Vasopressors and Inotropes - Pharmacology Summary Sheet
Norepinephrine ...
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Vasopressors and Inotropes - Pharmacology Summary Sheet

Norepinephrine - Levophed “Levo”

 • α1 > β1 agonist, ↑↑SVR , ↑CO, reflex brady can negate ↑HR from chronotropy

 • Septic (1st ), Cardiogenic (1st), Hypovolemic (1st) 

Phenylephrine - Neosynephrine “Neo”

 • Pure vasopressor α1 agonist: ↑↑SVR

 • Septic shock if ↑↑ HR from Levo or ↑CO w/ ↓↓ BP or 3rd pressor needed; AFRVR, HOCM, AS, RV failure

Vasopressin - Pitressin “Vaso”

 • V1 agonist: ↑SVR, V2 agonist: ↑renal, H2O reabsorption

 • Septic shock (2nd) (↓mortality vaso + NE vs NE alone), Anaphylaxis (2nd), RV failure

Epinephrine - Adrenalin “Epi”

 • Low: β1 >β2 >α1: ↑CO, neutral SVR, High: α1 > β1>β2: ↑CO, SVR

 • ACLS (1st), Anaphylaxis (1st), Symptomatic brady (2nd), Septic shock, Bronchospasm

Dopamine - Intropin “Dopa”

 • Low: D1 >β1, ↑CO, ↑ UOP; Med: β1>D1, ↑CO/↑SVR; High: α1>β1>D1, ↑SVR

 • Symptomatic brady, Septic shock w/ brady (No benefit in low “renal” dosing) ↑mortality vs levo in septic and cardiogenic 

Methylene blue

 • ↓NO and cGMP → ↑Sm musc tone ↑SVR

 • Sepsis/anaphylaxis, (refractory), Post-cardiopulm bypass, Amlodipine overdose, Methemoglobinemia

Dobutamine - Dobutrex “Dobuta”

 • β1, β2>α1 agonist: ↑CO ↓SVR

 • Cardiogenic Shock, Add to Levo in sepsis + ↓LVEF

Milrinone - Primacor

 • PDE inhibitor (↑cAMP) → ↑ inotropy, vasodilation ↑CO↓PVR/SVR

 • Cardiogenic Shock RV failure (↓PVR, ↓LVEDV) 

Isoproterenol - Isuprel

 • β1 = β2 agonist ↑HR, ↓SVR

 • Symptomatic brady, Mg refractory Torsades



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