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Pharm 2 > E1. Shock > Flashcards

E1. Shock Flashcards

1
Q

Define shock

A

Decreased cellular energy production

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2
Q

List the types of shock.

A

Hypovolemic, cardiogenic, distributive, hypoxemic, metabolic,

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3
Q 
A life-threatening decrease in circulating blood volume is \_\_\_\_\_\_\_\_
A. Hypovolemic shock
B. Distributive shock
C. Cardiogenic shock
D. Hyperemic shock
E.  metabolic shock
A

A. Hypovolemic shock

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4
Q 
\_\_\_\_\_\_ results mainly from failure of adequate forward blood flow (diastolic, systolic, obstructive)
A. Hypovolemic shock
B. Distributive shock
C. Cardiogenic shock
D. Hyperemic shock
E.  metabolic shock
A

B. Distributive shock

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5
Q 
\_\_\_\_\_\_\_  is a condition in which systemic vascular resistance (SVR)  is abnormal causing maldistribution of blood flow ( vasodilatory shock, septic shock, systemic inflammatory response syndrome (SIRS), anaphylaxis, heat stroke, neurogenic shock)
A. Hypovolemic shock
B. Distributive shock
C. Cardiogenic shock
D. Hyperemic shock
E.  metabolic shock
A

C. Cardiogenic shock

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6
Q 
\_\_\_\_ is caused by decreased blood and oxygen content (anemia,methemoglobinemia, carbon monoxide poisoning, hypoventilation, pulmonary parenchymal disease).
A. Hypovolemic shock
B. Distributive shock
C. Cardiogenic shock
D. Hyperemic shock
E.  metabolic shock
A

D. Hyperemic shock

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7
Q

______ is caused by deranged cellular metabolism that leads to decreased cellular energy production(
cyanide and bromethalin poisoning, severe hypoglycemia, relative adrenal insufficiency, severe pH changes, cytopathic hypoxia)
A. Hypovolemic shock
B. Distributive shock
C. Cardiogenic shock
D. Hyperemic shock
E. metabolic shock

A

E. metabolic shock

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8
Q 
A dog has been hit by a car and is bleeding badly, what type of shock  Will the dog go into?
A. Hypovolemic shock
B. Distributive shock
C. Cardiogenic shock
D. Hyperemic shock
E.  metabolic shock
A

A. Hypovolemic shock

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9
Q

What might be seen in early shock (compensated shock)? (5)

A
  • Tachycardia
  • Normal or mild decreased mentation
  • Normal, pale, or hyperemic mucous membranes
  • Tachypnea, strong pulse quality
  • Normotension
  • Early signs of shock may not be clinically obvious because of compensatory mechanisms
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10
Q

What might be seen in intermediate shock (early decompensated shock)? (12)

A
  • Profound vasoconstriction
  • Increase in salt and water retention (renin-angiotensin- aldosterone and ADH stimulation)
  • Organ dysfunction
  • Pale mucous membranes
  • Prolonged capillary refill time (CRT)
  • Tachycardia
  • Poor pulse quality
  • Hypotension
  • Decreased mentation
  • Weakness
  • Cool extremities
  • Decreased rectal temperature
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11
Q

What might you see in late shock (late decompensated shock or irreversible shock)? (6)

A
  • Stupor or coma
  • Pale mucous membranes
  • Prolonged or absent CRT
  • Bradycardia
  • Hypothermia
  • Poor or absent pulse quality
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12
Q

What are the vasopressors used to correct hypotension? Give classification then drugs. (3 classes, 3 drugs)

A

Nonselective alpha agonists (norepinephrine and epinephrine)
Selective alpha one agonists (Phenylephrine)
Vasopressin

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13
Q

What is not needed in any type of shock, but may be needed if the shock patient has an adrenal insufficiency?

A

Glucocorticoids

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14
Q

Get the 3 types of monitoring shock.

A

Physical examination
Laboratory
Advanced macrohemodynamic monitoring

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15
Q

List what’s involved in your physical examination of shock. (6)

A 
– Heart rate (HR)
– Mucous membrane color – Capillary Refill Time (CRT)
– Respiratory rate (RR)
– Temperature
– Mentation
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16
Q

List what’s involved in your laboratory monitoring of shock. (8)

A 
– Blood pressure (BP)
– Hematocrit
– Electrolytes
– Blood gases
– Urine output
– Central venous pressure – Body weight
– Blood pH
17
Q

Give a breakdown of adults body weight in water percent. Give the breakdown of the neonates body weight in water.

A

Adult 60% (40% is intracellular (ICF) (20% is extracellular fluid (ECF) (15% is in the interstitial space and 5% is in the intravascular space))) is water.
80% of the neonates body is water.

18
Q

What are the isotonic crystalline solutions used to treat shock? (5)

A 
– 0.9% NaCl solution (isotnoic saline, NS)
– Ringer’s solution (RS)
– Lactated Ringer’s solution (LRS)
– Sodium gluconate and acetate solutions
» Normosol-R 
» Paslma-lyte-A
19
Q

What can you add to crystalloids? (5)

A 
– 50% dextrose
– Potassium
– Sodium bicarbonate
– Calcium 
– Vitamins
20
Q

List your natural and synthetic colloids? (3 of each)

A 
• Natural colloids
– Whole blood
– Plasma
– Albumin (human/dogs)
• Synthetic colloids 
– Dextrans
– Hydroxyethyl starch (hetastarch)
– Hemoglobin glutamer-200 (Oxyglobin)
21
Q

What are the negative side effects of fluid therapy? (10)

A

– Fluid overload and life-threatening pulmonary edema
– Dilutional coagulopathy
– Hypoproteinemia
– Caution with LRS in liver disease patients
– Rapid administration of hypertonic or hypotonic solutions may cause destruction of RBCs
– Rapid administration of maintenance crystalloids may cause hyperkalemia
– Subcutaneous administration of dextrose may cause irritation and necrosis
– Human albumin may cause hypersensitivity reactions
– Caution with colloids in renal disease patients
– Hypertonic solutions should not be used dehydration

22
Q

Where the 4 ways you can get fluid therapy?

A

Intravenous
subcutaneous
intraperitoneal
oral rehydration

23
Q

Why would you use intravenous fluid therapy?

A

– Ideal route
– Essential in treatment of shock
– Necessary to place polyethene catheters

24
Q

Why would you use subcutaneous fluid therapy?

A

– Widely used
– Convenient
– Volumes given are limited and uptake is poor
– Inadequate for treatment of shock but may useful for maintenance after IV

25
Q

Why would you use intraperitoneal fluid therapy?

A

– Not widely used except for kittens and piglets where other routes are impractical
– Should not be used for plasma expanders

26
Q

Why would you use oral rehydration therapy?

A

– Very effective in reducing mortality in calves and piglets with enteritis

27
Q

What are the different levels of dehydration? Give the percentage of dehydration associated each.(5)

A
  • Mild or no evidence of clinical dehydration (4%)
  • Moderate dehydration (6%)
  • Severe dehydration (8%)
  • Circulatory insufficiency (12%)
  • Acute shock (up to 15%)
28
Q

Give symptoms associated with “mild or no evidence of dehydration” and “moderate dehydration”.

A

• Mild or no evidence of clinical dehydration (4%) – History of vomiting and diarrhea, and evidence of
thirst
• Moderate dehydration (6%)
– When the skin is lifted it will peak but will return to normal slowly
– The mucous membranes are dry but the tongue will still by moist

29
Q

Give symptoms associated with “severe dehydration”, “circulatory insufficiency”, and “acute shock”.

A

• Severe dehydration (8%)
– When the skin is lifted it will peak and stay
– Both the mucous membranes and the tongue will be dry
• Circulatory insufficiency (12%)
– All the classic signs of circulatory collapse are
evident
• Acute shock (up to 15%)
– Classic signs of acute shock

30
Q 
A dog came into your clinic with the case shock due to a decreased renal blood flow, what drug should use?
A. Glycopyrrolate
B. Naloxone
C. NSAIDs
D. Dopamine
E. None of the above
A

D. Dopamine

31
Q 
A dog came into your clinic with a case of shock due to endogenous endorphins, what should you use?
A. Glycopyrrolate
B. Naloxone
C. NSAIDs
D. Dopamine
E. None of the above
A

B. Naloxone

32
Q 
A dog came into your clinic with a case of shock due to an AV block, what should you use? 
A. Glycopyrrolate
B. Naloxone
C. Atropine
D. Dopamine
E.  two of the above
A

E. two of the above

A and B

33
Q

How would you treat systemic anaphylaxis?

A

– Epinephrine
• Slow IV, IM, or SQ at 0.01 mg/kg of 1:1000
• IV CRI
– Treatment of respiratory distress
• Intubation with endotracheal tube or perform
tacheostomy
• Supplemental oxygen if no airway obstruction
• Aminophylline if bronchodilation is refractory to epinephrine
– Cardiovascular support
• Hypovolemic shock secondary to increased vascular permeability
– Fluids (crystalloids or synthetic colloids)
– Blood products such as fresh frozen plasma for coagulopathy – Atropine for bradycardia if present
– Dopamine if refractory hypotension is present

34
Q

How would you treat septic shock?

A

– Antimicrobials
• Bactericidal
• Broad spectrum antibiotic combinations (e.g. fluorquinolone/β-lactam combination)
• Rapid systemic bioavailability preferably IV
• Maintenance with a specific antibiotic following sensitivity results
– Hypovolemia, hypotension and /or poor perfusion
• Fluids (isotonic crystalloids or colloids)
• Positive inotropes such as dobutamine
• Vasopressors such as dopamine, norepinephrine, or vasopressin are only used if volume resuscitation and positive inotropes failed to restore blood pressure
– Bacterial translocation from the GI may contribute to systemic inflammation during sepsis
• Placement of a feeding tube and enteral feeding or parenteral nutrition in vomiting animals
• Maintaining GI protective mechanisms (omperazole, ranitidine, sucralfate)
– Hyperglycemia should be avoided because it may increase systemic inflammation
– Supplemental oxygen
– Analgesics such as buprenorphine or ketamine but not morphine because it may increase inflammation
– Antiinflammatory agents
• Glucocorticoids are contraindicated except in patients
with adrenal insufficiency
• NSAIDs are contraindicated
• Human recombinant activated protein C has antithrombotic, profibrinolytic and antiinflammatory actions (studied in human clinical trials)
• Polymyxin B has antiinflammatory activity by binding to endotoxin from gram-negative bacteria

35
Q

How would you treat vasodilatory shock?

A

– Fluids

– Vasopressors

Pharm 2 (17 decks)

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