Which vasopressor acts primarily peripherally and is the preferred option during hypotension with arrhythmias?

Vasopressin is known for its primary action in vascular smooth muscle, leading to vasoconstriction, particularly in peripheral circulation. This property makes it an effective choice during episodes of hypotension, especially when arrhythmias are present, as it can help improve blood pressure without exacerbating cardiovascular instability.

In cases of hypotension with arrhythmias, it is crucial to avoid agents that may further increase heart rates or promote additional arrhythmogenic activity. Vasopressin not only addresses hypotensive states effectively through peripheral vasoconstriction but also does so without stimulating adrenergic receptors, which can trigger or worsen arrhythmias. This characteristic distinguishes it from other vasopressors that can have more significant central or cardiac effects.

Other agents, like epinephrine, while effective in raising blood pressure, also have intrinsic effects on heart rate and rhythm, making them less ideal in the context of pre-existing arrhythmias. Similarly, nitroprusside is a potent vasodilator, which would counteract the purpose of treating hypotension, and nicardipine is a calcium channel blocker that also does not address hypotension directly. Thus, vasopressin emerges as the preferred agent in this scenario due to its specific