Which Vasopressor and When? with Tina Vinsant from Good Nurse Bad Nurse

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Phenylephrine

AKA: Neosynephrine, “Neo”
Pure α₁ adrenergic agonist, increases SVR
Has no inotropic effect
What kind of patients do we see on this drip? Why?
- Surgical patients being treated for anesthesia associated hypotension
- Neurogenic shock, usually spinal cord injury
Notable SE: reflexive bradycardia
Drug interactions
- MAOIs, tricyclic antidepressants, linezolid (enhanced HTN effect)
- Acetaminophen: may increase serum concentration of phenylephrine
- Fentanyl – may decrease serum concentration of Fentanyl; onset effect of fentanyl may be delayed

Norepinephrine

AKA: Levophed, “Levo”, Norepi
α₁, α_2,β adrenergic agonist. Used for multifactorial problems, like sepsis
Vasoconstriction effects greater than inotropic and chronotropic effects, but inotropic effects can help some with CO
Extravasation can cause ischemic tissue necrosis/sloughing (tx: phentolamine)
Notable SE: Decreased splanchnic and renal flow
Do not administer in same line as bicarb
Drug interactions
- MAOIs, SSRI/SNRI, Linezolid, tricyclic antidepressants (may enhance hypertensive effect)

Epinephrine

AKA: Epi, Adrenalin
What kind of patients do we see on this drip? Why?
- Anaphylaxis because it mimics our endogenous adrenalin
- Adjunct to norepinephrine in septic shock
α₁, α_2,β₁, β₂ agonists: Increased SVR, inotropy and chronotropy
Notable SE: Can induce splanchnic (organs of the abdomen) flow, arrhythmia, Increases lactate levels and blood glucose

Dopamine

AKA: Dopa
Primary impact
- Low dose: Increased inotropy and heart rate
- Higher dose: Increased SVR and inotropy
Notable SE: Tachyarrhythmias
Drug interactions: MAOIs, Linezolid, SSRI/SNRI, tricyclic antidepressants (enhanced hypertensive effect)

Dobutamine

Positive lusitropic (myocardial relaxation), inotropic (contractility), & chronotropic (heart rate) effects
Tachyphylaxis w/ infusions > 72 hrs (diminishing effect of drug despite increasing dosage)
Can cause vasodilation
Minimal alpha effects
Decreases SVRIncreases CO
Most commonly used for severe HF and cardiogenic shock

Milrinone

What kind of patients do we see on this drip? Why?
- Advanced HF
- Bridge therapy
- Palliative
Does not work on adrenergic receptors
Phosphodiesterase III inhibitor. Phosphodiesterase III is present in the cardiac sarcoplasmic reticulum, smooth muscle in arteries and veins.
Positive inotropy, positive lusitropy, and vasodilation
Similar to dobutamine with few SE

Vasopressin

This drug is not vasoactive drug – it increases BP by increasing blood volume
Vasopressin is indicated to increase blood pressure in adults in vasodilatory shock refractory to the application of fluids and catecholamines.

Midodrine

PO!
Midodrine is an alpha agonist and acts as a peripheral vasoconstrictor

Tina Vinsant, RN, host of the podcast Good Nurse Bad Nurse, joins us for a run through of all the major vasoactive agents given in the hospital. We minimized the jargon and maximized on practical cases, so join us for a memorable discussion of this fundamental subject.

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Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).

See the show notes at upmynursinggame.com.