5.11
Hypertensive Agents
Phenylephrine
- Mechanism of Action
- α1 adrenergic receptor agonist (Figure 5.17)
- Clinical Indications
- Mild‐moderate hypotension
- Adult: 100–200 mcg IV
- Peds: 1–5 mcg/kg IV
- Infusion: 0.05–0.7 mcg/kg/min IV
- Mild‐moderate hypotension
- Cerebral
- ↓ CBF
- Cardiovascular
- ↑ MAP
- Baroreflex‐induced bradycardia
- ↓ CO
- Pulmonary
- Renal
- ↓ RBF
- Hepatic
- Partial metabolism
- Contraindications
- Hypotension in the setting of bradycardia as can further worsen bradycardia
- Board Facts
- Metabolized primarily by monoamine oxidase
- Extravasation can lead to tissue necrosis
Source: Adapted from McPherson et al. [77].
Norepinephrine
- Mechanism of Action
- Primarily α1, modest β1, and β2 adrenergic receptor agonist (Figure 5.17)
- Clinical Indications
- Moderate‐severe hypotension
- Adult: 5–15 mcg IV
- Peds: 0.05–0.2 mcg/kg IV
- Infusion: 0.1–0.5 mcg/kg/min IV
- Moderate‐severe hypotension
- Cerebral
- Minimal [80]
- Cardiovascular
- ↑ MAP
- Minimal HR change
- ↑ CO
- Pulmonary
- ↑ PAP [78]
- Renal
- Minimal [81]
- Hepatic
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