The purpose of this presentation is to provide the learner with information
about vasoactive medications used in emergency and critical care.
When using vasoactive medication it is important to identify the goal of
therapy and evaluate the response to treatment. The primary goal of most
vasoactive medication is the manipulation of the preload, afterload or
contractility. This presentation will review how this manipulation takes place
and which medications are vasoconstrictive, vasodilatory or inotropic.
We will review the pathophysiology of the sympathetic and parasympathetic
nervous system and discuss alpha and beta adrenergic receptors and their
response to medications. We will consider the pharmacokinetics and
pharmacodynamics of the most frequently used vasoactive medications. We will
include calculation of dosages, and how to titrate a medication to achieve
therapeutic goal. We will address the metabolism, elimination half lives and
The medications to be discussed include: dopamine dobutamine, epinepherine,
norepinephrine, phenylephrine, phosphodiesterase (PDE) inhibitors, nitrates,
and beta blockers. We will discuss the use of fluids, diuretics, calcium
channel blockers, ACE inhibitors, and some antiarrhythmic medications.
Combination therapy is often beneficial.
The presentation will identify the nursing implications in caring for a
patient receiving vasoactive medications. Additional monitoring techniques
many be needed and possible adjustment of medications for special population
groups such as the elderly or renally impaired.
The prerequisite for this class is a basic understanding of hemodynamics and
the treatment of patients in an acute setting. This class would be
beneficial to the new graduate, the seasoned ER or ICU nurse, the advanced
practice nurse or pharmacist. Approximately 50% of the information presented
is pharmacological, the other percentage includes assessment, nursing
implications and patient outcomes.