Drugs for Septic Shock

Question 1

Epinephrine

Answer 1

Pos chronotropic, inotropic
SNS EFFECTS
  -beta1 and 2 agonist 
      -pos chronotropic, inotropic, inc RR, bronchodilation
  -alpha agonist -vasoconstriction at higher doses
Indications
  -Cardiac arrest 1mg IV q3-5mins
  -Dec CO IV 2-10mcg/min 
  -anaphylaxis 0.1-0.25mg IV q5-15mins
  -shock

Question 2

Dopamine

Answer 2

SNS effects catecholamine
-low dose dopaminergic effects -renal and mesenteric vasodilation
-med dose -beta1 agonist -inc HR contractility
-high dose alpha agonist -vasoconstriction
Indications
-symptomatic bradycardia, hypotension, dec CO
- 1-5mcg/kg/min dopaminergic effects, renal perfusion
- 5-15mcg/kg/min beta1 inotropic, chronotropic
- >15mcg/kg/min alpha vasoconstriction

Question 3

Dobutamine

Answer 3

SNS effects adrenergic agonist
-limited B1 and slight beta2 (may even dec afterload), limited alpha effects - therefore Potent Inotrope

Indications

• mostly to improve contractility
• CHF

Onset 1-10 mins
Duration 10 mins

Dose Start 0.5-1mcg/kg/min, then 2-20 msg/kg/min titrate to desired CO

Question 4

Levophed/Norepinephrine

Answer 4

Norepinephrine 
Dominant alpha effects
-vasoconstriction, minor inotropic effects -inc contractility and coronary vasodilation
Indications 
-Sepsis
-Severe vasodilation/hypotension 

Onset 1-2 mins
Duration 1-2 mins

Dose 1-20mcg/min

Question 5

Vasopressin

Answer 5

Anti diuretic hormone
Binds to vasopressin receptor V1 and V2
V1-vasoconstriction 
V2-antidiuretic 
Indications 
-cardiac arrest, VT/VF, PEA
-vasodilatory shock

Onset 30-60 mins

Dose 0.01-0.04units/min

Question 6

Phenylephrine

Answer 6

Synthetic Catecholamine
Strong Alpha 1 agonist producing vasoconstriction, weak beta.

Indication: Severe hypotension/vasodilatory shock

Onset 10-15 mins
Duration 15 mins

Dose Bolus 100-180mcg, then 40-60mcg/min

Adverse: Decreased renal perfusion