Inotropes, Vasopressors, and
Chronotropes OH MY! A
Review for the Young and
the Seasoned
MATT RUBERTUS, PHARMD
CLINICAL PHARMACY SPECIALIST –CARDIOTHORACIC SURGERY/CRITICAL CARE
EMORY UNIVERSITY HOSPITAL
ATLANTA, GA
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Inotropes, Vasopressors, and Chronotropes OH MY! A Review ..., Summaries of Pharmacy
Review the mechanism of action for vasopressors and inotropes. ▷ Recognize common side effects of different ... Contractility and chronotropic effects.
Typology: Summaries
2021/2022
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Inotropes, Vasopressors, and
Chronotropes OH MY! A
Review for the Young and
the Seasoned
MATT RUBERTUS, PHARMD CLINICAL PHARMACY SPECIALIST – CARDIOTHORACIC SURGERY/CRITICAL CARE EMORY UNIVERSITY HOSPITAL ATLANTA, GA
Disclosure
I have nothing to disclose pertaining to this presentation http://oz.wikia.com
Clinical Scenarios
Shock Cardiogenic Vasodilatory Sepsis Cardiac Surgery Valve Disease Decompensated Heart Failure http://thefilmspectrum.com
Hypotension
Hypotension Baroreceptor Activation Decreased Renal Perfusion Increased Sympathetic Activity RASS Activation Cardiac Stimulation Vasoconstriction Volume Expansion Increased HR and Contractility Increased Preload Increased Cardiac Output Increased Systemic Vascular Resistance Increased Cardiac Output Increased Blood Pressure
Hemodynamics
Heart Rate Rate Rhythm Stroke Volume Preload CVP Contractility Afterload MAP
CO = X
Vasopressors http://thefilmspectrum.com
Beta Receptors
Beta 1 Located in cardiac tissue Contractility and chronotropic effects Beta 2 Smooth muscle relaxation in bronchi and GI tract Beta 3 Lipolysis – may be a target for weight loss
Vasopressin Receptors
V
1 receptor causes vasoconstriction in vascular smooth muscle V 2 receptor has an antidiuretic effect V 3 receptor is responsible for endocrine functions
Norepinephrine
Has effect on both alpha and beta receptors Primarily alpha causing vasoconstriction Beta activity less than other vasopressors First line vasopressor in most clinical scenarios SOAP-II trial Recommended as first-line agent in surviving sepsis guidelines
Epinephrine
Has both vasopressor and inotrope activity Could be considered an “ino-pressor”
Both alpha and beta activity
Nearly equal on both Important to know what the titration goal is!
Vasopressin
Acts on vasopressin receptors to induce vasoconstriction Differentiates from other vasopressors Targeting alternate pathway may provide additional benefit Potential for gut ischemia due to vasoconstriction in splanchnic circulation
Dopamine
Spectrum of primary activity is dose dependent Affects dopamine, beta, and alpha receptors No longer considered a first line vasopressor in sepsis guidelines Higher incidence of adverse effects than norepinephrine (SOAP II trial)
SOAP II Trial
N Engl J Med 2010;362:779- 89
SOAP II Trial
All patients with shock were randomized for first-line vasopressor therapy Dopamine: n = 858 Norepinephrine: n = 821 Over 60% of patients with septic shock Primary outcome was 28 day mortality N Engl J Med 2010;362:779- 89