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PK/PD: Inotropes - #MEDSHED

Updated: 5 days ago

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📋 PK/PD: Inotropes - #MEDSHED



💉 Inotropes are pharmacologic agents that increase cardiac output and contractility in the setting of acute heart failure with hypoperfusion.



💉 Commonly used inotropes include dobutamine, milrinone, and isoproterenol.



💉 Dobutamine


Mechanism


B1, B2, A1 agonist


B2 agonism (peripheral vasodilation) counteracts A1 activity (vasoconstriction)



Starting Rate: 2 - 5 mcg/kg/min


Titrate to clinical response


Max Rate: 20 mcg/kg/min



Metabolism


Renal - inactive metabolites



Precautions/Considerations


Ventricular arrhythmias


Reduced efficacy in patients on chronic beta blocker therapy



💉 Milrinone


Mechanism


Phosphodiesterase inhibitor --> cAMP mediated increase ionized Ca2+ and contractile force of cardiac muscle



Starting Rate: 0.125 - 0.25 mcg/kg/min


Titrate to clinical response


Dose Range: 0.125 - 0.75 mcg/kg/minute



Metabolism


Hepatic --> excreted as unchanged drug via urine (may accumulate with renal failure)



Precautions/Considerations


Ventricular arrhythmias


Dose reduction with renal insufficiency


Hypotension



💉 Isoproterenol


Mechanism


Potent B1, B2 agonist


Dose-dependent hypotension secondary to unopposed B2 agonism



Starting Rate: 1 mcg/min


Titrate to clinical response


Dose Range: 1 - 20 mcg/min



Metabolism


Hepatic via catechol O-methyltransferase



Precautions/Considerations


Ventricular arrhythmias


Hypotension


Reduced efficacy in patients on chronic beta blocker therapy



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Not medical advice. Educational purposes only. No relationships to report.



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