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Rationale. There is no high-quality primary evidence to recommend one catecholamine over another. Much literature exists that contrasts the physiologic effects of choice of vasopressor and combined inotrope/vasopressors in septic shock [ 73 – 85 ]. Human and animal studies suggest some advantages of norepinephrine and dopamine over epinephrine (the latter with the potential for tachycardia as well as disadvantageous effects on splanchnic circulation and hyperlactemia) and phenylephrine (decrease in stroke volume). There is, however, no clinical evidence that epinephrine results in worse outcomes, and it should be the first chosen alternative to dopamine or norepinephrine. Phenylephrine is the adrenergic agent least likely to produce tachycardia, but as a pure vasopressor would be expected to decrease stroke volume. Dopamine increases mean arterial pressure and cardiac output, primarily due to an increase in stroke volume and heart rate. Norepinephrine increases mean arterial pressure due to its vasoconstrictive effects, with little change in heart rate and less increase in stroke volume compared with dopamine. Either may be used as a first-line agent to correct hypotension in sepsis. Norepinephrine is more potent than dopamine and may be more effective at reversing hypotension in patients with septic shock. Dopamine may be particularly useful in patients with compromised systolic function but causes more tachycardia and may be more arrhythmogenic [ 86 ]. It may also influence the endocrine response via the hypothalamic-pituitary axis and have immunosuppressive effects.

It was decades later that the secret behind this spectacular success became known.  The East German Sports Federation had, with the help of the Stasi, used Performance Enhancing Drugs or PEDs to ensure that their athletes gained international recognition by winning the Olympic events. This systematic plan had been initiated in 1974 as a means to guarantee international glory through the achievement of gold medals at the prestigious sporting event. Oral- Turinabol , a testosterone derivative was used extensively to improve muscle mass and cut down recovery time. This allowed the German athletes to train harder and longer than other world athletes. 

Epo steroid forum

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