Inotropes & Vasopressors Inotropes & vasopressors binds to

Natalie Yeoh, 2011

Dopamine (D1 & D2) receptors Peripheral D1 renal, coronary & mesenteric vasoDILATATION & natriuretic response D2 PREsynaptic receptors found on nerve endings inhibit Norad release from sympathetic nerve endings inhibit prolactin release may reduce vomiting stimulation of either suppresses peristalsis & may precipitate ileus

Alpha (1 & 2) receptors POSTsynaptic cardiac 1 contractility w/out rate SVR but slower onset & longer duration than 1 receptor mediated response

Beta (1 & 2) receptors POSTsynaptic 1 predominant adrenergic receptors in the heart - stimulation rate, force of contraction POSTsynaptic 2 vasculature - stimulation vasoDILATATION

POSTsynaptic 1 & 2 in peripheral vessels mediate vasoCONSTRICTION

Agent Dobutamine Dopamine Adrenaline Noradrenaline

+ ++/+++ ++++ +++

+ ? ++++ +++

++++ ++++ ++++ +++

++ ++ +++ +/++

Dopamine 0 ++++ 0 0

References: 1. Drug Information Handbook, Lexi-Comp. 2. Overgaard CB & Dzavik V. Inotropes and Vasopressors: Review of Physiology and Clinical Use in Cardiovascular Disease. Circulation 2008. 118:1047-56.

Inotropes & Vasopressors Inotropes Mechanism of Action Stimulates , 1 & 2 receptors resulting in bronchoDILATATION, cardiac stimulation ( myocardial O2 consumption), vasoDILATATION (skeletal muscles) *Small doses vasoDILATATION *Large doses constriction of skeletal & vascular amooth muscle Stimulates & 1 receptors contractility HR vasoconstriction resulting in SBP & coronary blood flow *1st line for patients with heart problems Low CO (decompensated HF, cardiogenic shock Sepsis-induced myocardial dysfunction) Symptomatic bradycardia unresponsive to atropine or pacing Clinical Indication Dose Range IVI: 0.01 0.1 mcg/kg/min Bolus: IV 1 mg every 3-5 min (max 0.2 mg/kg) IM: (1:1000): 0.1 0.5 mg (max 1 mg)

Natalie Yeoh, 2011 Side Effects

Adrenaline

Shock (cardiogenic, vasodilatory) Cardiac arrest Bronchospasm/anaphylaxis Symptomatic bradycardia or heart block unresponsive to atropine or pacing

Ventricular arrhythmias, severe HPT resulting in cerebrovascular haemorrhage, cardiac ischaemia, sudden cardiac death

0.01 3 mcg/kg/min *1st line for patients with sepsis Shock (vasodilatory, cardiogenic) *Hosp Selayang: max 2 mcg/kg/min

Noradrenaline

Arrhythmias, bradycardia, peripheral (digital) ischaemia, HPT

Dobutamine

Stimulates 1 receptors - contractility - HR

2 20 mcg/kg/min (max 40 mcg/kg/min)

Tachycardia, increased ventricular response rate in pts with AF, ventricular arrhythmias, cardiac ischaemia, HPT, hypotension

References: 1. Drug Information Handbook, Lexi-Comp. 2. Overgaard CB & Dzavik V. Inotropes and Vasopressors: Review of Physiology and Clinical Use in Cardiovascular Disease. Circulation 2008. 118:1047-56.

Inotropes & Vasopressors Inotropes Mechanism of Action Lower doses: mainly DA stimulating renal & mesenteric vasoDILATATION Dopamine Higher doses: both DA & 1 stimulating cardiac stimulation renal vasoDILATATION Large doses: stimulates receptors Clinical Indication Dose Range

Natalie Yeoh, 2011 Side Effects

Shock (cardiogenic, vasodilatory) HF Symptomatic bradycardia unresponsive to atropine or pacing

2 20 mcg/kg/min (max 50 mcg/kg/min)

Severe HPT, ventricular arrhythmias, cardiac ischaemia, tissue ischaemia/gangrene (high doses or due to tissue extravasation)

Vasopressors

Mechanism of Action cAMP which water permeability at the renal tubule resulting in urine volume & osmolality causes peristalsis by directly stimulating the smooth muscle in GI tract direct constrictor w/out inotropic or chronotropic effects

Clinical Indication

Dose Range

Side Effects Arrhythmias, HPT, CO (at doses >0.4 U/min), cardiac ischaemia, severe peripheral vasoconstriction causing ischaemia (esp. skin), sphlanchnic vasoconstriction

Vasopressin

Shock (vasodilatory, cardiogenic) Cardiac arrest

IVI: 0.01 -0.1 U/min (Common fixed dose 0.04 U/min) Bolus: IV 40 U

References: 1. Drug Information Handbook, Lexi-Comp. 2. Overgaard CB & Dzavik V. Inotropes and Vasopressors: Review of Physiology and Clinical Use in Cardiovascular Disease. Circulation 2008. 118:1047-56.