USMLE

Milrinone

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Cardiovascular Pharm
  1. Adenosine
  2. Magnesium
  3. Nitroprusside
  4. Nitrates
  5. Ivabradine
  6. Digoxin/Digitalis
  7. Class IA Antiarrhythmics
  8. Class IB Antiarrhythmics
  9. Class IC Antiarrhythmics
  10. Class II Antiarrhythmics
  11. Class III Antiarrhythmics - Amiodarone
  12. Class III Antiarrythmics - Sotalol
  13. Class III Antiarrhythmics - Ibutilide, Dofetilide
  14. Class IV Antiarrhythmics - Verapamil, Diltiazem
  15. HMG-CoA Reductase Inhibitors (Statins)
  16. Ezetimibe
  17. Fibrates
  18. PCSK9 Inhibitors (Alirocumab, Evolocumab)
  19. Fish Oil and Omega-3s
  20. Milrinone
  21. Aliskiren
  22. Hydralazine
  23. Ranolazine
  24. Sacubitril

Summary

Milrinone is a selective PDE-3 inhibitor used for short-term treatment of acute heart failure. By blocking PDE3, milrinone increases cAMP levels in the heart, which leads to increased contractility. Milrinone’s inhibition of PDE3 also affects the blood vessels to cause vasodilation. This can result in the adverse effect of hypotension.

Key Points

  • Milrinone
    • Mechanism
      • Selective PDE3 inhibitor
        • Prevents PDE-mediated degradation of of cAMP
    • Clinical Use
      • Acute decompensated heart failure
        • Increased cAMP in cardiomyocytes causes Ca2+ influx
        • Increases contractility (ionotropy) and heart rate (chronotropy)
      • Pulmonary arterial hypertension (PAH)
    • Adverse Effects
      • Arrhythmias
      • Hypotension
        • In vascular smooth muscle, increase in cAMP induces vasodilation, causing decreased SVR and decreased BP