In the great dance of the heart and vasculature, we have seen inopressors (norepinephrine, epinephrine, dopamine) and pure vasopressors (phenylephrine, vasopressin). J Hypertens. CONTENTS Pressor Overview Core agents Inodilators (milrinone, dobutamine, isoproterenol) Pure vasopressors Inopressors (norepinephrine, epinephrine, dopamine) Peripheral vasopressors Midodrine Methylene Blue Podcast Questions & discussion Pitfalls PDF of this chapter (or create customized PDF) The table below categorizes vasoactive medications. Start with Part I , Part II, Part III, and Part IV. … Contractility is primarily determined by the availability of intracellular calcium. noradrenaline, vasopressin, metaraminol, vasopressin, methylene blue. (An authoritative review that examined the mechanisms of action of common inotropes and vasopressors, and the contemporary evidence for their use in important cardiac conditions.) Epinephrine, phenylephrine, dopamine and vasopressin … Vasopressors differ from inotropes, which increase cardiac contractility; however, many drugs have both vasopressor and inotropic effects. Vasopressors should be chosen based on their mechanism of action. Circulation. Crossref Medline Google Scholar. Although many vasopressors have been used since the 1940s, few controlled clinical trials have directly compared these agents or documented improved outcomes due to their use [ 1 ]. Inotropy or contractility is the intrinsic property of the cardiac myofibril. 1,2. adrenaline, dobutamine, isoprenaline, ephedrine. No skipping! inotropes are agents that increase myocardial contractility (inotropy) — e.g. 118. vol. vasopressors are agents that cause vasoconstriction leading to increased systemic and/or pulmonary vascular resistance (SVR, PVR) — e.g. There are three main adrenergic receptors acted upon by the sympathomimetics: beta-1, beta-2, and alpha receptors. Vasopressors V: Inodilators. ... Vasopressors act on arteries and arterioles to increase SVR (α-AR effect). Mosby items and derived items © 2008, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 19 Vasopressors, Inotropes, and Antiarrhythmic Agents INOTROPES. The following table outlines common vasopressors/inotropes and their general receptor activity profiles. So far, the drugs discussed in such question have been limited to levosimendan, dobutamine, noradrenaline, phenylephrine, vasopressin and dopamine. The positive inotropes and vasopressors that are used in anesthesia are sympathomimetics. Understanding vasopressors' receptor activity and resultant pharmacological response enables clinicians to select the ideal vasopressor (s) for a patient suffering from shock. Norepinephrine is first line for septic shock and cardiogenic shock. It defines the amount of work that the heart can perform at a given load. However, the need for a CVC for the management of septic shock has been questioned, and the risk of … Inotropes, Vasopressors, and Chronotropes OH MY! Overgaard, CB, Dzavik, V. “Inotropes and vasopressors: Review of physiology and clinical use in cardiovascular disease”. The college has historically asked a series of questions comparing vasopressors and inotropes to one another, presumably to see who among the trainees could explain why they use vasopressin and not phenylephrine (for example). A Review for the Young and the Seasoned MATT RUBERTUS, PHARMD CLINICAL PHARMACY SPECIALIST –CARDIOTHORACIC SURGERY/CRITICAL CARE EMORY UNIVERSITY HOSPITAL ATLANTA, GA. Disclosure 1999; 17: 673–678. 2008. pp. 35 Jolly S, Newton G, Horlick E, Seidelin PH, Ross HJ, Husain M, Dzavik V. Effect of vasopressin on hemodynamics in patients with refractory cardiogenic shock complicating acute myocardial infarction. Dobutamine is an ionotropic agent that is used for cardiogenic shock. Vasopressors are an integral component of the management of septic shock and are traditionally given via a central venous catheter (CVC) due to the risk of tissue injury and necrosis if extravasated. 1047-56.