VOLATILE AGENTS



SYMPATHOMIMETICS

| |Agent |Noradrenaline |Adrenaline |Dopamine |Isoprenaline |Dobutamine |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

|Drug | | | | | | |

| |Class |Endogenous |Endogenous catecholamine |Endogenous catecholamine |Synthetic catecholamine|Synthetic catecholamine|

| | |catecholamine | | | | |

| |Structure | | | | |(Isoprenaline deriv) |

| | | | | | | |

| | | | | | | |

| |Formulation | | | | | |

| | | | | | | |

| |Isomers |Levo=10x dextro |Levo = 10 x dextro | | | |

| |Direct |4+ |4+ |4+ |4+ |3+ |

| | | | | | | |

|Action | | | | | | |

| |α1 (IP3, DAG) |+++ |++ |1-5 |5-10 |>15 |

| | | |(2-10xNA) |D1 |+ |+++ |

| |Dose | |0.5ml/kg 1:1000 neb | |20mcg iv bolus | |

| | | |Cardiac arrest 1mg, | | | |

|Admin | | |kid 10mcg/kg | | | |

| | | |anaphylaxis 1-2mcg/kg | | | |

| |Infusion |0.05-0.3mcg/kg/min |0.01-0.1mcg/kg/min | |1-20mcg/min |0.5-15mcg/kg/min |

| |Onset (min) | | | | |Cpss 10min ivi |

| |Duration (min) | | | | | |

| |Uptake |Uptake 1 |Uptake 2 |Uptake 1 | | |

| | | | | | | |

|P/kin | | | | | | |

| |Lipid solubility (CNS |Low |Low |Low | | |

| |penetration) | | | | | |

| |Oral bioav |Low |Low |Low | |Low |

| |Metabolism |MAO |MAO |MAO |COMT (liver) |COMT |

| | |COMT |COMT |COMT | | |

| |Excretion |Urine 95% VMA |Urine (VMA) |Urine (HVA) |Urine |Urine, |

| | |> +ve |

| | | |↓SVR→↓dia/MAP |excr |GIT→↓SVR→↓BP |chronotrope |

|CVS | | | | | | |

| | |↑VR→↑preload→ reflex |2-10mcg/min → β2, β1 |D rec → ↑GIT Q |+ve inotrope |↑CO→↑UO |

| | |↓HR |↑HR, ↑contr,↑sys | |+ve chronotrope | |

| | |↑PVR |>10mcg/min →β2, β1, α | |↑CO | |

| | |↓renal Q |v/c skin, gut, kidney | | | |

|Resp | |Minimal b/d |Potent b/d |Activate carotid bodies |b/d | |

| | | |Mast cell stabiliser |↓response to hypoxia | | |

|CNS | |Minimal |Minimal |CTZ → nausea |Stimulation |stimulation |

|Other | |↓hepatic Q |↑glucose, lactate, FFA |↓prolactin, aldosterone |↓GIT tone, motility | |

| | |↓splanchnic Q |↓insulin, ↑glucagon |natriuresis (direct |↑glucose | |

| | |↑BSL |↓ K+ |tubular effect) |↑FFA | |

| | |↑contraction gravid |↑BMR 20-30% | | | |

| | |uterus |Uterus | | | |

| | |Contraindicated in |- non gravid relax | | | |

| | |pregnancy |- 1st tri contract | | | |

| | | |- last month relax | | | |

|SEs | |Headache |Anxiety, tremor |Nausea, vomiting |Tachycardia |HT |

| | |Photophobia |Headache |Arrhythmias |Hypotension |Risk RVR in AF |

| | |Chest pain |Palpitations |Headache |Angina |↑AV conduction |

| | |N&v |Arrhythmias |angina |Palpitations | |

| | |Mesenteric infarction |Cerebral haemorrhage | |Flushing | |

| | |Renal failure |APO | |Arrhythmias | |

|Uses | |1) septic shock |1) with LAs |1) ?periop renal |1) bradyarrhythmias |1) CCF |

| | |2) cardiogenic shock |2) anaphylaxis |protection |2) heart block |2) AMI low output |

| | | |3) asthma / croup |2) low CO states | |3) post CPB |

| | | |4) cardiac arrest | | | |

D1 rec – post-synaptic →v/d renal, mesenteric, coronary, cerebral, via ↓cAMP

D2 rec – pre-synaptic →Inhibit release NA, n&v

SYMPATHOMIMETICS

| |Agent |Ephedrine |Metaraminol |Phenylephrine |Clonidine |Dexmedetomidine |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

|Drug | | | | | | |

| |Class |Natural non |Synthetic non |Synthetic |Imidazoline | |

| | |catecholamine |catecholamine |non-catecholamine | | |

| |Structure | | | | | |

| | | | | | | |

| | | | | | | |

| |Formulation | | | | | |

| | | | | | | |

| |Isomers | | | | | |

| |Direct |2+ |1+ |4+ | | |

| | | | | | | |

|Action | | | | | | |

| |α1 (IP3, DAG) |+ |++ |++ |1 |1 |

| |α2 (↓cAMP) | | | |39 |1300 |

| |β1 (↑cAMP) |+++ |++ | | | |

| |β2 (↑cAMP) |++ | | | | |

| |Indirect |3+ |3+ | | | |

| |Dose |3-30mg |0.5-5mg |0.1mg | | |

| | | | | | | |

|Admin | | | | | | |

| |Infusion | | | | | |

| |Onset (min) |1min |1-2min iv |1-2min | | |

| | | | ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download