Please enable JavaScript.
Coggle requires JavaScript to display documents.
Pediatric shock treatment Meds :pill: (Dopamine :star::baby::skin-tone-3:,…
Pediatric shock treatment
Meds
:pill:
Dopamine
:star::baby::skin-tone-3:
Age specific insensitivity to Dopamine
:gear:
Mech
Release NE fr sympathetic vesicles ➯ Vasoconstriction
Immature animals & young human (< 6 mo)
may not developed
their full complement of
sympathetic vesicles
Dopamine-
resistant
shock commonly respond to NE or High dose Epinephrine
:classical_building:
Classifications:
Catecholamine, Vasopressor, Inotrope
:check:
I/C
: CHF, Shock
:pill:
Doses & Administration
IV/IO: 2 - 20 mcg/kg/min infusion (titrated to desired effect)
Note: 2-5 renal; 5-10 inotropic; 10-20 increase SVR
:woman-running::skin-tone-4:
Pharmacokinetics (PKs)
Absorption
Not applicable with IV/IO
Distribution
Extracellular fluid
Metabolism
Liver, Kidney
Half-life
2 min
:bowling:
Pharmacodynamics (PDs)
IV/IO
Onset: 1-2 min
Peak: 10 min
Duration: < 10 min when stop infusion
:warning:
Caution with Dilantin ➯ Hypotension, Bradycardia
More sense in Newborn
Not in A-line
:star: ตัวเดียวที่เป็น dose-related
:fireworks:
Actions
:grapes:
Stimulate α-adrenergic receptors
:arrow_up: SVR (via constricting arterioles)
Stimulate β1 adrenergic receptor (predominate effect)
:arrow_up: HR (SA node effect)
:arrow_up: Myocardial contractility, Automaticity, & Conduction velocity (ventricular effect)
Stimulate β2 adrenergic receptor
:arrow_up: HR
:arrow_down: SVR
Stimulate Dopaminergic receptor
cause Renal & Splanchnic vasodilation
:arrow_up: Renal
:desktop_computer:
Monitoring
: ECG & BP continuously
:explode:
Precautions & Special considerations
High infusion rates (> 20 mcg/kg/min) may ➯ peripheral, Renal and splanchnic vasoconstriction & ischemia
Don’t mix with NaHCO3
TFT mayb affected with prolonged use because dopamine may inhibit TSH release
High conc & Large volume infusion should be administered via Central venous catheter
SEs: Local necrosis, Arrhythmias
Dobutamine
Beta1
> Beta2 > Alpha
More appropriate for Improving cardiac index & Decreasing afterload
It reverses microcirculatory dysfunction
:classical_building:
Classifications:
Catecholamine, β-adrenergic agent
:check:
I/C
: CHF, Shock
:pill:
Doses & Administration
IV/IO: 2 - 20 mcg/kg/min infusion (titrated to desired effect)
:woman-running::skin-tone-4:
Pharmacokinetics (PKs)
Absorption
Not applicable with IV/IO
Distribution
Extracellular fluid
Metabolism
Liver, Kidney
Half-life
2 min
:bowling:
Pharmacodynamics (PDs)
IV/IO
Onset: 1-2 min
Peak: 10 min
Duration: < 10 min when stop infusion
:fireworks:
Actions
:grapes:
Stimulate β1 adrenergic receptor (predominate effect)
:arrow_up: HR (SA node effect)
:arrow_up: Myocardial contractility, Automaticity, & Conduction velocity (ventricular effect)
Stimulate β2 adrenergic receptor
:arrow_up: HR
:arrow_down: SVR
Intrinsic α-adrenergic blocking effects
:arrow_up: Risk of hypotension fr vasodilation
:explode:
Precautions & Special considerations
Don’t mix with NaHCO3
SEs: Local necrosis, Arrhythmias
consider carefully in Vasodilation septic shock
:desktop_computer:
Monitoring
: ECG & BP continuously
Norepinephrine
Beta1
> Alpha > Beta2
Mark alpha effect
than Epinephrine (esp. periphery)
:classical_building:
Classifications:
Catecholamine, Vasopressor, Inotrope
:check:
I/C
: Distributive Shock (assoc. with low SVR & unresponsive to fluid resuscitation)
:pill:
Doses & Administration
IV/IO: 0.02 - 0.3 mcg/kg/min infusion (> 0.3 mcg/kg/min in
cold shock
)
:woman-running::skin-tone-4:
Pharmacokinetics (PKs)
Absorption
Not applicable with IV/IO
Distribution
Extracellular fluid
Metabolism
Liver, Kidney, Sympathetic nerve
Half-life
2 - 4 min
:bowling:
Pharmacodynamics (PDs)
IV/IO
Onset: < 30
sec
Peak: 5 - 10 min
Duration: ≤ 10 min when stop infusion
:fireworks:
Actions
:grapes:
Stimulate α-adrenergic receptors
:arrow_up: SVR (via constricting arterioles)
Activate myocardial β1 adrenergic receptor
:arrow_up: Myocardial contractility
HR effect is blunted by Baroreceptor stimulation that results fr vasoconstrictive effects
:desktop_computer:
Monitoring
: ECG & BP continuously
:explode:
Precautions & Special considerations
High dose ➯ vasoconstriction
Don’t mix with NaHCO3
Central venous catheter is preferred for administration
SEs: Local necrosis, Arrhythmias, Anxiety, Headache, Renal failure
Epinephrine
Beta1 = Beta2
> alpha
:classical_building:
Classifications:
Catecholamine, Vasopressor, Inotrope
:check:
I/C
: Shock, Symptomatic Bradycardia, Pulseless arrest
:pill:
Doses & Administration
IV/IO for
arrest
: 0.01 mg/kg (0.1 ml/kg) 1:10,000 q 3-5 min
IV/IO: 0.1 - 2 mcg/kg/min infusion (consider higher dose if needed)
:woman-running::skin-tone-4:
Pharmacokinetics (PKs)
Absorption
IM absorption is affected by perfusion
Distribution
Unknown
Metabolism
Liver, Kidney, Endothelium
Half-life
2 - 4 mins
:bowling:
Pharmacodynamics (PDs)
IM: Onset 5-10 min, Peak unknown
IV/IO: Onset Immediate, Peak within 1 min
Inhalation: Onset 1 min, Peak unknown
:fireworks:
Actions
:grapes:
Stimulate α-adrenergic receptors
at higher rate
:arrow_up: SVR
0.3 mcg/kg/min in infant & young children
Older children need Lower infusion rate to achieve vasoconstriction
Stimulate β1 adrenergic receptor (predominate effect)
:arrow_up: HR (SA node effect)
:arrow_up: Myocardial contractility, Automaticity, & Conduction velocity (ventricular effect)
Intrinsic β2 adrenergic
blocking
effects(
<0.3 mcg/kg/min)
:arrow_up: HR
Bronchodilation
Vasodilation of arterioles
:desktop_computer:
Monitoring
: ECG & BP continuously
:explode:
Precautions & Special considerations
High dose ➯ vasoconstriction & may compromise organ perfusion
SEs: Local necrosis, Arrhythmias,
ICH
(from severe HT),
Renal vascular ischemia
,
hyperglycemia
, :arrow_up:
lactate
,
Hypokalemia
:arrow_up: myocardial O2 requirements
Central line is preferred for this administration
:red_cross:
C/I
Cocaine induced VT
Milirinone
:classical_building:
Classifications:
Phosphodiesterase inhibitor, Inodilator
:check:
I/C
: Myocardial dysfunction & increase SVR, PVR
eg Cardiogenic Shock with High SVR, CHF
:pill:
Doses & Administration
IV/IO: loading 50 - 75 mcg/kg over 10-60 min
then
0.5 - 1 mcg/kg/min
:woman-running::skin-tone-4:
Pharmacokinetics (PKs)
Absorption
Not applicable with IV/IO
Distribution
Unknown
Metabolism
Liver
Half-life
2 - 4 hrs
Reduce dose in a Renal impaired
IV/IO
Onset: 2-5 min
Peak: 10 min
Duration variable (1.5-5 hr)
:fireworks:
Actions
:grapes:
:arrow_up: Myocardial contractility
:arrow_down: preload & afterload by relaxation of vascular sm. ms.
:desktop_computer:
Monitoring
: ECG & BP continuously & platelet count
:explode:
Precautions & Special considerations
Hypovolemia ➯ may worsen Hypotensive effects of drug
SEs: :stars:
Thrombocytopenia
, ventricular arrhythmias, headache, hepatoxicity, jaundice, HypoKalemia
Drug has shorter half-life & less effect on Plt.
Compare with Inamrinone
Central vein is preferred for this administration
Drug may accumulate in pt with Renal failure or Low Cardiac output
Longer infusion times :arrow_down: risk of hypotension
Positive inotropic agents
:diamonds:
Adrenergic agonists
Isoproterenol
Dopamine
Dobutamine
Epinephrine
Norepinephrine
:diamonds:
Phosphodiesterase inhibitors
Milrinone
:diamonds:
Digoxin