Introduction to CV Pharmacology - Orlando Health
Introduction to CV Pharmacology - Orlando Health
Introduction to CV Pharmacology - Orlando Health
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<strong>CV</strong> <strong>Pharmacology</strong><br />
It is important <strong>to</strong> remember that by enhancing preload, afterload, and myocardial workload,<br />
epinephrine increases the myocardial oxygen demand resulting in an increased myocardial<br />
irritability that can induce ventricular ec<strong>to</strong>py.<br />
Norepinephrine<br />
Norepinephrine (Levophed) is a naturally occurring catecholamine that is structurally similar <strong>to</strong><br />
epinephrine. Norepinephrine has very little effect on beta-2 recep<strong>to</strong>rs so it does not produce<br />
bronchodilation. The beta-1 agonist effects are comparable <strong>to</strong> epinephrine with additional effects<br />
such as increasing au<strong>to</strong>maticity, myocardial electrical activity, myocardial contractility, and<br />
cardiac output. Additionally, norepinephrine’s alpha agonist effects result in a more pronounced<br />
peripheral vasoconstriction.<br />
As the dose of norepinephrine increases, the resulting increased afterload limits the beneficial<br />
inotropic effects and increases myocardial oxygen demands. This increased stress on the heart<br />
may exacerbate myocardial ischemia and extend a myocardial infarction. However, in shock<br />
states, the use of norepinephrine at low doses is common. It is especially beneficial in patients<br />
with septic and neurogenic shock, or other conditions that result in vasodilation (decreased<br />
systemic vascular resistance).<br />
Indications<br />
Norepinephrine is indicated for hemodynamically significant hypotension (
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