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Ionotrops 3
- 2. VASOACTIVE DRUGS Vasopressors Ionotropes Increase the force of contraction of myocardial muscle Positive ionotropism Stimulates smooth muscle contraction of the capillaries & arteries Vasoconstriction Rise in Mean Blood Pressure Improved tissue perfusion and oxygenation
- 3. VASOPRESSORS ↑MAP = CO x↑SVR ~ 1 ↓r4 HR x SV PRELOAD CONTRACTILITY AFTERLOAD NORADRENALINE VASOPRESSIN
- 4. IONOTROPES ↑MAP = ↑ CO xSVR ~ 1 r4 HR x ↑ SV PRELOAD ↑ CONTRACTILITY AFTERLOAD DOPAMINE DOBUTAMINE ADRENALINE
- 6. RECEPTO R LOCATION ACTION on stimulation 1 & 2 • Vascular smooth muscle • Myocardium Increase systemic & pulmonary vascular resistance Increase contractility Decrease rate 1 • Myocardium • + ve Ionotropism • + ve Chronotropism 2 • Bronchi • Blood vessels • Bronchodilation • Vasodilation
- 10. 1 adrenergic receptors function through Gs to stimulate the effector adenylylcyclase to produce the 2ndmessenger cyclic AMP Ca 2+
- 12. Classification of inotropic agents cAMP dependent agents adrenergic agonists dopaminergic agonists: phosphodiesterase III isoenzyme inhibitors: cAMP independent inotropic agents Na+-K+-ATPase inhibitors: Potassium channels inhibitors Calcium Phenylephrine Other new agents Calcium Sensitizers vasopressin natriuretic brain peptide
- 13. Medication SVR HR PCW MAP Dopamine ↓ ↑ ↑ ↑ ↑ ↓ ↑ ↓ ↑ Dobutamine ↓ ↑ ↑ ↑ ↓ ↓ ↔ ↑ Epinephrine ↓ ↑ ↑ ↑ ↓ ↑ ↑ Milrinone/Inamrinone ↓ ↓ ↑ ↓ ↓ Isoproterenol ↓ ↓ ↑ ↑ ↑ ↑ ↓ ↓ ↑ Norepinephrine ↑ ↑ ↑ ↑ ↑ ↑ ↑ ↑ ↑ Phenylephrine ↑ ↑ ↔ ↑ ↑ ↑ Vasopressin ↑ ↑ ↔ ↑ ↑ ↑ ↑ Nesiritide ↓ ↔ ↓ ↓ ↓
- 14. • α1 and α2 stimulation result in increased systemic and pulmonary vascular resistance. • Cardiac a1-receptors increase contractility and decrease the heart rate • Β1 stimulation results in increased contractility (inotropy), heart rate (chronotropy), and conduction (dromotropy) • Β2 stimulation results in peripheral vasodilation and bronchodilation
- 15. • Inotropes with vasoconstrictive (α) properties can be combined with vasodilators to improve contractility while avoiding an increase in SVR (e.g., norepinephrine with nitoprusside) • Inotropes with vasodilator properties can be combined with α- agonists to maintain SVR (e.g. milirinone with neosynephrine or norepinephrine) • Catecholamines can be combined with the PDE inhibitors to provide synergistic inotropic effects while achieving pulmonary and systemic vasodilation (e.g., epinephrine with milrinone)
- 16. THANK YOU!