Inotropes, Vasopressors, and Chronotropes OH MY! A Review ...
[Pages:53]Inotropes, Vasopressors, and Chronotropes OH MY! A Review for the Young and the Seasoned
MATT RUBERTUS, PHARMD CLINICAL PHARMACY SPECIALIST ? CARDIOTHORACIC SURGERY/CRITICAL CARE EMORY UNIVERSITY HOSPITAL ATLANTA, GA
Disclosure
I have nothing to disclose pertaining to this presentation
Objectives
Review the mechanism of action for vasopressors and inotropes
Recognize common side effects of different vasopressors and inotropes
Review data for the use of alternative agents to treat vasoplegia
Describe where angiotensin II fits into therapy
Clinical Scenarios
Shock Cardiogenic Vasodilatory
Sepsis Cardiac Surgery Valve Disease Decompensated Heart Failure
Hypotension
Hypotension
Baroreceptor Activation
Increased Sympathetic Activity
Decreased Renal Perfusion
RASS Activation
Cardiac Stimulation
Vasoconstriction
Volume Expansion
Increased HR and Contractility
Increased Cardiac Output
Increased Systemic Vascular Resistance
Increased Blood Pressure
Increased Preload
Increased Cardiac Output
Hemodynamics
The ultimate goal of cardiac function is perfusion Must deliver adequate oxygen to meet metabolic demand of end organs
Oxygen delivery is affected by multiple factors Hemoglobin Oxygen saturation Cardiac output
Cardiac Output (CO) = Heart Rate (HR) x Stroke Volume (SV)
Hemodynamics
CO =
Heart Rate
X
Stroke Volume
Rate
Rhythm
Preload Contractility Afterload
CVP
MAP
Vasopressors
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