Vasopressors and inotropes
Angiotensin II (Giapreza) drip
Giapreza
Dosing
| Start | 20 ng/kg/min |
|---|---|
| Titrate | Up to 15 ng/kg/min every 5 minutes |
| Maximum | 80 ng/kg/min in the first 3 hours, then 40 |
| Common bags | 2.5 mg in 250 mL (10 mcg/mL); 2.5 mg in 500 mL (5 mcg/mL) |
| Dose units | ng/kg/min |
Line and administration
- Central line advised
Watch for
- Thrombosis: give VTE prophylaxis
- Doses are nanograms
Angiotensin II: full drug monographIndications, mechanism, pharmacokinetics, cautions and every dose the app lists.
In the one-pagers
- Vasopressors and InotropesReceptors and effects: Angiotensin II: AT1: ↔ / ↔ / ↑↑
- After Cardiac SurgeryHemodynamics, low output and vasoplegia: Vasoplegia is low-SVR shock with a normal or high CI, reported in 5% to 45% depending on the definition (Unic-Stojanovic 2025; IBCC quotes about 5%). Drivers are excess nitric oxide and cGMP from inducible NO synthase, KATP channel opening and relative vasopressin deficiency. Risks: long bypass and cross-clamp, redo or complex surgery, preoperative ACE inhi
- Endocrine EmergenciesAdrenal physiology, adrenal crisis and stress-dose steroids: CRH and vasopressin drive pituitary ACTH, which drives cortisol with a morning peak; aldosterone answers mainly to angiotensin II and potassium. Cortisol is permissive for vascular tone (it sustains α₁ and angiotensin responsiveness and restrains NO), raises glucose and lets the kidney excrete free water; resting output is about 9–10 mg/
- Heart FailurePathophysiology: neurohormones, remodeling and phenotypes: Angiotensin II and aldosterone drive myocyte hypertrophy, apoptosis and fibrosis; norepinephrine is toxic to myocytes, provokes arrhythmias and downregulates β₁ receptors; vasopressin causes hyponatremia. Wall stretch releases the counterweight, ANP and BNP (natriuresis, vasodilation, RAAS inhibition), which neprilysin degrades: the reason
- Sepsis and Septic Shock BundleVasopressors and corticosteroids: Epinephrine is the third agent, or the first with cardiac dysfunction; expect lactate and glucose to rise. Angiotensin II (ATHOS-3, 2017, 321 patients on NE-equivalent >0.2 mcg/kg/min) raised MAP at 3 h in 69.9% vs 23.4%, with 28-day mortality 46% vs 54% (ns).
- Shock Types at a GlanceResuscitation endpoints, mixed and late shock: Refractory shock, loosely a norepinephrine-equivalent dose above 0.5–1 mcg/kg/min with persistent hypoperfusion, calls for a checklist: confirm the infusion is running and the arterial line is accurate, repeat the echo, give hydrocortisone, add vasopressin, correct ionized calcium, severe acidosis and hypothermia, consider angiotensin II or methylene
Practice Vasopressors and Inotropes questions free132 exam-style questions with rationales on the topic where angiotensin ii comes up most. No account or download needed.
Other vasopressors and inotropes
Practice free in your browser3,800+ exam-style questions with rationales. No account, no ads. Also free on the App Store and Google Play.
For education and exam preparation only. Follow your institution’s protocols. Study aid: check every dose against the order, the bag label, your pump library and your institution's protocol.