Challenge Your Exam Readiness With Our Free CCP-C Practice Questions

For septic shock with persistent hypotension after adequate fluid resuscitation, first-line vasopressor therapy is norepinephrine. It primarily stimulates α1 receptors with some β1 activity, improving vascular tone and MAP with less tachyarrhythmia than dopamine. While central venous administration is preferred, evidence supports initiating norepinephrine through a well-placed large-bore peripheral IV in a proximal vein (forearm/antecubital) with frequent site checks during transport. Initial dosing commonly starts at 0.05–0.1 mcg/kg/min (or 2–5 mcg/min titrated to MAP ≥65 mmHg), titrating to effect. Phenylephrine (A) is pure α-agonist and can decrease stroke volume; it’s reserved for specific scenarios (e.g., catecholamine-induced tachyarrhythmias). Dopamine (C) at 10–20 mcg/kg/min increases tachyarrhythmia risk and is no longer favored. Epinephrine (D) is acceptable as an alternative pressor, but its β-effects increase lactate and tachycardia; it’s typically second-line in septic shock. Monitor for extravasation and have phentolamine available if permitted by protocol.