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2020-07-04T01:18:01Z

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== Receptors ==

* Alpha-adrenergic receptors:
** Alpha-1 agonists cause vasoconstriction
** Alpha-2 agonists causes vasodilatation especially of coronary arteries
* Beta-adrenergic receptors:
** Beta-1 agonists increases HR and cardiac contractility --> increased CO
** Beta-2 agonists dilate small coronary A's, visceral organ A's, skeletal muscle A's and increase bronchodilation
* Dopaminergic receptors:
** 7 types of dopamine receptors
** D4 agonists increase cardiac contractility
** D1 and D2 agonists increase renal diuresis and naturesis
* Vasopressin receptors:
** V1 agonists cause vasoconstriction mostly in peripheral arterioles and increased sensitivity to catecholamines

{|
! Pressor
! Alpha
! Beta-1
! Beta-2
! Notes
|-
| Dobutamine
| –
| ++
| +
| More of an inotrope, really.
|-
| Dopamine, moderate
| –
| +++
| +++
| Precursor to norepi/epi. Higher risk of tachyarrhythmias than norepi.
|-
| Dopamine, high
| ++
| +++
| +++
| More alpha with high doses.
|-
| Epinephrine
| +++
| ++++
| +++
| Increases lactate.
|-
| Norepinephrine
| +++
| +
| –
|
|-
| Phenylephrine
| +++
| –
| –
| Beware reflex bradycardia.
|-
| Vasopressin
| –
| –
| –
| Acts on V1 receptors. Increase SVR and can cause ischemia.
|-
| Milrinone
|
|
|
| Phosphodiesterase III inhibitor. Avoid in renal failure. Long half-life.
|}

== Treatment Algorithms ==

* Distributive shock: norepinephrine, then add vasopressin or epinephrine, then add dopamine or dobutamine
* Cardiogenic shock
** If left heart failure and BP can tolerate: Dobutamine
** If right heart failure and BP can tolerate: Milrinone
* Opioid-induced hypotension: phenylephrine

[[Category:Critical care]]
[[Category:Medications]]

Vasopressors and inotropes - Revision history

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