PGY3 - Vasotropic/Inotropic Drugs

Question 1

Norepinephrine

Answer 1

2-20 mcg/min IV

0.02-2 mcg/kg/min IV

1st line for sepsis/vasodilartory shock

Question 2

Epinephrine (Drip)

Answer 2

2-20 mcg/min

0.05-0.5 mcg/kg/min

A1, B1/2

Cardiogenic, Vasodilatory, ACLS

Question 3

Dirty Epi Drip

Answer 3

10 mL of 1:10K in 1 L NS

–> 1 mcg/mL

Run at 2-10 mcg/min

Wide open in 18ga IV is ~30 mcg/min

Question 4

Push Dose Epi

Answer 4

1 mL of 1:10K + 9 mL NS

–> 10 mcg/mL

Push 0.5-2 mL q2-5 minutes (5-20 mcg)

Question 5

Vasopressin

Answer 5

0.01-0.04 units/min

V1, V2

Sepsis adjunct

Question 6

Dopamine

Answer 6

2-20 mcg/kg/min (Low dose)

D1/2 at low dose, A1/B1 at high dose

Vasodilatory Shock, Cardiogenic Shock

Question 7

Dobutamine

Answer 7

2-20 mcg/kg/min

B1 and 2

ADHF, Cargiogenic SHock, Vasodilatory Shock

Question 8

Phenylephrine

Answer 8

0.02-2 mcg/kg/min

A1

Vasodilatory shock, obstructive shock

Question 9

Milrinone

Answer 9

Load: 50 mcg/kg

Drip: 0.25-0.75 mcg/kg/min

PDE Inhibitor

ADHF

Question 10

Hypertension Tx - Dissection

Answer 10

• First Line - Esmolol
• Second Line (BB Contraindication)
  
  • Dilt First –> Decrease HR
  • Nitroprusside Second –> Decrease BP

Goals

HR 60

SBP 100-140

Question 11

Hypertension Tx - Pulmonary Edema

Answer 11

Nitroglycerin

Goal reduce by 20%

Question 12

Hypertension Tx - ACS

Answer 12

Treat if SBP > 160, goal reduce by 20%

Nitroglycerin or Metoprolol

Question 13

Hypertension Tx - Renal Failure/Enceph

Answer 13

Treat > 180/110, Reduce by 20%

Labetalol or Cardene

Question 14

Hypertension Tx - Pre E

Answer 14

Treat if > 160/110

Labetalol or Hydralazine

Question 15

Hypertension Tx - ICH

Answer 15

• Cardene or Esmolol or Labetalol
• Goals:
  
  • No Inc ICP - SBP < 160, MAP < 130
  • Inc ICP - MAP < 110

Question 16

Hypertension Tx - CVA

Answer 16

• Cardene or Nitro or Labetalol
• Goals:
  
  • tPA - < 180/110
  • If no tPA - < 220/120

Question 17

Diltiazem

• aka
• Dose

Answer 17

Cardizem

0.25 mg/kg bolus (usually 20mg), can repeat at 0.35 mg/kg

Drip at 10-15 mg/hr

Question 18

Esmolol

Answer 18

500 mcg/kg IV

then 50-200 mcg/kg/min

Question 19

Hydralazine

Answer 19

5-10mg q 20 min

Question 20

Labetalol

Answer 20

0.25-1 mg/kg (10-20 mg)

Double q 10 min

Max 300 mg total

Drip = 1-2 mg/kg/hr

Question 21

Nicardipine

Answer 21

5-15 mg/hr

Question 22

Nitroglycerin

Answer 22

• SL = 0.4 mg x 3 doses
• Topical - 1-2 inches paste
• 20-80 mcg/min IV

Question 23

Nitroprusside

Answer 23

0.25-10 mcg/kg/min