Podcast 642: Vasopressors - The Emergency Medical Minute

Podcast 642: Vasopressors

 

Contributor:  Nick Tsipis, MD

Educational Pearls:

  • 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
  • Norepinephrine: alpha-1 and beta-1 agonist – used in septic shock to increase cardiac output and peripheral vasoconstriction
  • 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
  • Dopamine: alpha-1, alpha-2, beta-1, beta 2, and dopamine agonist – used for sepsis in the past, but not recommended due to dysrhythmias
  • Vasopressin: V1 agonist (vasoconstricts) –  used when maxed out of norepinephrine for septic shock
  • Milrenone: phosphodiesterase inhibitor – used in heart failure to drop preload and afterload
  • Dobutamine: beta-2 (with minimal beta-1) adrenergic agonist – used in heart failure and cardiogenic shock to reduce afterload


References

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.

Episode 31 – Vasopressors. FOAMcast: An Emergency Medicine Podcast. 25 July 2015. https://foamcast.org/tag/vasopressors/

Summarized by John Spartz, MS3 | Edited by Erik Verzemnieks, MD

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