Pressors

All the pressors you mentioned as well as other cardioactive meds have different effect on SVR, HR, myocardial contractillity. If you are off orientation you should know the effect of the most common meds and what to titrate based on the patients hemodynamic parameters. I'm not faulting you- your hospital should never have allowed someone off orientation to an CVICU without a fair understanding of the effects and complications of these meds. It would be a post of several pages to go over what you should know to safely use these meds. The general idea is do you want a faster heart rate,more forceful contraction, more vascular constriction/ or are you seeing too much of these properties and reducing the optimal function of the patients heart.

These drugs work on different receptors. I'm familiar with coming off neo (alpha 1 agonist) first (because it's your adjunct or 3rd line pressor), then vaso (works on ADH), then levo (works on alpha 1 & 2, and beta, and various other receptors). You should definitely know what these drugs effects are, if any on heart rate and contractility. For example, Neo does not affect rate or contractility. Neither does vaso. Levo can affect rate (but not nearly to the degree of dopamine and epi, which also, by the way do have some effect on contractility, but nearly as much such so as milrinone or dobutatime), does not really affect contractility. Just take a little time to get more familiar with their modes of action. If ever in doubt what to titrate off of first, think it through, and double check with an experienced nurse for guidance. Say something like..."I'm thinking of titrating down such as such drug, by so much, is that what you would do?" Also, sometimes MDs will specifically say, titrate off such and such drug first, then the next one. And when in doubt, always check with the MD. Also, as a side note, in general drugs can, in different dosages work on different receptors =)

I appreciate your input but I do know the basics of each drug as far as what Increases/decreases HR and bp or contractility etc. I am getting the hang of it more as I have been admitting more frequently and getting some sicker patients and not just the darn chronics. Just didn't know specifics as far as why one is preferred vs the other and why...thanks :)

To answer your question as to why some pressors are preferred over the other, it basically all boils down to MD preferrence as well as each patients specific case. Each patient reacts differently to each pressor. The important thing is to get a firm understanding on what receptors they stimulate and efficacy of each one as explained by sugarmagnolia.

It's also a balancing act betweed providing adequate tissue prefusion and decrease myocardial oxygen demand. A relatively high SVR will tire out your heart more so levophed might be more effecient than dopa or if more contractility is needed, dopa or epi might serve it's purpose.

It's also important to fix volume first before fixing SVR or contractility.

Come on suanna! She a new grab working in the CVICU. Good for you by the way! And I'm happy you finally got your question answered. But to Suanna maybe instead of tell us what she "should" know and what the hospital "should've done', maybe just help her. I've been in a MICU for 2 years and still have to ask questions and review. Congratulations to you though for be so smart:no: