Sodium Bicarbonate

The Indication of Sodium Bicarbonate PO,IV: Management of metabolic acidosis. Action as an alkalinizing agent by releasing bicarbonate ions, following oral administration,releases bicarbonate, which is capable of neutralizing gastric acid.
Sodium bicarbonate is the chemical compound with the formula NaHCO₃. Because it has long been known and is widely used, the salt has many other names including sodium hydrogen carbonate, sodium bicarb, baking soda, bread soda, cooking soda, bicarb soda, saleratus or bicarbonate of soda. It is soluble in water. Sodium bicarbonate is a white solid that is crystalline but often appears as a fine powder. It has a slight alkaline taste resembling that of sodium carbonate. It is a component of the mineral natron and is found dissolved in many mineral springs. The natural mineral form is known as nahcolite. It is also produced artificially.
CONTRAINDICATED IN Metabolic or respiratory alkalosis, hypocalcemia

Route and Dosage.

Carbonic acid
Other names	Carbon dioxide solution
Identifiers
CAS number	[463-79-6]
SMILES	C(=O)(O)O
Properties
Molecular formula	H2CO3
Molar mass	62.03 g/mol
Density	1.0 g/cm3 (dilute solution)
Solubility in water	exists only in solution
Acidity (pKa)	6.36 (see text) 10.25

Metabolic acidosis.
Doses should be determined on the basis of frequent lab assessment.
Adult/oral;20-36 meq/day in divided doses
Adult and children>12 yr; 2- 5 meq/kg as a 4-8 -hr infusion or bolus.

Cardiopulmonary Resuscitation(CPR).
Dose should be determined on the basis of frequent lab assessment
IV for adult; 1 meq/kg may repeat 0,5 meq/kg q 10 minutes.
IV for neonatal and children 1 meq/kg, may repeat q 10 minutes

Nor adrenaline

Nor adrenaline, nor epinephrine or levophed . the classification as vasopressor.
Produces vasocontriction and myocardial stimulation,which may be required after adequate fluid replacement in the treatment of shock.

Norepinephrine (INN) or noradrenaline (BAN) is a catecholamine and a phenethylamine with chemical formula C₈H₁₁NO₃. Increased blood pressure, Increased cardiac output.The natural stereoisomer is L-(−)-(R)-norepinephrine. It is released from the medulla of the adrenal glands as a hormone into the blood, but it is also a neurotransmitter in the central nervous system and sympathetic nervous system where it is released from noradrenergic neurons during synaptic transmission.Stimulated alpha-adrenergic receptors located mainly in in the blood vessels causing constriction of both capacitance and resistance vessel. As a stress hormone, it affects parts of the human brain where attention and responding actions are controlled. Along with epinephrine, norepinephrine underlies the fight-or-flight response, directly increasing heart rate, triggering the release of glucose from energy stores, and increasing skeletal muscle readiness.

Norepinephrine is released when a host of physiological changes are activated by a stressful event. This is caused in part by activation of an area of the brain stem called the locus ceruleus. This nucleus is the origin of most norepinephrine pathways in the brain. Neurons that are activated by norepinephrine project bilaterally (send signals to both sides of the brain) from the locus ceruleus along distinct pathways to many locations, including the cerebral cortex, limbic system, and the spinal cord.

At synapses, norepinephrine acts on both alpha and beta.

Dobutamine

By. Dahlan Rahmat

Dobutamine as a short-term management of heart failure due ti depressed contractility from organic heart disease or surgical procedures.
The action of dobutamine is stimulating beta,(myocardial) adrenergic receptors with relatively minor effect on heart rate disease or peripheral blood vessels.
The therapeutic Effect of dopamine increased cardiac output without significantly increasing heart rate along with blood preesure.
Dobutamine is a beta-1 adrenergic agonist. Use Cautiously in Myocardial Infarction,atrial fibrillation,pregnancy,lactation and children .It is a direct-acting agent whose primary activity results from stimulation of the beta-adrenoceptors of the heart, increasing contractibility and cardiac output. Since it does not act on dopamine receptors to induce the release of norepinephrine (an alpha-1 agonist), dobutamine is less prone to induce hypertension than dopamine. Chronotropic, arrhythmogenic, and vasodilative effects are negligible. Dobutamine is indicated when parenteral therapy is necessary for inotropic support in the short-term treatment of patients with cardiac decompensation due to depressed contractility, which could be the result of either organic heart disease or cardiac surgical procedures.

Dopamine

Dopamineis one of Inotrop adjunct to standar measure to improve of blood pressure,cardiac out put,uirne out put in the treatment of shock unresponsive to fluid replacement.
Dopamine was discovered by Arvid Carlsson and Jils-Ake Hillarp at the Laboratory for Chemical Pharmacology of the National Heart Institute of Sweden, in 1952. It was named Dopamine because it was a monoamine, and its synthetic precursor was 3,4-dihydroxyphenylalanine (L-DOPA).^[1] Arvid Carlsson won a share of the 2000 Nobel Prize in Physiology or Medicine for showing that dopamine is not just a precursor of noradrenaline and adrenaline, but a neurotransmitter as well.

NursingnImplication
Monitor Blood pressure,pulse,respiration, ECG and hemodynamic parameters every 5-15 minutes during and after administration. Notify physician if significant changes in vital signs or arrythmias occur at any time.
Monitor urine output frequently throughout administration.Notify if urine output decreases.
Palpate peripheral pulses and asses appearance of extremities routinely.
Potential Nursing Diagnoses for the patient that receiving dopamin are Cardiac output,decreased(indication). Tissue perfusion,alterred (indication)

Formulation and Biochemistry

Dopamine has the chemical formula (C₆H₃(OH)₂-CH₂-CH₂-NH₂). Its chemical name is 4-(2-aminoethyl)benzene-1,2-diol and it is abbreviated "DA."

As a drugs of the catecholamine family, dopamine is a precursor to epinephrine (adrenaline) and norepinephrine (levoped) in the biosynthetic pathways for these neurotransmitters.

Dopamine is biosynthesized in the body (mainly by nervous tissue and adrenal glands) first by the hydration of the amino acid L-tyrosine to L-DOPA via the enzyme tyrosine 3-monooxygenase, which is often known by its former name tyrosine hydroxylase, and then by the decarboxylation of DOPA by L-aromatic-amino-acid decarboxylase. In neurons, dopamine is packaged after synthesis into vesicles, which are then released in response to the presynaptic action potential. The inactivation mechanism of neurotransmission are 1) uptake via a specific transporter; 2) enzymatic breakdown; and 3) diffusion. Uptake back to the presynaptic neuron via the dopamine transporter is the major role in the inactivation of dopamine neurotransmission. The recycled dopamine will face either breakdown by an enzyme or be re-packaged into vesicles and reused.

http://memorylossonline.com/glossary/images/dopamine.jpg

Epinephrine

Epinephrine as bronchodilator in the symptomatic treatment of asthma and other forms of reversible air way disease, which may occur in the association with chronic bronchitis and emphysema. Intra Venous or subcutan, epinephrine as a treatment of anaphylaxis.
The European pharmaceutical is a listing of a wide range of active substances and excipients used to prepare pharmaceutical products in Europe. The 2006 edition includes 1900 specific and general monographs, including various chemical substances, antibiotics, biological substances; Vaccines for human or veterinary use; Immunosera; Radiopharmaceutical preparations; Herbal drugs; Homoeopathic preparations and homoeopathic stocks. It also contains Dosage forms, General monographs, Materials and Containers, Sutures; 268 General methods with figures or chromatograms and 2210 reagents are described

Contraindications and Precautions of this drug.
Hypersensitivity to sympathomimetics, may contain bisulfites, avoid use in patients with bisulfite hypersensivity.
for the patient of diabetic may increase the need for insulin or oral hypoglycemic agent.

Atropine

Atropine, this is one of the lead from emergency drugs.injections of atropine are used in the treatment of bradicardia, showing low heart rate, asystole and pulseless electrical activity (PEA) in cardiac arrest. This works because the main action of the vagus nerve of the parasympathetic system on the heart is to slow it down. Atropine blocks that action and therefore may speed up the heart rate. The usual dose of atropine is 0.5-1 mg every three to five minutes, up to a maximum dose of 3mg.

Therapeutic Effect.
Increased the heart rate,decreased Gastro Intestinal and respiratory secretion,reversal of muscarinic effects, bronchodilation, may have a spasmolityc action on the biliary and genitourinary tract.

The drugs Atropine is also useful in treating first degree heart block, second degree heart block Mobitz Type 1 (Wenckebach block), and also third degree heart block with a high Purkinje or AV-nodal escape rhythm. It is usually not effective in second degree heart block Mobitz type 2, and in third degree heart block with a low Purkinje or ventricular escape rhythm. Atropine is contraindicated in ischaemia-induced conduction block, because the drug increases oxygen demand of the AV nodal tissue, thereby aggravating Ischaemia and the resulting heart block.

One of the main actions of the parasympathetic nervous system is to stimulate the M2 muscarinic receptor in the heart but atropine inhibits this action as emergency drugs.

Keep ready always beside the patient.