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Both positive and negative inotropes are used in the management of various cardiovascular conditions. The choice of agent depends largely on specific pharmacological effects of individual agents with respect to the condition. One of the most important factors affecting inotropic state is the level of calcium in the cytoplasm of the muscle cell ...
Unlike general inotropes, these agents exhibit a higher level of specificity as they selectively target the myocardium. They can be categorised into four distinct groups based on their unique mechanisms of action: cardiac glycosides , beta-adrenergic agonists , phosphodiesterase III inhibitors , and calcium sensitizers.
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The most common side effects during treatment with vasopressin are dizziness, angina, chest pain, abdominal cramps, heartburn, nausea, vomiting, trembling, fever, water intoxication, pounding sensation in the head, diarrhoea, sweating, paleness, and flatulence. The most severe adverse reactions are myocardial infarction and hypersensitivity. [53]
Although both vasopressors, vasopressin and epinephrine differ in that vasopressin does not have direct effects on cardiac contractility as epinephrine does. [18] Thus, vasopressin is theorized to be of increased benefit over epinephrine in cardiac arrest due to its properties of not increasing myocardial and cerebral oxygen demands. [18]
Medications used include: diuretic agents, vasodilator agents, positive inotropes, ACE inhibitors, beta blockers, and aldosterone antagonists (e.g., spironolactone). Some medications which increase heart function, such as the positive inotrope milrinone, lead to increased death, and are contraindicated. [9] [10]
Treatment typically involves uses of vasopressor, inotropes, fluid boluses, and introduction of resuscitation. [4] In case vasodilatory shock fails to respond to high doses of vasopressors (defined as ≥ 0.5 mg/kg/min norepinephrine-equivalent dose [ 7 ] ), meaning it's vasopressor-resistant and advances to being called refractory vasodilatory ...
Side effects of metaraminol include reflex bradycardia among others. Metaraminol is a norepinephrine releasing agent and at high doses a α 1-adrenergic receptor agonist with some β-adrenergic effect. [6] [7] [8] It is a substituted amphetamine and is closely related to phenylpropanolamine, ephedrine, and oxilofrine. [4] [5]