What are the differences of levophed,dopamine and dobutamine in terms of their action?
can this three medication administer to the patient all at the same time?
Asked by Shawna Brzostek 2 years ago.
Levophed (norepinephrine) acts predominantly on alpha-adrenergic receptors to produce constriction of resistance and capacitance vessels, thereby increasing systemic blood pressure and coronary artery blood flow. Norepinephrine also acts on beta1-receptors, although quantitatively less than either epinephrine or isoproterenol. In relatively lower doses, the cardiac-stimulant effect of norepinephrine is predominant; with larger doses, the vasoconstrictor effect predominates. Similar to epinephrine, norepinephrine has direct agonist effects on effector cells that contain alpha- and beta-receptors. As with other catecholamines, the intracellular action of norepinephrine is mediated via cyclic adenosine monophosphate (cAMP), the production of which is augmented by beta stimulation and attenuated by alpha stimulation. The primary pharmacodynamic effects of norepinephrine are cardiac stimulation, particularly at lower doses, and vasoconstriction, which tends to predominate with moderate to higher doses of the drug. Metabolic effects observed with epinephrine, such as glycogenolysis, inhibition of insulin release, and lipolysis, also occur with norepinephrine but are much less pronounced. The hemodynamic consequences of norepinephrine's cardiovascular stimulation include increases in systolic, diastolic, and pulse pressures. Cardiac output is generally unaffected, although it can be decreased, and total peripheral resistance is also elevated. The elevation in resistance and pressure result in reflex vagal activity, which slows the heart rate and increases stroke volume. The elevation in vascular tone or resistance reduces blood flow to the major abdominal organs as well as to skeletal muscle. As with epinephrine, however, coronary blood flow is substantially increased secondary to the indirect effects of alpha stimulation. Therefore, unlike epinephrine, norepinephrine does not significantly increase myocardial oxygen consumption, except in patients with variant angina who are hyperresponsive to alpha stimulation. Norepinephrine is ineffective orally, and subcutaneous absorption is poor. As a result, it is recommended that norepinephrine be administered only via the intravenous route. Following IV administration, the onset of activity is rapid, with a short duration of action of only 1—2 minutes following discontinuation of the infusion. The short half-life of norepinephrine is due to the fact that the drug is rapidly inactivated by catechol-O-methyltransferase and monoamine oxidase in the liver and other tissues. The pharmacologic activity of norepinephrine is rapidly terminated by uptake and metabolism in the synaptic cleft. Negligible amounts of norepinephrine are excreted unchanged in urine. Most of the drug is eliminated renally as sulfate- or glucuronide-conjugated metabolites. The drug crosses the placenta but not the blood-brain barrier. Dopamine is a neurotransmitter that possesses intrinsic activity, as well as serving as the metabolic precursor of norepinephrine and epinephrine. Endogenous dopamine is synthesized from tyrosine. During gestation, the adrenal medulla is formed in parallel with the peripheral sympathetic nervous system; hence there are two CNS and peripheral sources of catecholamines in the body. Once synthesized, dopamine is converted to norepinephrine and norepinephrine is converted to epinephrine in peripheral sites. In the CNS, dopamine is secreted to stimulate central dopamine receptors directly, however, exogenous dopamine does not cross the blood-brain barrier. Dopamine receptors are subdivided into D1 and D2, and exogenous dopamine stimulates both. DA1 receptors are postsynaptic receptors and mediate vasodilation in renal, mesenteric, coronary, and cerebral blood vessels. DA2 are presynaptic receptors located on postganglionic sympathetic nerves and, when stimulated, norepinephrine release from sympathetic nerve endings is inhibited. The clinical effects of exogenous dopamine vary depending on the rate of infusion. At low doses (0.5—2 mcg/kg/min), dopamine principally acts on specific dopaminergic receptors in the renal, mesenteric, coronary, and intracerebral vasculature, resulting in vasodilation. The most clinically significant effect of this vasodilatory response is increased renal blood flow. This increase improves GFR which can be critical in patients with diminished renal perfusion. The corresponding increase in urinary output serves as an indirect marker of increased perfusion to other vital organs. At moderate therapeutic doses (2—10 mcg/kg/min), dopamine also stimulates beta1-adrenergic receptors, resulting in increased cardiac output while maintaining the dopaminergic-induced vasodilatory effects. Compared to isoproterenol, dopamine exerts selectively greater effects on contractility than on heart rate. At high dopamine doses (> 10 mcg/kg/min), alpha-adrenergic agonism predominates, and increased peripheral vascular resistance and renal vasoconstriction result. Interestingly, fenoldopam and bromocriptine, selective agonists at D1- and D2-receptors, respectively, both lower blood pressure in hypertensive patients. Following administration of continuous IV dopamine infusion, the onset of action occurs within 5 minutes and persists for less than 10 minutes. The plasma half-life is about 2 minutes. Distribution occurs throughout the body; however, dopamine does not significantly cross the blood-brain barrier. Dopamine is metabolized in the liver, kidneys, and plasma to inactive compounds by monoamine oxidase (MAO) and catechol-O-methyltransferase (COMT). About 25% of dopamine is metabolized to norepinephrine within adrenergic nerve terminals. Excretion occurs in the urine, mainly as metabolites and conjugates. Dobutamine is a direct-acting sympathomimetic. It is primarily an agonist at beta1-adrenergic receptors, with minor beta2 and alpha1 stimulatory effects. Clinical actions reflect both beta agonism by the (+) isomer and the alpha agonism by the less potent (-) isomer. Agonism at the beta1-adrenergic receptor predominates and increases myocardial contractility and stroke volume with modest chronotropic effects, resulting in increased cardiac output. The inotropic effects are dose-dependent. Dobutamine's secondary hemodynamic effects include decreases in systemic vascular resistance (afterload) and ventricular filling pressure (preload). Systolic blood pressure is generally elevated as a consequence of increased stroke volume, although diastolic blood pressure and mean arterial pressure are usually unchanged with normal doses in normotensive patients. Increased myocardial contractility results in increased coronary blood flow and myocardial oxygen consumption. Dobutamine has minimal effect on pulmonary vascular resistance. Unlike dopamine, dobutamine does not affect dopaminergic receptors, nor does it cause release of norepinephrine from sympathetic nerve endings. Urinary output can increase, however, secondary to increased cardiac output. Electrophysiologically, dobutamine can facilitate AV nodal conduction, particularly in patients with concomitant atrial fibrillation. Onset of action occurs within 2 minutes, although peak pharmacodynamic activity can be delayed up to 10 minutes. The plasma half-life of dobutamine is about 2 minutes. The drug is metabolized in the liver enzymatically by catechol-O-methyltransferase and by glucuronidation to inactive metabolites. Excretion occurs mainly by the kidney as the metabolites and conjugates. The answer to you second question, in the clinical setting you wouldn't normally administer all 3 drugs at the same time and they shouldn't be. Answered by Latonya Ralko 2 years ago.
Dopamine Vs Dobutamine Answered by Anton Ealey 2 years ago.
This Site Might Help You. RE: what are the differences of levophed,dopamine and dobutamine in terms of their action? can this three medication administer to the patient all at the same time? Answered by Apryl Verela 2 years ago.
that is a great question Answered by Georgie Sollberger 2 years ago.
Side effects of using levophed for BLP support are? a. arrthythmias b. Peripheral vasoconstriction?
c respiratort difficulty d. all the above
Asked by Keva Corburn 2 years ago.
Certainly B. I never gave levophed to a patient not already on a ventilator, but it is a powerful stimulant and should increase respirations if they weren't already on the vent. Since it's a powerful stimulant, it might cause a more frequent incidence of PVC's, but at that point that's a lesser consideration. So, from that list, it would have to be B, Peripheral Vasoconstriction. Levophed is a drug used in very critically ill patients who can't maintain their blood pressure with lesser drugs, Dopamine or Dobutamine. If they "max out" on the first two drugs, then a critical care physician may order Levophed, but it's kind of considered a "Hail Mary" drug. Some patients survive it, but lots don't, too. Usually when we put a patient on Levophed, we started inquiring of the family if they might want a Priest. Answered by Sofia Ziernicki 2 years ago.
Levophed (Norepinephrine) computation?
Can somebody give me the formula for Levophed to compute dosage in mcg/kg/min and nanograms?
Asked by Joannie Balliet 2 years ago.
you haven't given enough information. what is the dosage you are working with? please feel free to email me with a little more info and i'm pretty sure i can help you out. Answered by Trinidad Hickingbotham 2 years ago.
Levophed Dosage Answered by Donte Verity 2 years ago.
1 gram = 1000 mg = 0.0353 oz = 0.001 kg = 0.002205 lb milligrams (mg) = 0.001 grams 1 kilogram (kg) = 1000 grams = 35.3 oz = 2.205 lbs microgram (mg) = 10 -6 grams = 0.001 mg nanogram (ng) = 10 -9 grams = 0.001 micrograms (mg) picogram = 10 -12 grams 1 ppm= 0.0001%= 0.013 fl oz in 100 gal =1 mg/kg=1 mg/L=1 mg/g= 0.379 g in 100 gal water= 8.34 x 10 -6 lb/gal=1ml/l 10 ppm = 0.001% = 10 mg/L 100 ppm = 0.01% = 100 mg/L1000 ppm = 1mg/g = 0.1% = 1000 mg/L 1 ppb = 1 ug/kg or 1 ug/L or 1 ng/g 1 ppt = 1 picogram/g 1 % = 10,000 ppm = 10g/L = 1g/100ml = 10g/kg = 1.33 oz by weight/gal water = 8.34 lbs/100 gal water Answered by Alvin Ysquierdo 2 years ago.
Doage of drug infusing/hr or min (ml/hr known)?
Dextrose 5% in water with Levophed is infusing at a rate of 6ml/hr. The IV solution was prepared by adding 2 mg of levophed to dextrose 5% in water. The final solution contained a total volume of 50 ml. How many mg are infusing per hour? How many mg are infusing per minute? I have no clue how to do this please...
Asked by Sherlyn Morta 2 years ago.
Dextrose 5% in water with Levophed is infusing at a rate of 6ml/hr. The IV solution was prepared by adding 2 mg of levophed to dextrose 5% in water. The final solution contained a total volume of 50 ml. How many mg are infusing per hour? How many mg are infusing per minute? I have no clue how to do this please help!!! Answered by Nobuko Dowless 2 years ago.
Just take it step by step. Step 1 You have 2mg/50ml or 0.04mg/1ml. Step 2 Since the flow rate is 6ml/hr you are infusing 0.04mg/1ml * 6ml/hr or 0.24mg/hr. Step 3 0.24mg/1hr * 1hr/60min is 0.004mg/min Answered by Nilda Brockie 2 years ago.
What does drug code mean past postoperative surgery?
Bleeding at operative site and very low blood pressure. Can drugs stabilize The bleeding and low blood pressure?
Asked by Darren Bethley 2 years ago.
Vasopressors or "pressors" can be given to stabilizer a patient's blood pressure, these include Levophed, Vasopressin, Dopamine, and Neo-Synephrine (spelling could be wrong). These drips are started when a patient has critically low BP such as when the Systolic or top number in the BP is in the 70s or below. Above that, the patient will recieve fluid boluses or blood product if the patient is bleeding out. For the bleeding the patient would probably recieve Packed Red Blood Cells (PRBCs) Platlets, Fresh Frozen Plasma (FFPs) or a combination. There is also a non-blood product that will help with bleeding, but I can;t remember what it is right now. Just remember that every patient and situation is different, and this is only what I have experienced Answered by Chelsie Dettling 2 years ago.
Anesthesia and severe truama?
My fiance years ago was in a severe motorcycle accident which resulted in a coma for a month. When he arrived at the hospital his femurs where shattered (the x-rays show literally dust where they used to be). He had several other broken bones and severe head trauma (a diffuse axonal injury- which he recovered...
Asked by Kori Reuter 2 years ago.
My fiance years ago was in a severe motorcycle accident which resulted in a coma for a month. When he arrived at the hospital his femurs where shattered (the x-rays show literally dust where they used to be). He had several other broken bones and severe head trauma (a diffuse axonal injury- which he recovered from). He was obviously completely unresponsive. He had to have rods inserted into his femurs, hands, and arm. The surgery on his body took almost 24 hours. I was wondering, when someone is a state like this do they put them under anesthesia? What do they do to insure that they will not be in pain, but the stress of the anesthesia will not kill them? Answered by Gary Aldarondo 2 years ago.
Pangolin will probably be able to give you the best advice (as she's an anesthesiologist). The goals of anesthesia are unconsciousness, amnesia, and immobility. Someone who is "clinically unresponsive" cannot be presumed to be unconscious (even if they are), so drugs like propofol (Diprivan) would still be given. Amnestics like Versed (midazolam) would also be given, not just to ensure amnesia, but also to help reduce further damage to a swelling brain (to maintain or even reduce intracranial pressure (ICP), although totally different drugs such as mannitol and dexamethasone are the main ones used to reduce brain swelling). Fentanyl and shorter-acting narcotics (e.g. sufentanil, or remifentanil) are others that the anesthesiologist may choose to give at strategic points throughout the case -- the anesthesiologist also has to choose gases (e.g. sevoflurane) to maintain normal ICPs ... long-acting narcotics given at the right time are also going to be given to prevent the risk of post-op pain. A paralytic must be chosen (since spinal reflexes are still intact even with severe DAI) -- bad choices are depolarizing neuromuscular blockers like succynylcholine (sux) which cause a period of muscular fasciculations (because the C-spine can't be properly cleared even with good quality CT scans), but others (e.g. pancuronium or rocuronium) are probably good choices for head-injured patients with possible (or actual) C-spine injuries. That's not even the short version -- the brain, spinal cord, heart, liver, and kidneys need to get enough oxygen, so drugs (called pressors) are given to increase the patient's blood pressure -- these may include Levophed (neosynephrine), phenylephrine, dopamine and others. Anesthesia during long cases is essentially a balancing act: trying to keep the patient still and "comfortable," with stable vital signs. With traumas like the one you described, multi-system organ failure can develop ... ventilator settings often need to be adjusted more frequently (to manage blood pH and CO2 levels) and the anesthesiologist may have to alert the surgeon(s) if s/he suspects decompensation (e.g. an evolving hemo- or pneumothorax and myriad other complications). The anesthesiologist also decides when to give what blood products. Even though more attention is paid to monitoring the CNS, CVS, and RESP systems, other systems are also monitored in the controlled chaotic environment that is the OR during trauma surgery -- urine output is watched to ensure the kidneys are getting enough blood ... *lots* of stuff is being monitored all at once (while the surgeons focus on their job of restoring function). As any anesthesiologist will tell you, there is no way to guarantee the patient will survive the operation -- bringing a critically ill trauma patient through a long surgery requires years of training and experience and continuous observation of the patient. Even with all the modern equipment available (e.g. bispectral index (BIS) monitoring, and the use of closed-loop control (CLC) technology), the anesthesiologist's clinical experience is tantamount to a good outcome. Answered by Kattie Ellenbee 2 years ago.
Anesthesiology is a science and allows for trained professionals to insure pain free procedures using the bodies current state as a guideline. Blood flow, oxygenation, severity of trauma, and weight are factors that are considered. Sometimes the amount of chemical(s) necessary to sedate someone for surgery is relatively small when such severe trauma is present. Vital signs are monitored throughout the procedure to see if the anesthesia is contributing too much stress to a traumatized system. If oxygen levels drop it can be administered. Cardio pulmonary function is monitored to make sure heart and lungs are still functioning strongly enough to withstand continued sedation. Risks of side effects are weighed against the necessity for continued sedation and positive outcome. Case Answered by Hilda Flaugher 2 years ago.
Nursing? I need some information.?
I have recently graduated from high school and I'm looking for something to go to school for. Lately I have heard A LOT about nursing. Some of it seems TOO good to be true. The pay seems to good to be true. I even heard of someone going to school for 2 yrs and making 30 an hour after school!!! I know nothing...
Asked by Florinda Carlill 2 years ago.
I have recently graduated from high school and I'm looking for something to go to school for. Lately I have heard A LOT about nursing. Some of it seems TOO good to be true. The pay seems to good to be true. I even heard of someone going to school for 2 yrs and making 30 an hour after school!!! I know nothing about nursing. I would like for someone to tell me the average pay, what a nurse actually does, will the nursing industry stay this way for atleast a couple more years, I would also be a male nurse and I'm wondering about that too, how many years should I go to school, and should I go to a university or just a nursing school. Thanks! Answered by Lorraine Klarr 2 years ago.
Nurses do make that much. Most of what you have heard is probably true. Nursing is extremely rewarding, and it also pays well, and you can get your degree in two or four years. I am a guy and I plan to go to a four year nursing school after high school, right now I work as a CNA in an emergency department. There is no problem with being a male nurse, some hospitals will actually hire you before a female because you are thought to be stronger than the female nurses. Nurses do a lot of things, and these things differ depedning on what department they work in. Nurses who work on a general medical floor take vital signs, give shots, start IVs, change dressings, give medicines, take care of IV lines, help the family with things they may need, sometimes they give baths, sometimes they help with dental hygiene, they also help if someone stops breathing or if their heart stops. They must be able to rapidly diagnose changes in a patient's status that should not be happening and alert the rest of the medical staff. Floor nurses often take care of a lot of patients, sometimes seven or eight, so they have a very difficult job. Nurses who work in the ICU manage invaise drips, such as nitroglycerin, Insulin, Levophed, Norepinephrine, Heparin, and other infusions. They keep close tabs on their patient's vital signs, often their patients have arterial lines or pulmonary lines to measure the pressure in distinct arteries of the body. Some of these lines can also be used to give infusions and draw blood from. Most ICU patients are on ventilatiors, and the nurse must manage the ventilators and make sure that the settings are benefitting the patient. They must know what to do if someone begins to crash, as in what labs to order, what medicines to give, what rhythms to shock, and how to read the tests and lab work they have ordered. ICU nurses are also heavily involved with the families of their patients, as they must keep them informed and make sure that what they wish to be done is done. They have a very stressful but rewarding job. Emergency department, or ED, nurses do a lot of different things. They see so many different types of patients that the things they do are never the same. One day they might take care of a gun shot wound who has to have their chest cut open, and the next they may have someone who is having a heart attack, or who has broken a bone. ED nurses have to be at the top of their game all the time. They have to be very confident about the things that they know, and they must be able to keep a level head no matter what is going on. They start IVs, draw blood, give medicines, help with resuscitation, help put in sutures, put in catheters, preform many procedures, and do much more. Being an ED nurse is a truly exciting experience. These are just a few of the positions that are available, and I did not do justice to what nurses do each day. They do all of the things I have listed and more. They take care of the patient, the family, and anyone else involved. They are great clinicans and also great humanitarians. Nursing is a great profession. Answered by Kena Crivello 2 years ago.
It is true what you've heard about nursing. Nursing at an RN level can be very rewarding and very challenging. It can also be tailored to your individual interests and abilities. There are several levels of nursing from a nurses aid which is just as the title imples to an LPN, to an RN and ARNP. The professional nurse is usually educated as an RN at the 2 year or 4 year degree program. You take the same State Boards and can apply for most of the same jobs which pay well. However the 4 year degree is paced better and encompases more that just bedside nursing. I graduated from an Associates Degree 2 year RN program and had a healthy carreer as an RN. The intensity of study in the 2 year program is challenging and requires your undivided attention for at least 3 years. Most 2 year programs require at least a year of prerequisites. I would recommend Nursing to anyone who is interested in caring for others and has an interest in science and giving to others. It requires an extra measure of devotion and patience to others. You will be rewarded but you will definately earn it. You can't really do it for the money. If you're interested, find some type of summer job where you will be able to observe first hand the job of nursing. I suggest a nursing home job or volunteer in some fashion. Good Luck. We need you BTW, Men are some of the best and for some reason get to administrative positions more quickly than women... Go Figure... Answered by Lane Trippett 2 years ago.
Hi, I highly recommend the nursing field- the pay is excellent. I started working right out of LPN (licensed practical nurse) school making almost $18 an hour. I work in a long term care facility (nursing home). I am currently working on my RN and our local hospital here pays RN's around $30 an hour. Travel nurses make a great salary. There is a huge demand for nurses, expecially males. But let me say one thing....don't go into nursing just for the money. This is a field that requires caring, compassionate people. There are a lot of fields to go into- working with elderly, children, doctors offices, home health, school nursing. The possibilities are endless. Answered by Leila Rylowicz 2 years ago.
This is a great site and should help, pure medical jobs, puremedicaljobs (dot com) Answered by Prudence Vanderbilt 2 years ago.