PK/PD: Inotropes - #MEDSHED

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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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