Intravenous agents for treatment of heart failure. (Update soon)

 DoseOnsetLastMechanismIndicationAdverse reactionComment
Nitroglycerine5-200 mcg/min. Infusion.
Start at 5-10 mcg/min.
Increase 5-10 mcg q 5-10 min.
2-5 min3-5 minVasodilatorLower LA pressure.
Lower BP.
Coronary insuffeciency
Hypotension, headache, GI upset, develope tolerancePatient with CVA may increase intracranial pressure.
Nitroprusside0.25-10 mcg/kg/min
Infusion. Start at lowest dose.
Immediate1-2 minVasodilatorLower BP. Lower afterload
Lower LA pressure.
Aortic dissection.
Hypotension, nausea, vomiting, muscle twitching, cyanide toxicity Avoid prolonged use in hepatic and renal insuffeciency to prevent cyanide toxicity
Require arterial line in hypotensive patient.
2 mcg/kg. Bolus. Then 0.01 mcg/kg/min infusion. Hemodynamic effect seen in <1 hr2-4 hr

Recombinant BNP. Vasodilator

Lower LA pressure.
Promote diuresis.
No tachyphylaxis
Hypotension, headache, nausea

May Use short term up to 7 days.
Caution in hypovolemia, AS and HOCM.
Caution in patient on ACEI.

DobutamineStart at 2.5 mcg/kg/min then 5.0, (or up to 7.5-20) q 1/2-1 hr.
Duration 48-72(or more)hr

Inotropic and chronotropic. Vasodilator.

Symptomatic improvement for heart failure class III and IV.
Increase CO and promote diurees

TachyarrhythmiasNo mortality benefit and may increase
Require ECG monitor.
Dopamine2-3 mcg/kg/min for renal perfusion.
5-20 mcg/kg/min for Increase BP.
..Inotropic and chronotropic. Vasoconstrictor at higher dose.

At low dose, increase renal perfusion., increase CO, promote diuresis.
At high dose, cause vasoconstrictor, increase BP. increase CO.

At high dose, increase afterload.

Require ECG monitor.
25-50 mcg/kg. Bolus over 15 min. Maintenance dose of 0.375-0.5 mcg/kg/min....Hypotension
No bolus if BP is low.
Prefer over Dobutamine in patient on chronic Beta blocker.
Require ECG monitor.

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