Vasopressors, Inotropes, & Vasodilators
Drug Category
Vasopressors (vasoconstrictors)
Norepinephrine (Levophed)
Phenlyephrine (Neosynephrine)
Epinephrine (Adrenalin)
Inotropes
Dobutamine (Dobutrex)
Milrinone (Primacor)
Major systemic effects
Increased venous and arterial
tone (vasoconstriction)increased BP
Increase in preload and
contractility (slight)
Increased venous and arterial
tone (vasoconstriction)increased BP
Increased venous and arterial
tone (vasoconstriction)increased BP
Increase in preload and
contractility (slight)
Increased heart rate
Increases cardiac contractility
and heart rate
Increases cardiac contractility
and heart rate
Primary shock use
Major side effects
Initial vasopressor in septic,
cardiogenic, neurogenic, and
hypovolemic shock
Cardiac arrhythmia
Peripheral ischemia
Alternative vasopressor when
tachyarrhythmias develop with
Norepinephrine
Often used as a secondary
vasopressor when
Norepinephrine isn’t enough
Initial vasopressor in
anaphylactic shock
Often used as a secondary
vasopressor when
Norepinephrine isn’t enough
Used in neurogenic shock
Decreased kidney perfusion and
urine output
Extravasation if drug gets
infiltrated
Initial inotrope used in
cardiogenic shock
Used for management of heart
failure to increase cardiac output
and blood pressure
Used in cardiogenic shock (often
with dobutamine)
Used for management of heart
failure to increase cardiac output
and blood pressure
Tachyarrhythmias, hypertension,
premature ventricular
contractions (PVC’s)
Tachycardia, tachyarrhythmias
Peripheral ischemia
Increased myocardial O2
consumption
Peripheral vasodilation,
hypotension, ventricular
arrhythmias
Vasopressors, Inotropes, & Vasodilators
Vasodilators
Nitroprusside
Nitroglycerin
Improve myocardial perfusion by
vasodilation of coronary arteries
From a hemodynamic
perspective, the net result is a
decrease in systemic vascular
resistance (afterload), ventricular
filling pressures, and systemic
blood pressure with an increase
in cardiac output
Relaxation of smooth muscle
within blood vessels, resulting in
vasodilation
Used with inotropes in
cardiogenic shock
Hypotension, cyanide toxicity
Increased intracranial pressure
(ICP): related to cerebral
vasodilation.
*Use with caution with other
vasodilators
Used with inotropes in
cardiogenic shock
Dizziness, weakness, palpitations,
vertigo, headaches, nausea,
vomiting, diaphoresis, syncope
*Use with caution with other
vasodilators
Dose-dependent drug that acts
as a peripheral vasostimulant
used to treat hypotension,
bradycardia, and cardiac arrest
0.5 to 2 mcg/kg/min: act on the
visceral vasculature to produce
vasodilation, including the
kidneys, resulting in increased
urinary flow.
2 to 10 mcg/kg/min: stimulate
myocardial contractility and
increase electrical conductivity in
the heart leading to increased
cardiac output.
>10mcg/kg/min:
vasoconstriction and increased
blood pressure via the adrenergic
receptors alpha-1, beta-1, and
beta-2
Tachycardia, dysthymias
Peripheral ischemia at doses
greater than 10mcg/kg/min
Other
Dopamine
Vasopressors, Inotropes, & Vasodilators