Milrinone (Primacor) Flashcards

Milrinone (Primacor) Overview

• Pharmacological Class: Phosphodiesterase inhibitor
• Therapeutic Class: Inotropic agent and vasodilator; classified as Pregnancy Risk Class C

Actions and Uses

• Indicated for short-term treatment of heart failure, primarily in ICU settings
• Inhibits phosphodiesterase, increasing intracellular levels of cyclic adenosine monophosphate (cAMP)
• Enhanced cAMP leads to:
  • Positive inotropic effects, improving heart contractility
  • Vasodilation, reducing preload and afterload on the heart

Administration Considerations

• Available only in injectable form
• Avoid injecting furosemide into IV lines with milrinone due to immediate precipitation risk
• If significant blood pressure drop occurs, slow or stop the infusion
• Continuous monitoring of EKG is required

Toxicity and Management

• No specific antidote is available for milrinone toxicity
• Excessive doses can cause hypotension due to vasodilation; may require dosage adjustment or temporary discontinuation until stabilization

Side and Adverse Effects

• Risk of dysrhythmias, particularly ventricular types (e.g., ventricular tachycardia, ventricular fibrillation)
• Potential side effects include hypotension, angina, hypokalemia, tremor, thrombocytopenia, and elevated liver enzymes

Nursing Considerations

• Essential to monitor heart rate (HR), blood pressure (BP), EKG patterns, renal function, brain natriuretic peptide (BNP) levels, and vital signs (V/S)
• Pay attention to signs of adverse effects or toxicity, facilitating prompt response if necessary

Contraindications

• Not suitable for patients with known allergies, severe aortic or pulmonary valve disease, or heart rate issues due to diastolic dysfunction