fenoldopam


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fenoldopam

 [fe-nol´do-pam]
a vasodilator used for short-term, inpatient management of severe hypertension, administered intravenously as the mesylate salt.

fenoldopam

(fen-ole-doe-pam) ,

Corlopam

(trade name)

Classification

Therapeutic: antihypertensives
Pharmacologic: vasodilators
Pregnancy Category: B

Indications

Short-term (<48 hr), in-hospital management of hypertensive emergencies, including malignant hypertension with end-organ deterioration.

Action

Acts as an agonist at dopamine d1-like receptors.
Also binds to alpha-adrenergic receptors.
Acts as a vasodilator.

Therapeutic effects

Rapid lowering of BP.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.
Distribution: Unknown.
Metabolism and Excretion: Mostly metabolized by the liver; 90% of metabolites are excreted in urine, 10% in feces.
Half-life: 5–10 min.

Time/action profile (effect on BP)

ROUTEONSETPEAKDURATION
IVrapid15 min1–4 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity to fenoldopam or sulfites; Concurrent beta blocker therapy (will prevent reflex tachycardia).
Use Cautiously in: Glaucoma or intraocular hypertension; Obstetric / Pediatric / Lactation: Safety not established.

Adverse Reactions/Side Effects

Central nervous system

  • headache (most frequent)
  • nervousness/anxiety
  • dizziness

Cardiovascular

  • hypotension (most frequent)
  • tachycardia (most frequent)
  • ECG changes
  • peripheral edema

Gastrointestinal

  • nausea (most frequent)
  • abdominal pain
  • constipation
  • diarrhea
  • vomiting

Dermatologic

  • flushing (most frequent)
  • sweating

Fluid and Electrolyte

  • hypokalemia

Local

  • injection site reactions

Musculoskeletal

  • back pain

Interactions

Drug-Drug interaction

Concurrent use with beta blockers may result in excessive hypotension (concurrent use should be avoided).

Route/Dosage

Intravenous (Adults) 0.01–1.6 mcg/kg/min.

Availability

Concentrate for injection: 10 mg/mL in 1– and 2-mL single-use ampules (with sodium meta-bisulfite)

Nursing implications

Nursing assessment

  • Monitor BP, heart rate, and ECG frequently throughout therapy; continuous monitoring is preferred. Consult physician for parameters.
  • Lab Test Considerations: Monitor serum potassium concentrations every 6 hr during therapy. May cause hypokalemia. Treat with oral or IV potassium supplementation.

Potential Nursing Diagnoses

Ineffective tissue perfusion (Indications)

Implementation

  • Intravenous Administration
  • pH: 2.8–3.8.
  • Administer via continuous infusion; do not use bolus doses. Avoid hypotension and rapid decreases in BP. Initial dose titration should occur no more frequently than every 15 min and less frequently as desired BP is reached. Increments of 0.05 to 0.1 mcg/kg/min are recommended for titration. Lower initial doses (0.03 to 0.1 mcg/kg/min) titrated slowly have been associated with less reflex tachycardia than higher initial doses.
    • Infusion can be abruptly discontinued or gradually tapered before discontinuation. Oral therapy with other antihypertensives can begin anytime after the BP is stable. Do not administer beta blockers concurrently with fenoldopam.
  • Continuous Infusion: Diluent: Dilute 4 mL (40 mg of drug) with 1000 mL, 2 mL (20 mg of drug) with 500 mL, or 1 mL (10 mg of drug) with 250 mL of 0.9% NaCl or D5W. Infusion is stable for 24 hr at room temperature. Concentration: 40 mcg/mL.
  • Rate: Based on patient's weight (see Route/Dosage section). Titrate to desired effect. Administer via infusion pump to ensure accurate dosage rate.
  • Y-Site Compatibility: alfentanil, amikacin, aminocaproic acid, amiodarone, ampicillin/sulbactam, argatroban, atracurium, atropine, azithromycin, aztreonam, butorphanol, calcium chloride, calcium gluconate, caspofungin, cefazolin, cefepime, cefotaxime, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol, cimetidine, ciprofloxacin, cisatracurium, clindamycin, cyclosporine, daptomycin, dexmedetomidine, digoxin, diltiazem, diphenhydramine, dobutamine, dolasetron, dopamine, doxycycline, droperidol, enalaprilat, epinephrine, ertapenem, erythromycin, esmolol, famotidine, fentanyl, fluconazole, gentamicin, granisetron, haloperidol, heparin, hydralazine, hydrocortisone sodium succinate, hydromorphone, imipenem/cilastatin, insulin, isoproterenol, labetalol, levofloxacin, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, meperidine, metoclopramide, metoprolol, metronidazole, micafungin, midazolam, milrinone, morphine, nafcillin, nalbuphine, naloxone, nicardipine, nitroglycerin, nitroprusside, norepinephrine, ondansetron, palonosetron, pancuronium, phenylephrine, piperacillin/tazobactam, potassium chloride, potassium phosphate, procainamide, promethazine, propofol, propranolol, quinupristin/dalfopristin, ranitidine, remifentanil, rocuronium, sufentanil, tacrolimus, theophylline, ticarcillin/clavulanate, tirofiban, tobramycin, trimethoprim/sulfamethoxazole, vancomycin, vasopressin, vecuronium, verapamil, voriconazole
  • Y-Site Incompatibility: acyclovir, aminophylline, amphotericin B, ampicillin, bumetanide, cefoxitin, dexamethasone sodium phosphate, diazepam, fosphenytoin, furosemide, ganciclovir, ketorolac, meropenem, methohexital, methylprednisolone sodium succinate, pantoprazole, pentobarbital, phenytoin, prochlorperazine, sodium bicarbonate, thiopental

Patient/Family Teaching

  • Explain purpose of medication to patient.
  • Advise patient to report headache or pain at the injection site.

Evaluation/Desired Outcomes

  • Decrease in BP without the appearance of side effects.
References in periodicals archive ?
The following pharmacological measures for CIN prevention were investigated: N-acetylcysteine, theophylline, fenoldopam, iloprost, alprostadil, prostaglandin E 1, statins, statins plus ACC, bicarbonate sodium, bicarbonate sodium plus ACC, ascorbic acid (vitamin C), tocopherol (vitamin E), alpha-lipoic acid, atrial natriuretic peptide, B-type natriuretic peptide, and carperitide.
performed a randomized trial of the vasodilator fenoldopam in 17 deceased-donor kidney transplant patients with cold ischemia time >12 hours [42].
The reduced quadratic mixture model predicted that glycerol, fenoldopam mesylate, carnosine, and DMSO added as single additives significantly affected the number of live cells (Table 4).
In the same patient group, fenoldopam seems to be superior compared to dopamine in the improvement of serum creatinine levels when renal dysfunction is present [105] and according to a meta-analysis in 1290 patients, fenoldopam administration reduced the need for RRT support and intensive care unit hospitalization [106].
Halley, "Comparative renal effects of intravenous administration of fenoldopam mesylate and sodium nitroprusside in patients with severe hypertension," JAMA Internal Medicine, vol.
Fenoldopam, a peripheral dopamine-1-receptor agonist, induces peripheral vasodilation; administered by intravenous infusion.
Sharma, "A protocol for prevention of radiographic contrast nephropathy during percutaneous coronary intervention: effect of selective dopamine receptor agonist fenoldopam," Catheterization and Cardiovascular Interventions, vol.
(38) Controversy exists with regard to the usefulness of other medications to prevent acute kidney injury, such as sodium bicarbonate, N-acetylcysteine, fenoldopam, and theophylline.
Se han propuesto diferentes estrategias que pueden interrumpir la fisiopatologia de la NIC como el uso de: 1) farmacos con propiedades antioxidantes (N-acecetilcisteina (NAC), acido ascorbico, vitamina E, estatinas, bicarbonato de sodio y teofilina), 2) vasodilatadores (prostaglandinas, dopamina y fenoldopam), 3) alcalinizantes (bicarbonato de sodio) y 4) la expansion del volumen intravascular con solucion salina (SSN) (5,18,40).
(10.) Bove T, Landoni G, Calabro MG, Aletti G, Marino G, Cerchierini E, et al: Renoprotective action of fenoldopam in high-risk patients undergoing cardiac surgery: A prospective, double-blind, randomized clinical trial.
Fenoldopam mesylate in early acute tubular necrosis: a randomized, double-blind, placebo-controlled clinical trial.