PEDS 602 Cardiac_Drip_Presentation_2020 | Cardiac Medications Used in the Critical Care Unit

PEDS 602 Cardiac_Drip_Presentation_2020 Cardiac Medications Used in the Critical Care Unit ALEXANDRA ANGEL, PHARM.D. PHARMACY RESIDENT WEST KENDALL BAPTIST HOSPITALObjectives  Provide an overview for the management of vasoactive medications  Apply knowledge and concepts in the initiation, administration, and monitoring of therapy for patients receiving vasoactive medications  Discuss overall rationale and management for vasoactive medicationsOutline  Adrenergic receptor physiology  Medication therapy in:  Hypotension (i.e., shock)  Hypertension Emergencies  Acute Decompensated Heart Failure  Arrhythmias  Review of:  Vasopressors and Inotropes  Vasodilators  Anti-arrhythmics  Other Cardiac medicationsVasoactive Therapy CO: Cardiac Output SVR: Systemic Vascular ResistanceVasopressorsVasopressors  Norepinephrine (NE) – Levophed®  Epinephrine (Epi) – Adrenalin®  Dopamine (DA) – Intropin®  Phenylephrine – Neosynephrine  Dobutamine – Dobutrex®  Vasopressin – Vasostrict®Vasopressors  Induce vasoconstriction → ↑ mean arterial pressure (MAP)  Some agents may have both vasopressor and inotropic effects  Inotropes that ↑ cardiac contractility  Dopamine  DobutamineAdrenergic Receptor Physiology Receptor Location Physiologic Effect Alpha-1 (α1) Vascular walls • Vasoconstriction (significant) • Heart: ↑ duration of contraction without ↑ chronotropic effects Beta-1 (β1) Heart • ↑ inotropic & chronotropic effects with minimal vasoconstriction Beta-2 (β2) Lungs • Vasodilation Dopamine (DA) Renal, mesenteric, coronary, and cerebral vascular beds • Vasodilation • Stimulates DA receptors → vasoconstriction inducing NE releaseIndications for Vasopressors  End-Organ dysfunction due to hypo-perfusion AND either one of the following:  Decrease of 30mmHg from baseline SBP  MAP 60mmHg- - - - -