Vasoactive medications, including inotropes and vasopressors, are used in the treatment of various shock states. Understanding the hemodynamic impact of shock on cardiac output, preload and afterload is important to identify the role of vasoactive medications. Through adrenergic and non-adrenergic mechanisms, inotropes increase myocardial contractility while vasopressors cause vasoconstriction of vascular smooth muscle. Studies evaluating vasopressors in shock have identified norepinephrine as a first-line therapy, especially in patients with septic shock. Vasoactive medication selection should be driven by the patient's presentation to achieve the desired hemodynamic effects while minimizing adverse effects.
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