Template:Vasopressor table: Difference between revisions

No edit summary
 
(5 intermediate revisions by 5 users not shown)
Line 1: Line 1:
===[[Vasopressors]]===
===[[Vasopressors]]===
{| class="wikitable"
{| class="wikitable"f
|-
|-
! Pressor!! Initial Dose !! Max Dose !! Cardiac Effect  !! BP Effect !! [[Arrhythmias]] !! Special Notes
! Pressor!! Initial Dose !! Max Dose !! Cardiac Effect  !! BP Effect !! [[Arrhythmias]] !! Special Notes
|-
|-
| [[Dobutamine]] || 2.5 mcg/kg/min || 10-40 mcg/kg/min || mainly inotrope (ß1) || alpha effect minimal || Some HR(ß1) increase. Also Increase SA and AV node fx || Debut Research 1979<ref>Edmund H. Sonnenblick, M.D., William H. Frishman, M.D., and Thierry H. LeJemtel, M.D. Dobutamine: A New Synthetic Cardioactive Sympathetic Amine</ref> Isoproterenol has most Β2 vasodilatory and Β1 HR effects
| [[Dobutamine]] || 3-5 mcg/kg/min || 5-15 mcg/kg/min (as high as 200) <ref>https://www.ncbi.nlm.nih.gov/pubmed/8449087 </ref> || Strong ß1 agonist +inotrope +chronotrope, Weak ß2 agonist +weak vasodilatation ) || alpha effect minimal || HR variable effects.|| indicated in decompensated systolic HF, Debut Research 1979<ref>Edmund H. Sonnenblick, M.D., William H. Frishman, M.D., and Thierry H. LeJemtel, M.D. Dobutamine: A New Synthetic Cardioactive Sympathetic Amine</ref> Isoproterenol has most Β2 vasodilatory and Β1 HR effects
|-
|-
| [[Dopamine]] || 2 mcg/kg/min || 20-50 mcg/kg/min || β1 and NorEpi release || α effects if > 20mcg/kg/min || Arrhythmogenic from β1 effects || More adverse events when used in shock compared to Norepi<ref name="soap2">De Backer Daniel et al. Comparison of Dopamine and Norepinephrine in the Treatment of Shock. NEJM 363(9). 779-789</ref>
| [[Dopamine]] || 2 mcg/kg/min || 20-50 mcg/kg/min || β1 and NorEpi release || α effects if > 20mcg/kg/min || Arrhythmogenic from β1 effects || More adverse events when used in shock compared to Norepi<ref name="soap2">De Backer Daniel et al. Comparison of Dopamine and Norepinephrine in the Treatment of Shock. NEJM 363(9). 779-789</ref>
|-
|-
| [[Epinepherine]] ||0.1-1 mcg/kg/min||  ||  ||  ||  ||  
| [[Epinepherine]] ||0.1-1 mcg/kg/min||  || + inotropy, + chronotropy ||  ||  ||  
|-
|-
| [[Norepinephrine]] || 8-12 mcg/min || 30 mcg/min || β1 direct effect || β1 and α1,2 effects || Less arrhythmias than Dopamine<ref  name="soap2"></ref>  || Increases MAP, coronary perfusion pressure, little β2 effects.
| [[Norepinephrine]] || 0.2 mcg/kg/min || 0.2-1.3 mcg/kg/min (5mcg/kg/min) <ref> https://www.ncbi.nlm.nih.gov/pubmed/15542956 </ref> || mild β1 direct effect || β1 and strong α1,2 effects || Less arrhythmias than Dopamine<ref  name="soap2"></ref>  || First line for sepsis. Increases MAP with vasoconstriction, increases coronary perfusion pressure, little β2 effects.
|-
|-
|[[Milrinone]] || 50 mcg/kg x 10 min || 0.375-75 mcg/kg/min || Direct influx of Ca<sup>2+</sup> channels|| Smooth muscle vasodilator ||  || PDE Inhibitor which increases Ca<sup>2+</sup> uptake by sarcolemma.  No venodilatory activity  
|[[Milrinone]] || 50 mcg/kg x 10 min || 0.375-75 mcg/kg/min || Direct influx of Ca<sup>2+</sup> channels|| Smooth muscle vasodilator ||  || PDE Inhibitor which increases Ca<sup>2+</sup> uptake by sarcolemma.  No venodilatory activity  
Line 16: Line 16:
| [[Phenylephrine]] || 100-180 mcg/min then 40-60 mcg/min || 0.4-9 mcg/kg/min  ||  || Alpha agonist  ||  || Long half life
| [[Phenylephrine]] || 100-180 mcg/min then 40-60 mcg/min || 0.4-9 mcg/kg/min  ||  || Alpha agonist  ||  || Long half life
|-
|-
| [[Vasopressin]] || Fixed Dose || 0.4 U/min || unknown || increases via ADH peptide ||  || should not be titrated due to ischemic effects  
| [[Vasopressin]] || Fixed Dose || 0.01 to 0.04 U/min || unknown || increases via ADH peptide ||  || should not be titrated due to ischemic effects  
|-
|-
| [[Methylene blue]]<ref>Pasin L et al. Methylene blue as a vasopressor: a meta-analysis of randomised trials. Crit Care Resusc. 2013 Mar;15(1):42-8.</ref>|| IV bolus 2 mg/kg over 15 min || 1-2 mg/kg/hour || Possible increased inotropy, cardiac use of ATP || Inhibits NO mediated peripheral vasodilation ||  || Don't use in [[G6PD deficiency]], [[ARDS]], [[pulmonary hypertension]]
| [[Methylene blue]]<ref>Pasin L et al. Methylene blue as a vasopressor: a meta-analysis of randomised trials. Crit Care Resusc. 2013 Mar;15(1):42-8.</ref>|| IV bolus 2 mg/kg over 15 min || 1-2 mg/kg/hour || Possible increased inotropy, cardiac use of ATP || Inhibits NO mediated peripheral vasodilation ||  || Don't use in [[G6PD deficiency]], [[ARDS]], [[pulmonary hypertension]]

Latest revision as of 22:48, 7 December 2022

Vasopressors

Pressor Initial Dose Max Dose Cardiac Effect BP Effect Arrhythmias Special Notes
Dobutamine 3-5 mcg/kg/min 5-15 mcg/kg/min (as high as 200) [1] Strong ß1 agonist +inotrope +chronotrope, Weak ß2 agonist +weak vasodilatation ) alpha effect minimal HR variable effects. indicated in decompensated systolic HF, Debut Research 1979[2] Isoproterenol has most Β2 vasodilatory and Β1 HR effects
Dopamine 2 mcg/kg/min 20-50 mcg/kg/min β1 and NorEpi release α effects if > 20mcg/kg/min Arrhythmogenic from β1 effects More adverse events when used in shock compared to Norepi[3]
Epinepherine 0.1-1 mcg/kg/min + inotropy, + chronotropy
Norepinephrine 0.2 mcg/kg/min 0.2-1.3 mcg/kg/min (5mcg/kg/min) [4] mild β1 direct effect β1 and strong α1,2 effects Less arrhythmias than Dopamine[3] First line for sepsis. Increases MAP with vasoconstriction, increases coronary perfusion pressure, little β2 effects.
Milrinone 50 mcg/kg x 10 min 0.375-75 mcg/kg/min Direct influx of Ca2+ channels Smooth muscle vasodilator PDE Inhibitor which increases Ca2+ uptake by sarcolemma. No venodilatory activity
Phenylephrine 100-180 mcg/min then 40-60 mcg/min 0.4-9 mcg/kg/min Alpha agonist Long half life
Vasopressin Fixed Dose 0.01 to 0.04 U/min unknown increases via ADH peptide should not be titrated due to ischemic effects
Methylene blue[5] IV bolus 2 mg/kg over 15 min 1-2 mg/kg/hour Possible increased inotropy, cardiac use of ATP Inhibits NO mediated peripheral vasodilation Don't use in G6PD deficiency, ARDS, pulmonary hypertension
Medication IV Dose (mcg/kg/min) Concentration
Norepinephrine (Levophed) 0.1-2 mcg/kg/min 8mg in 500mL D5W
Dopamine 2-20 mcg/kg/min 400mg in 250 D5W
Dobutamine 2-20 mcg/kg/min 250mg in 250 mg D5W
Epinephrine 0.1-1 mcg/kg/min 1mg in 250 D5W
  1. ↑ https://www.ncbi.nlm.nih.gov/pubmed/8449087
  2. ↑ Edmund H. Sonnenblick, M.D., William H. Frishman, M.D., and Thierry H. LeJemtel, M.D. Dobutamine: A New Synthetic Cardioactive Sympathetic Amine
  3. ↑ 3.0 3.1 De Backer Daniel et al. Comparison of Dopamine and Norepinephrine in the Treatment of Shock. NEJM 363(9). 779-789
  4. ↑ https://www.ncbi.nlm.nih.gov/pubmed/15542956
  5. ↑ Pasin L et al. Methylene blue as a vasopressor: a meta-analysis of randomised trials. Crit Care Resusc. 2013 Mar;15(1):42-8.
Retrieved from "https://www.wikem.org/w/index.php?title=Template:Vasopressor_table&oldid=367454"