Inotropes= affect strength of contraction of the heart
muscle
Negative inotropes
Positive inotropes
Decrease cardiac workload
and blood pressure
Increase cardiac workload
and blood pressure
Betablockers
Diltiazem
verapamil
Dopamine
Dobutamine
Epinephrine
norepinephrine
Chronotropes= any medication that affects the heart rate
Negative response
Positive response
Lopressor
cardizem
dobutamine
Levophed
-alpha/beta agonist
-for severe hypotension, shock or bradycardia
-mix 4 mg/250 ml of D5w → 16mcg/ml
-has a rapid onset and short half life
-usually started at 2 mcg/min
-protect from light
-incompatible with sodium bicarb
-immediate onset
-half life 1-2 minutes
-can cause arrhythmias
-use PHENTOLAMINE for extravasation
-DO NOT USE WITH HYPOVOLEMIA
-DO NOT USE WITH MAOI therapy
Catecholamine= stimulates the adrenergic system to
raise blood pressure
Catecholamine meds
Epinephrine
Norepinephrine
Dopamine
dobutamine
Adrenergic= having characteristics of secreting epi or
substances with similar activity
Epinephrine
Norepinephrine
Cardiac output is a vital part of oxygen delivery, BP,
urine output, and perfusion!
Epinephrine drip
-first drug of choice in CARDIAC ARREST
-used for profound refractory hypotension, v-fib, VT,
PEA, and aystole
-it is a vasopressor and sympathomimetic that
increases coronary perfusion
-mix 1 mg/250 ml NS or D5W
-start at 1-4 mcg/min
-usual dose is 2-10 mcg/min
-very quick acting and extremely short half-life 1-2
minutes
MORE IS NOT BETTER
-high doses can cause post resuscitation
myocardial dysfunction
-can cause HYPERGLYCEMIA, monitor glucose
levels
-can cause DECREASED URINE OUTPUT and
metabolic acidosis
Dopamine
Vasopressin
-adrenergic agonist
-used for central hypotension, heart failure, and
increased renal and mesenteric perfusion in the
absence of hypovolemia
-if etiology of shock is unknown, this drug is a good
first line drug of choice
-it is a positive inotrope
-increase cardiac output and heart rate
-increase cardiac performance and renal perfusion
in shock and sepsis
-mix 400 mg in 250ml/D5w
-onset of action is 5 minutes and half life is 2
minutes
-usually started at 5 mcg/kg/min
-THIS DRUG IS CONTRAINDICATED IN
PATIENTS WITH SULFITE ALLERGY
-can cause vasoconstriction, limb ischemia, and
widened QRS complex
-monitor urine output every hour
-is an anti-diuretic hormone
-used in septic shock
-also used in PEA, VF
-retains water and constricts blood vessels →
increases BP and SVR and decrease heart rate
-20 units/100 ml D5w or NS = 0.2 units/ml
-initially started at 0.01 units/min-0.04 units/min
-used in refractory shock despite marked fluid
resuscitation
-can cause adverse reactions= arrhythmias,
cardiac arrest, angina, MI and peripheral
constriction
-abrupt → rapid rebound hypotension
-titrate slowly by 0.01 unit/min
-metabolized by kidneys/liver
-first alternative to epinephrine drip
-monitor for HYPONATREMIA
Dobutamine
Nipride (vasodilator)
-adrenergic agonist and first-line inotropic
-used for cardiogenic shock and associated
hypotension
-reduces afterload, increases rate and cardiac
contractility
-drug will cause hypotension in the presence of
hypovolemia → if hypotension is noted after
infusion → STOP infusion and address fluid volume
losses
-can cause tachycardia and headache
-CONTRAINDICATED IN PATIENTS WITH
SULFITE ALLERGY
-onset 1-2 mins, half life 2 mins.
-mix 500 mg in 250ml D5w
-hypertensive crisis, acute pulmonary edema and
congestive heart failure
-decreases cardiac afterloa
-potent vasodilator
-must be protected from light
-acts quickly and reversed quickly
-CYANIDE TOXIC
-to prevent cyanide toxicity → thiocyanate levels
must be monitored
-mix 50 mg in 250 ml D5w
-dose is 0.3-10 mcg/kg/min and slowly titrated
-do not stop abruptly → can cause REBOUND
HYPOTENSION AND SEIZURES
Nitroglycerin (vasodilator)
Lidocaine
-strong vasodilator
-increases coronary artery perfusion
-decreases PRELOAD
-used for chest pain, hypertensive crisis, pulmonary
edema, CHF, and MI
-drug of choice for cocaine induced MI
-CAUTION!! In inferior wall MIs, sexual
performance-enhancing drugs→ HYPOTENSION
-It can cause severe bradycardia and hypotension
-causes headache
Diltiazem
-is a calcium channel blocker and anti-arrhythmic
for heart rate control → a-fib, multifocal atrial
tachycardia, a-fib with RVR
-DO NOT USE for wide complex QRS tachycardias
-antidote is CALCIUM
-CAUTION in patients with 1st degree block, WPW
syndrome, V-tach, SSS, short PR syndrome
-can rapidly decrease blood pressure
-can cause HYPOCALCEMIA
-monitor for QRS widening
Amiodarone
Do not mix with normal saline, only D5W NON TITRATABLE
-recurrent VF or hemodynamically unstable T and
cardiac arrest
-commonly used for VF pulseless and VT
unresponsive to shock delivery and CPR
-BOLUS 150 MG/100 ML OVER 10 MINUTES
-bolus may be repeated
-2ND BOLUS 300 MG/100 ML OVER 10 MINUTES
-drip 450 mg/250 ml and runs at 1 mg/min (33
ml/hour) for 6 hours → then 0.5 mg/hour for 18
hours→ transition to cordarone PO
-IT HAS A 53 DAY HALF LIFE
-can cause hypotension, bradycardia, thyroid
dysfunction, thyroid storm, nausea/vomiting and
pulmonary toxicity
-USE IN-LINE FILTER
-high incidence of EXTRAVASATION
-ventricular anti-arrhythmic
-decreases automaticity
-onset is 30-90 seconds
-use caution in elderly as a complete heart block
can occur
-can cause confusion, hypotension,
lightheadedness, double vision, seizures, tinnitus,
perioral numbness (all of which indicate signs of
toxicity)
-CONTRAINDICATED in COMPLETE OR 2ND
DEGREE AV BLOCKS
-CHF or hepatic disease patients need decreased
doses
-monitor for BRADYCARDIA, DO NOT USE IN AMI
-WATCH FOR CIRCULATORY DEPRESSION
-1-1.5 MG/KG IV BOLUS OVER 2-3 MINS IS
INITIATED
-may be repeated 2 mg/kg
-drip at 1-4 mg/minute
Esmolol
-for sinus tach, SVT, hypertension
-selective beta-blocker
-will decrease heart rate, CO, and SVR →
decreased cardiac oxygen demand
-drug acts rapidly
-half-life is 9 minutes
-may be started at 50 mcg/kg/min up to 300
mcg/kg/min every 5 minutes
-DO NOT STOP MEDICATION ABRUPTLY
Adenosine
-used for paroxysmal SVT and Wolff Parkson White
Syndrome
-initial dose 6 mg IVP
-2nd dose after 1-2 minutes → 12 mg IVP
-strong vasodilator
-transient episode of aystole
-extremely short half life
-patients will complain of chest pain and SOB after
the administration of adenosine