
Contents
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Chapter contents Chapter contents
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β-Adrenergic agonists β-Adrenergic agonists
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Effects of β-adrenergic agonists Effects of β-adrenergic agonists
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Drugs Drugs
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Epinephrine (adrenaline) Epinephrine (adrenaline)
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Norepinephrine (noradrenaline) Norepinephrine (noradrenaline)
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Isoprenaline Isoprenaline
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Dopamine Dopamine
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Dobutamine Dobutamine
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Dopexamine Dopexamine
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Ephedrine Ephedrine
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Salbutamol Salbutamol
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Role of β agonist drugs Role of β agonist drugs
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High-risk surgical patient High-risk surgical patient
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Post-cardiac surgery Post-cardiac surgery
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Cardiogenic shock Cardiogenic shock
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Septic shock Septic shock
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Multi-organ failure Multi-organ failure
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Further reading Further reading
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Phosphodiesterase inhibitors Phosphodiesterase inhibitors
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Non-selective PDE inhibitors Non-selective PDE inhibitors
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Methylxanthines Methylxanthines
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Selective PDE inhibitors Selective PDE inhibitors
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Phosphodiesterase type 3 Inhibitors Phosphodiesterase type 3 Inhibitors
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Milrinone Milrinone
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Enoximone Enoximone
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Amrinone Amrinone
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Dipyridamole Dipyridamole
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Phosphodiesterase type 4 inhibitors Phosphodiesterase type 4 inhibitors
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Phosphodiesterase type 5 inhibitors Phosphodiesterase type 5 inhibitors
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Sildenafil Sildenafil
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Further reading Further reading
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Vasodilators Vasodilators
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Nitrates Nitrates
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Glyceryl trinitrate (GTN) Glyceryl trinitrate (GTN)
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Isosorbide mononitrate (ISMN) Isosorbide mononitrate (ISMN)
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Isosorbide dinitrate (ISDN) Isosorbide dinitrate (ISDN)
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Directly acting vasodilators Directly acting vasodilators
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Sodium nitroprusside (SNP) Sodium nitroprusside (SNP)
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Hydralazine Hydralazine
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Diazoxide Diazoxide
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Calcium antagonists Calcium antagonists
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α-Adrenergic receptor antagonists α-Adrenergic receptor antagonists
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Other α receptor antagonists Other α receptor antagonists
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Mized α and β antagonists Mized α and β antagonists
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Centrally acting vasodilators Centrally acting vasodilators
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Angiotensin inhibitors Angiotensin inhibitors
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Angiotensin-converting enzyme (ACE) inhibitors Angiotensin-converting enzyme (ACE) inhibitors
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Pulmonary vasodilators Pulmonary vasodilators
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Pulmonary hypertension in the critically ill Pulmonary hypertension in the critically ill
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Chronic pulmonary vasodilator therapy Chronic pulmonary vasodilator therapy
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Further reading Further reading
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Vasopressors Vasopressors
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Classes of vasopressors Classes of vasopressors
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Indications Indications
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Contraindications and cautions Contraindications and cautions
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Effects and sideeffects Effects and sideeffects
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Cardiovascular effects Cardiovascular effects
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Effects on the splanchnic circulation Effects on the splanchnic circulation
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Effects on renal function Effects on renal function
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Effects on the skin Effects on the skin
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Metabolic effects Metabolic effects
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Pharmacology of specific agents Pharmacology of specific agents
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α1-Adrenoceptor agonists α1-Adrenoceptor agonists
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Vasopressin receptor agonists Vasopressin receptor agonists
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Guanylate cyclase inhibitors Guanylate cyclase inhibitors
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Use of vasopressors in specific situations Use of vasopressors in specific situations
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Septic shock Septic shock
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Cardiac arrest Cardiac arrest
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Brain injury Brain injury
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Further reading Further reading
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Antiarrhythmic agents Antiarrhythmic agents
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Clinical classification Clinical classification
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Commonly used antiarrhythmic agents Commonly used antiarrhythmic agents
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Verapamil Verapamil
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Adenosine Adenosine
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Digoxin Digoxin
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β-Blockers β-Blockers
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Esmolol Esmolol
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Amiodorone Amiodorone
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Procainamide Procainamide
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Sotalol Sotalol
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Lignocaine Lignocaine
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Magnesium Magnesium
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Key points Key points
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Further reading Further reading
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Chronotropes Chronotropes
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Isoprenaline Isoprenaline
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Indications Indications
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Contraindications Contraindications
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Adverse effects Adverse effects
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Dobutamine Dobutamine
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Adrenaline Adrenaline
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Atropine Atropine
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Adverse effects Adverse effects
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Glycopyrrolate Glycopyrrolate
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Glucagon Glucagon
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Adverse effects Adverse effects
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Triiodothyronine (T3) Triiodothyronine (T3)
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Esmolol Esmolol
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Contraindications Contraindications
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Propanolol Propanolol
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Adverse effects Adverse effects
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Metoprolol Metoprolol
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Verapamil Verapamil
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Adverse effects Adverse effects
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Diltiazem Diltiazem
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Adverse effects Adverse effects
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Magnesium Magnesium
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Caution Caution
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Digoxin Digoxin
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Disadvantages Disadvantages
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Adverse effects Adverse effects
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Amiodarone Amiodarone
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Adverse effects Adverse effects
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Electrical methods Electrical methods
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Advantages Advantages
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Indications for temporary cardiac pacing: Indications for temporary cardiac pacing:
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Indications for permanent pacing: Indications for permanent pacing:
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Further reading Further reading
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Antianginal agents Antianginal agents
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Pathophysiology Pathophysiology
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β-Blockers β-Blockers
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Other beneficial actions Other beneficial actions
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Cardiac and circulatory adverse actions Cardiac and circulatory adverse actions
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Extracirculatory adverse actions Extracirculatory adverse actions
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Pharmacokinetics and drug specifics Pharmacokinetics and drug specifics
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β-Blocker overdose β-Blocker overdose
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Calcium channel blockers Calcium channel blockers
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Pharmacokinetics and drug specifics Pharmacokinetics and drug specifics
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Calcium channel blocker overdose Calcium channel blocker overdose
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Nitrates Nitrates
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Other antianginal drugs Other antianginal drugs
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Further reading Further reading
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Antiplatelet agents Antiplatelet agents
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Aspirin Aspirin
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Clinical use Clinical use
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Issues in intensive care Issues in intensive care
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Dipyridamole Dipyridamole
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Clopidogrel Clopidogrel
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Clinical use Clinical use
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Acute coronary syndrome Acute coronary syndrome
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Post-coronary stenting Post-coronary stenting
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Issues in intensive care Issues in intensive care
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GpIIb/IIIa receptor antagonists GpIIb/IIIa receptor antagonists
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Clinical use Clinical use
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Epoprostenol (prostacyclin, PGI2, Flolan®) Epoprostenol (prostacyclin, PGI2, Flolan®)
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Summary of indications Summary of indications
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Aspirin Aspirin
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Dipyridamole Dipyridamole
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Clopidogrel Clopidogrel
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GpIIb/IIIa inhibitors GpIIb/IIIa inhibitors
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Further reading Further reading
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Diuretics and the critically ill Diuretics and the critically ill
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Introduction Introduction
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Tissue oedema, pulmonary oedema and ascites Tissue oedema, pulmonary oedema and ascites
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Appropriateness of diuretics for oedema Appropriateness of diuretics for oedema
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Indications for diuretic therapy Indications for diuretic therapy
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Commonly used diuretics in the critically ill Commonly used diuretics in the critically ill
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Thiazides Thiazides
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Bendrofluazide Bendrofluazide
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Metolazone Metolazone
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Loop diuretics Loop diuretics
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Frusemide Frusemide
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Aldosterone antagonists Aldosterone antagonists
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Spironolactone Spironolactone
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Amiloride Amiloride
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Potassium canrenoate Potassium canrenoate
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Carbonic anhydrase inhibitors Carbonic anhydrase inhibitors
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Acetazolamide Acetazolamide
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Osmotic diuretics Osmotic diuretics
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Mannitol Mannitol
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Further reading Further reading
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Levosimendan Levosimendan
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Clinical Studies Clinical Studies
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Drug Use Drug Use
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References References
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Cite
Extract
Chapter contents
...
β-Adrenergic agonists
β-Adrenergic agents are used commonly for cardiovascular support in critical care to increase cardiac output via β1 receptor-mediated inotropic and chronotropic effects (see Chapter 11.6) in order to maintain adequate organ perfusion.
Non-cardiovascular indications for β2 agonists include bronchodilatation (Chapter 10.1) and uterine relaxation. Research is ongoing into the potential benefits of β2 agonists in reducing EVLW in patients with ARDS.
Effects of β-adrenergic agonists
Most β-adrenergic agonists in clinical use are active at more than one type of adrenergic receptor (β1, β2, β3, α1 and α2).
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The clinical effects of a specific agent result from the sum of actions at different receptors and may alter as dose increases. In addition, effects may vary with alterations in intravascular volume.
As with vasoconstrictor drugs, it is important to optimize circulating volume for a particular patient before initiating β agonist therapy. This may include the use of cardiac output monitoring.
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