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pharm exam 2 > drug therapy shock & hypotension > Flashcards

drug therapy shock & hypotension Flashcards

1
Q

chronotropic effect

A

causing a change in heart rate

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2
Q

dromotropic effect

A

causing a change in speed of electrical conduction in the heart(velocity)

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3
Q

inotropic effect

A

causing a change in myocardial contraction(force)

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4
Q

pressor

A

effect that increase blood pressure

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5
Q

what are homeostatic mechanisms

A

autonomic reflexes, capillary fluid shifts, variations in neurohormones

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6
Q

normotensive

A

having a normal blood pressure

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7
Q

causes of hypotension

A

failure of heart to pump effectively, blood or fluid loss, extreme stress that depletes NE (dehydration, N/V, diarrhea)

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8
Q

hypotension impacts

A

decreased O2 delivery to tissues, accumulation of waste products, shock, cell death

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9
Q

negative hemodynamic effects of hypotension

A

shock

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10
Q

what is shock

A

clinical condition initiated by compromised oxygen delivery, oxygen consumption, and/or oxygen utilization that leads to cellular and tissue hypoxia

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11
Q

acute hypotension is a clinical indicator of

A

shock; the management will be ideally related to the underlying cause of shock

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12
Q

hypotension =

A

circulatory failure, decrease tissue perfusion

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13
Q

4 types of shocks

A

hypovolemic, cariogenic, obstructive, distributive

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14
Q

what is hypovolemic shock

A

deficient circulating volume; result of a hemorrhage, trauma, burns, diabetes insidious/ ketoacidosis; children often develop this shock from vomiting and diarrhea

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15
Q

what is cardiogenic shock

A

pumping problem with the heart; MI, cardiac dysrhythmias or a valve or ventricle septum rupture

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16
Q

what is obstructive shock

A

obstruction of outflow; mass, accumulation of fluid, or blood clot, prevents heart from adequately pump

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17
Q

what is distributive shock

A

massive vasodilation

18
Q

distributive shock has 3 subsets of shock, what are they

A

anaphylactic, neurogenic, septic

19
Q

what is anaphylactic shock

A

major vasodilation caused by histamine release in severe allergic reactions

20
Q

hat is neurogenic shock

A

major vasodilation from high level spinal cord injuries because there is a loss of signals from the sympathetic nervous system

21
Q

what is septic shock.

A

major vasodilation r/t inflammatory mediators as a result of a overwhelming infection

22
Q

what are the three stages of shock

A

compensated, uncompensated, irreversible

23
Q

what is the compensated stage of shock

A

first stage “preshock”, body attempt to restore hemostasis, increase HR/ vasoconstriction (activation of SNS)

24
Q

what is the uncompensated stage of shock

A

“decompensated”, r/t compensated shock = not diagnosised or left untreated, compensatory mechanism worsen organ dysfunction, CO/BP is low = hypo perfusion = endothelial damage = decrease capillary blood flow, CO/HR/BP continue to decrease

25
Q

s/sx of uncompensated shock

A

cool/ clammy skin, restlessness, diaphoretic, decrease/concentrated urine output; if rapid medical attention - may be a treatable condition

26
Q

what is irreversible shock

A

“end stage”, permanent and irreversible damage, irreversible tissue and end organ damage (multiple organ failure), renal failure (anuric), anerobic metabolism = lactic acidosis = decreased CO/ severe hypotension

27
Q

medications used for hypotension/ shock

A

adrenergic agonists/ vasopressors

28
Q

example of adrenergic agonists/ vasopressor

A

norepinephrine; alpha adrenergic agonist/ emergency drug in the treatment of acute cardiovascular and respiratory collapse/ severe hypotension/ shocks

29
Q

therapeutic action of adrenergic agonists/ vasopressor

A

cause potent peripheral arterial vasoconstriction, which will cause an increase in blood pressure and at times will also increase the HR, it will also increase force of contraction and CO

30
Q

pharmacokinetics of adrenergic agonists/ vasopressor

A

immediate onset/ metabolized via monoamine oxidase (MAO) and catechol-O-methylthransferase, excreted in urine

31
Q

adverse effects of adrenergic agonists/ vasopressor

A

decreased renal perfusion, decrease liver perfusion, cardiac dysrhythmias, limb ischemia (r/t vasoconstriction), extravasation

32
Q

nursing considerations when using adrenergic agonists/ vasopressor

A

monitor urine output, monitor ALT/AST, tissue and circulation checks, monitor IV sites

33
Q

contraindications of adrenergic agonists/ vasopressor

A

cardiac dysrhythmias, angina pectoris, hypertension, hyperthyroidism and cerebrovascular disease, narrow angle glaucoma, can worse anxiety, insomnia and some psychiatric disorders

34
Q

other adrenergic agonists/ vasopressor medications

A

phenylephrine, epinephrine, dopamine (critical care medications)

35
Q

what does epinephrine do for hypotension

A

stimulates alpha and beta adrenergic receptors (potent vasoconstrictor), emergency medication, increased HR/ contractility and vasoconstrictor

36
Q

what does dopamine do for hypotension

A

potent alpha adrenergic agonist, low dose= dilates renal and coronary arteries, high dose = increase HR/ vasoconstrictor

37
Q

what does dobutamine do for hypotension

A

stimulates beta 1 receptors, low dose= increase contractility = increase CO, does not cause tachycardia (incompatible with bicarb/ run separately)

38
Q

nursing concerns with medications for hypotension

A

must be ACLS certified; fluids first (not with CHF pts), infusion pump(maybe 3, 4, 5), arterial line(in radial artery/ continuers BP reading), central line, titrate meds per protocol, DC slowly(discontinue), assess skin integrity and perfusion, close monitor of VS and UOP(urine output)

39
Q

extravasation is

A

the leakage of an intravenous or IV fluid with potential damaging medications into the extravascular tissue around the site of infusion

40
Q

what to do if extravasation occurs

A

stop infusion immediately, leave the needle/ catheter in place and slowly aspirate as much of the drug as possible (do not apply pressure to area), remove IV access while aspirating, elevate area for 48 hours to minimize swelling -> give phentolamine (alpha blocker)

pharm exam 2 (8 decks)

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