Vasopressors: Choosing the Right Agent with Dr. Harmon

Pressors save lives, but only when they match the real problem. Dr. Matthew Harmon joins us to decode how norepinephrine, phenylephrine, and vasopressin change vascular tone, cardiac output, and organ perfusion—and how to pick the right one under pressure. We start with a crisp hemodynamic framework: MAP as the product of cardiac output and SVR, and stroke volume shaped by preload, contractility, and afterload. From there, we translate receptor pharmacology into bedside choices so you can raise pressure without stealing flow.We walk through why norepinephrine’s strong alpha-1 with modest beta-1 support often makes it a go-to for septic shock and low EF patients, delivering perfusion pressure while keeping heart rate and myocardial oxygen demand in check. Phenylephrine earns its place for anesthetic-induced hypotension and aortic stenosis by tightening vessels and slowing the heart, but we call out its hidden tax on flow when contractility lags. Then we pivot to vasopressin’s V1 pathway, ideal for catecholamine-resistant vasodilation, ACE inhibitor–induced vasoplegia, and acidotic states where adrenergic drugs stumble—plus practical dosing that avoids gut and skin hypoperfusion.Throughout, we focus on individualizing MAP targets, honoring cerebral and renal autoregulation, and protecting patients in high-risk scenarios like sitting shoulder surgery. You’ll hear why short-acting agents beat long-acting antihypertensives intraop, how to convert ICU drip instincts to precise push-dose habits, and when to rethink nitrous, ephedrine, and ketamine. We also share CRNA interview prep you can use today: anchor answers in ACLS and PALS, show your receptor-level reasoning, and explain not just what you’d do, but why.If you’re an ICU nurse eyeing anesthesia, or a practicing provider sharpening your pressor playbook, this session brings clarity you can use on your next case. Subscribe, share with a teammate who loves clean hemodynamics, and leave a review with your favorite pressor pearl. Want more support as you prepare for CRNA school? Get 7 days FREE inside CRNA School Prep Academy!Explore the CSPA community, learning pathways, clinical education, interview prep, and resources designed to help you become a stronger, more confident CRNA school applicant.👉 Start your 7 days FREE inside CSPA [HERE]We’re heading to Panama City, Florida for the 2027 CRNA School Prep Academy Conference, hosted in partnership with Florida State University! Join us September 10–12, 2027 for an inspiring weekend designed for aspiring CRNAs who are ready to grow, connect, and take the next step toward nurse anesthesia school.Join the waitlist today and be the first to know when tickets become available.Get free CRNA school prep resources, guidance, and tools right inside the CSPA app so you can keep moving toward your CRNA goals with more clarity and confidence. 👉Download the App