MOA
This pressor increases SVR and decreases HR
phenylephrine
1mL phenylephrine =
100 mcg
Targets the cAMP pathway
Milrinone
Cardiac Output =
SV x HR
Anaphylactic
epinephrine
This pressor if first-line for bronchospasm
Epinephrine
100mcg phenylephrine is equivalent to __mcg norepinephrine
9 mcg (norepi is ~10x stronger than phenylephrine)
Milrinone effect on HR, inotropy, SVR
HR ^
Inotropy ^
SVR v
SVR=
(MAP-CVP)/CO * 80
*CVP or RAP
Septic
norepinephrine
This pressor does not work on alpha or beta receptors but increases SVR
Vasopressin
1mL ephedrine =
5 mg
Target: B1&B2
Isoproterenol
Increases HR/inotropy/CO; decreases SVR
PVR=
(MPAP-LAP) / CO * 80
*LAP or PAWP
Vasodilatory/distributive
phenylephrine
This pressor works on different targets depending on dose
Dopamine
1mL "baby" epinephrine =
10 mcg
Increases pulse pressure
Dobutamine (Increases systolic pressure (B1 incr in CO), decreases diastolic pressure (B2 arteriolar dilation))
MAP=
(1/3) SBP + (2/3) DBP
DBP + 1/3 (SBP-DBP)
Cardiogenic
epinephrine, milrinone, dobutamine
This pressor decreases pulmonary vascular resistance
Vasopressin
Starting phenylephrine infusion rate; Starting norepinephrine infusion rate; Weight-based: which weight?
0.2 mcg/kg/min phenylephrine
0.02 mcg/kg/min norepinephrine
IDEAL BODY WEIGHT
Milrinone MOA
PDE inhibitor that ^ cAMP, ^ intracell Ca++, increases inotropy, chronotropy, periph vasodilation (unpredictable effect on BP)
Pythagorean theorem
a^2+b^2=c^2
Hypovolemic
NO PRESSOR -- FLUID/BLOOD!