Podcast 642: Vasopressors

<p> </p> <p><strong>Contributor:  Nick Tsipis, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;"><span style= "font-weight: 400;">Epinephrine: alpha-1, alpha-2, beta-1, and beta 2 agonist - used in cardiac arrest with positive effects on ROSC in prehospital and peri-hopsital setting</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Norepinephrine: alpha-1 and beta-1 agonist - used in septic shock to increase cardiac output and peripheral vasoconstriction</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Phenylephrine: alpha-1 adrenergic agonist - used in spinal/neurogenic shock as well as medication-induced peri-procedural hypotension (propofol for RSI) as it only helps with vasoconstriction</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Dopamine: alpha-1, alpha-2, beta-1, beta 2, and dopamine agonist - used for sepsis in the past, but not recommended due to dysrhythmias</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Vasopressin: V1 agonist (vasoconstricts) -  used when maxed out of norepinephrine for septic shock</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Milrenone: phosphodiesterase inhibitor - used in heart failure to drop preload and afterload</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Dobutamine: beta-2 (with minimal beta-1) adrenergic agonist - used in heart failure and cardiogenic shock to reduce afterload</span></li> </ul> <p><strong><br /> References</strong></p> <p><span style="font-weight: 400;">Shields SH, Holland RM. Pharmacology of Vasopressors and Inotropes. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 7e. McGraw-Hill; Accessed February 14, 2021.</span></p> <p><span style="font-weight: 400;">Episode 31 - Vasopressors. FOAMcast: An Emergency Medicine Podcast. 25 July 2015. https://foamcast.org/ta