Pharmacology, part 13: Cardiovascular Medications for Shock

by Cathy Parkes

In this video

Epinephrine

  • Code blue
  • Epinephrine mode of action
  • Side effects of epinephrine
  • What to monitor

Norepinephrine

  • Mode of action
  • Side effects of norepinephrine
  • What to monitor

Dopamine

  • Easy way to remember dopamine is for shock
  • Dopamine mode of action
  • Side effects of dopamine
  • What to monitor

Dobutamine

  • Easy way to remember what dobutamine is for
  • Mode of action of dobutamine
  • Side effects of dobutamine
  • What to monitor

Albumin

  • Albumin is used for
  • Mode of action
  • Easy way to remember what albumin is for
  • Side effects
  • What to assess
  • Contraindication

Full transcript

Okay, we are going to continue on with cardiovascular medications, and specifically in this video we will cover medications that are used for shock. So if you are following along with cards, I'm on card number 37.

As we talk about some of these vasopressors that are used for shock, keep in mind that you always want to correct your patient's hypovolemia first, before administering a vasopressor.

So let's first talk about epinephrine, which is an important medication that is used for severe allergic reactions, including anaphylaxis. It is also used for advanced cardiac life support.

When you're a nurse and you're involved in a code blue situation, chances are your patient is definitely going to be getting epinephrine.

Epinephrine works by stimulating the alpha 1 receptors, which result in vasoconstriction. It stimulates beta 1 receptors in the heart, which increases the heart rate, and it also stimulates the beta 2 receptors in the lungs, which results in bronchodilation.

Side effects of epinephrine include hypertension, dysrhythmias, angina, nervousness and tremor.

If your patient is getting epinephrine, you're going to want to closely monitor their vital signs as well as their heart rhythm, and definitely take a look at their EKG because of the side effect of dysrhythmias.

Let's talk about our next vasopressor, which is norepinephrine. Norepinephrine is used for shock or severe hypotension.

Its mode of action is to stimulate alpha-1 receptors, which results in vasoconstriction. It has minor beta-1 activity as well, so it does increase cardiac output to a certain extent.

Side effects of norepinephrine include hypertension and dysrhythmias.

So again, with this medication, we're going to want to closely monitor the patient's vital signs as well as their heart rhythm.

Next we're going to talk about dopamine. So dopamine can be used for shock, sepsis, heart failure, as well as renal failure.

The way I remember dopamine is for shock is I say, "Why are you acting like such a dope? Oh, wait. Are you in shock? Let me get you some dopamine." So if your patient's kind of acting really out of it, they might be in shock. So that's how I remember that dopamine is for shock.

Dopamine works by stimulating alpha-1 receptors, which causes vasoconstriction. It stimulates beta-1 receptors, which increases cardiac output and heart rate. And then it also stimulates the dopaminergic receptors, which helps to increase renal perfusion, which is why why we would use this for renal failure.

So side effects of dopamine can include dysrhythmias as well as angina.

So just like with our other medications, we're going to really monitor vital signs as well as the patient's EKG.

Now let's talk about dobutamine. Dobutamine is used for heart failure as well as cardiogenic shock.

And the way I remember that dobutamine is used for those things is if you look at the word dobutamine, it looks like butt and mine. So I imagine looking at my backside in the mirror and going, "Oh, no. That butt is mine, and it puts me into heart failure," which requires me to get dobutamine for my heart. So it's a stretch, but it's what I got.

So the mode of action of dobutamine is that it stimulates beta-1 receptors to help increase cardiac input, but it has less effect on the heart rate. So it's not going to jack up the heart rate as much. So it's increasing cardiac output, less effect on the heart rate, as well as the blood pressure.

So side effects of dobutamine include hypertension, dysrhythmias, and angina.

If your patient is on this medication, you'll definitely want to monitor their vital signs, their EKG. But with heart failure too, you're probably going to be doing some hemodynamic monitoring and monitoring their pulmonary artery wedge pressure and as well as their central venous pressure. So in all likelihood, they may have an arterial line in place where we are monitoring these pressures as well.

So the last medication I'm going to cover in this video is albumin, which is a colloid and a volume expander.

Albumin is used for conditions such as shock, hemorrhage, and burns.

It helps to maintain osmotic pressure in the plasma. It works by drawing fluid from the extravascular space into that intravascular space, into the blood vessels.

So the way I remember that albumin does that, what the mode of action is, is I think that Al is a bum that sits outside of a grocery store and everybody brings him bottles of water to help him stay hydrated. And that helps me remember that albumin draws in water, or fluid, into that intravascular space.

So if we bring too much fluid into that intravascular space, then we can end up with side effects such as fluid volume overload, pulmonary edema, as well as hypertension.

So those things will hopefully make sense to you. If we do too good of a job of bringing that fluid into the blood vessels, these would be the natural side effects you would have.

So if your patient is on albumin, you're definitely going to want to assess them for signs of fluid overload, which could include edema, including pulmonary edema. You might hear crackles in the lungs.

And then, this medication would be contraindicated for heart failure patients, who already have issues with fluid overload. So albumin would definitely not be a good idea for heart failure patients.

Okay. So those are all the medications for shock. In my next video, we will get into medications that are used for high cholesterol. Thanks so much for watching.


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