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CPR II Exam 1 > Drugs to Treat Shock > Flashcards

Drugs to Treat Shock Flashcards

1
Q

Which drug is an arterial vasodilator with an unclear MOA, used in hypertensive emergencies and is also noteworthy for causing DIL?

A

Hydralazine

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2
Q

Which drug blocks microtubule formation, is useful in treating acute and recurrent pericarditis because it disrupts the leukocyte infiltration of the pericardium?

A

Colchicine

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3
Q

What is hypertensive urgency?

A

No evidence of end organ damage and conventional means should be taken to lower it

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4
Q

Which alpha/beta blocker can be used for hyperadrenergic hypertensive emergencies?

A

labetalol

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5
Q

Inhalation of albuterol can help relieve breathing problems associated with what?

A

Anaphylactic shock

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6
Q

What increases during the early hyper dynamic phase of septic shock?

A

CO and mixed venous oxygen tension due to the fall in systemic vascular resistance

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7
Q

Which dopamine-1 receptor agonist can be used to lower BP during hypertensive emergencies?

A

Fenoldopam

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8
Q

What can cause anaphylactic shock?

A

Penicillins, cephalosporins, bee stings, peanuts, etc

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9
Q

What is essential BP?

A

referred to BP elevation needed to provide adequate blood flow when vascular lumen was small

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10
Q

What causes acidosis?

A

lactic acid build up when tissue lacks oxygen

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11
Q

When does tachycardia typically occur?

A

during shock

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12
Q

Describe the skin in septic shock

A

Cold, typically appearing in the feet first (mottled and has petechiae), as this moves upward above the knees it signals irreversible multi system failure

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13
Q

What is obstructive shock?

A

when something extrinsic to the heart is physically disrupting CO

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14
Q

What is sympathomimetic hypertensive crisis?

A

can occur with the use of cocaine, amphetamines, etc or with the abrupt discontinuation of alpha2 agonists or beta blockers after a period of use to control BP

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15
Q

What is pericarditis?

A

pain behind the breastbone with a characteristic rub sound that typically shows PR depression and concave ST elevation in multiple leads and can interfere with cardiac filling causing obstructive shock

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16
Q

What is a potential adverse affect of anaphylactic shock?

A

Coronary vasoconstriction

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17
Q

Which drug stimulates beta1 receptors in the heart to increase CO if needed when treating shock, but also stimulates peripheral beta2 receptors?

A

dobutamine

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18
Q

Measuring jugular venous distension with a ruler in a pt at 45 degree incline is a means of assessing what?

A

central venous pressure

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19
Q

What drug is a non-adrenergic vasoconstrictor used as adjunctive therapy in shock?

A

Vasopressin

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20
Q

What is immediately administered as treatment for anaphylactic shock?

A

epinephrine

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21
Q

What is the mental status of someone with <30% blood loss?

A

anxious

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22
Q

When cells are anoxic what occurs?

A

intracellular edema

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23
Q

What happens if there is fat in the venous blood?

A

obstructive shock

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24
Q

What is hypovolemic shock?

A

form of shock where a primary decrease in pulmonary capillary wedge pressure gives rise to decreased CO

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25
Q

What is phenylephrine?

A

An alpha1 agonist administered if there is a need for peripheral vasoconstriction when beta1 stimulation causes arrhythmias or TPR remains low during beta1 stimulation

26
Q

What is the name of the early non selective alpha adrenergic blocker with a short half life that still has use during hypertensive emergencies caused by catecholamine excess?

A

phentolamine

27
Q

When is crystalloid administered?

A

At ~30mg/kg body weight to raise JVP to 10-12cm H2O (unless shock is cariogenic)

28
Q

What is used in addition to JVD to pinpoint the cause of hypotension and guide its tx?

A

lung sounds

29
Q

If there is a hypertensive emergency due to intracranial hemorrhage what should be done?

A

Use IV drugs to lower BP <220mmHg (do not lower below 140 as this causes harm)

30
Q

What is the name of the agent that stimulates beta receptors at lower doses and both alpha and beta receptors at high doses?

A

Dopamine; no evidence of meaningful renal sparing from vasoconstrictor effects because of D1 receptor stimulation

31
Q

What is esmolol?

A

a short acting beta blocker that can be used in hypertensive emergencies, contraindications include bradycardia and decompensated HF

32
Q

What is an indication of brain hypoperfusion?

A

coma

33
Q

Cardiac tamponade can cause what?

A

obstructive shock due to RV compression

34
Q

Pulmonary embolism can be a cause of what type of shock?

A

obstructive (e.g. if saddle type)

35
Q

What is cardiogenic shock?

A

shock due to cardiac arrhythmia, MI, heart valve failure, etc

36
Q

If septic shock is present administration of which drug will improve outcomes?

A

corticosteroids (also a late choice for treating pericarditis)

37
Q

Which type of shock does not usually require a drug such as NE?

A

Shock due to blood loss

38
Q

What is enalaprilat?

A

IV formulation of an ACEi administered orally as a pro-drug; can be useful when the underlying cause of a hypertensive emergency leads to high levels of renin secretion (e.g. acute unilateral renal stenosis)

39
Q

What can be administered as adjunct therapy in pts with anaphylactic shock?

A

diphenhydramine

40
Q

What is a clinical sign of shock?

A

hypotension

41
Q

What can cause hypertensive emergency?

A

acute ischemic stroke

42
Q

What typically increases 2-3x normal when blood loss is in the 30-40% of total range?

A

respiratory rate

43
Q

What causes respiratory distress, tracheal deviation and decreased venous return leading to obstructive shock?

A

tension pneumothorax

44
Q

What is distributive shock?

A

Shock in which there is a loss of arterial vascular tone and/or too much venous capacitance for adequate venous return

45
Q

What is a potential adverse effect of shock and can be a cause of hypertensive emergency?

A

Acute kidney failure

46
Q

Blood is generally not required for tx of blood loss unless it exceeds what?

A

30-40% when hematocrit and clotting factor dilution becomes more of a concern

47
Q

What is an adverse effect seen with anaphylactic shock that is treated with epinephrine but not NE?

A

bronchoconstriction

48
Q

What is the name of the ultra-short acting dihydropyridine CCB used for hypertensive emergencies?

A

Clevidipine

49
Q

If air is present in the venous blood what can it cause?

A

obstructive shock

50
Q

What needs to be given to a pt with an aortic dissection to keep them alive?

A

Esmolol or labetalol to lower HR to <60bpm and SBP to 100-120

51
Q

What are some features of nitroprusside?

A

dIlates arterial and venous circulation; given IV; short half life allows hypertensive effect to be controlled with dial

52
Q

What are alternative to lowering HR and SBP during tx of aortic dissection if esmolol and labetalol are contraindicated or unavailable?

A

Non-dihydropyridine CCB

53
Q

Evidence now supports administration of what when septic shock is suspected?

A

Abx; only of benefit in pericarditis when underlying cause is bacteria infection

54
Q

What is given IV to control the severe pain associated with aortic dissection?

A

opioids

55
Q

What drug class can be used to tx the pain associated with pericarditis?

A

NSAIDs

56
Q

What tends to be the best inotropic/vasoconstrictor agent for treating shock (other than anaphylactic)?

A

NE

57
Q

Which drug selectively dilates the venous side of the circulation and is useful if hypertensive emergency is associated with acute pulmonary edema?

A

Nitroglycerin

58
Q

When causes urine output to fall?

A

When blood loss exceeds 30-40% of total

59
Q

Where does fluid accumulate during septic shock?

A

third spaces because of leaky capillaries

60
Q

What makes an aortic dissection an emergency?

A

if it is ascending otherwise it is an urgency

61
Q

What kind of toxicity is associated with prolonged use of nitroprusside to control BP?

A

Cyanide (antidote = thiosulfate)

CPR II Exam 1 (11 decks)

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