| Drug Name | Receptor affected | HR | BP | CO | Uses |
| Norepinephrine | α, β1 | ↔ | ↑↑↑ | ↔ or ↑ | cardiogenic shock |
| Epinephrine | α, β1, β2 | ↑↑↑ | ↑↑↑ | ↑↑↑ | cardiogenic shock and anaphylaxis epi activates everything) |
| Dopamine | α, β1, dopaminergic | ↑↑ | ↑ | ↑↑ | cardiogenic and neurogenic shock, if not tachy |
| Phenylephrine | α | ↔ or ↓ | ↑↑↑ | ↓ | septic shock only, can use if tachy |
| Vasopressin | vasopressin | – | ↑↑↑ | – or ↑ | septic only |
| Isoproterenol | β1, β2 | ↑ | ↓ | ↑ | |
| Dobutamine | β1, 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 |
| Milrinone | inotrope, 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:
