응급약물 정리

소개

응급양물에관하에 정리해놓은레포트입니다.

목차

@3 classes of adrenergic receptor
@ 응급실 응급 약물
1) nitroglycerin(10mg/10ml)
2) Sodium Nitroprusside(Nipride)
3) Dobutamine(Dobutrex) 250mg/5ml
4) Dopamin (200mg/5ml)

본문내용

@3 classes of adrenergic receptor
1) alpha stimulation
① alpha 1 : vasoconstriction
② alpha 2 : decrease norepinephrine release
2) beta 1 : cardiac
① positive : 심박동 변동, 근수축, 전도 변화
② increase HR, Contractility, Speed of conduction(전도)
3) Beta 2 : Lungs
① vasodilation(확장)
② Bronchodilation
4) Dopaminergic stimulation
① Dopaminergic 1-smooth muscle
: Renal, 내장, 관상동맥, 대뇌 동맥 확장
② Dopaminergic 2-autonomic ganglia / symp nerve endings
: inhibits aldosterone synthesis / release
@ General consideration
1) infusion pump
2) monitoring : V/S, 혈역동학, tissue perfusion
3) central line
4) titrate(적정하다) slowly
5) Assume incompatibility(불화합)
@ 응급실 응급 약물
1) nitroglycerin(10mg/10ml)
① mechanism of action
-venodilation : ↓MVO2, ↓preload
-dilates coronary arteries
-arteriolar dilaton(>1~2mcg/kg/min)
② Dosage
-mcg/min
-mix in glass bottle D5W or NS : 50mg/250cc, 100mg/250cc
-onset : 1~2min
-duration : 4~5min
-titrate : 50~200 mcg/min
-indication : CHF(congestive heart failure, 울혈성 심부전), Pulmonary edema(폐부종), Hypertension, Angina(협심증), Acute MI
③ Adverse reactions
: Hypotension, Tachycardia, Headache, Coronary steal
④ Nursing concerns
: Maintain BP, NTG binds to PVC(use non-pvc tubing, glass bottle system)
2) Sodium Nitroprusside(Nipride)
① mechanism of action
-potent(중요) peripheral(말초) vasodilator
-acts on both arterial and venous smooth muscle
-direct action on systemic, coronary, pulmonary and renal circulation
-preload and afterload reduction
-decrease MVO2
② Dosage
-mcg/kg/min
-mix in D5W only : 50mg/250cc, light sensitive
-onset : 30~60secs
-duration : 1~10min
-titrate : 3~10mcg/kg/min
③ Adverse reactions
-hypotension
-Thiocyanate and cyanide toxicity with high dose or long term use
: N/V, abd pain, dizziness, palpitation, metabolic acidosis
④ Nursing concerns
-light sensitive
-use prepared solution within 4hrs, discard(버리다) at 24hrs
3) Dobutamine(Dobutrex) 250mg/5ml
① mechanism of action
-inotropic(근수축)
-synthetic(합성) cathecholamine
-beta-1(primary effect) : ↑CO, SV, contractility, automacity
-beta-2(Nild dffect) : ↓PCWP, CVP, SVR
-no marked increase in HR or BP
② Dosage
-mix in D5W or NSS
-onset : 1~10min
-duration : <10min
-titrate : 2.5~20mcg/kg/min
③ Adverse reactions
-Hypersensitivity
-AF/Atrial Flutter
④ Nursing concerns
-correct hypovolemia
-titration based on hemodynamic response
-consider dose reduction if HR increases by 10%
-May increase insulin requirement
4) Dopamin (200mg/5ml)
① mechanism of action
-direct action on alpha, beta and dopaminergic receptors
-effects is dose dependent
-endogeneous(내인성) precursor(선구물질) of NE
-positive inotropic effect on myocardium(심근)
: increase CO with increase BP
-renal, mesenteric(장간막), CO increase at low dose
② Dosage
-Low : 2~5 mcg/kg/min : dopaminergic, renal, mesenteric vasodilation, renal dose
-medium : 5~10mcg/kg/min, beta1, alpha Contractility dose
-High >10mcg/kg/min alpha, Vasoconstriction dose

참고자료

· 없음