Common Cardiovascular Drugs R 3 Inotropic agents n

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Common Cardiovascular Drugs R 3顏廷珊

Common Cardiovascular Drugs R 3顏廷珊

Inotropic agents n Vasodilators n Antiarrythmic agents n

Inotropic agents n Vasodilators n Antiarrythmic agents n

α receptors ↑ protein kinase C ↑intracellular Ca smooth muscle contraction n β receptor

α receptors ↑ protein kinase C ↑intracellular Ca smooth muscle contraction n β receptor ↑ intracellular c. AMP relax smooth muscle, increase cardiac muscle contractility n

α 1 : peripheral vascular contraction n β 1 : increase HR, contractility n

α 1 : peripheral vascular contraction n β 1 : increase HR, contractility n β 2 : 主要vasodilation, bronchodilation; 次 要increase HR, contractility n

Inotropic agents

Inotropic agents

Dopamine 因dose (ug/kg/min)的不同而作用在不同的 receptor上 n 1 -3 dopaminergic (DA): ↑renal and mesenteric blood flow

Dopamine 因dose (ug/kg/min)的不同而作用在不同的 receptor上 n 1 -3 dopaminergic (DA): ↑renal and mesenteric blood flow 3 -10 β 為主: increase HR, contractility; decrease SVR, but increase PVR > 10 α 為主: increase SVR and PVR; decrease renal flow n

Levophed ( norepinepherine) 以α為主,β 1為輔 n Increase SVR increase BP; may increase contractility; increase

Levophed ( norepinepherine) 以α為主,β 1為輔 n Increase SVR increase BP; may increase contractility; increase PVR n 4 mg/400 ml 0. 01 ml/ml =10 ug/ml n Usual range for infusion: 0. 05 -0. 3 ug/kg/min n

Dobutrex (dobutamine) β為主 (尤其β 1),minimal α effects n Increase HR, contractility; decrease SVR, PVR

Dobutrex (dobutamine) β為主 (尤其β 1),minimal α effects n Increase HR, contractility; decrease SVR, PVR n dobutamine is an inotrope but not a pressor ! n Infusion dosage: 2 -20 ug/kg/min n

Milrinone (primacor) Phosphodiesterase inhibitor n Inhibit c. AMP to breakdown increase intracellular c. AMP

Milrinone (primacor) Phosphodiesterase inhibitor n Inhibit c. AMP to breakdown increase intracellular c. AMP concentration n In cardiac muscle: increase contractility, HR n In vascular smooth muscle: vasodilation; decrease SVR, PVR n

Loading dose: 25 -75 ug/kg over 1 -10 min n Infusion dose: 0. 375

Loading dose: 25 -75 ug/kg over 1 -10 min n Infusion dose: 0. 375 -0. 75 ug/kg/min n

Bosmin (epinephrine) 因dose (ug/kg/min)不同著重於不同的 receptor n 0. 01 -0. 03: β 0. 03 -0.

Bosmin (epinephrine) 因dose (ug/kg/min)不同著重於不同的 receptor n 0. 01 -0. 03: β 0. 03 -0. 15: β為主,α為輔 > 0. 15: α為主,β為輔 n

For cardiac arrest: adult: 0. 5 -1 mg IV bolus pediatric : 5 -15

For cardiac arrest: adult: 0. 5 -1 mg IV bolus pediatric : 5 -15 ug/kg IV bolus may be given intratracheally in 1 -10 ml volume n Severe allergic reaction or bronchospasm: 10 ug/kg n

Vasodilators

Vasodilators

Nitroglycerin Direct vasodilator, venous > arterial dilation n Mainly preload reduction ; reduce PVR

Nitroglycerin Direct vasodilator, venous > arterial dilation n Mainly preload reduction ; reduce PVR n large dose > 10 ug/kg/min produce arteriolar dilation n Relieve coronary spasm, increase coronary flow, decrease ischemia n

IV bolus: 50 -100 ug n Infusion: 0. 1 – 7 ug/kg/min n Nitroderm

IV bolus: 50 -100 ug n Infusion: 0. 1 – 7 ug/kg/min n Nitroderm n

Trandate (labetalol) α blocker: β blocker = 1: 7 n decrease HR; decrease BP

Trandate (labetalol) α blocker: β blocker = 1: 7 n decrease HR; decrease BP n Long duration n

Perdipine Ca channel blocker n Arterial dilation, decrease SVR n Mild myocardial depressant: minimal

Perdipine Ca channel blocker n Arterial dilation, decrease SVR n Mild myocardial depressant: minimal in clinical dosage n

PGE 1 Selectively dilate the ductus arteriosus in neonates and infants n Potent pulmonary

PGE 1 Selectively dilate the ductus arteriosus in neonates and infants n Potent pulmonary vascular vasodilating effects n Infusion dosage: 0. 05 – 0. 4 ug/kg/min n

Antiarrythmic agents

Antiarrythmic agents

Isuprel (isoproterenol) Pure β effect n Positive inotropic and chronotropic effects n May decrease

Isuprel (isoproterenol) Pure β effect n Positive inotropic and chronotropic effects n May decrease BP n Infusion: 0. 02 -0. 05 ug/kg/min n

Esmolol Selective β 1 blocker n Decrease HR, BP n IV: 0. 25 -0.

Esmolol Selective β 1 blocker n Decrease HR, BP n IV: 0. 25 -0. 5 mg/kg n Infusion: 50 -200 ug/kg/min n Rapid elimination n

Amiodarone Use in Af, SVT, ventricular arrthymia n Loading: 150 mg IV for 10

Amiodarone Use in Af, SVT, ventricular arrthymia n Loading: 150 mg IV for 10 min n Infusion: max. 900 -1200 mg/24 hr first 24 hr, 720 mg/24 hr next n Potent vasodilating effects and negative inotropic effects n