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Digital PharmD

Informatics in Pharmacy

Pressors and Ionotropes

August 12, 2018 By Dr. G, PharmD

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Drug NameReceptor affectedHRBPCOUses
Norepinephrineα, β1↔↑↑↑↔ or ↑cardiogenic shock
Epinephrineα, β1, β2↑↑↑↑↑↑↑↑↑cardiogenic shock  and anaphylaxis
epi activates everything)
Dopamineα, β1, dopaminergic↑↑↑↑↑cardiogenic and neurogenic
shock, if not tachy
Phenylephrineα↔ or ↓↑↑↑↓septic shock only, can use if tachy
Vasopressinvasopressin–↑↑↑ – or ↑septic only
Isoproterenolβ1, β2↑↓↑ 
Dobutamineβ1, β2 (less β2
than isoproterenol
↑↓↑cardiogenic and septic shock   At high doses, causes headaches, paresthesias, and muscle cramps Doesn’t work well if the patient on beta blocker, milrinone is similiar choice
Milrinoneinotrope, vasodilation,
PDE (phosphodiesterase
inhibitor)
↑↑–↑ 

α = smooth muscle contraction

β1 = positive chronography, dromotropic and ionotropic

β2 = smooth muscle relaxation

Remember:

  • BP = SBP/DBP
  • MAP = [SBP + (2 * DBP)]/3    (normal is 70-100)
    • Map is largely based off of DBP because most of cardiac cycle is in diastole (filling)
  • Cardiac Output (CO) = Sv + HR

Which pressor when:

  • Septic shock: norepinephrine is first line, +/- vasopressin +/- dopamine
  • Cardiogenic shock: dobutamine is first line, +/- IABP (intra-aortic balloon pump) +/- milrinone.
  • Post-op: phenylephrine
  • Post-code:epinephrine

I like these graphics, which came from here:

Filed Under: Critical Care, Guideline Materials and Tips Tagged With: ionotropes, pressors, shock

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