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Topic:Pharmacology

Pharmacology in horses involves the study and application of drugs and medications to diagnose, treat, and prevent diseases and conditions in equine species. This field encompasses the understanding of pharmacokinetics and pharmacodynamics specific to horses, including how drugs are absorbed, distributed, metabolized, and excreted by the equine body. Commonly studied pharmacological agents in horses include non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics, sedatives, and anthelmintics. Research in equine pharmacology focuses on determining appropriate dosages, understanding drug interactions, and minimizing adverse effects. This page compiles peer-reviewed research studies and scholarly articles that investigate the efficacy, safety, and regulatory aspects of pharmacological interventions in equine veterinary practice.
Association of a mutation in the ryanodine receptor 1 gene with equine malignant hyperthermia.
Muscle & nerve    August 20, 2004   Volume 30, Issue 3 356-365 doi: 10.1002/mus.20084
Aleman M, Riehl J, Aldridge BM, Lecouteur RA, Stott JL, Pessah IN.Equine malignant hyperthermia MH has been suspected but never genetically confirmed. In this study, we investigated whether mutations in a candidate gene, RyR1, were associated with MH in two clinically affected horses. RyR1 gene sequences revealed polymorphisms in exons 15, 17, and 46 in WTRyR1 and MHRyR1 horses with one derived amino acid change in MHRyR1 exon 46, R2454G. The MHRyR1 horses were genetically heterozygous for this mutation, but presented an MH phenotype with halothane challenge. Skeletal sarcoplasmic reticulum from a R2454G heterozygote collected during a fulminant MH episode s...
Treatment of inflammatory airway disease in young standardbreds with interferon alpha.
The Canadian veterinary journal = La revue veterinaire canadienne    August 20, 2004   Volume 45, Issue 7 594-601 
Moore I, Horney B, Day K, Lofstedt J, Cribb AE.The effect of oral treatment with natural or recombinant human interferon alpha (HIA) on inflammatory airway disease in young standardbreds was assessed in a double-blind, randomized clinical trial. A total of 34 horses with nasal discharge, excess mucus in the trachea, and a persistent cough of at least 2 weeks' duration that interfered with training completed the trial. Horses were rested for 1 week and received oral treatment with either a saline placebo, recombinant human interferon alpha (rHIA; 90 U/horse/day), or natural human interferon alpha (nHIA: 50 U/horse/day) for 5 days. There was...
In-vitro contraction of the equine aortic valve.
The Journal of heart valve disease    August 18, 2004   Volume 13, Issue 4 593-599 
Bowen IM, Marr CM, Chester AH, Wheeler-Jones CP, Elliott J.The equine aortic valve is subject to non-inflammatory degenerative changes, associated with aortic valvular regurgitation (AR). This disease shares pathological and epidemiological features with AR in humans, and may serve as a useful model to study in-vitro functional responses associated with aging and disease. The study aim was to determine the contractile properties of the normal equine aortic valve. Methods: The contractile responses of equine aortic valves to angiotensin II, the thromboxane-mimetic U44069, endothelin-1, 5-hydroxytryptamine and the alpha-adrenoceptor agonists medetomidin...
Use of topical mitomycin C in myoplasty of the medial rectus muscle of rabbits.
Veterinary ophthalmology    August 18, 2004   Volume 7, Issue 5 335-342 doi: 10.1111/j.1463-5224.2004.04026.x
Mamede FV, Laus JL, Cabral VP, Vicenti FA, Barbieri-Neto J.To possibly reduce postoperative adhesions that occur after ocular myoplasties, we investigated the topical effects of 0.04% mitomycin C on the repaired areas of the medial rectus muscle using an equine renal capsule preserved in 98% glycerin for reinforcement of the sutures. Twenty-four rabbits, divided into two groups of 12 animals each [untreated (control) and treated group (MMC)], were submitted to surgical rupture of the medial rectus muscle of one eye and repair of the defect 24 h later with sutures and an equine renal capsule. Post-operative prophylactic treatment of the two groups cons...
[Amitraz intoxications in the horse: cases and backgrounds].
Tijdschrift voor diergeneeskunde    July 29, 2004   Volume 129, Issue 13 438-441 
Westermann CM, Boerma S, van Nieuwstadt RA.Since the only registrated anti-ectoparasiticum for horses (foxim) is no longer available in The Netherlands, some cases of amitraz intoxication of the horse have occurred. In this article the literature concerning amitraz intoxications and experiments will be discussed and some cases will be described.
Suppressing reproductive activity in horses using GnRH vaccines, antagonists or agonists.
Animal reproduction science    July 24, 2004   Volume 82-83 633-643 doi: 10.1016/j.anireprosci.2004.04.009
Stout TA, Colenbrander B.There are a number of situations in which it is desirable to suppress part or all of the reproductive endocrine system in a horse, notably the competing animal whose tractability during training, or performance during competition, is compromised by the expression of sexual or aggressive behavior. The current therapeutic approaches to reproductive endocrine suppression include gonadectomy and progestagen administration, where the former carries surgical risks and entails irreversible loss of breeding potential, and effective progestagen therapy requires frequent administration for extended peri...
Detection of endogenous boldenone in the entire male horses.
Journal of chromatography. B, Analytical technologies in the biomedical and life sciences    July 21, 2004   Volume 808, Issue 2 287-294 doi: 10.1016/j.jchromb.2004.05.018
Ho EN, Yiu KC, Tang FP, Dehennin L, Plou P, Bonnaire Y, Wan TS.Boldenone (1,2-dehydrotestosterone) is a common veterinary anabolic agent. Its structure is very similar to testosterone. Testosterone is endogenous in the horse, whereas there has been no report concerning the detection of endogenous boldenone. This paper reports the direct observation of sulphate conjugate of boldenone in equine urine from entires. The detection procedures involved solid-phase extraction, immunoaffinity column (IAC) purification, and then LC-MS-MS analysis on a Q-ToF instrument. The identification of boldenone sulphate has provided direct evidence for the endogenous nature o...
Effect of anaesthesia of the palmar digital nerves on proximal interphalangeal joint pain in the horse.
Equine veterinary journal    July 16, 2004   Volume 36, Issue 5 409-414 doi: 10.2746/0425164044868404
Schumacher J, Livesey L, DeGraves FJ, Schumacher J, Schramme MC, Hathcock J, Taintor J, Gomez J.Anaesthesia of the palmar digital nerves is claimed to attenuate lameness in some horses that are lame because of pain in the proximal interphalangeal (PIP) joint. Objective: To determine the response of horses with pain in the PIP joint to anaesthesia of the palmar digital nerves. Methods: Horses were video recorded trotting before and after induction of pain in the PIP joint and 10 mins after anaesthesia of the palmar digital nerves. The palmar digital nerves were anaesthetised 3 times at different sites, and the video recorded gaits were scored subjectively. Results: The median lameness sco...
Polymyxin B protects horses against induced endotoxaemia in vivo.
Equine veterinary journal    July 16, 2004   Volume 36, Issue 5 397-401 doi: 10.2746/0425164044868350
Barton MH, Parviainen A, Norton N.A safe, affordable and effective treatment for endotoxaemia in horses is needed in order to reduce the incidence of this potentially fatal condition. Objective: To evaluate the effect of polymyxin B (PMB) on signs of experimentally-induced endotoxaemia. Objective: PMB ameliorates the adverse effects of endotoxaemia without causing nephrotoxicity. Methods: Four groups of 6 healthy mature horses each received 20 ng endotoxin/kg bwt i.v. over 30 mins. Additionally, each group received one of the following i.v.; 5000 u PMB/kg bwt 30 mins before endotoxin infusion; 5000 u PMB/kg bwt 30 mins after e...
Efficacy of oral and intravenous dexamethasone in horses with recurrent airway obstruction.
Equine veterinary journal    July 16, 2004   Volume 36, Issue 5 426-430 doi: 10.2746/0425164044868413
Cornelisse CJ, Robinson NE, Berney CE, Kobe CA, Boruta DT, Derksen FJ.Although the efficacy of dexamethasone for the treatment of recurrent airway obstruction (RAO) has been documented, the speed of onset of effect and duration of action are unknown, as is the efficacy of orally administered dexamethasone with or without fasting. Objective: To document the time of onset of effect and duration of action of a dexamethasone solution i.v. or orally with and without fasting. Methods: Protocol 1 used 8 RAO-affected horses with airway obstruction in a crossover design experiment that compared the effect of i.v. saline and dexamethasone (0.1 mg/kg bwt) on pulmonary func...
Effects of flunixin meglumine or etodolac treatment on mucosal recovery of equine jejunum after ischemia.
American journal of veterinary research    June 17, 2004   Volume 65, Issue 6 761-769 doi: 10.2460/ajvr.2004.65.761
Tomlinson JE, Wilder BO, Young KM, Blikslager AT.To examine the effects of flunixin meglumine and etodolac treatment on recovery of ischemic-injured equine jejunal mucosa after 18 hours of reperfusion. Methods: 24 horses. Methods: Jejunum was exposed to 2 hours of ischemia during anesthesia. Horses received saline (0.9% NaCl) solution (12 mL, i.v., q 12 h), flunixin meglumine (1.1 mg/kg, i.v., q 12 h), or etodolac (23 mg/kg, i.v., q 12 h). Tissue specimens were obtained from ischemic-injured and nonischemic jejunum immediately after ischemia and 18 hours after recovery from ischemia. Transepithelial electric resistance (TER) and transepithel...
Effects of trimethoprim-sulfadiazine on thyroid function of horses.
Journal of veterinary internal medicine    June 11, 2004   Volume 18, Issue 3 370-373 doi: 10.1892/0891-6640(2004)18<370:eototf>2.0.co;2
Rothschild CM, Hines MT, Breuhaus B, Gay J, Sellon DC.Trimethoprim-sulfadiazine was administered to horses in a randomized, placebo controlled study to determine the effects of potentiated sulfonamides on thyroid function in normal horses. The treatment group included eight horses that received trimethoprim-sulfadiazine mixed with molasses orally at 30 mg/kg once daily for eight weeks. The control group included 8 horses that received an oral placebo (flour mixed with molasses) once daily for the same period. Thyroid function was evaluated prior to initiation of treatment and after 8 weeks of treatment. Serum concentrations of total and free trii...
Detection and confirmation of ractopamine and its metabolites in horse urine after Paylean administration.
Journal of analytical toxicology    June 11, 2004   Volume 28, Issue 4 226-238 doi: 10.1093/jat/28.4.226
Lehner AF, Hughes CG, Harkins JD, Nickerson C, Mollett B, Dirikolu L, Bosken J, Camargo F, Boyles J, Troppmann A, Karpiesiuk WW, Woods WE, Tobin T.We have investigated the detection, confirmation, and metabolism of the beta-adrenergic agonist ractopamine administered as Paylean to the horse. A Testing Components Corporation enzyme-linked imunosorbent assay (ELISA) kit for ractopamine displayed linear response between 1.0 and 100 ng/mL with an I-50 of 10 ng/mL and an effective screening limit of detection of 50 ng/mL. The kit was readily able to detect ractopamine equivalents in unhydrolyzed urine up to 24 h following a 300-mg oral dose. Gas chromatography-mass spectrometry (GC-MS) confirmation comprised glucuronidase treatment, solid-pha...
Phenytoin sodium as a treatment for ventricular dysrhythmia in horses.
Journal of veterinary internal medicine    June 11, 2004   Volume 18, Issue 3 350-353 doi: 10.1892/0891-6640(2004)18<350:psaatf>2.0.co;2
Wijnberg ID, Ververs FF.Five adult horses with ventricular extra systoles (VES) and 2 with ventricular tachycardia (VT) refractory to treatment with rest, anti-inflammatory drugs, lidocaine, or procainamide were treated with phenytoin sodium p.o. q12h. The starting dosage of phenytoin was 20 or 22 mg/kg body weight (BW) q12h, and the maintenance dosage varied from 8 to 17 mg/kg BW q12h. The mean +/- standard deviation therapeutic blood concentration of total phenytoin was 8.8 +/- 2.1 mg/L, and the mean concentration of free phenytoin of 2.5 +/- 0.5 mg/L was relatively constant at a range of 24 to 29% of the total phe...
A modified critical test for the efficacy of pyrantel pamoate for Anoplocephala perfoliata in equids. Slocombe JO.Aims of this study with 13 equids naturally infected with Anoplocephala perfoliata were to document (i) a critical test with a period of 48 h from treatment to necropsy to assess the efficacy of an anthelmintic against the tapeworm, (ii) the efficacy of pyrantel pamoate oral paste at 13.2 mg pyrantel base/kg body weight, and (iii) the time after treatment when fecal egg counts would best estimate the tapeworm's prevalence in a herd. Feces passed in successive 12-h periods after treatment were examined for tapeworms. At necropsy, tapeworms in equids were identified as attached to the mucosa or ...
Deslorelin on Day 8 or 12 postovulation does not luteinize follicles during an artificially maintained diestrous phase in the mare.
Theriogenology    May 26, 2004   Volume 62, Issue 1-2 57-64 doi: 10.1016/j.theriogenology.2003.07.024
Glazar BS, McCue PM, Bruemmer JE, Squires EL.Practical estrus synchronization schemes are needed for mares. The Ovsynch synchronization protocol for cattle involves the administration of gonadotropin-releasing hormone (GnRH) to induce ovulation or luteinization of dominant follicles during the luteal phase and prostaglandin 7 days later to cause regression of any luteal tissue and development of a preovulatory follicle. An Ovsynch-type synchronization program potentially could be developed for horses if luteinization or ovulation of diestrous follicles occurred in response to GnRH treatment. The objective of this study was to determine i...
The effects of vasoactive amines found in the equine hindgut on digital blood flow in the normal horse.
Equine veterinary journal    May 19, 2004   Volume 36, Issue 3 267-272 doi: 10.2746/0425164044877297
Bailey SR, Menzies-Gow NJ, Marr CM, Elliott J.Disturbances of digital blood flow are thought to be fundamental to the pathophysiology of acute laminitis. However, factors linking the initiating events in the equine hindgut with these disturbances in the foot remain to be determined. Objective: Amine compounds, formed by bacteria in the equine hindgut, have digital vasoconstrictor effects in vivo. Methods: Tryptamine (1.6 microg/kg/min) and phenylethylamine (2.13 microg/kg/min) were infused i.v. into standing nonsedated horses. Digital blood flow was measured by Doppler ultrasound and foot surface temperature was monitored. Plasma 5-hydrox...
Serum insulin concentrations in horses with equine Cushing’s syndrome: response to a cortisol inhibitor and prognostic value.
Equine veterinary journal    May 19, 2004   Volume 36, Issue 3 295-298 doi: 10.2746/0425164044877288
McGowan CM, Frost R, Pfeiffer DU, Neiger R.Serum insulin concentration and its use as a prognostic indicator in horses with equine Cushing's syndrome (ECS) have been poorly documented. Objective: To examine daily insulin variations in horses with ECS and the effect of treatment using trilostane, a competitive inhibitor of 3beta-hydroxysteroid dehydrogenase. Further, we aimed to examine the relationship between baseline serum insulin concentration and survival in horses with ECS. Methods: Basal serum insulin concentrations were measured in 20 confirmed ECS cases by taking blood at regular 4 h intervals for 24 h (1200, 1600, 2000, 2400, ...
Evidence for vascular and enzymatic events in the pathophysiology of acute laminitis: which pathway is responsible for initiation of this process in horses?
Equine veterinary journal    May 19, 2004   Volume 36, Issue 3 204-209 doi: 10.2746/0425164044877116
Moore RM, Eades SC, Stokes AM.To date, there is a substantial amount of data to support the hypotheses that vascular and enzymatic changes are ongoing in experimental laminitis. Furthermore, there is substantial in vitro evidence that the enzymatic changes weaken the dermo-epidermal attachments leading to mechanical failure of the hoof-bone interface of the equine digit. However, investigators of both the vascular and enzymatic theories have, to date, been unable to substantiate the effects of these pathophysiological changes in vivo on laminar tissues of horses afflicted with experimentally induced or naturally acquired l...
Effects of epidural opioid analgesics on heart rate, arterial blood pressure, respiratory rate, body temperature, and behavior in horses.
Veterinary therapeutics : research in applied veterinary medicine    May 12, 2004   Volume 4, Issue 4 364-375 
Natalini CC, Robinson EP.Heart rate, arterial blood pressures, respiratory rate, body temperature, and central nervous system excitement were compared before and after epidural administration of morphine (0.1 mg/kg), butorphanol (0.08 mg/kg), alfentanil (0.02 mg/kg), tramadol (1.0 mg/kg), the k-opioid agonist U50488H (0.08 mg/kg), or sterile water using an incomplete Latin square crossover design in five conscious adult horses. Treatments were administered into the first intercoccygeal epidural space. Significant (P <.05) reductions in respiratory rate were detected after epidural administration of morphine, alfent...
Allergen challenge alters lymphocyte phosphodiesterase activity in horses with heaves.
Pulmonary pharmacology & therapeutics    May 5, 2004   Volume 17, Issue 3 163-172 doi: 10.1016/j.pupt.2004.02.001
Rickards KJ, Page CP, Cunningham FM.Heaves is an allergic airway disease in horses characterised by reversible airway obstruction, bronchial hyperresponsiveness and airway inflammation associated with a Th(2) response. Cyclic nucleotide-dependent signalling pathways can regulate lymphocyte function. In this study, we examined lymphocyte PDE activity comparing horses with heaves to healthy control animals. Total PDE activity and the effects of isoenzyme selective inhibitors were measured before, 5 and 24 h after the start of a 7 h allergen challenge. Allergen challenge had no effect on either total cAMP PDE activity or its inhibi...
Evaluation of a larval development assay (DrenchRite) for the detection of anthelmintic resistance in cyathostomin nematodes of horses.
Veterinary parasitology    April 28, 2004   Volume 121, Issue 1-2 125-142 doi: 10.1016/j.vetpar.2003.09.016
Tandon R, Kaplan RM.A larval development assay (LDA, DrenchRite) was evaluated to determine the effectiveness of this method in detecting anthelmintic resistance in cyathostomin nematodes of horses. A total of 15 horse farms from Georgia and South Carolina (USA) and Population S ponies from the University of Kentucky (USA) were included in this study. Nematode eggs were extracted from pooled fecal samples and placed into the wells of a DrenchRite plate for testing against thiabendazole (TBZ), levamisole (LEV) and 2 ivermectin (IVM) analogs (IVM-1, IVM-2). After a 7-day incubation larvae in each well were counted ...
Effects of the ACE inhibitor quinapril on echocardiographic variables in horses with mitral valve insufficiency.
Journal of veterinary medicine. A, Physiology, pathology, clinical medicine    April 28, 2004   Volume 50, Issue 9 460-465 doi: 10.1046/j.1439-0442.2003.00580.x
Gehlen H, Vieht JC, Stadler P.Twenty horses with mitral valve insufficiency, but without signs of congestive heart failure, and five horses without signs of heart disease were examined before and after medication with an angiotensin-converting enzyme (ACE) inhibitor. The examination included echocardiography assessment as well as heart catheterization. The echocardiographic examination included B-mode, M-mode, conventional and colour Doppler techniques. For 8 weeks, all horses were treated with Accupro 20 (active substance: Quinapril) at an oral dose rate of 120 mg/horse/day. A follow-up of the horses with mitral valve ins...
Immunophenotypic characterization and depletion of pulmonary intravascular macrophages of horses.
Veterinary research    April 22, 2004   Volume 35, Issue 1 39-51 doi: 10.1051/vetres:2003041
Parbhakar OP, Duke T, Townsend HG, Singh B.Pulmonary intravascular macrophages (PIMs) are present in horses and are believed to increase their sensitivity to endotoxin-induced cardio-pulmonary shock. However, owing to a lack of a marker for PIMs and the inability to isolate them, their precise contributions in the horse remain unknown. We designed this study to identify an immuno-phenotypic marker for PIMs and to develop a protocol for their transient depletion with gadolinium chloride (GC). GC is a lanthanide that has been used to deplete liver and lung macrophages. The horses (N = 15) were divided into control (n = 5) and GC-treated ...
The bioavailability and pharmacokinetics of glucosamine hydrochloride and chondroitin sulfate after oral and intravenous single dose administration in the horse.
Biopharmaceutics & drug disposition    April 15, 2004   Volume 25, Issue 3 109-116 doi: 10.1002/bdd.392
Du J, White N, Eddington ND.The purpose of this study was to determine if glucosamine (GL) hydrochloride (FCHG49) and low molecular weight (LMW) chondroitin sulfate (CS) (TRH122) are absorbed after oral administration to horses. The bioavailability of LMWCS was evaluated by quantifying the total disaccharides found in the plasma following chondroitinase ABC digestion. Methods: Two separate studies were conducted. In study 1, ten adult horses received the following four treatments in a randomized crossover fashion: (1) i.v. LMWCS (3 g of 8 kDa), (2) p.o. LMWCS (3 g of 8 kDa), (3) i.v. LMWCS (3 g of 16.9 kDa) and (4) p.o. ...
Effects of glycopyrrolate on cardiorespiratory function in horses anesthetized with halothane and xylazine.
American journal of veterinary research    April 14, 2004   Volume 65, Issue 4 456-463 doi: 10.2460/ajvr.2004.65.456
Teixeira Neto FJ, McDonell WN, Black WD, Duronghphongtorn S.To evaluate cardiopulmonary effects of glycopyrrolate in horses anesthetized with halothane and xylazine. Methods: 6 horses. Methods: Horses were allocated to 2 treatment groups in a randomized complete block design. Anesthesia was maintained in mechanically ventilated horses by administration of halothane (1% end-tidal concentration) combined with a constant-rate infusion of xylazine hydrochloride (1 mg/kg/h, i.v.). Hemodynamic variables were monitored after induction of anesthesia and for 120 minutes after administration of glycopyrrolate or saline (0.9% NaCl) solution. Glycopyrrolate (2.5 m...
In vitro effects of oxytetracycline on matrix metalloproteinase-1 mRNA expression and on collagen gel contraction by cultured myofibroblasts obtained from the accessory ligament of foals.
American journal of veterinary research    April 14, 2004   Volume 65, Issue 4 491-496 doi: 10.2460/ajvr.2004.65.491
Arnoczky SP, Lavagnino M, Gardner KL, Tian T, Vaupel ZM, Stick JA.To determine the effects of oxytetracycline on matrix metalloproteinase-1 (MMP-1) mRNA expression and collagen gel contraction by equine myofibroblasts in an effort to explain the mechanistic basis for the pharmacologic treatment of flexural deformities in foals. Methods: Cultured myofibroblasts from the accessory ligament (distal check ligament) of 6 foals. Methods: Collagen gel scaffolds seeded with equine myofibroblasts were cultured in individual culture dishes containing complete media (Dulbecco's modified Eagle medium with 10% fetal bovine serum) and oxytetracycline (0, 12.5, 25, or 75 m...
Treatment for a severe reaction to intravenous administration of diatrizoate in an anesthetized horse.
Journal of the American Veterinary Medical Association    April 13, 2004   Volume 224, Issue 7 1143-1112 doi: 10.2460/javma.2004.224.1143
Gunkel CI, Valverde A, Robertson SA, Thompson MS, Keoughan CG, Ferrell EA.A mature horse developed acute signs of bronchoconstriction causing hypoxemia and hypercapnia during anesthesia for computerized tomography of the maxillary sinus after i.v. administration of diatrizoate contrast medium. The horse was treated with aerosolized albuterol, atropine, and oxygen insufflation and recovered uneventfully despite severe hypoxemia and low hemoglobin saturation. The horse's condition continued to improve after treatment, and the horse was discharged with no further complications. Caution is advised with the use of contrast media in anesthetized horses.
Comparison of ropivacaine with a combination of ropivacaine and fentanyl for the caudal epidural anaesthesia of mares.
The Veterinary record    April 8, 2004   Volume 154, Issue 11 329-332 doi: 10.1136/vr.154.11.329
Ganidagli S, Cetin H, Biricik HS, Cimtay I.Two groups of six mares aged from eight to 18 years were anaesthetised by caudal epidural injections of ropivacaine (0.5 per cent, 0.1 mg/kg) or a combination of ripovacaine (0.08 mg/kg) and fentanyl (100 microg) in a randomised study. The onset of anaesthesia was significantly more rapid (P<0.001) and it lasted significantly longer (P<0.001) in the group anaesthetised with the combination of drugs. The surgical comfort scores of the group anaesthetised with the combination were higher than those of the group anaesthetised with ropivacaine alone (P<0.001), and the quality of intraoper...
Inotropes and vasopressors in adults and foals.
The Veterinary clinics of North America. Equine practice    April 6, 2004   Volume 20, Issue 1 77-106 doi: 10.1016/j.cveq.2003.12.003
Corley KT.Successful treatment with inotropes and vasopressors depends on an understanding of the interplay of flow, pressure, and resistance in the cardiovascular system and an appreciation of the pathophysiologic mechanisms leading to inadequate tissue perfusion. Any treatment strategy is necessarily a compromise between the requirements of different vascular beds.Furthermore. the underlying hemodynamic derangements can change rapidly. Therefore. inotropes and vasopressors should be titrated to measures of improved hemodynamic status, and the treatments should be frequently reviewed.
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