Cardiovascular Medicine Book

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Intravenous Angiotensin 2

Aka: Intravenous Angiotensin 2, Intravenous Angiotensin II, Giapreza
  1. See Also
    1. Vasopressor
    2. Angiotensin
  2. Indications
    1. Septic Shock or other Distributive Shock
      1. Adjunct to other management (Intravenous Fluids, Vasopressors)
  3. Pharmacology
    1. See Angiotensin for mechanism
    2. Angiotensin 2 increases Blood Pressure
  4. Dosing: Adults
    1. Initial
      1. Start 20 ng/kg/min
      2. Titrate in 5 to 15 ng/kg/min increments every 5 min for Blood Pressure response
      3. Maximum: 80 ng/kg/min in first 3 hours of management
    2. Maintenance
      1. Titrate in 5 to 15 ng/kg/min increments down every 5 to 15 min
      2. Maximum: 40 ng/kg/min
      3. Lowest effective dose: 1.25 ng/kg/min
  5. Adverse Effects
    1. Venous Thromboembolism (e.g. DVT, PE)
      1. Most common adverse effect (>10% Incidence)
    2. Thrombocytopenia
    3. Tachycardia
    4. Fungal infection
    5. Delirium
    6. Acidosis
    7. Hyperglycemia
    8. Peripheral ischemia
  6. Drug Interactions
    1. ACE Inhibitors
      1. Increase response to Angiotensin 2
    2. Angiotensin Receptor Blockers (ARB)
      1. Decrease response to Angiotensin 2
  7. References
    1. LoVecchio (2018) Crit Dec Emerg Med 32(7): 28

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