Vasopressors: Inodilators, Inopressors, Pure Vasopressors, Methylene Blue, Midodrine

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Ninja Nerds!
In this high-yield pharmacology and critical care lecture, Professor Zach Murphy breaks down the spectrum of vasopressors and inotropes, focusing on their mechanisms of action, receptor profiles, clinical indications, and when to use them based on the type of shock and hemodynamic status.

We begin by classifying these agents into functional categories:
• Inopressors (e.g., Norepinephrine, Epinephrine, Dopamine): Drugs with both inotropic (↑ contractility) and vasopressor (↑ vascular tone) effects—ideal for distributive and cardiogenic shock
• Inodilators (e.g., Dobutamine, Milrinone): Drugs that increase cardiac output while promoting vasodilation—useful in low-output heart failure and cardiogenic shock with elevated afterload
• Pure Vasopressors (e.g., Phenylephrine, Vasopressin): Drugs that raise systemic vascular resistance without significant cardiac stimulation—used in neurogenic shock, septic shock adjuncts, or when tachyarrhythmias limit beta-agonist use

We also discuss:
• Methylene Blue: A rescue agent for refractory vasodilatory shock, working by inhibiting nitric oxide–mediated vasodilation
• Midodrine: An oral alpha-1 agonist used in chronic orthostatic hypotension and as a weaning agent from IV vasopressors in the ICU

The lecture emphasizes receptor pharmacology (α, β, DA, V1), dosing strategies, monitoring parameters, and how to individualize therapy based on preload, afterload, cardiac output, and MAP targets. We also address key side effects like arrhythmias, tachyphylaxis, ischemia, and extravasation injury.

Enjoy the lecture and support us below!

Table of Contents:
0:00 Lab
0:08 Vasopressors Introduction
0:36 Inodilators - Dobutamine, Milrinone, and Isoproterenol
23:02 Inopressors - Epinephrine, Norepinephrine, and Dopamine
43:10 Pure Vasopressors - Phenylephrine, Vasopressin, and Angiotensin-II
1:07:35 Methylene Blue
1:17:13 Methods to Administrate Vasopressors
1:22:07 Midodrine - Alternative Vasopressor
1:26:06 Comment, Like, SUBSCRIBE!

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