IONOTROPES

DR.SUBIKSHAVARTHNI
MEM
MMHRC
OBJECTIVES

 Definition
 Mechanism of action
 Uses
 Dosage
 Adverse effects
Inotropes:

Increase the myocardial contractility , thus

increasing the cardiac output (COP) and
the systolic blood pressure.
 Vasopressors:

Vasoconstriction

Increasing the peripheral vascular resistance and

diastolic blood pressure

Increasing the venous return to the heart

 It’s a natural catecholamine
normally produced in the adrenal
medulla by methylation of nor
adrenaline.

 1 mg in 1ml.

 Vasopressor and inotrope,

Indications:
 Acute asthma
 Cardiac arrest
 Anaphylaxis
 Severe hypotension due to any cause
 Post arrest as infusion
 Refractory symptomatic
bradycardia
Caution in known cases of:

 IHD.

 Arrhythmias.

 Hypertension

 Cerebral arteriosclerosis.
Onset : 1 -2 mins

Duration : 2- 10 mins

Dosage :

 1 mg iv every 3 – 5 mins – cardiac arrest

 0.3 to 0.5 mg of 1:1000 every 20 to 30 mins- asthma

 2 to 10 mcg /min iv of 1:10000 solution-hypotension

ADVERSE REACTIONS:

 Sweating/palpitations/tachycardia

 Tremors/headache
 NOREPINEPHRINE

• Endogenous catecholamine

• Ionotropy ,chronotropy

• Onset 1- 2 mins

Duration 5 to 10mins
Indications:
 Hypotension
 Sympathectomy

Dosage
 2 to 30 mcg/min
Adverse effects:

 Extravasation-phentolamine

 Uncorrected blood loss

 Mesentric/peripheral vascular

thrombosis
 PHENYLEPHRINE

 Similar to epinephrine

 Predominant alpha action-marked vasoconstriction

 Onset-5 to 10 mins

 Duration-15 mins
Indications

SevereHypotension

Shock

Dosage

100-200mcg/min –initial infusion

Adverse effects

reflexbradycardia
 DOPAMINE

 Synthetic catecholamine with

dopaminergic, β1 and α actions.

 First choice inotrope in cardiogenic shock

 It’s available as 200 mg ampules in 5 ml

 Onset – 5 mins

 Duration -10 mins

 Low dose (0.5 – 5 µg/kg/min) it activates the D1
receptors-leading to vasodilation and increased GFR

Intermediate dose (5– 10 µg/kg/min) activation of

the cardiac beta 1 receptors -> +ve inotropic,
chronotropic effects.
High doses (>10 µg/kg/min) activation of alpha 1
receptors with increased peripheral vascular resistance
and afterload.

Very high doses > 20 µg/kg/min. vasoconstrictor

action > vasodilator action and compromise the blood
flow to the limbs, kidney & mesentery.
 Indications

 Cardiogenic shock

 Hypotension –Heart /Renal failure

MI/Trauma
 Side effects

 Tachycardia, tachyarrythmias ,palpitations

 Increased myocardial oxygen demand

 Hypotension/hypertension

 Gangrene in vascular disease and diabetic

 Contraindications

Pheochromocytoma

Tachyarrhythmias

Asthmatic-sodium metabisulphate
 DOBUTAMINE

 Predominant beta 1 action

 Potent ionotropic,less chronotropic

 Onset – 1-2 mins

 Peak response -10 mins

 INDICATIONS

Cardiogenic shock

Septic shock

DOSE

2-20mcg/kg/min

Route –iv
 ADVERSE EFFECTS

 Tachycardia

 Arrhythmias

 hypertension
 Vasopressin

 Maintain serum osmolality through v2

receptors
 V1 -phospholipase c-calcium release from
sarcoplasmic reticulum- vasoconstriction
capillaries/small arterioles
 Endogenous vasopressin increased in rosc –
exogenous vasopressin beneficial
Onset -immediate

Duration -10-30 min

Indications

Sepsis with refractory hypotension

Dosage
40 units iv
0.01-0.04 unit/min
Adverse effects-
 Arrhythmias
 Pvd/coronary insufficiency/mesentric
thrombosis
 Myocardial ischaemia
 Infusion rate (ml/hr)

Desired dose (µg) x body weight (kg) x 60

Concentration in the syringe in (µg)

Example
Inj.DOPAMINE
 1 ampule =5ml = 200 mg
 5ml + 45 ml NS = 50 ml
 Desired dose = 5 mcg,body weight -60kg

According to formula:

5 * 60 *60

200/50 * 1000

4.5 ml/hr
INJ.DOBUTAMINE
 1 ampule = 10 ml = 250 mg
 10 ml + 40 ml NS = 50 ml
 Desired dose = 5 mcg ; weight = 60 mg
According to formula :
5 * 60* 60
250/50 *1000
3.6 ml/hr
Desired dose *60

Strength of the drug * 1000

Strength of the solution
EXAMPLE :

INJ.NOR ADRENALINE
 1 ampule =2 ml=4mg
 2ml + 48 ml NS = 50 ml
 Desired dose 5 mcg;
According to formula :
5 * 60

4/50 *1000

3.7 ml/hr
Take home message
 Wake up..
Time for ur brains…
1)IONOTROPE OF CHOICE IN CARDIOGENIC SHOCK

2)IONOTROPE OF CHOICE IN SEPTIC SHOCK

3)IONOTROPE OF CHOICE IN CARDIAC ARREST

4)PERIPHERAL LIN E SIDE EFFECTS

5)EXTRAVASATION – TREATMENT

6)MOST COMMON SIDE EFFECT OBSERVED IN ED

7)DOSE CALCULATION FOR INFUSION- DOPAMINE-5mcg;60 KG

8)DOSE CALCULATION FOR INFUSION – ADRENALINE-5MCG

9)DOSE CALCULATION FOR INFUSION – DOBUTAMINE-10 MCG WT

– 50 KG

10)VASOPRESSIN INDICATION
Reference

*Tintinalli textbook of emergency medicine – 7th

edition

*www.lifeinthefastlane.com

*Cardiac drugs textbook-margaretwood

Thank you