title: Inotropes and Vasopressors tags: #FFICM notebook: ð-FFICM type: anki
Inotropes and Vasopressors
Table From [^oh_hf]
| Drug | Receptors Affected | Cardiac Contracility | HR | BP | CO | Splanchnic Blood Flow | SVR | PVR |
|---|---|---|---|---|---|---|---|---|
| Dopamine (low doses) | Dopamine, $\beta1$ | + | +/o | +/o | + | +/o | +/o | +/o |
| Dopamine (high doses) | $\alpha 1$, $\beta1$ , Dopamine | ++ | + | + | ++ | o | + | + |
| Adrenaline | $\beta1$ , $\beta2$ , $\alpha1$ | ++ | ++ | ++ | +++ | - | + | + |
| Noradrenaline | $\alpha1$ , $\beta1$ | o/+ | o | ++ | o/- | o/- | ++ | ++ |
| Vasopressin | Vasopressin | o | o | ++ | o/- | o/- | ++ | ++ |
| Isoprenaline | $\beta1$ , $\beta2$ | + | ++ | +/o | o/+ | o/+ | - | - |
| Dobutamine | $\beta1$ , $\beta2$ , $\alpha1$ | ++ | + | -/o/+ | ++ | o | - | - |
| Levosimenden | Intracellular calcium sensitiser, binding cardiac troponin to calcium. PDE-3 enzyme inhibitor | ++ | o/+ | o/- | ++ | o | - | - |
| Dopexamine | $\beta2$, Dopamine, $\alpha1$ | + | + | o/- | + | + | - | - |
| GTN | Via Nitric Oxide | o | o/+ | - | + | + | - | - |
| Sodium Nitroprusside | Via Nitric Oxide | o | o/+ | - | + | + | - | - |
| Milrinone | PDE-3 Enzyme inhibitor | + | + | - | ++ | o/+ | - | - |
| Inhaled Nitric Oxide | Via Nitric Oxide | o | o | o | o/+ | o | o | - |
| Prostacyclin | Prostacyclin receptors | o | o/+ | - | + | + | - | - |
Dopamine
Low Dose (<5 micro/kg/min)
| Flashcard | type:basic |
|---|---|
| What receptors does low dose dopamine act on? | Dopamine Beta 1 |
| What affect does low dose dopamine have on cardiac contractility? | Increases a bit |
| What affect does low dose dopamine have on heart rate? | Increases minimal |
| What affect does low dose dopamine have on cardiac output? | Increases a bit |
| What affect does low dose dopamine have on systemic vascular resistance? | Increases minimal |
| What affect does low dose dopamine have on pulmonary vascular resistance? | Increases minimal |
High Dose (>5 micro/kg/min)
Alpha 1
Dopamine
What affect does high dose dopamine have on cardiac contractility? | Increases a lot
What affect does high dose dopamine have on heart rate? | Increases a bit
What affect does high dose dopamine have on cardiac output? | Increases a lot
What affect does high dose dopamine have on systemic vascular resistance? | Increases a bit
What affect does high dose dopamine have on pulmonary vascular resistance? | Increases a bit
Adrenaline
| Flashcard | type:basic |
|---|---|
| What receptors does adrenaline act on? | Beta 1 Beta 2 Alpha 1 |
| What affect does adrenaline have on cardiac contractility? | Increases a lot |
| What affect does adrenaline have on heart rate? | Increases a lot |
| What affect does adrenaline have on cardiac output? | Increases a lot of a lot (loads) |
| What affect does adrenaline have on systemic vascular resistance? | Increases a bit |
| What affect does adrenaline have on pulmonary vascular resistance? | Increases a bit |
Noradrenaline
| Flashcard | type:basic |
|---|---|
| What receptors does noradrenaline act on? | Alpha 1 Beta 1 |
| What affect does noradrenaline have on cardiac contractility? | Increases minimal |
| What affect does noradrenaline have on heart rate? | No effect |
| What affect does noradrenaline have on cardiac output? | Decreases minimal |
| What affect does noradrenaline have on systemic vascular resistance? | Increases a lot |
| What affect does noradrenaline have on pulmonary vascular resistance? | Increases a lot |
Vasopressin
| Flashcard | type:basic |
|---|---|
| What receptors does vasopressin act on? | Vasopressin! |
| What affect does vasopressin have on cardiac contractility? | No effect |
| What affect does vasopressin have on heart rate? | No effect |
| What affect does vasopressin have on cardiac output? | Decreases minimal |
| What affect does vasopressin have on systemic vascular resistance? | Increases a lot |
| What affect does vasopressin have on pulmonary vascular resistance? | Increases a lot |
Isoprenaline
| Flashcard | type:basic |
|---|---|
| What receptors does isoprenaline act on? | Beta 1 Beta 2 |
| What affect does isoprenaline have on cardiac contractility? | Increases a bit |
| What affect does isoprenaline have on heart rate? | Increases a lot |
| What affect does isoprenaline have on cardiac output? | Increases minimal |
| What affect does isoprenaline have on systemic vascular resistance? | Decreases a bit |
| What affect does isoprenaline have on pulmonary vascular resistance? | Decreases a bit |
Dobutamine
| Flashcard | type:basic |
|---|---|
| What receptors does dobutamine act on? | Beta 1 Beta 2 Alpha One |
| What affect does dobutamine have on cardiac contractility? | Increases a lot |
| What affect does dobutamine have on heart rate? | No real effect (maybe up maybe down) |
| What affect does dobutamine have on cardiac output? | Increases a lot |
| What affect does dobutamine have on systemic vascular resistance? | Decreases a bit |
| What affect does dobutamine have on pulmonary vascular resistance? | Decreases a bit |
Levosimenden
Intracellular calcium sensitiser.
| Flashcard | type:basic |
|---|---|
| What receptors does levosimenden act on? | Intracellular calcium sensitiser, binding cardiac troponin to calcium PDE-3 enzyme inhibitor |
| What affect does levosimenden have on cardiac contractility? | Increases a lot |
| What affect does levosimenden have on heart rate? | Increases minimal |
| What affect does levosimenden have on cardiac output? | Increases a lot |
| What affect does levosimenden have on systemic vascular resistance? | Decreases a bit |
| What affect does levosimenden have on pulmonary vascular resistance? | Decreases a bit |
GTN
| Flashcard | type:basic |
|---|---|
| What receptors does GTN/Sodium Nitroprusside act on? | Via Nitric Oxide |
| What affect does GTN/Sodium Nitroprusside have on cardiac contractility? | No effect |
| What affect does GTN/Sodium Nitroprusside have on heart rate? | Minimal minimal increase |
| What affect does GTN/Sodium Nitroprusside have on cardiac output? | Increases a bit |
| What affect does GTN/Sodium Nitroprusside have on systemic vascular resistance? | Decreases a bit |
| What affect does GTN/Sodium Nitroprusside have on pulmonary vascular resistance? | Decreases a bit |
Milrinone
Milrinone acts by competitively inhibiting PDE-3 iscoenzyme. As PDE-3 breaks down intracellular cAMP, inhibiting it increases cAMP levels, increasing contractility. It's an SSRI for the heart!
| Flashcard | type:basic |
|---|---|
| What is cAMP used for in the heart? | Contractility of muscle cells |
| What does increasing cAMP do for cardiac myocytes? | Increases contractility |
| What does PDE-3 do? | Breaks down intracellular cAMP |
| How does milrinone act on mycoardial cells? | Competitively inhibiting PDE-3 |
| Flashcard | type:basic |
|---|---|
| What receptors does milrinone act on? | PDE-3 Enzyme Inhibitor (Competitive) |
| What affect does milrinone have on cardiac contractility? | Increases a bit |
| What affect does milrinone have on heart rate? | Increases a bit |
| What affect does milrinone have on cardiac output? | Increases a lot |
| What affect does milrinone have on systemic vascular resistance? | Decreases a bit |
| What affect does milrinone have on pulmonary vascular resistance? | Decreases a bit |
Inhaled Nitric Oxide
| Flashcard | type:basic |
|---|---|
| What receptors does inhaled nitric oxide act on? | Via Nitric Oxide |
| What affect does inhaled nitric oxide have on cardiac contractility? | No effect |
| What affect does inhaled nitric oxide have on heart rate? | No effect |
| What affect does inhaled nitric oxide have on cardiac output? | Increases minimal |
| What affect does inhaled nitric oxide have on systemic vascular resistance? | Decreases a bit |
| What affect does inhaled nitric oxide have on pulmonary vascular resistance? | Decreases a bit |
Prostacyclin
| Flashcard | type:basic |
|---|---|
| What receptors does prostacyclin act on? | Prostacyclin! |
| What affect does prostacyclin have on cardiac contractility? | No effect |
| What affect does prostacyclin have on heart rate? | Increases minimal |
| What affect does prostacyclin have on cardiac output? | Increases a bit |
| What affect does prostacyclin have on systemic vascular resistance? | Decreases a bit |
| What affect does prostacyclin have on pulmonary vascular resistance? | Decreases a bit |
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Oh's Intensive Care Medicine - Chapter 24 - Acute Heart Failure and Pulmonary Hypertension ↩