dopamine
TRANSCRIPT
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DOPAMINE
JAHANGIR AHMAD
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HISTORY
The function of dopamine as a neurotransmitter was discovered in 1958 by Arvid Carlsson and Nils-Åke Hillarp at the Laboratory for Chemical Pharmacology of the National Heart Institute of Sweden. It was named dopamine because it was a monoamine, and its synthetic precursor was 3,4-dihydroxyphenylalanine . Arvid Carlsson was awarded the 2000 Nobel prize for physiology or medicine for showing that dopamine is not just a precursor of norepinephrine (noradrenaline) and epinephrine (adrenaline) but a neurotransmitter, as well.
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INTRODUCTION
Dopamine is an endogenous catecholamine that serve as both a neurotransmitter and a precursor of nor epinephrine synthesis.
When given as an exogenous drug dopamine activates a variety of receptors in dose dependent manner.
Regulates cardiac, vascular and endocrine function.
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Each ampoule contains 200 mg /5ml
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STRUCTURE
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SYNTHESIS
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RECEPTORS
o Dopamine acts through D1 , D2 as well as adrenergic alpha and B1 receptors ( But not B2)
o D1 and D2 receptors are the most abundant and widespread in areas receiving a dopaminergic innervation ( namely the striatum ,limbic system, thalamus and hypothalamus) as are D2 receptors, which also occur in the pituitry gland
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MECHANISM OF ACTION
At low dose (0.5 to 3 mic /kg /min ):- Selectively activates dopamine
specific receptors in the renal and splanchnic circulation.
Increase blood flow in these region.
Low dose dopamine also directly affects renal tubular epithelial cells.
It causes an increase in urinary Na excretion
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Contd…. Intermediate dose (3 to 10 mic /kg /min ):-
It stimulates B1 receptors in the heart and peripheral circulation.
Increases myocardial contractility, increases heart rate and peripheral vasodilatation
It increases myocardial oxygen demand, so when ever dopamine is to be used oxygen must be supplemented
Over all increase in cardiac output Contractile response to dopamine is modest
when compared to dobutamine
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Contd…
At high dose (> 10 mic /kg / min ):- Dopamine produces a
progressive activation of alpha receptors in the systemic and pulmonary circulation resulting in progressive pulmonary and systemic vasoconstriction
This vassopressor effect by virtue of increasing ventricular afterload
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Contd..
Dopamine not effective orally and does not cross blood brain barrier in sufficient amounts to cause CNS effects.
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PHARMACOKINETICS
Rapid metabolism of dopamine mandates its use as a continuous infusion. A portion of the positive inotropic effect of dopamine is due to stimulation of release of endogenous norpinephrine which may predispose to development of cardiac disarrythmias never theless, dopamine is less disarrythmogenic than epinephrine
It is used only intravenously .
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CLINICAL USES
Dopamine is often used in situation where both cardiac stimulation and peripheral vasoconstriction desired such as cardiogenic shock
Also used to correct the hypotension in the septic shock .But norepinephrine become the preferred vassopressor in this condition
Low dose is often used in an attempt to prevent or reverse acute renal failure
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Contd…
Drug initially administered at a rate of 2 to 5 mic / kg /min . During infusion ,pt require clinical assessments of myocardial function perfusion of vitals organs such as the brain , and the production of urine
Most pts should receive intensive care with monitoring of arterial and venous pressures and ECG
Reduction in urine flow ,tachycardia or the development of arrhythmias may be indications to slow or terminate the infusion
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DOPAMINE IN PULMONARY OEDEMA
The sympathomimetic amines dopamine is potent ionotropic agents
Used in pulmonary edema Forcefully contracts the heart and
thus decreases the pulmonary load
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DOPAMINE INFUSION IN WHICH FLUID ?
D-5-- No RL -- No NS -- yes DNS-- No HEMACCIL -- No
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DOPAMINE AND ADRENALINE/NORADRENALINE COMBINED INFUSION
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DOPAMINE AND DOBUTAMINE COMBINED INFUSION
The divergent pharmacologic effects of dopamine and dobutamine make their use in combination potentially useful.Infusion of the combination of dopamine and dobutamine have been noted to produce a greater improvement in cardiac output, at lower doses, than can be achieved by either drug alone.
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Conti-
Low dose simultaneously increases:
Glomerular filtration rate
Renal blood flow Urine output
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DOSE AND ADMINISTRATION
Commercial preparation of dopamine are concentrated drug solution [Containing 40 mg /80 mg dopamine HCL /ml]
Provided in small volume vial / ampoule in 5 ml /10 ml
THE Preparation must be diluted to prevent intense vasoconstriction during drug infusion
Dopamine solution diluted 100-fold in isotonic saline to prepare the infusate
Always delivered into , large central veins
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DOSING REGIMEN
Weight based There are two recommended doses:- 3 to 10 mic /kg /min is for
augmenting cardiac output thereby increasing BP
More than 10 mic /kg /min is recommended to increase the blood pressure directly
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INCOMPABILITIES
Like dobutamine, dopamine is inactivated by higher PH So ,alkaline fluids should not be infused along with dopamine
INFUSATE:- Use 5 ml 2 vials containing
40 mg /ml dopamine HCL add to 500 ml isotonic saline [Final concentration= 40mic /drop ]
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PRECAUTIONS
Before dopamine is administered to pt in shock ,hypovolemia should be corrected by transfusion of whole blood , plasma or other appropriate fluid
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ADVERSE EFFECTS
o Tachyarrhythmia's are the most common adverse effects of dopamine
o Malignant tachyarrhythmia [ Multifocal ventricular ectopic , ventricular tachycardia ]
o The most feared complication of dopamine infusion is limb necrosis
o Extravasations of drug through a peripheral vein can be treated with local injection of phentolamine [5 to 10 mg in 15 ml saline ]
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Contd…
Allergic reactions Delays gastric emptying which
could predispose to nosocomial pneumonia
If pt is on dopamine infusion and is to be anaesthetized , he / she will be treated as a full stomach pt
Less dysarrytmogenic than epinephrine
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Contd…
Continuous infusion of dopamine increase intraocular pressure
Ventilation effects :- Infusion of dopamine interferes with
the ventilatory response to arterial hypoxemia
They results in unexpected depression of ventilation
ABG have been observed to deteriote during infusion of dopamine
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Contd…
Hyperglycemia that is commonly present in pts receiving a continuous infusion of dopamine is likely to reflect drug induced inhibition of insulin secretion
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DRUGS MAY INTERACTS WITH DOPAMINE
Cyclopropane Bromocriptine Dyhydroergotamine Entacapone Halothane Linezolide Phenytoine
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CONTRAINDICATION
Pt receiving MAO inhibitors Tricyclic antidepressants agents Pheochromocytoma Uncorrected tachyarrhythmia Ventricular fibrillation
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If dopamine liquid falls on floor /cloth it gives permanent staining if allowed to dry and was not mopped off wet
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Thank you…