Template:Vasopressor table: Difference between revisions
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! Pressor!! Initial Dose !! Max Dose !! Cardiac Effect !! BP Effect !! [[Arrhythmias]] !! Special Notes | ! Pressor!! Initial Dose !! Max Dose !! Cardiac Effect !! BP Effect !! [[Arrhythmias]] !! Special Notes | ||
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| [[Dobutamine]] || | | [[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 <ref> </ref>. Also Increase SA and AV node fx || 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 | ||
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| [[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> | ||
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| [[Epinepherine]] ||0.1-1 mcg/kg/min|| | | [[Epinepherine]] ||0.1-1 mcg/kg/min|| || || || || | ||
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| [[Norepinephrine]] || | | [[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> || Increases MAP with vasoconstriction, increasescoronary perfusion pressure, little β2 effects. | ||
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|[[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 | ||
Revision as of 22:37, 13 July 2017
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 Cite error: Invalid <ref> tag; refs with no name must have content. Also Increase SA and AV node fx |
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 | |||||
| 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] | Increases MAP with vasoconstriction, increasescoronary 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 | 0.4 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 |
- ↑ https://www.ncbi.nlm.nih.gov/pubmed/8449087
- ↑ Edmund H. Sonnenblick, M.D., William H. Frishman, M.D., and Thierry H. LeJemtel, M.D. Dobutamine: A New Synthetic Cardioactive Sympathetic Amine
- ↑ 3.0 3.1 De Backer Daniel et al. Comparison of Dopamine and Norepinephrine in the Treatment of Shock. NEJM 363(9). 779-789
- ↑ https://www.ncbi.nlm.nih.gov/pubmed/15542956
- ↑ Pasin L et al. Methylene blue as a vasopressor: a meta-analysis of randomised trials. Crit Care Resusc. 2013 Mar;15(1):42-8.