6. Adrenaline
Dosing
Shock (IV or IO): 0.05 – 1 mic/kg/min.
Anaphylaxis or asthma (IM or SC): 0.1 ml/kg of 1/1000 solution
Arrest (IV or IO): 0.1 ml/kg of 1/10,000 solution
Arrest (ET): 0.1 ml/kg of 1/1000 solution
Side effects
Tachycardia & tachy-arrythmia
Renal impairment & urine retention (in high doses)
Rebound bronchospasm
Skin necrosis
Mesenteric vaso-constiction & ischemia (in high doses)
RFVF
7. Nor-adrenaline
Mechanism of action:
It stimulates α1 & weaker on β1 adrenergic
receptors
Vasoconstriction causing
hypertension
Very weak Inotropic &
chronotropic effect
Action: Indications:
Shock (hypotensive&
vasoplegic)
Can be used in
hypotensive fallot
tetralogy patient
with cyanotic spell
8. Nor-adrenaline
Dosing
Shock (IV or IO): 0.05 – 2 mic/kg/min.
Side effects
Renal impairment even in low doses
Skin necrosis esp. if extravasated
Mesenteric vaso-constiction & ischemia (in high doses)
Tachycardia & tachy-arrythmia to a lesser extent
9. Dopamine
Mechanism of action:
It stimulates α1, α2, β1& to a lesser extent β2 adrenergic receptors
It also stimulates dopaminergic receptor (DA1 & DA2)
Low dose: ++ DA1 & DA2
Intermediate dose: ++ β
High dose: ++ α1
Action: Systematic action:
Low doses: for mesenteric
ischemia
Intermediate dose: cardiac &
septic shock
High doses: hypotensive
shock
Renal dose
become
obsolete
10. Dopamine
Dosing
Low dose: 2 – 5 mic/kg/min
Intermediate dose: 5 – 10 mic/kg/min
High dose:10 – 20 mic/kg/min
Side effects
Tachycardia & tachy-arrythmia
Skin necrosis if extravasated
11. Dobutamine
Mechanism of action:
It stimulates β1 & very mild β2& α1 adrenergic
receptors
Inotropic & chronotropic
effect
May cause mild
vasodilatation
Action: Indications:
Heart failure
Cold septic shock with
normal blood pressure
With noradrenaline to save
mesenteric vasculature
Improve the
diastolic
dysfunction
12. Dobutamine
Dosing
5 – 20 mic/kg/min may increase to 30 mic
Side effects
Tachycardia & tachy-arrythmia
Skin necrosis if extravasation
13. Milrinone
Mechanism of action:
It is phosphodiesterase inhibitor so, increase cAMP that
lead to increase Ca delivery to myocardium
Inotropic & chronotropic
effect
Vasodilatation (pulmonary
& systemic)
Action: Indications:
Cardiac failure
Pulmonary hypertension
Cold septic shock with
normal blood pressure
Improve the
diastolic
dysfunction&
Rt sided failure
Inhalation in
pulmonary
hypertension
15. Vasopressine
Mechanism of action:
It stimulates VR1 causing increase cAMP that
lead to increasing Ca delivery to bl. Vs wall
Vasoconstriction causing
hypertension
Water retention causing
renal impairment
Decrease intestinal motility
& gut ischemia
Action: Indications:
Profound hypotension
DI
GI bleeding
ADH analogue
17. Vasodilator drugs
Inhibits ACE so, decrease
angiotensin 2 (potent VC)
Captopril,
ramipril
ACE inhibitors
Competitive inhibition to angio 2
receptors
LosartanAngiotengen 2
receptor antagonist
Block Ca entrance to vascular wall
causing relaxation
Nifidipine,
amlodipine
Ca channel blockers
NO donor, increase cGMP causing
relaxation
Nitroglycerine,
nitroperusside
Nitrates
Comprtitive inhibition of α1
receptors
PhentolamineAdrenoreceptor
antagonists
Bind to dopaminergic receptorsFenoldapamDopaminergic
receptor agonists
Bind to PG receptor increasing
cGMP
alprostadilProstaglandin
Direct areriolar dilatationHydralazine
18. Nitroglycerine
Mechanism of action:
It is NO donor so, stimulation of cGMP causing
vascular wall relaxation
Vasodilator mainly veins
Decrease myocardial oxygen
demands (by improving
atrial filling pressure by
venodilatation)
Action: Indications:
Heart failure
Cold septic shock with
normal blood pressure
Hypertensive urgencies
Cautious use
in shock
19. Nitroglycerine
Dosing
0.5 – 5 mic/kg/min upto 20 mic/kg/min in
hypertensive emergencies
Side effects
Tachycardia, hypotension
Prespiration
Headache
20. Nitroperosside
Mechanism of action:
It is NO donor so, stimulation of cGMP causing
vascular wall relaxation
Vasodilator mainly arteriolar
Hypotension
Action: Indications:
Hypertensive urgencies