Flashcards in Milrinone Deck (23)
What is the trade name of Milrinone Lactate?
What is the formal drug classification of Milrinone?
Milrinone Lactate is a bypyridine inotropic/vasodilator agent with phosphodiesterase inhibitor activity
What are the clinical uses of Milrinone?
-short term treatment of patients with acute decompensated heart failure, managment of acute LV dysfunction following cardiac surgery, weaning patients from cardiopulmonary bypass, calcium antagonist intoxication, and short term IV therapy of congestive heart failure
Is Milrinone good for CHF?
Inotrope of choice for severe congestive heart failure patients taking beta blockers
What is the MOA of Milrinone?
Selective phosphodiesterase inhibitors act by selectively inhibiting Phosphodiesterase (PDE) III, which is the heart specidifc enzyme responsible for the degradation of cAMP/ cGMP. This inhibition decreases hydrolysis of cAMP and cGMP in the myocardium and vascular smooth muscle, which leads to increased intracellular concentrations in the heart and vascular smooth muscle
-the increased intracellular cAMP concentrations activate protein kinases that promote phosphorylation and increase intracellular calcium stores
-The increase in intracellular calcium in the heart increases contractility and inotropy
-Increased cAMP in the vascular smooth muscle causes vasodilation and decreases peripheral vascular resistance
What is the onset of action of IV Milrinone?
When does the peak response occur for IV Milrinone?
after 5 minutes
How is Milrinone excreted?
approximately 80% of the drug is excreted unchanged by the kidneys; therefore it should be decreased in patients with severe renal diease
What is the E 1/2 time of Milrinone?
Which patients have a prolonged 1/2 life of Milrinone?
patients with severe CHF have a reduction in systemic clearance and therefore have prolonged 1/2 life
What is the Volume of Distribution of Milrinone? What is special about the peds/ children?
0.32 - 0.45 L/kg
-Infants and children demonstrate a larger volume of distribution and clearance of milrinone compared with adults, and thus need higher loading dose.
Is Milrinone protein bound?
70% protein bound
What are the side effects of Milrinone?
-Cardiac dysrhythmias, including ventricular and supraventricular arrhythmias
What are precautions/warnings to Milrinone?
-Avoid in severe obstructive aortic or pulmonary vascular disease
-Ensure ventricular rate controlled in afib
-Adjust dose in renal dysfunction
-Monitor and correct fluid and electrolyte problems
When is Milrinone NOT recommended for use?
in acute MI
What is a contraindication to the use of Milrinone?
Hypersensitivity to Milrinone, inamrinone, or any component of the formulation; concurrent use of inamrinone
What are the drug interactions with Milrinone?
-None noted. Milrinone is compatible with other adrenergic agonists
Which drug will form precipitation if given with Milrinone?
Milrinone and furosemide will form a precipitate when administered in the same IV line
With regards to IV infusion, which drugs are compatible with Milrinone, which drugs are not?
Compatible: Atropine, Calcium Chloride, Digoxin, Epi, Lidocaine, Morphine, Propranolol, and sodium Bicarbonate
Incompatible: Furosemide and Procainamide
What is the loading dose for Milrinone?
Loading dose: 50 mcg/kg IV over 10 minutes
What is the maintenance dose for Milrinone, and not to exceed?
0.375 - 0.75 mcg/kg/min not to exceed 1.13 mcg/kg/day
When should you omit a loading dose of Milrinone and initiated maintenance doses?
if Hypotension is a problem