1. DOPAMINE JAHANGIR AHMAD

2. HISTORY The function of dopamine as a neurotransmitter was discovered in 1958 by ArvidCarlssonand Nils-ÅkeHillarpat 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 . ArvidCarlssonwas 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.

3. 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.

4. Each ampoule contains 200 mg /5ml

5. STRUCTURE

6. SYNTHESIS

11. Contd.. Dopamine not effective orally and does not cross blood brain barrier in sufficient amounts to cause CNS effects.

12. 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 .

13. CLINICAL USES Dopamine is often used in situation where both cardiac stimulation and peripheral vasoconstriction desired such ascardiogenic 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

14. 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

15. 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

16. DOPAMINE INFUSION IN WHICH FLUID ? D-5-- No RL -- No NS -- yes DNS-- No HEMACCIL -- No

17. DOPAMINE AND ADRENALINE/NORADRENALINE COMBINED INFUSION

18. 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.

19. Conti- Low dose simultaneously increases: Glomerular filtration rate Renal blood flow Urine output

20. 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

24. Malignant tachyarrhythmia [ Multifocal ventricular ectopic , ventricular tachycardia ]

25. The most feared complication of dopamine infusion is limb necrosis

27. 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

28. Contd… Hyperglycemia that is commonly present in pts receiving a continuous infusion of dopamine is likely to reflect drug induced inhibition of insulin secretion

29. DRUGS MAY INTERACTS WITH DOPAMINE Cyclopropane Bromocriptine Dyhydroergotamine Entacapone Halothane Linezolide Phenytoine

30. CONTRAINDICATION Pt receiving MAO inhibitors Tricyclic antidepressants agents Pheochromocytoma Uncorrected tachyarrhythmia Ventricular fibrillation

31. If dopamine liquid falls on floor /cloth it gives permanent staining if allowed to dry and was not mopped off wet

32. Thank you…