angiotensin II

General

Pronunciation:
an-jee-oh-ten-sin too

Trade Name(s)

  • Giapreza

Ther. Class.
vasopressors

Pharm. Class.
vasopressors

Indications

Increases blood pressure in septic or other distributive shock.

Action

Causes vasoconstriction and release of aldosterone, which lead to an increase in blood pressure.

Therapeutic Effect(s):

Increase in mean arterial pressure.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.

Distribution: Unknown.

Metabolism and Excretion: Metabolized by aminopeptidase A and angiotensin converting enzyme 2 to angiotensin-(2-8) [angiotensin III] and angiotensin-(1-7), respectively in plasma, erythrocytes and many major organs.

Half-life: <1 min.

TIME/ACTION PROFILE (increase in mean arterial pressure)

ROUTEONSETPEAKDURATION
IVminutes5 minminutes

Contraindication/Precautions

Contraindicated in:

  • None.

Use Cautiously in:

  • OB: Use only if potential maternal benefit outweighs potential fetal risk
  • Lactation: Safety not established;
  • Pedi: Safety and effectiveness in children not established.

Adverse Reactions/Side Effects

CNS: delirium

CV: THROMBOEMBOLIC EVENTS, peripheral ischemia, tachycardia

Endo: hyperglycemia

Hemat: thrombocytopenia

Misc: fungal infection

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

  • Concurrent use with ACE inhibitors may ↑ vasopressor effects.
  • Concurrent use with angiotensin receptor blockers may ↓ vasopressor effects.

Route/Dosage

IV (Adults) 20 ng/kg/min continuous infusion; may be titrated every 5 min of up to 15 ng/kg/min to achieve or maintain target mean arterial pressure. Do not exceed dose of 80 ng/kg/min during first 3 hr. During maintenance therapy, do not exceed dose of 40 ng/kg/min. Once shock has adequately improved, titrate down by 15 ng/kg/min every 5–15 min based on mean arterial pressure.

Availability

Solution for IV infusion (must be diluted): 2.5 mg/mL

Assessment

  • Monitor blood pressure continuously or frequently during therapy.
  • Monitor for deep venous thromboses. Use concurrent venous thromboembolism (VTE) prophylaxis (TED stockings, hydration) during therapy.

Potential Diagnoses

Implementation

  • Rate:Administer based on rate in Route/Dosage. After sufficient improvement in underlying shock, down-titrate every 5–15 min by increments of up to 15 ng/kg/min based on blood pressure.

IV Administration

Continuous Infusion: Diluent: Dilute vial of angiotensin II in 250 ml for fluid restriction or 500 ml of 0.9% NaCl.Concentration: 5,000 ng/mL or 10,000 ng/mL.Store at room temperature or refrigerated for up to 24 hrs. Discard unused portion of vial or diluted solution after 24 hrs. Administer through central line.

Patient/Family Teaching

  • Educate patient on purpose of angiotensin II.
  • Advise female patient to notify health care profession if pregnant.

Evaluation/Desired Outcomes

Increase in mean arterial pressure.

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