Pharmacology, part 21: Cardiovascular Medications for Shock

Updated:

In this article, we cover the following cardiovascular medications used for shock:

  • Epinephrine, which is used to treat severe allergic reactions.
  • Norepinephrine, which is a vasoconstrictor used to treat low blood pressure.
  • Dopamine, a neurotransmitter made in the brain that acts as a chemical messenger between neurons.
  • Dobutamine, which is medication used to increase cardiac output
  • Albumin, which is a type of protein made by your liver that helps keep fluid in your bloodstream.

The Nursing Pharmacology video series follows along with our Pharmacology Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.

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Epinephrine

Epinephrine (Adrenalin, EpiPen) is a medication used to treat severe allergic reactions caused by insect bites or stings, foods, medications and anaphylaxis (a potentially life-threatening allergic reaction). It can also be used for advanced cardiac life support.

Use during code blue

The Code Blue hospital code is used to indicate that a patient is in immediate need of medical attention—likely because they have gone into cardiac arrest and need to be resuscitated. When you're a nurse and you're involved in a code blue situation, your patient will very likely be getting epinephrine.

Epinephrine

Epinephrine works by stimulating the alpha 1 receptors in the body resulting in vasoconstriction (constriction of blood vessels, which increases blood pressure). It stimulates beta 1 receptors in the heart, which increase the heart rate, and also stimulates the beta 2 receptors in the lungs, which result in bronchodilation.

Side effects

Side effects of epinephrine include hypertension, dysrhythmias, angina, nervousness, tachycardia, and tremors. These are easy to remember when you think of adrenaline giving an all-around “jolt” to the body.

Nursing care

When a patient is taking epinephrine, their vital signs as well as heart rhythm will need to be monitored closely. The patient's EKG will also need to be evaluated due to the side effect of dysrhythmias. If you would like to learn more about EKG interpretation in nursing, check out our EKG flashcards and EKG video series.

Norepinephrine

Norepinephrine (Levophed) is a vasoconstrictor used to treat life-threatening low blood pressure (hypotension) and shock.

Mode of action

Norepinephrine (Levophed) works by stimulating alpha-1 receptors in the body resulting in vasoconstriction. It also has some beta-1 receptor agonist activity that results in increased cardiac output.

Side effects

Side effects of norepinephrine include hypertension, dysrhythmias, and, more rarely, digital necrosis (death of tissue in the fingers, causing them to turn black).

Nursing care

When caring for a patient on norepinephrine, you’ll want to closely monitor the patient's vital signs as well as their heart rhythm and then fingers and toes for signs of necrosis. .

Dopamine

Dopamine (Intropin) is a medication used as a treatment for shock resulting from a heart attack, trauma, surgery, heart failure, kidney failure, and other serious medical conditions.

Dopamine is also naturally occurring in the body and acts as a chemical messenger between neurons in the brain. Dopamine is released when your brain is expecting a reward.

Cool Chicken Why are you acting like such a dope? Oh wait, are you in shock….?!? Let me get you some dopamine.

Mode of action

Dopamine (Intropin) works by stimulating alpha-1 receptors in the body resulting in vasoconstriction. It also stimulates beta-1 receptors which increase cardiac output and heart rate. Dopamine also stimulates dopaminergic receptors, which helps to increase renal perfusion (blood flow into kidneys), making it an effective treatment for renal failure.

Side effects

Side effects of dopamine can include both dysrhythmias and angina.

Nursing care

As with the other medications in this article, a patient’s vital signs as well as their EKG should be monitored closely during dopamine therapy because of its effect on the heart.

Dobutamine

Dobutamine (Dobutrex) is used to treat acute heart failure usually occurring from cardiac surgery or in cases of septic or cardiogenic shock. Dobutamine can also be used in cases of congestive heart failure to increase cardiac output.

Cool Chicken I just looked at my backside in the mirror and realized that butt is mine. Now my heart is failing, and I need some dobbutamine.

Mode of action

Dobutamine works by directly stimulating beta-1 receptors of the heart to increase myocardial contractility and stroke volume, resulting in increased cardiac output.

Side effects of dobutamine

Side effects with Dobutamine (Dobutrex) can include hypertension, dysrhythmias and angina.

Nursing care

When caring for a patient on dobutamine, you’ll want to monitor their vital signs and their EKG. The patient should also be monitored for signs of heart failure. You will most likely have an arterial line in place to monitor the patient’s pulmonary artery wedge pressure (PAWP) and their central venous pressure (CVP) during therapy.

Pulmonary artery wedge pressure (PAWP)

PAWP is the pressure measured by wedging a pulmonary catheter with an inflated balloon into a small pulmonary arterial branch. This is considered an indirect estimate of the pressure in the left atrium of the heart. It's the same as Pulmonary capillary wedge pressure.

The expected range for PAWP is 4 - 12 mmHg.

PAWP values under 4 mmHg can be caused by hypovolemia and vasodilation. PAWP values over 12 mmHg can be caused by congestive heart failure (CHF), hypervolemia, PE, or cardiac tamponade.

Central Venous Pressure (CVP)

CVP is considered a direct measurement of the blood pressure in the right atrium and vena cava (large vein carrying deoxygenated blood into the heart). CVP is the same as right arterial pressure.

The expected range for CVP is 2 - 6 mmHg.

CVP values under 2 mmHg can be caused by hypovolemia and distributive shock. CVP values over 6 mmHg can be caused by heart failure, hypervolemia, PE, or cardiac tamponade.

Both PAWP and CVP lab value ranges are covered in our Lab Values flashcards for nursing students.

Albumin

Albumin is a type of protein made by your liver that helps keep fluid in your bloodstream and helps carry various substances throughout your body, including hormones, vitamins, and enzymes. Albumin as a medication is used to treat or prevent shock following serious injury, bleeding, surgery, or burns by increasing the volume of blood plasma. Low albumin levels can indicate a problem with your liver or kidneys.

Mode of action

Albumin works by helping maintain osmotic pressure in plasma, which can be thought of as the pressure that would be required to stop water from diffusing through a barrier by osmosis. Albumin increases intravascular fluid volume by drawing fluid from the extravascular space (fluid outside blood vessels) into the intravascular space (space contained within blood vessels).

Cool Chicken My friend Al is a bum who sits outside a grocery store, where people bring him lots of water (fluid).

Side effects

Side effects of albumin can include fluid overload, pulmonary edema (excess fluid in the lungs) and hypertension.

Nursing care

If your patient is taking albumin, assess them for signs of fluid overload, which could include swelling (edema) and pulmonary edema, which is a condition caused by excess fluid in the lungs.

Contraindications

Albumin is contraindicated for (not advised for use with) heart failure patients who already have issues with fluid overload.

Full Transcript: Pharmacology, part 21: Cardiovascular Medications for Shock

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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