Pressors


1. Levophed (Norepinephrine)
 -
1st line agent in septic shock,
 - 2nd line otherwise behind dopamine.
 - b1+a agonists.
 - Start:
    - Sparks: 1 mcg/min Max: 30 mcg/min
      -OR-
      Mercy: 0.01 mcg/kg/min, Max: 0.3 mcg/kg/min.

2. Dopamine
- hypotension refractory to fluids. (+ chrono)

3. Dobutamine - Cardiogenic hypotension, MI, CHF etc.

4. Vasopressin - adjunct to NE in shock, 4 units/hour IV (0.01 - 0.04 units/min)
 *Consider using colloidal preparations i.e. Hespan or Hetastarch , bolus 500 ml to provide volume when oncotic pressure is low. No survival benefit in sepsis.

5. May use Hydrocortisone, 50 mg q6hrs, taper over 11 days



Agent Receptor Activity Effects Indication
a1 b1 b2 DA
(Levophed)
Norepinephrine
1-30 mcg/min
+++

 

++ 0 0 SVR ↑↑
CO ↔↓↑
Sepsis
Phenylephrine
(Neo-synephrine)
40-180 mcg/min
+++

 

0

 

0

 

0

 

SVR ↑↑
CO ↔/↑
Sepsis,
Neurogenic shock
Epinephrine +++

 

+++ ++ 0

 

CO ↑↑
SVR ↓ (L)
SVR ↔/↑ (H)
Anaphylaxis,
ACLS,
Sepsis
Dopamine (mcg/kg/min)
Low-dose (0.5-2) 0 + 0 ++ CO ↑
SVR ↑↓
Sepsis,
Cardiogenic shock
Mid-dose(5-10) + ++ 0 ++ CO ↑
High-dose(10-20) ++ ++ 0 ++ SVR ↑↑
Doubutamine
2.5-20 mcg/kg/min
0/+ +++ ++ 0 CO ↑
SVR ↓
Cardiogenic shock
Isoproterenol
2-10 mcg/min
0

 

+++ +++ 0 CO ↑
SVR ↓
Cardiogenic shock w/
bradycardia
Vasopressin
(Adjunct)
0.01-0.04 U/min
        V2 receptors Vasoconstriction
Augments catecholamine
 

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SVR = Cold, Clammy hands/feet
CO = HR x SV