Today is phenylephrine day everyone! Thank u for following our shock/vasoactive drugs week so far. Phenylephrine is a pure alpha-adrenergic agonist, resulting in vasoconstriction with minimal ino/chronotropy. Midodrine is its oral equivalent. Main side effect: reflex bradycardia
Phenyl is useful in septic shock and for anesthesia-induced hypotension ncbi.nlm.nih.gov/pmc/articles/P…
ncbi.nlm.nih.gov/pmc/articles/P…
ncbi.nlm.nih.gov/pmc/articles/P…
ncbi.nlm.nih.gov/pmc/articles/P…
ncbi.nlm.nih.gov/pmc/articles/P…
Phenyl's pure alpha effect will increase diastolic BP and improve coronary perfusion. It's reflex bradycardia, leading to decrease myocardial oxygen demand makes it a helpful drug to be used in the hypotensive patient with severe AS pubmed.ncbi.nlm.nih.gov/21519053/
How about it's oral twin, midodrine? Despite the only FDA approved use being orthostatic hypotension, midorine has been increasingly being used in ICUs in refractory shock (in order to stop IV vasoactive drugs
pubmed.ncbi.nlm.nih.gov/26945564/
pubmed.ncbi.nlm.nih.gov/26945564/
We must remember that even used orally, midodrine is still a pressor, and the reason why it was started shouldn't be forgotten. Midodrine is continued in transitions of care in the majority of patients transferred out of the ICU
pubmed.ncbi.nlm.nih.gov/31107279/
@erin_barreto
pubmed.ncbi.nlm.nih.gov/31107279/
@erin_barreto
Bottom line: phenyl is great adjunct in patients with distributive shock (SVR below 700), for anesthesi-induced hypotension and for patients with severe AS who are hypotensive.
It's twin, midodrine, even though used orally, is still a pressor, so keep thinking about why the shock hasn't resolved and remember to discuss stopping it on transitions of care if the patient didn't come to the hospital on it (FDA approved for orthostatc hypotension)
