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Vasopressors and Inotropes - DRAFT

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Introduction

Vasopressors and inotropes are sympathetic drugs that are used to support the cardiovascular system during resuscitation and other life-threatening states. Vasopressors cause vasoconstriction, leading to increased Mean Arterial Pressure (MAP), while inotropes increase cardiac contractility. However, many drugs acts as both vasopressors and inotropes through action on various receptors.

Given the signficiant physiological impacts of these drugs, they should only be used by health care providers with extensive background knowledge and experience, and under monitored settings.

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Indications

Vasopressors are indicated for a decrease of >30 mmHg from baseline systolic blood pressure or MAP <60 mmHg, when either condition results in end-organ dysfunction secondary to hypoperfusion.

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Background Physiology

There are a number of cardiovascular receptors that are involved in response to vasopressors and inotropes. These are as follows:

Alpha-1 adrenergic

location

peripheral vasculature

effect

increase vascular tone, shunting blood to critical organs

Beta-1 adrenergic

location

effect

Beta-2 adrenergic

location

airways

effect

bronchodilation

Dopamine

location

effect

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Common Medications

The following medications are commonly used as vasopressors or inotropes:

Drug	Actions	Uses	Other
epinephrine	alpha agonist beta agonist	anaphylaxis (SC, IM) cardiac arrest (IV, IE) symptomatic bradycardia severe hypotension
dopamine	beta agonist (low doses) alpha agonist (high doses)	symptomatic bradycardia (IM) severe hypotension
nor-epinephrine	alpha agonist weak beta agonist
phenylephrine	alpha agonist
vasopressin		cardiac arrest (IM)
dobutamine	heart failure