The RV Inotrope
Inodilator for right ventricular failure. Works independently of -receptors, making it ideal for beta-blocked patients. Long half-life (2-4 hours) requires careful monitoring.
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Mechanism: PDE3 Inhibitor: Prevents breakdown of cAMP increases intracellular Calcium. Independent of -receptors.
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Dosing: Loading: 50 mcg/kg over 10 min. Maintenance: 0.375-0.75 mcg/kg/min. Renal Failure: Dose adjust or avoid in AKI (accumulates refractory hypotension).
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PK: Half-life: 2–4 hours (Much longer than dobutamine). Clearance: Renal.
indications
- Right Ventricular Failure – Specific niche (Preferentially reduces Pulmonary Vascular Resistance / PVR)
- Beta-Blocked Patients – Drug of choice if patient is on chronic beta-blockers (works downstream of the blocked receptor)
cautions
- Hypotension: Significant risk due to duration of effect. Often needs Norepinephrine support. If hypotension occurs, it takes hours to wash out
- Renal Failure: Dose adjust or avoid in AKI (accumulates refractory hypotension)
clinical pearl
The Beta-Blocked Patient: Drug of choice if the patient is on chronic beta-blockers (works downstream of the blocked receptor).