Vasopressors and inotropes

Nursing pharmacology study reference (NCLEX-style monograph). Numeric values are standard teaching ranges for study and must be verified against current manufacturer labeling before clinical use. This is educational content, not prescribing guidance.

Vasopressors and inotropes (brand name Levophed) — Vasopressor and inotrope; Adrenergic agonists (most), vasopressin analog, phosphodiesterase-3 inhibitor (milrinone).

Identification

• Therapeutic class: Vasopressor and inotrope.
• Pharmacologic class: Adrenergic agonists (most), vasopressin analog, phosphodiesterase-3 inhibitor (milrinone).

Pharmacology

• Mechanism of action: Increase blood pressure, cardiac output, or both by stimulating adrenergic receptors (epinephrine, norepinephrine, dopamine, dobutamine, phenylephrine), V1 receptors (vasopressin), or inhibiting phosphodiesterase (milrinone).
• Onset / peak / duration: Rapid IV onset; titrated by continuous infusion.
• Half-life / therapeutic level: Very short; titrate to hemodynamic targets.

Clinical use

• Indications: Shock and severe hypotension, cardiac arrest (epinephrine, vasopressin), low cardiac output (dobutamine, milrinone), anaphylaxis (epinephrine).
• Usual dose, route, frequency: IV infusion titrated to mean arterial pressure or cardiac output; epinephrine IV push or IM in arrest and anaphylaxis.
• Maximum dose / adjustments: Titrate to effect; central line preferred for potent vasopressors.

Safety

• Contraindications: Use with caution; relative based on the clinical emergency.
• Black box warning: None.
• Interactions: MAO inhibitors and tricyclics (exaggerated pressor response), beta blockers (blunted response), other vasoactive drugs.
• Pregnancy / lactation: Used in emergencies as needed.
• High-alert: Yes.

Adverse effects

• Common side effects: Tachycardia, arrhythmias, hypertension, anxiety; dobutamine and milrinone can cause hypotension.
• Serious effects to report: Severe hypertension, arrhythmia, organ or limb ischemia, extravasation causing tissue necrosis.
• Antidote / reversal: Phentolamine injected locally for extravasation; supportive care.

Nursing process

• Assessment before administration: Hemodynamics, IV access (central preferred), continuous monitoring readiness.
• Interventions during therapy: Use an infusion pump with continuous blood pressure and ECG monitoring; assess the IV site frequently for extravasation; titrate carefully; never stop abruptly.
• Monitor: Blood pressure, heart rate and rhythm, urine output, perfusion, IV site.
• Evaluation / expected outcome: Restored perfusion and blood pressure.

Patient teaching

• Patient teaching: Critical care setting; the team manages closely.
• Notify provider if: Not applicable (continuous monitoring); team responds to changes.
• Administration tips: Infusion pump and central access preferred; monitor the site for extravasation; high-alert double-check.