Vasopressors Drug Bullets

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Term 1
Definition 1
Norepinephrine (Levophed)
Mechanisms of Action
Endogenous catecholamine
Potent alpha-adrenergic receptor stimulation
Increases myocardial contractility due to weaker
beta-1 effects
Arterial and venous vasoconstriction from potent
alpha stimulation
Increased SVR (afterload) increases blood
pressure and may diminish cardiac output.
Due to an increase in myocardial oxygen demand,
may worsen myocardial ischemia, especially if
coronary vasoconstriction is induced by coronary
alpha receptor stimulation.
Term 2
Definition 2
Indications
Hemodynamically significant hypotension

refractory to other sympathomimetics
Cardiogenic shock
Used more often with low SVR states (e.g., sepsis)
than in MI-related hypotension
Term 3
Definition 3
ContraIndications
Hypotension due to hypovolemia (may be used as

a temporary agent until volume can be replaced)
Profound hypoxemia or hypercarbia
Mesenteric or peripheral vascular thrombosis
Pre-existing hypertension
Use with caution in patients with heart disease
and/or hyperthyroidism.
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Term 4
Definition 4
Precautions
Taper infusion off slowly to prevent severe

hypotension.
Extravasation causes tissue necrosis and
sloughing (use phentolamine (regitine), 5 - 10 mg
diluted in 15 ml of 0.9% NSS to minimize damage).
Avoid mixing with sodium bicarbonate (forms a
precipitate).
Term 5
Definition 5
Dosages
Start at 0.5 - 1.0 mcg/min

Titrate to desired effect (SBP of 90 - 100 mmHg);
up to 30 mcg/min
Adult dosage commonly 2 - 12 mcg/min
Mix 4 ml ampule (1 mg/ml) in 500 ml D5W or 0.9%
NSS to make 8 mcg/ml
Term 6
Definition 6
Phenylephrine (Neo-synephrine)
Medication Classifications
Vasopressor
Term 7
Definition 7
Potent direct-acting sympathomimetic (synthetic)

with strong alpha-adrenergic and weak
beta-adrenergic cardiac stimulant properties
Elevates systolic and diastolic pressures due to
peripheral arteriolar constriction.
Constricts capacitance vessels and increases
venous return.
Cardiac output is slightly decreased due to the
increase in afterload.
Coronary blood flow is increased.
Rise in blood pressure may cause reflex
bradycardia due to aortic baroreceptor stimulation.
Produces little or no CNS stimulation
Term 8
Definition 8
Indications
Hypotension from shock, shock-like states, or

drug-induced shock
To overcome PSVT
During anesthesia to maintain adequate level of
blood pressure and prolong anesthesia drugs
effects
Term 9
Definition 9
Precautions
Use vein of antecubital fossa or central line to

prevent extravasation.
Avoid getting medication on hands and then
rubbing eyes (may cause aniscoria, blurred vision,
and compromised depth perception).
Monitor BP and CVP every 2 - 5 minutes.
Term 10
Definition 10
Contra-indications
Severe coronary disease or hypertension

Hypotension due to hypovolemia
Ventricular tachycardia
Cautious use in thyroid dysfunction, diabetes
mellitus, myocardial disease, bradycardia, or
cerebral atherosclerosis
Term 11
Definition 11
Dosages
Titrate 0.1 - 0.18 mg/min until BP stabilizes, then

0.04 - 0.06 mg/min for maintenance infusion.
Dilute 10 mg in 500 ml D5W or 0.9% NSS to make
0.02 mg/ml concentration.
Term 12
Definition 12
Vasopressor
Sympathomimetic
Term 13
Definition 13
Vasopressors
Norepinephrine
Phenylephrine
Dopamine
Dobutamine
Vasopressin(antidiuretic, Hemostatic)
Term 14
Definition 14
Vasodilators
Nitroglycerin
Morphine sulfate(narcotic Analgesic)
Sodium nitroprusside
Hydralazine
Inamrinone(inotropic agent)
Milrinone(inotropic agent)
Term 15
Definition 15
Dopamine (Inotropin)
Vasopressor
Term 16
Definition 16
Mechanism of action low and mid dose
Chemical precursor of norepinephrine

Low doses = dopaminergic receptor stimulation
Vasodilation of renal, mesenteric, and cerebral
arteries
Urine output increased, while heart rate and blood
pressure are usually unchanged
Mid-range doses = beta-1 adrenergic receptor
stimulation with weak alpha-stimulation
Increased cardiac output due to increased heart
rate and contractility
Small increase in SVR
Weaker alpha-1 at this dose antagonized by beta-1
stimulation
Term 17
Definition 17
Mechanism of action high dose
High doses = alpha-adrenergic receptor

stimulation
Renal, mesenteric, and peripheral vasoconstriction
Increase in SVR and preload
Doses above 20 mcg/kg/min produce alpha
stimulation similar to norepinephrine
Increases myocardial work without compensatory
increase in coronary blood flow
Term 18
Definition 18
Indications
Cardiogenic shock
Hemodynamically significant hypotension, in
absence of hypovolemia (systolic blood pressure
[SBP] < 70 mmHg)
CHF, in combination with other agents (such as
sodium nitroprusside)
Term 19
Definition 19
Precautions
Excessive vasoconstriction at high doses

Can compromise circulation to the extremities in
some patients (monitor peripheral pulses, color,
and temperature).
Will increase heart rate and may cause
supraventricular or ventricular arrhythmias.
Increased myocardial workload without increase in
coronary perfusion can cause or worsen ischemia.
Taper infusion carefully to avoid acute
hypotension.
Monoamine oxidase (MAO) inhibitors may
potentiate effects of dopamine.
Term 20
Definition 20
ContraIndications
Cardiogenic shock
Uncorrected tachyarrhythmias
Ventricular fibrillation
Hemodynamically significant hypotension, in
presence of hypovolemia (SBP < 70 mmHg)
Term 21
Definition 21
Dopamine (Ionotropin)
Dosage
Low dose: 2 - 5 mcg/kg/min

Mid-range dose: 5 - 10 mcg/kg/min
High dose: > 10 mcg/kg/min
Titrate dosage to desired hemodynamic effect,
using data from right heart catheterization as
measure of effects.
Dilute 400 mg in 250 ml D5W for concentration of
1600 mcg/ml.
Term 22
Definition 22
Hydralazine (Apresoline)
Anti-hypertensive
Direct vasodilator
Term 23
Definition 23
Non-nitrate vasodilator and antihypertensive

Reduces blood pressure mainly by direct effects
on vascular smooth muscles of the arterioles,
resulting in vasodilation
Little effect on venous-capacitance vessels
Diastolic response often greater than systolic
Vasodilation reduces afterload and substantially
improves cardiac output, as well as renal and
cerebral perfusion.
Hypotensive effect may be limited by sympathetic
reflexes (increases in heart rate, stroke volume, and
cardiac output).
Term 24
Definition 24
Indications
Moderate to severe hypertension, including acute

hypertensive emergency
Pregnancy-induced hypertension and
preeclampsia
May be used in conjunction with cardiac
glycosides or other vasodilators in short-term
treatment of CHF
Unexplained pulmonary hypertension
Term 25
Definition 25
Contraindications
Coronary artery disease or MI

Pre-existing hypotension
Persistent tachycardia
Advanced renal impairment
Mitral valve disease
Term 26
Definition 26
Precautions
Taper drug slowly to avoid sudden possible rise in

blood pressure.
Blood dyscrasia resulting in decrease in
hemoglobin and hematocrit
Obtain baseline and periodic BUN, creatinine, uric
acid, serum potassium, blood glucose, and CBC;
also obtain ECG.
Use with caution if used concomitantly with
beta-adrenergic blockers.
Tartrazine may be contained in some products;
may cause allergic-type reaction in patients who
also have aspirin hypersensitivity.
Term 27
Definition 27
Adverse reactions
Headache and dizziness

Palpitations and tachycardia
Drug-induced hypotension
Angina
Nausea and vomiting, diarrhea, anorexia
Decreased hematocrit and hemoglobin levels
Hypersensitivity reactions: rash, urticaria, fever,
chills, arthralgia, hepatitis, eosinophilia
Term 28
Definition 28
Dosages
Hypertension in adults:
: 10 - 50 mg QID
Intravenous: 5 - 40 mg slow IV push over 1 - 2
minutes, may repeat every 4 - 6 hours as needed
Hypertension in geriatrics: start with 10 mg PO BID
or TID and titrate as needed
Term 29
Definition 29
Inamrinone
Medication Classification
Inotrophic Agent
Term 30
Definition 30
Inamrinone
Mechanism of Action
*Phosphodiesterase inhibitor; noncatecholamine

inotropic agent
* Formerly called amrinone
* Inhibits peak IIIcyclic AMP isoemzyme in cardiac
and vascular muscle, resulting in direct inotropic
effect and drect arterial vasodilation; effects are
linked to inhibition of phosphodiesterase
*Drug acts slightly different than digitalis and beta
adrenergic stimulants
* Rapid acting potent inotropic and vasodilator
*Cardiac output increases and SVR and preload
decrease at dosages of 2-15 mcg/kg/min
*higher dosage produces tachycardia
*Hemodynamic effects are similar to dobutamine
Term 31
Definition 31
Inamrinone
Indications
*Severe CHF refractory to diuretics, vasodilators,

and conventional inotropic agents
Additive to digitalis and catechoamine therapy
* Promotion of hemodynamic improvements in
patients with CHF from ischemic heart disease
Term 32
Definition 32
Inamrinone
Precautions
*Clear yellow in appearance

*Store at room temperature and protect from light
* May increase or induce myocardial ischemia
* Do not mix with furosemide(LAsix)or dextrose
containing solutions
* Adjust dosage frequently to achieve desired effect
at the lowest possible dosage
Term 33
Definition 33
Inamrinone
Contra indications
*Hypersensitivity to inamrinone or bisulfites

*pre-existing hypotension
*presence of uncorrected aortic or pulmonic valve
obstruction
*Right ventricular outflow tract or left ventricular
outflow tract obstruction
*Patients with uncorrected hypokalemia or
dehydration
Term 34
Definition 34
Inamrinone
Adverse Reactions
-Nausea and vomiting

-Thrombocytopenia due to hepatotoxicity
-Dose-dependent Tachydysrhythmias, ventricular
irritability, hypotension
-Muscular stiffness, myalgias, tenderness, and
localized inflammatory reaction at site of infusion
-Hypersensitivity reaction (Itching) may occur with
long term use
-Fever
Term 35
Definition 35
Inamrinone
Dosages
-IV
-Loading dose: 0.75 mcg/kg over 2-5 min.
-Infusion @5-10 mcg/kg/min, titrated to desired
effect
-Adjust frequently to achieve optimal effects at
lowest possible dose
-Mix 20 ml ampule of 100mg(5mg/ml) with 0.9% NS
for 1-3mg/ml concentration
Term 36
Definition 36
Digitalis
Antidysrhythmic
Term 37
Digitalis
Mechanism of Action
Term 38
Definition 37
-Cardiac Glycoside
-mild positive inotropic effect due to increased
calcium in the sarcoplasmic reticulum, increasing
contractility
-Vasoconstriction of coronary and mesenteric
arteries is due to increased calcium levels;
increases SVR via increased vascular tone
-since digitalis effects are caused by increased
calcium concentrations,betablockers have no
effects on positive inotropic activity
-Slows AV nodeal conduction by lengthening the
refractory period
-Increaes aortic root baroreceptor sensitivity
-Results i reduction in heart rate due to increased
arterial pressure
-High doses cause increased and potentionally
dangerous adrenergic activity(binds to muscle as
Definition 38
Digitalis
Indications
-Effective control of ventricular response in atrial

tachydysrhythmias without adversely affecting
contractility
-Calcium channel blockers may supplant digitalis
as drug of choice for atrial fibrillation
-If the BP is high, use calcium channel blocker
-If the BP is normal or low , use digitalis
-May convert PSVT to normal sinus rhythm
- Congestive heart failure
Term 39
Definition 39
Digitalis
Precautions
-Toxicity occurs i 20% of all patients

-Toxicity and overdose treated with Digibind
-Hypokalemia
-Hypokalemia sensitizes the myocardium to
digitalis
-May alter onset and rate of positive inotropic
effects
-Hyperkalemia possible with massive digitalis
overdose
-Causes massive coronary vasoconstriction
-May induce or worsen ischemia
Term 40
Definition 40
Digitalis
Contra indications
-Ventricular tachycardia or ventricular fibrillation

-Acute myocardial infarction
-High degree AV blocks
-Digitalis intoxication
-WPW syndrome
-use with cautin if at all
Term 41
Definition 41
Digitalis
Adverse Reactions
-Increases slope of phase 4 of action potential

-May induce delayed after depolarizations
-Results in ectopy
-Alters the ECG
-Increases the PR interval
-Depresses the ST Segment, scooped appearance
-Flattens or inverts t waves
-Shortens the QT Interval
Term 42
Definition 42
Digitalis
Adverse reactions
-Slows impulse tranmission throught hte

ventricular conduction system
-Wide range of Cardiac Arrhythmias
-Extra cardiac side effects
-Anorexia
-Nausea and Vomiting
-Diarrhea
-Fatigue
-Mental status Change
-Blurred vision
-Yellow-green hue to visual spectrum
-Presence of Halos around lights
Term 43
Definition 43
Digitalis
Dosage
Loading dose: 10 - 15 mcg/kg

IV effects in 5 - 30 minutes and peaks in 1.5 - 3.0
hours
Maintenance dosing dependent on body size and
renal function (monitor creatinine clearance)
Normal therapeutic range is 0.5 - 2.0 ng/ml.
Also available in oral preparations (0.125, 0.25, and
0.50 mg tablets)
Term 44
Definition 44
Furosemide (Lasix)
Antihypertensive
Diuretic
Term 45
Definition 45
Milrinone (Primacor)
Inotropic Agent
Term 46
Definition 46
Mechanism of Action
Phosphodiestrerase inhibitor; noncatecholamine

inotropic agent
Term 47
Definition 47
Indications
-short term treatment of CHF refractory to diuretics

or digitalis
-TO increase cardiac output and to reduce
pulmonary capillary wedge pressure and SVR
without increasing myocardial oxygen demand
-Chronic heart failure with decompensation
Term 48
Definition 48
Precautions
-Use cautously in patients with atrial flutter ar

fibrillation due to shortening of AV nodal
conduction time and poential for increased
ventricular response
-Avoid infusion in same IV line as Furosemide
-Monitor Vial Signs, Cardiac monitor, I&Os, renal
function, and platelet level
-Expect dose reduction as cardiac output and
urinary output improve
Term 49
Definition 49
Contra Indications
-Hypersenitivity to the drug

-Severe aortic and pulmonary valvular stenosis
-Hypertrophic cardiomyopathy
-Acute MI
-Hypotension
Term 50
Definition 50
Adverse Reactions
-Headache
-Ventricular ectopy. ventricular tachycardia, v-fib
-Hypotension
-Chest pain and cardiac ischemia
-Thrombocytopenia
-Local tissue discomfort or necrosis
Term 51
Definition 51
Dosage
-Inital loading dose; 50mcg/kg slow push over 10

min
-Continuous infusion: .375 -.75 mcg/kg/min
-Titrate dose to desired effect
-Commonly used concomitantly with digitali and
diuretics
-with renal impairment max dose is 1.13 mg/kg/day
Term 52
Definition 52
Furosemide (Lasix)
Mechanism of action
-Diuretic
-Inhibits the reabsorbtion or sodium and chloride in
the Kidneys
-Decreases reanl vascular resistance; increases
reanl blood flow and urine output
Term 53
Definition 53
Furosemide (Lasix)
Indications
Edema asociated with CHF, cirrhosis of the liver,

and ranal disease
-Initiation of rapid diuresis in acute pulmonary
edema
-Volume overload
-Mild impairment of renal function
Term 54
Definition 54
Furosemide (Lasix)
Precautions
-Observe for signs of electolyte disturbances

-Digitalis may exacerbate metabolic effect of
hypokalemia
Term 55
Definition 55
Furosemide (Lasix)
Contra Indications
-Anuria(Renal failure)
-Hypersensitivity to sulfonamides
-Chronic metabolic alkalosis or hyper kalemia
-hypotension or dehydration
Term 56
Definition 56
Furosemide (Lasix)
Adverse reactions
-Electrolyte depeletion: hypokalemia, hyponatremia

-dehydration, hypotension
-Vascular thrombosis or embolism
-Hypergycemia
-Nausea, vomiting, diarrhea, cramping
-rash urticaria, leukopenia, anemia
Term 57
Definition 57
Furosemide (Lasix)
Dosage
IV or Oral
IV - 20-80 mg in increment of 20mg
oral- 20 -40 mg initially titrate to desired effect

Vasopressors Drug Bullets

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Hemodynamically significant hypotension

Hypotension due to hypovolemia (may be used as

Taper infusion off slowly to prevent severe

Start at 0.5 - 1.0 mcg/min

Potent direct-acting sympathomimetic (synthetic)

Hypotension from shock, shock-like states, or

Use vein of antecubital fossa or central line to

Severe coronary disease or hypertension

Titrate 0.1 - 0.18 mg/min until BP stabilizes, then

Chemical precursor of norepinephrine

High doses = alpha-adrenergic receptor

Excessive vasoconstriction at high doses

Low dose: 2 - 5 mcg/kg/min

Non-nitrate vasodilator and antihypertensive

Moderate to severe hypertension, including acute

Coronary artery disease or MI

Taper drug slowly to avoid sudden possible rise in

Headache and dizziness

*Phosphodiesterase inhibitor; noncatecholamine

*Severe CHF refractory to diuretics, vasodilators,

*Clear yellow in appearance

*Hypersensitivity to inamrinone or bisulfites

-Nausea and vomiting

-Effective control of ventricular response in atrial

-Toxicity occurs i 20% of all patients

-Ventricular tachycardia or ventricular fibrillation

-Increases slope of phase 4 of action potential

-Slows impulse tranmission throught hte

Loading dose: 10 - 15 mcg/kg

Phosphodiestrerase inhibitor; noncatecholamine

-short term treatment of CHF refractory to diuretics

-Use cautously in patients with atrial flutter ar

-Hypersenitivity to the drug

-Inital loading dose; 50mcg/kg slow push over 10

Edema asociated with CHF, cirrhosis of the liver,

-Observe for signs of electolyte disturbances

-Electrolyte depeletion: hypokalemia, hyponatremia

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