School of Medicine | UT Health San Antonio



Pressors, Inotropes and Anti-hypertensivesCO = HR x SVSV determined by: Preload, Afterload and ContractilityAdrenergic Receptors:????vascoconstriction of blood vessels in skin, viscera and mucous membranes; reflex bradycardia????+ inotrope, chronotrope, dromotrope????mixed effects on vascular smooth muscles but mostly relaxes; myocardial relaxation, decreased norepi release in CNS, increase glucagon release and decrease insulin release?? bronchodilation, increase rennin release, increase insulin release, increased blood flow to skeletal muscle, decreased GI motilityPressors: Help to increase CO by increasing afterloadNorepinephrine (Levophed): 0.01-1 mcg/kg/min ?????????????Epinephrine: 0 .01-0.1 mcg/kg/min????????????Phenylephrine: 0.5-3 mcg/kg/min??Dopamine: 2-20 mcg/kg/min (2-5 = DA, 5-10 = ?1, 10-20 = ?1)DA >?????????????Vasopressin: 0.01-.1 units/min (physiologic dose 0.04)Vascular smooth muscle contraction (V1 )Increase water reabsorption at collecting ducts (V2)Midodrine: 10mg po q8-q6hrs??Inotropes: Increase cardiac output by increasing contractilityDobutamine: 2-20 mcg/kg/min?????????????Isoproterenol: 2-10 mcg/min???= ??Milrinone: 0.375-0.75 mcg/kg/minPhosphodiesterase inhibitor Other?2 agonists: Clonidine, Dexmedetomidine?1 blockers: doxazosin, tamsulosin, prazosin, phentolamine, TCA’s?2 agonists: albuterol, salmeterol, terbutaline? blockers?1Selective- atenolol ,esmolol, metoprololNonselectivepropranololcarvedilol (has ?1 blocking)labetolol (has ?1 blocking)AntihypertensivesCalcium Channel Blockers: decrease afterload?and negative inotropeNicardipine: 5-15mg/hrDiltiazem: 0.25-0.35mg/kg bolus then run at 5-15mg/hrBeta Blockers: decrease contractility and afterloadEsmolol: 50-300 mcg/kg/ minGood for hypertension with tachydysrhythmiaLabetolol: 20mg IV then may repeat at 80mg in 10 min intervals to 300mgOral dosing 100mg daily (divided) to max 2400nmg/day Nitrates: decrease preload more than afterloadNitroglycerine: 0.1-3 mcg/kg/minVenous and arterial vasodilatorGood for HTN with pulmonary edema and chest painACE Inhibitors: decrease preload and afterloadEnalaprilat (vasotec): 0.625-1.25mg/doseGood for patients with hypertension and bradycardiaAvoid in patients with renal dysfunctionOtherHydralazine: 10-20mg IV q4-6 hrs; max 40mg/dosePeripheral vasodilator and causes Na+ reabsorption by increased renin secretion: decreases afterloadCan cause cerebral vasodilation increased ICP ................
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