Vasopressors Flashcards
Dopamine: Receptors
Alpha 1, Beta 1, Dopaminergic
Dopamine: Releases which Catecholamine
Norepi
Dopamine: Effect on CO
Increase BP via peripheral vasoconstriction, little effect on stroke volume
Dopamine: Effect on MAP
More effective than dobutamine, colloid, or hydrocortisone in increasing MAP
Dopamine: Dosing Effects
Low dose: dopaminergic effect
Medium: primarily beta receptor effects
High: Primarily alpha receptor effects
Dobutamine: Receptors
Alpha 1, beta 1, beta 2
Dobutamine: Releases Catecholamine?
Does not release norepi
Dobutamine: Effect on CO
Augments myocardial contractility, decreases afterload
Epinephrine: Receptors
Alpha 1, Alpha 2, beta 1, beta 2
Epi: Effect on MAP
Increases MAP and UOP
Epi: Effect on CO
INcrease SV and HR
Epi: Cautions
Peripheral ischemia
Tachycardia
Higher incidence of hyperglycemia and lactic acidosis
Epi: Low Dose stimulate
Beta Receptors –> increase contractility and peripheral vasodilation
Norepir: Receptors
Alpha 1, alpha 2, beta 1
Norepi: Use
Greater than 35 weeks and refractory to dopamine or dobutamine
Norepi: Effect on CO
Increases SVR more than PVR
Vasopressin: Other Hormone Name
ADH
Vasopressin: MoA
Regulating water balance:
Activates collecting duct of kidney to increase water absorption
Regulating Vascular tone:
vascular smooth muscle cells increase SVR
Vasopressin: Vasodilatory effects
Pulmonary, coronary, and cerebral smooth muslce
Vasopressin: Caution
Hyponatremia (retaining fluid leads to dilutional hyponatremia) and transmanitis
Milrinone: MoA
Inhibits PDE-3 –> Increases cAMP
Improves contractility and myocardial relaxation
Increase cAMP with Milrinone?
Enhances myocardial contractility while promoting vasodilation
Milrinone: Beneficial for which conditions/diseases
PPHN, CDH, and post-ligation PDA
Hydrocortisone: Electrolyte Effects
Decreased Na
Increased K
Decreased Cl
Increased Glucose
Hydrocortisone: Use
Refractory initial vasopressor administration. Effective in increasing systemic BP and reducing catecholamine requirements through upregulation adrenergic receptors
USE IN WARM SHOCK
Hydrocortisone: Benefits
Improves endothelial integrity, reduces capillary leak, increases available calcium by myocardial and smooth muscle contraction
Hydrocortisone: Negative Side Effects
Short term: hyperglycemia and gastric irritation
Long term: Growth impairment, immunosuppression, osteopenia
Dopamine: Dosage
5-20 microg/kg/min
Dobutamine: Dosage
5-20 microg/kg/min
Epinephrine: Dosage
0.01-0.03 microg/kg/min
Norepinephrine: Dosage
0.02-0.1 microg/kg/min
Vasopressin: Dosage
0.01-0.36 units/kg/hour
Hydrocortisone: Dosage
Loading: 2mg/kg
Maintenance: 0.5-1 mg/kg/dose, q6-8hr
Milrinone: Dosage
Loading: 75 microg/kg
Maintenance: 0.3-0.9 microg/kg/min
Dopamine:
Effect on Stroke Volume, SVR, and PVR
SV: Increase
SVR: Increase (x2)
PVR: Increase (x3)
Norepinephrine:
Effect on Stroke Volume, SVR, and PVR
SV: Increase/no effect
SVR: Increase (x3)
PVR: Decrease/no effect
Vasopressin:
Effect on Stroke Volume, SVR, and PVR
SV: Decrease
SVR: Increase (x3)
PVR: Decrease
Dobutamine:
Effect on Stroke Volume, SVR, and PVR
SV: Increase (x2)
SVR: No effect
PVR: No effect
Milrinone:
Effect on Stroke Volume, SVR, and PVR
SV: Increase (x2)
SVR: Decrease (x2)
PVR: Decrease (x2)
Epinephrine:
Effect on Stroke Volume, SVR, and PVR
SV: Increase (x3)
SVR: Increase (x3)
PVR: Increase (x2)
