Vasopressors and Inotropes - Pharmacology Summary Vasopressors Phenylephrine (alpha-1) • Increases BP, SVR • Risk of reflex bradycardia due to increased MAP Norepinephrine (Levophed, alpha-1 / beta1, beta1 > beta2) • Increases BP, SVR, CO • Preferred first agent in shock Epinephrine (beta1 > beta2 / alpha1) • Increases HR, SVR, CO, BP • Higher doses cause more alpha-effect • 1st agent in anaphylaxis, 2nd line in septic shock Vasopressin (V1, V2) • Increases BP, SVR, not inotropic/chronotropic • V1, vessel constriction • V2 antidiuretic effect at kidney Dopamine (D1 > beta1 > alpha1) • Dose dependent receptor activation • D1 (1-2 mcg/kg/min): renal artery dilation • beta /mild alpha (5-10 mcg/kg/min): increases HR, contractility, CO • a (>10 mcg/kg/min): vasoconstriction, SVR Inotropes Dobutamine (beta1 > beta2 > alpha1) • Increases CO, less of a BP effect Milrinone (PDE3) • Phosphodiesterase inhibitor > increases cAMP/cGMP • Causes vasodilation and increased contractility - Rebecca Steinberg @RebeccaSteinb17 #Vasopressors #Inotropes #Pharmacology #Summary #management #medications
