Drugs to Treat Shock

Question 1

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

Answer 1

Hydralazine

Question 2

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

Answer 2

Colchicine

Question 3

What is hypertensive urgency?

Answer 3

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

Question 4

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

Answer 4

labetalol

Question 5

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

Answer 5

Anaphylactic shock

Question 6

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

Answer 6

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

Question 7

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

Answer 7

Fenoldopam

Question 8

What can cause anaphylactic shock?

Answer 8

Penicillins, cephalosporins, bee stings, peanuts, etc

Question 9

What is essential BP?

Answer 9

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

Question 10

What causes acidosis?

Answer 10

lactic acid build up when tissue lacks oxygen

Question 11

When does tachycardia typically occur?

Answer 11

during shock

Question 12

Describe the skin in septic shock

Answer 12

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

Question 13

What is obstructive shock?

Answer 13

when something extrinsic to the heart is physically disrupting CO

Question 14

What is sympathomimetic hypertensive crisis?

Answer 14

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

Question 15

What is pericarditis?

Answer 15

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

Question 16

What is a potential adverse affect of anaphylactic shock?

Answer 16

Coronary vasoconstriction

Question 17

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

Answer 17

dobutamine

Question 18

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

Answer 18

central venous pressure

Question 19

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

Answer 19

Vasopressin

Question 20

What is immediately administered as treatment for anaphylactic shock?

Answer 20

epinephrine

Question 21

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

Answer 21

anxious

Question 22

When cells are anoxic what occurs?

Answer 22

intracellular edema

Question 23

What happens if there is fat in the venous blood?

Answer 23

obstructive shock

Question 24

What is hypovolemic shock?

Answer 24

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

Question 25

What is phenylephrine?

Answer 25

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

Question 26

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?

Answer 26

phentolamine

Question 27

When is crystalloid administered?

Answer 27

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

Question 28

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

Answer 28

lung sounds

Question 29

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

Answer 29

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

Question 30

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

Answer 30

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

Question 31

What is esmolol?

Answer 31

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

Question 32

What is an indication of brain hypoperfusion?

Answer 32

coma

Question 33

Cardiac tamponade can cause what?

Answer 33

obstructive shock due to RV compression

Question 34

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

Answer 34

obstructive (e.g. if saddle type)

Question 35

What is cardiogenic shock?

Answer 35

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

Question 36

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

Answer 36

corticosteroids (also a late choice for treating pericarditis)

Question 37

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

Answer 37

Shock due to blood loss

Question 38

What is enalaprilat?

Answer 38

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)

Question 39

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

Answer 39

diphenhydramine

Question 40

What is a clinical sign of shock?

Answer 40

hypotension

Question 41

What can cause hypertensive emergency?

Answer 41

acute ischemic stroke

Question 42

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

Answer 42

respiratory rate

Question 43

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

Answer 43

tension pneumothorax

Question 44

What is distributive shock?

Answer 44

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

Question 45

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

Answer 45

Acute kidney failure

Question 46

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

Answer 46

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

Question 47

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

Answer 47

bronchoconstriction

Question 48

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

Answer 48

Clevidipine

Question 49

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

Answer 49

obstructive shock

Question 50

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

Answer 50

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

Question 51

What are some features of nitroprusside?

Answer 51

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

Question 52

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

Answer 52

Non-dihydropyridine CCB

Question 53

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

Answer 53

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

Question 54

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

Answer 54

opioids

Question 55

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

Answer 55

NSAIDs

Question 56

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

Answer 56

NE

Question 57

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

Answer 57

Nitroglycerin

Question 58

When causes urine output to fall?

Answer 58

When blood loss exceeds 30-40% of total

Question 59

Where does fluid accumulate during septic shock?

Answer 59

third spaces because of leaky capillaries

Question 60

What makes an aortic dissection an emergency?

Answer 60

if it is ascending otherwise it is an urgency

Question 61

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

Answer 61

Cyanide (antidote = thiosulfate)