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Titration Vasoactive Medications in Adults

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 adverse reactions.

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.

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