diltiazem (Cardizem); felodipine (Plendil) SR; isradipine (DynaCirc) SR; nicardipine (Cardene) SR; nifedipine (Procardia) SR; nimodipine (Nimotop); nisoldipine (Sular); verapamil (Isoptin, Calan)  ANTI – ARRHYTHMIC AGENTS ACTION: Stabilize the cell membrane by binding to sodium channels, blocks potassium channels, blocks calcium access depressing phase 0, prolonging the phase 3 of the action potential, and changing the duration of the action potential. They have a local anesthetic effect which prolongs repolarization and slows the rate and conduction of the heart causing a ↓ in contractility. ANTI – ARRHYTHMIC AGENTS INDICATIONS: Potentially life – threatening ventricular arrhythmias and should not be used to treat other arrhythmias because of the risk of proarrhythmic effect. OTHER SPECIFIC INFORMATION: Risk for arrhythmias ↑ if combined with digoxin and beta blockers. ↑ digoxin levels and toxicity if combined with quinidine. ↑ risk of bleeding if combined with oral anticoagulants. ANTI – ARRHYTHMIC AGENTS INTERVENTION: 1. Avoid foods that alkalanize urine (citrus/grapefruit juices, vegatables, antacids, milk products) which could ↑ toxicity. 2. Titrate the dose to the smallest amount needed to achieve control arrthythmias. 3. Encourage to take with meals or milk. 4. Do not chew tablets or capsules; instead, swallow them whole. 5. Do not attempt to drive or perform hazardous tasks if light-headedness or dizziness should occur.  ADENOSINE TRISULFATE ACTION: Slows impulse formation in SA node and conduction time through AV node. Acts as a diagnostic aid in myocardial perfusion imaging or stress echocardiography by causing coronary vasodilation and increased blood flow. INDICATIONS: Treatment of paroxysmal supraventricular tachycardia (PSVT), including patients associated with accessory bypass tracts (Wolff- Parkinson-White syndrome) ADENOSINE TRISULFATE INTERVENTION: 1. Administer very rapidly (over 1-2 sec) undiluted directly into vein, or if using IV line, use closest port to insertion site. If IV line is infusing any fluid other than 0.9% NaCl, flush line first. 2. Cardiac monitor should be used on patients receiving adenosine IV boluses. 3. IV site should be on the Left antecubital area if feasible. 4. Carotid Massage PHOSPHODIESTERASE INHIBITORS DRUGS: inamrinone (Inocor), milrinone (Primacor), sildenafil (Viagra), tadalafil, vardenafil sometimes contraindicated but may be given to moderately CHF. The primary indication is for Erectile Dysfunction. PHOSPHODIESTERASE INHIBITORS ACTION: Block the enzyme phosphodiesterase leading to an increase in myocardial cell cyclic adenosine monophosphate (cAMP), which ↑ Ca levels in the cell. INDICATIONS: Short term treatment of CHF that has not responded to digoxin or diuretics alone or that has had poor response to digoxin, diuretics and vasodilators. PHOSPHODIESTERASE INHIBITORS OTHER SPECIFIC INFORMATION: Precipitates form when these drugs are given in solution with furosemide. Use alternate lines if both of these drugs are being given IV. Viagra should not given with CHF in Nitrate management. INTERVENTION/EDUCATION: 1. Monitor pulse and BP. 2. Monitor input and output and record daily weight. 3. Monitor platelet counts before and regularly during therapy. 4. Monitor injection sites and provide comfort measures. 5. Provide life support equipment on standby. ANTIANGINAL AGENTS DRUGS: nitroglycerin (Nitro – Bid, Transderm, Nitrostat), amyl nitrate, isosorbide dinitrate (Isordil, Isoket), isosorbide mononitrate (Imdur, Montra).  ANTIANGINAL AGENTS ACTION: Relaxes vascular smooth muscle with a resultant ↓ in venous return and ↓ in arterial blood pressure, reducing the left ventricular workload and ↓ myocardial O2 consumption. INDICATIONS: Treatment of acute angina, prophylaxis of angina, IV treatment of angina unresponsive to beta blockers or organic nitrates, peri operative hpn, CHF associated with acute MI; to produce controlled hypotension during surgery.  ANTIANGINAL AGENTS OTHER SPECIFIC INFORMATION: Risk of hpn. and ↓ antianginal effects if given with ergot derivatives. ↓ therapeutic effects of heparin if given together. INTERVENTION/EDUCATION: 1. Give SL under the tongue or buccal pouch, and encourage not to swallow. Give sustained release forms with water, and caution the patient not to chew or crush. 2. Rotate the sites of topical forms, to ↓ breakdown and abrasions. 3. Provide life support equipment on a stand by basis. 4. Patch: Apply the left anterior chest wall for at least 16hrs on and 8 hour off. Area should be dry, clean and hairless. CARDIAC GLYCOSIDES DRUGS: Digitoxin(Crystodigin); Digoxin(Lanoxin) CARDIAC GLYCOSIDES ACTION: Inhibits the ATPase, resulting in cardiac contraction. INDICATION: CHF, atrial fibrillation and or flutter, and paroxysmal atrial contractions. UNDESIRABLE EFFECTS: Anorexia, nausea(1st sign of adult toxicity), upset stomach(1st sign of toxicity in older children).Vertigo, headache, depression, muscle weakness, drowsiness, confusion(1st sign in elderly). Bradycardia, ECG changes, photophobia, yellow-green halos around visual images, flashes of light.  CARDIAC GLYCOSIDES OTHER SIGNIFICANT INFORMATION: ↓K+, ↓Mg+, and ↑Ca+ maybe associated with digitalis toxicity. Administer separately from antacids(1-2hrs apart). Antidote: Digibind INTERVENTIONS: 1. Monitor K+, Mg++, ECG, liver/renal function tests, drug level (therapeutic level 0.5ng/ml- 2ng./ml, toxicity is ≥ 2.0ng/ml). 2. Before each dose, assess apical pulse for full minute; record and report for changes in rate or rhythm. 3. Withhold drug if pulse is ≤60/min or ≥100(adults) or ≤110/min(children). 4. 4.Weigh daily, monitor I & O, and signs of CHF. ANTILIPIDEMIC Classification 1. HMG CoA Reductase Inhibitor – statin drugs. atorvastatin 2. Fibric Acid Derivatives – fibrates drugs. fenofibrate 3. Bile Acid Binding Resins – colestipol 4. Niacin - nicotinic acid 5. Omega -3 Marine Triglycerides - Omacor HMG COA Inhibitors DRUGS: - statin atorvastatin (Lipitor), cerivastatin( Baycol), fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor). HMG COA INHIBITORS ACTION: The “statins” are competitive inhibitors of HMG – CoA reductase, and enzyme necessary for cholesterol biosynthesis in the intestine and liver. INDICATIONS: Hypercholesterolemia, ↓ LDL, ↑ HDL.  HMG COA INHIBITORS OTHER SPECIFIC INFORMATION: ↑ effect of warfarin, bile acid binding acids. May ↓ availability of statin. Digoxin ↑ statin levels. Concomitant use of ACE inhibitors may result in ↑ K+. Concomitant use of erythromycin, fibric acid derivatives, immunosuppresive drugs, and niacin may ↑ rhabdomyolysis. HMG COA INHIBITORS INTERVENTIONS: 1. Monitor serum cholesterol and tricyglycerol levels, serum creatinine kinase (CK) and LFT in relation to baseline and at regular intervals. Discontinue statins if LFT ↑ > 3 times normal. 2. Prior to initiating drug therapy, encourage appropriate diet, exercise and weight reduction. 3. Taken during bedtimes BILE ACID SEQUESTRANT DRUGS: cholestyramine (Questran), colestipol (Colestid). BILE ACID SEQUESTRANT ACTION: Combines with bile acids in the intestine resulting in excretion in the feces. Cholesterol is oxidized in the liver to replace the loss bile acids serum cholesterol and LDL are decreased INDICATIONS: Hypercholesterolemia when dietary management does not lower cholesterol. BILE ACID SEQUESTRANT OTHER SPECIFIC INFORMATION: ↓ absorption of warfarin, ↓ absorption of digoxin, thiazides, propanolol, penicillin, tetracyclines, vancomycin, folic acid and thyroid hormones, ↓ absorption of fat soluble vit. (ADEK). BILE ACID SEQUESTRANT INTERVENTIONS: 1. Monitor serum cholesterol, triglycerol levels and PT in relation to baseline at regular intervals. 2. Monitor I and O and bowel status. 3. Advice to take other meds 1 hr. before or 4 – 6 hrs. after cholestyramine. 4. Diet should be low in fats, cholesterol and sugars, high in fibers. 5. Follow directions in mixing, never take as a dry powder (incomplete mixing may result in mucosal irritation). Mix with 3 – 6 oz of water, milk, fruit juices or soup. 6. Take before meals and drink several glasses of water between meals. 7. Instruct that a laxative or stool softener may assist in preventing constipation. ANTIPLATELET DRUGS: aspirin (Bayer, Bufferin, Ecotrin, Aspilet); abciximab (ReoPro); cilostazol (Pletal); clopidogrel (Plavix); dipyrimole (Persantine); eptifibatide (integrilin); sulfinpyrazone (Anturanel) ticlopidine (Ticlid); tirofiban (Aggrastat) ANTIPLATELET ACTION: Platelet aggregation inhibitor; inhibits platelet synthesis of thromboxane A2, a vasoconstrictor and inducer of platelet aggregation. This occurs at low doses and lasts for 8 days (life of the platelets). INDICATIONS: TIA’s: CVA’s with a history of TIA due to fibrin platelet emboli. Reduces risk of death from MI in clients with a history of infarction or unstable angina.  ANTIPLATELET OTHER SPECIFIC INFORMATION: ↑ risk of bleeding with anticoagulants, thrombolytics. Risk of GI ulceration with alcohol, NSAIDs, phenylbutazone, steroids. Do not give to patient with Dengue Hemorrhagic Fever. INTERVENTIONS: 1. Monitor liver and renal function tests. 2. CBC clotting times, stool guaiac (fecal occult blood) and vital signs. 3. Instruct to take drug with food and a full glass of water. Usually lunch time. 4. Assess for toxicity( Tinnitus). Antidote for ASA: Sodium Bicarbonate THROMBOLYTIC AGENTS DRUGS: alteplase (Activase), tenecteplase (TNKase), Eminase), streptokinase (Strepnase), urokinase (Abbokinase), reteplase (Retavase).  THROMBOLYTIC AGENTS ACTION: Binds with plasminogen causing conversion to plasmin, which dissolves blood clots. INDICATIONS: Dissolves blood clots due to coronary artery thrombi, deep vein thrombosis, pulmonary embolism. OTHER SPECIFIC INFORMATION: Increase in risk for bleeding with heparin, oral anticoagulants, antiplatelet drugs and NSAIDs. THROMBOLYTIC AGENTS INTERVENTIONS: B leeding Monitoring L ook for occult blood E mploy pressure on punctured sites E xplore for neuro changes D etermine HTN & Tachycardia I njection is avoided N ice to use electric razor G et ready for AMICAR as antidote ANTICOAGULANT DRUGS: heparin sodium (Heparin); Low-Molecular-Weight - parin Heparins; ardeparin, (Normiflo); Dalteparin (Fragmin); danaparoid (Orgaran); enoxaparin (Clexane); warfarin (Coumadin), rivaroxaban (Xarelto), Apixaban ( Eliquis), fondaparinux (Arixtra) ANTICOAGULANT ACTION: Combines with antithrombin III to retard thrombin activity. Low- molecular-weight heparin blocks factor Xa, factor lla. INDICATIONS: Thrombosis. Reduces risk of myocardial infarction (MI). CVA, clots associated with atrial fibrillation; pulmonary embolism. Prevents or slows extension of a blood clot.  ANTICOAGULANT OTHER SPECIFIC INFORMATION: Foods – ↑ effectiveness (i.e., asparagus, cabbage, cauliflower, turnip greens and othe green leafy vegetables). Drugs ↑ effectiveness: Glucocorticosteroids, Alcohol, Salicylate (GAS). Drugs ↓ effectiveness: Rifampin, Oral contraceptives, Phenytoin, Estrogen (ROPE). Risk of bleeding with chamomile, garlic, ginger, ginkgo, and ginseng therapy.  ANTICOAGULANT INTERVENTION: H ave a Protamine Sulfate W OF Bleeding E nd after 2 weeks of therapy A ntidote is Vit K P TT check ssess for PT level A ssess for Bleeding R eminder: ASA + Coumadin = R emind not to Aspirate & Severe Bleeding or Reye Dse Massge eminder: avoid green leafy I njection subcutaneous vegetable = ↑ Vit K N ote for Hematuria  TITRATION DRIPS It involves incorporation of medication in an IVF solution to run for a prescribed period of time. It involves 2 step approaches: 1. drug calculation 2. flow rate computation  TITRATION DRIPS SCENARIO: B. for drips computation Mr. X was admitted at ICU with the Dx of Acute MI. Heparin 20,000 “u” x 1 ml = 20 ml 5000 “u” was given as bolus. The AMD ordered to hook IVF of 1000 “u” PNSS 1 liter + 20,000 “u” of C. Calculation of flow rate heparin. How many mgtts/min will you regulate the present IVF if the 1000 “u”/ hr x 1000 ml = 50ml/hr AMD orders Heparin drip @ 1000 “u”/hr? 20,000 “u” D. 60 mgtts/ min 50 ml x 60mgtts x 1 hr = 50mgtts/min hr x cc x 60 min PREPARE & CALCULATE DOPAMINE AND DOBUTAMINE DOSE DOPAMINE = increases myocardial contraction and cardiac output. (cardiac drugs) DOBUTAMINE = increases myocardial contractility and stroke volume). (cardiac drugs)  PREPARE & CALCULATE DOPAMINE Scenario: B. Compute your desired dose Unconscious patient was brought to the ER. No BP, No pulse, (5 mcg/kg/ min) after resuscitation the doctor 5 mcg x 45kg x 60 min = 13,500 mcg/hr ordered for Dopamine at 5 mcg/kg/min.The patient’s weight is 45 kg. How will you prepare the solution? How will you regulate C. Convert microgram → mg. your infusion pump? 13,500 mcg/hr = 13.5 mg/hr 1000mcg/mg STEPS: D. Use the formula A. Dilute 200mg of D x Q = q 13.5 mg/hr x 250cc = 16. 88 cc/hr Dopamine (1 amp) in 250 cc of NS. S 200mg PREPARE & CALCULATE DOPAMINE Dopamine single concentrate (200mg in 250cc D5W) Formula: dose in mcg. x KBW 13.33 Example: Regulate dopamine drip to a 60kg. client to run for 3mcg./KBW. 3mcg. x 60kgs. = 180 = 13. 5 mgtts/min 13.33 13.33 Dopamine double Concentrate (400mg in 250cc D5W) Formula: dose in mcg. x KBW 26.66 PREPARE & CALCULATE DOBUTAMINE Scenario: B. Compute your desired dose A patient with a BP of palpatory 50 was (10 mcg/kg/min) assigned to you. Dobutamine was ordered at 10 mcg/kg/min. Patient 15mcg x 55kg x 60min = 33,000mcg/hr weighs 55kgs. How will you prepare and regulate the medication? C. Convert microgram → mg STEPS: 33,000 mcg/hr = 33 mg/hr A. Dilute 250mg of dobutamine 1000mcg/mg (1 amp or vial) in 250cc of NS. D. Use the formula D x Q = q 33 mg/hr x 250cc = 33 cc/hr S 250mg PREPARE & CALCULATE DOBUTAMINE Dobutamine single concentrate (250mg in 250cc D5W) Formula: dose in mcg. x KBW 16.66 Example: Regulate dopamine drip to a 40kg. client to run for 10mcg./KBW. 10mcg. x 4Okgs. = 400 = 24.01 mgtts/min 16.66 16.66 Dobutamine double Concentrate (500mg in 250cc D5W) Formula: dose in mcg. x KBW 33.33 Healthy Heart is Needed