DRUG NAME Generic: Dopamine Hydrochloride Brand: dopamine Classification System: Cardiovascular Action: Vasopressor Mechanism of Action Stimulates

beta-1 receptors in the heart, causing more complete and forceful contractions (inotropy). Also acts on alpha receptors (dose dependent) and has dopaminergic effects. Side Effects Adverse Reactions Cardiovascular-Anginal pain, bradycardia, ectopic beats, hypertension, hypotension, vasoconstriction, ventricular arrhythmia, CNS-Anxiety, headache. GI-Nausea, vomiting. Miscellaneous-Azotemia, dyspnea, gangrene cyanosis, piloerection. Nursing Implication cardiac conduction abnormalities, palpitation, tachycardia, widened QRS complex. of the extremities, peripheral

Monitor vital signs and ECG closely throughout therapy. Monitor I&O regularly; note decreases in urine output. Monitor CVP or pulmonary wedge pressure if possible during infusion. Note significant changes in vital signs, ECG changes, deterioration of peripheral pulses, and/or cold, mottled extremities. Closely monitor urine flow, cardiac output, and BP during dopamine infusion. DRUG NAME Generic: Dobutamine hydrochloride Brand: Dobutamine Classification System: Cardiovascular Action: Vasodilator Mechanism of Action Dobutamine is a direct-acting inotropic agent whose primary activity results from stimulation of the receptors of the heart while producing comparatively mild chronotropic, hypertensive, arrhythmogenic, and vasodilative effects. It does not cause the release of endogenous norepinephrine, as does dopamine. Side Effects Adverse Reactions Increased Heart Rate, Blood Pressure, and Ventricular Ectopic Activity, Hypotension, nausea, headache, anginal pain, nonspecific chest pain, palpitations, and shortness of breath. Nursing Implication 1. During the administration of Dobutamine, as with any adrenergic agent, ECG and blood pressure should be continuously monitored. In addition, pulmonary wedge

pressure and cardiac output should be monitored whenever possible to aid in the safe and effective infusion of Dobutamine. 2. Hypovolemia should be corrected with suitable volume expanders before treatment with Dobutamine is instituted. 3. No improvement may be observed in the presence of marked mechanical obstruction, such as severe valvular aortic stenosis. DRUG NAME Generic: tolazoline Brand: Priscoline Classification System:CNS Action: alpha-sympathetic blocker Mechanism of Action Vasodilation by means of a direct effect on peripheral vascular smooth muscle and indirect effects produced, in part, by release of endogenous histamine; tolazoline has moderate alpha-adrenergic blocking activity and has histamine agonist activity. Tolazoline usually reduces pulmonary arterial pressure and vascular resistance. Side Effects Adverse Reactions Cardiovascular: Hypotension, tachycardia, cardiac arrhythmias, hypertension, pulmonary hemorrhage. Digestive and Hepatic: Gastrointestinal hemorrhage, nausea, vomiting, diarrhea, hepatitis. Skin: Flushing, increased pilomotor activity with tingling or chilliness, rash. Hematologic: Thrombocytopenia, leukopenia. Renal: Edema, oliguria, hematuria. Nursing Implication if hypochloremic metabolic alkalosis occurs, patient should be weaned from tolazoline therapy and replacement chloride and potassium administered Hematest of gastric aspirates (recommended at periodic intervals to detect gastrointestinal bleeding) Renal function, including urine flow, determinations (recommended periodically during tolazoline therapy)

DRUG NAME Generic: Nitric Oxide Brand: INOmax Classification System: Cardiovascular Action: vasodilator Mechanism of Action Used in conjunction with ventilatory support and other appropriate therapy to improve oxygenation and reduce the need for extracorporeal membrane oxygenation (ECMO) in term or near-term (>34 weeks of age) neonates with hypoxic respiratory failure and clinical or ECG evidence of pulmonary hypertension

Side Effects Adverse Reactions Hypotension, withdrawal manifestations (e.g., increased pulmonary artery pressure, decreased PaO2, increase in or return to right-to-left shunting of blood, atelectasis, hematuria, hyperglycemia, sepsis, infection, stridor, cellulitis. Nursing Implication Abrupt discontinuance of nitric oxide therapy can result in oxygen desaturation and a rebound increase in pulmonary artery pressure. Such manifestations also can occur in neonates who do not respond to inhaled nitric oxide therapy. To minimize adverse effects associated with withdrawal of therapy, neonates should be weaned from therapy by a gradual reduction in dosage and should be monitored for evidence of deterioration during and after weaning DRUG NAME Generic: Prostaglandin I2 Brand: prostacyclin Classification System: Action: Vasodilator Mechanism of Action Prostacyclin (PGI2) is released by healthy endothelial cells and performs its function through a paracrine signaling cascade that involves G protein-coupled receptors on nearby platelets and endothelial cells. The platelet Gs proteincoupled receptor (prostacyclin receptor) is activated when it binds to PGI2. This activation, in turn, signals adenylyl cyclase to producecAMP. cAMP goes on to inhibit any undue platelet activation (in order to promote circulation) and also counteracts any increase in cytosolic calcium levels that would result fromthromboxane A2 (TXA2) binding (leading to platelet activation and subsequent coagulation). Side Effects Adverse Reactions Facial flushing, headache, tachycardia and decrease in diastolic blood pressure, Erythema over the venous infusing site bradycardia, pallor and sweating--the vagal reflex--(seven times) and chest pain (twice)