Review of Vasopressor Pharmacology

Medications             Alpha            Beta1            Beta2            Dopamine            V1                V2

Norepinephrine       ++++                 ++

Epinephrine                +                   +++                   ++

Phenylephrine         ++++

Dopamine  1-5                                  +                                            ++++

Dopamine 5-10          +                    ++                                            +++

Dopamine 10-20      +++                  ++                                              +

Vasopressin                                                                                                             ++++              ++++

Dobutamine               +                  ++++                  ++

Isoproterenol                                 ++++                ++++

General guidelines for different forms of shock

Septic shock

  • Norepinephrine is the first line pressor
  • Vasopressin can decrease norepinephrine requirements and may decrease the need for renal replacement therapy and frequently used as a second line vasopressor
  • Epinephrine is a third-line vasopressor
  • The new Angiotensin II (Giapreza) is now FDA-approved as an adjunctive vasopressor for septic shock and decreases the norepinephrine requirements but may increase the risk for DVT.

Spinal shock

  • Responds well to both norepinephrine or phenylephrine

Cardiogenic shock

  • Wet/cold
    • Diuresis
    • Norepinephrine if tachycardic
    • Dopamine if bradycardic
    • Once euvolemic can convert to dobutamine
  • Dry/cold
    • Small fluid boluses
    • May benefit from dobutamine once euvolemic
  • Wet/warm
    • Diuresis
    • May benefit from dobutamine

Read all articles in Cardiovascular diseases, Featured, Hospital Procedures, Medical General, medical procedures
Tags: featured, HPC updates, shock, vasopressors

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