Milrinone

Question 1

What is the trade name of Milrinone Lactate?

Answer 1

Primacor

Question 2

What is the formal drug classification of Milrinone?

Answer 2

Milrinone Lactate is a bypyridine inotropic/vasodilator agent with phosphodiesterase inhibitor activity

Question 3

What are the clinical uses of Milrinone?

Answer 3

-short term treatment of patients with acute decompensated heart failure, managment of acute LV dysfunction following cardiac surgery, weaning patients from cardiopulmonary bypass, calcium antagonist intoxication, and short term IV therapy of congestive heart failure

Question 4

Is Milrinone good for CHF?

Answer 4

Inotrope of choice for severe congestive heart failure patients taking beta blockers

Question 5

What is the MOA of Milrinone?

Answer 5

Selective phosphodiesterase inhibitors act by selectively inhibiting Phosphodiesterase (PDE) III, which is the heart specidifc enzyme responsible for the degradation of cAMP/ cGMP. This inhibition decreases hydrolysis of cAMP and cGMP in the myocardium and vascular smooth muscle, which leads to increased intracellular concentrations in the heart and vascular smooth muscle

• the increased intracellular cAMP concentrations activate protein kinases that promote phosphorylation and increase intracellular calcium stores
• The increase in intracellular calcium in the heart increases contractility and inotropy
• Increased cAMP in the vascular smooth muscle causes vasodilation and decreases peripheral vascular resistance

Question 6

What is the onset of action of IV Milrinone?

Answer 6

5-15 minutes

Question 7

When does the peak response occur for IV Milrinone?

Answer 7

after 5 minutes

Question 8

How is Milrinone excreted?

Answer 8

approximately 80% of the drug is excreted unchanged by the kidneys; therefore it should be decreased in patients with severe renal diease

Question 9

What is the E 1/2 time of Milrinone?

Answer 9

2.5 Hours

Question 10

Which patients have a prolonged 1/2 life of Milrinone?

Answer 10

patients with severe CHF have a reduction in systemic clearance and therefore have prolonged 1/2 life

Question 11

What is the Volume of Distribution of Milrinone? What is special about the peds/ children?

Answer 11

0. 32 - 0.45 L/kg
   - Infants and children demonstrate a larger volume of distribution and clearance of milrinone compared with adults, and thus need higher loading dose.

Question 12

Is Milrinone protein bound?

Answer 12

70% protein bound

Question 13

What are the side effects of Milrinone?

Answer 13

• Cardiac dysrhythmias, including ventricular and supraventricular arrhythmias
• Hypotension
• Angina
• Headaches
• Hypokalemia
• Tremor
• Thrombocytopenia

Question 14

What are precautions/warnings to Milrinone?

Answer 14

• Avoid in severe obstructive aortic or pulmonary vascular disease
• Ensure ventricular rate controlled in afib
• Adjust dose in renal dysfunction
• Monitor and correct fluid and electrolyte problems

Question 15

When is Milrinone NOT recommended for use?

Answer 15

in acute MI

Question 16

What is a contraindication to the use of Milrinone?

Answer 16

Hypersensitivity to Milrinone, inamrinone, or any component of the formulation; concurrent use of inamrinone

Question 17

What are the drug interactions with Milrinone?

Answer 17

-None noted. Milrinone is compatible with other adrenergic agonists

Question 18

Which drug will form precipitation if given with Milrinone?

Answer 18

Milrinone and furosemide will form a precipitate when administered in the same IV line

Question 19

With regards to IV infusion, which drugs are compatible with Milrinone, which drugs are not?

Answer 19

Compatible: Atropine, Calcium Chloride, Digoxin, Epi, Lidocaine, Morphine, Propranolol, and sodium Bicarbonate

Incompatible: Furosemide and Procainamide

Question 20

What is the loading dose for Milrinone?

Answer 20

Loading dose: 50 mcg/kg IV over 10 minutes

Question 21

What is the maintenance dose for Milrinone, and not to exceed?

Answer 21

0.375 - 0.75 mcg/kg/min not to exceed 1.13 mcg/kg/day

Question 22

When should you omit a loading dose of Milrinone and initiated maintenance doses?

Answer 22

if Hypotension is a problem

Question 23

What is the standard dilution of Milrinone?

Answer 23

For a final concentration of 0.2mg/ml: Dilute Primacor 1mg/mL (10mL) with 40 mL diluents (final volume: 50mL)

Administration requires an infusion pump; continuous IV infusion; 20mg/100 ml 0.9% sodium chloride or D5W (0.2 mg/mL)