Drugs to Treat Shock Flashcards
Which drug is an arterial vasodilator with an unclear MOA, used in hypertensive emergencies and is also noteworthy for causing DIL?
Hydralazine
Which drug blocks microtubule formation, is useful in treating acute and recurrent pericarditis because it disrupts the leukocyte infiltration of the pericardium?
Colchicine
What is hypertensive urgency?
No evidence of end organ damage and conventional means should be taken to lower it
Which alpha/beta blocker can be used for hyperadrenergic hypertensive emergencies?
labetalol
Inhalation of albuterol can help relieve breathing problems associated with what?
Anaphylactic shock
What increases during the early hyper dynamic phase of septic shock?
CO and mixed venous oxygen tension due to the fall in systemic vascular resistance
Which dopamine-1 receptor agonist can be used to lower BP during hypertensive emergencies?
Fenoldopam
What can cause anaphylactic shock?
Penicillins, cephalosporins, bee stings, peanuts, etc
What is essential BP?
referred to BP elevation needed to provide adequate blood flow when vascular lumen was small
What causes acidosis?
lactic acid build up when tissue lacks oxygen
When does tachycardia typically occur?
during shock
Describe the skin in septic shock
Cold, typically appearing in the feet first (mottled and has petechiae), as this moves upward above the knees it signals irreversible multi system failure
What is obstructive shock?
when something extrinsic to the heart is physically disrupting CO
What is sympathomimetic hypertensive crisis?
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
What is pericarditis?
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
What is a potential adverse affect of anaphylactic shock?
Coronary vasoconstriction
Which drug stimulates beta1 receptors in the heart to increase CO if needed when treating shock, but also stimulates peripheral beta2 receptors?
dobutamine
Measuring jugular venous distension with a ruler in a pt at 45 degree incline is a means of assessing what?
central venous pressure
What drug is a non-adrenergic vasoconstrictor used as adjunctive therapy in shock?
Vasopressin
What is immediately administered as treatment for anaphylactic shock?
epinephrine
What is the mental status of someone with <30% blood loss?
anxious
When cells are anoxic what occurs?
intracellular edema
What happens if there is fat in the venous blood?
obstructive shock
What is hypovolemic shock?
form of shock where a primary decrease in pulmonary capillary wedge pressure gives rise to decreased CO
What is phenylephrine?
An alpha1 agonist administered if there is a need for peripheral vasoconstriction when beta1 stimulation causes arrhythmias or TPR remains low during beta1 stimulation
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?
phentolamine
When is crystalloid administered?
At ~30mg/kg body weight to raise JVP to 10-12cm H2O (unless shock is cariogenic)
What is used in addition to JVD to pinpoint the cause of hypotension and guide its tx?
lung sounds
If there is a hypertensive emergency due to intracranial hemorrhage what should be done?
Use IV drugs to lower BP <220mmHg (do not lower below 140 as this causes harm)
What is the name of the agent that stimulates beta receptors at lower doses and both alpha and beta receptors at high doses?
Dopamine; no evidence of meaningful renal sparing from vasoconstrictor effects because of D1 receptor stimulation
What is esmolol?
a short acting beta blocker that can be used in hypertensive emergencies, contraindications include bradycardia and decompensated HF
What is an indication of brain hypoperfusion?
coma
Cardiac tamponade can cause what?
obstructive shock due to RV compression
Pulmonary embolism can be a cause of what type of shock?
obstructive (e.g. if saddle type)
What is cardiogenic shock?
shock due to cardiac arrhythmia, MI, heart valve failure, etc
If septic shock is present administration of which drug will improve outcomes?
corticosteroids (also a late choice for treating pericarditis)
Which type of shock does not usually require a drug such as NE?
Shock due to blood loss
What is enalaprilat?
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)
What can be administered as adjunct therapy in pts with anaphylactic shock?
diphenhydramine
What is a clinical sign of shock?
hypotension
What can cause hypertensive emergency?
acute ischemic stroke
What typically increases 2-3x normal when blood loss is in the 30-40% of total range?
respiratory rate
What causes respiratory distress, tracheal deviation and decreased venous return leading to obstructive shock?
tension pneumothorax
What is distributive shock?
Shock in which there is a loss of arterial vascular tone and/or too much venous capacitance for adequate venous return
What is a potential adverse effect of shock and can be a cause of hypertensive emergency?
Acute kidney failure
Blood is generally not required for tx of blood loss unless it exceeds what?
30-40% when hematocrit and clotting factor dilution becomes more of a concern
What is an adverse effect seen with anaphylactic shock that is treated with epinephrine but not NE?
bronchoconstriction
What is the name of the ultra-short acting dihydropyridine CCB used for hypertensive emergencies?
Clevidipine
If air is present in the venous blood what can it cause?
obstructive shock
What needs to be given to a pt with an aortic dissection to keep them alive?
Esmolol or labetalol to lower HR to <60bpm and SBP to 100-120
What are some features of nitroprusside?
dIlates arterial and venous circulation; given IV; short half life allows hypertensive effect to be controlled with dial
What are alternative to lowering HR and SBP during tx of aortic dissection if esmolol and labetalol are contraindicated or unavailable?
Non-dihydropyridine CCB
Evidence now supports administration of what when septic shock is suspected?
Abx; only of benefit in pericarditis when underlying cause is bacteria infection
What is given IV to control the severe pain associated with aortic dissection?
opioids
What drug class can be used to tx the pain associated with pericarditis?
NSAIDs
What tends to be the best inotropic/vasoconstrictor agent for treating shock (other than anaphylactic)?
NE
Which drug selectively dilates the venous side of the circulation and is useful if hypertensive emergency is associated with acute pulmonary edema?
Nitroglycerin
When causes urine output to fall?
When blood loss exceeds 30-40% of total
Where does fluid accumulate during septic shock?
third spaces because of leaky capillaries
What makes an aortic dissection an emergency?
if it is ascending otherwise it is an urgency
What kind of toxicity is associated with prolonged use of nitroprusside to control BP?
Cyanide (antidote = thiosulfate)
