Which medications in the drug class Vasopressors are used in the treatment of Basilar Artery Thrombosis?

Updated: Jan 11, 2019
  • Author: Salvador Cruz-Flores, MD, MPH, FAHA, FCCM, FAAN, FACP, FANA; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

Vasopressors

These agents augment coronary and cerebral blood flow during the low-flow state associated with hypotension. If the MAP continues to be low despite fluid management, vasopressors such as dopamine, dobutamine, norepinephrine or phenylephrine should be used.

Dopamine

Dopamine stimulates adrenergic and dopaminergic receptors. Its hemodynamic effect depends on the dose. Lower doses primarily stimulate dopaminergic receptors that produce renal and mesenteric vasodilation. Higher doses produce cardiac stimulation and vasoconstriction.

Dobutamine

Dobutamine is a sympathomimetic amine with stronger beta effects than alpha effects. It produces systemic vasodilation and increases the inotropic state. Higher doses may cause an increase in heart rate, exacerbating myocardial ischemia. Dobutamine is the pressor of choice in patients with congestive heart failure.

Norepinephrine (Levophed)

Norepinephrine is a naturally occurring catecholamine with potent alpha-receptor and mild beta-receptor activity. It stimulates beta1- and alpha-adrenergic receptors, resulting in increased cardiac muscle contractility, heart rate, and vasoconstriction. Norepinephrine increases blood pressure and afterload. Increased afterload may result in decreased cardiac output, increased myocardial oxygen demand, and cardiac ischemia.

Norepinephrine is generally reserved for use in patients with severe hypotension (eg, systolic blood pressure <70mm Hg) or hypotension unresponsive to other medication.

Phenylephrine (Vazculep)

Produces systemic arterial vasoconstriction, which in turn results in dose dependent increases in systolic and diastolic blood pressure and reductions in heart rate and cardiac output, especially in patients with heart failure. As a second-line treatment, phenylephrine (Neo-Synephrine) may be added to or substituted for dopamine.


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