Harvey Flashcards
What is shock?
Life threatening condition.
Body isn’t getting enough blood flow.
What are the 3 main forms of shock?
Hypovolemic: like a hemorrhage…loss of tissue perfusion
Cardiogenic: Heart failure–>insufficient flow to tissues–>blood pressure decreases
Vasodilatory: Septic or anaphylactic shock–>causes dilation of the vascular smooth muscle of blood vessels
A positive inotropic effect changes what determinant of BP?
Changes stroke volume.
Changes Cardiac output.
What determines systolic pressure?
Afterload.
TPR determines afterload.
alpha 1 vs. beta 2 determines TPR.
What determines diastolic pressure?
TPR.
alpha 1 vs. beta 2
What determines pulse pressure?
Stroke Volume.
Remember…contractiliity determines SV.
Beta 1 determines contactility.
What changes does NE cause w/ the following: Mean Arterial Pressure Systolic Pressure Diastolic Pressure Pulse Pressure TPR HR
Mean Arterial Pressure: increases
Systolic Pressure: increases (alpha 1 effect)
Diastolic Pressure: increases (alpha 1 effect)
Pulse Pressure: increases (SV up b/c beta 1)
TPR: increases (alpha 1 effect)
HR: decreases (baroreceptor reflex of increase parasymp w/ sense of increased MAP)
What changes does Isoproterenol cause w/ the following: Mean Arterial Pressure Systolic Pressure Diastolic Pressure Pulse Pressure TPR HR
Mean Arterial Pressure: decreases (beta 2 effect)
Systolic Pressure: increases slightly (b/c of increased SV–>beta 1 effect)
Diastolic Pressure: decreases (beta 2 effect)
Pulse Pressure: increases (SV increased–>beta 1 effect)
TPR: decreases (beta 2 effect)
HR: increases (beta 1 effect)
What changes does a low dose of epinephrine cause w/ the following: Mean Arterial Pressure Systolic Pressure Diastolic Pressure Pulse Pressure TPR HR
Mean Arterial Pressure: stays relatively constant
Systolic Pressure: increases slightly (b/c of SV increased…beta 1 effect)
Diastolic Pressure: decreases (b/c of beta 2)
Pulse Pressure: increases (b/c of SV up b/c of beta 1)
TPR: decreases (beta 2)
HR: increases (beta 1)
At low doses epinephrine acts more like ______ b/c the ______ effects dominate.
At high doses epinephrine acts more like ______ b/c the _______ effects dominate.
Isoproterenol: beta
NE: alpha
What changes does a high dose of epinephrine cause w/ the following: Mean Arterial Pressure Systolic Pressure Diastolic Pressure Pulse Pressure TPR HR
Mean Arterial Pressure: increases (alpha 1)
Systolic Pressure: increases (alpha 1 & a little beta 1)
Diastolic Pressure: increases (alpha1)
Pulse Pressure: increases (SV–>beta 1)
TPR: increases (alpha 1)
HR: increases (beta 1–>but no reflex)
What are the differences in responses b/w high dose Epinephrine & phenylephrine?
High Dose Epinephrine: acts like NE
**alpha 1 & beta 1
Phenylephrine
*alpha 1
**main difference: increase in HR w/ Epi b/c of beta 1…possible reflex decrease in HR or no change w/ phenyl.
Bigger pulse pressure difference w/ Epi b/c of SV change b/c of contractility change b/c of beta 1.
How does dopamine act as low, intermediate, & high conc’ns?
Low: causes vasodilation of the kidney
Intermediate: acts like isoproterenol b/c agonist of beta 1 & 2
High: acts like NE: alpha 1 & beta 1 agonist.
What dose of dopamine would you need to increase renal blood flow?
A low dose. Causes vasodilation in the kidney.
What dose of dopamine would you need to increase cardiac output?
Intermediate dose.
Something that acts on Beta 1…here acts like isoproterenol
What dose of dopamine would you need to increase TPR & MAP?
High Dose.
Finally an alpha agonist. Acts like NE.
What is phenylephrine used for OTC? Why shouldn’t you take it if you have HTN?
It is an OTC decongestant.
But it is an alpha 1 agonist so you shouldn’t take it if you have hypertension.
What is NE an agonist of mainly?
alpha 1 & Beta1
What is Epi an agonist of mainly in low doses? High doses?
Low doses: mainly a beta 1 & beta 2 agonist
High doses: mainly an alpha 1 & beta 1 agonist
What is isoproterenol an agonist of?
beta 1 & beta 2
What is dobutamine an agonist of?
beta 1
What is phenylephrine an agonist of?
alpha 1
What is clonidine an agonist of?
alpha 2
what is oxymetazoline an agonist of?
alpha 1 & alpha 2
What is terbutaline an agonist of?
beta 2
What is propranolol an antagonist of?
beta 1 & beta 2
What is metoprolol an antagonist of?
beta 1
What is phentolamine an antagonist of?
alpha 1 & alpha 2
What is prazosin an antagonist of?
alpha 1
What is cavadilol an antagonist of?
all 4 receptors!
What is yohimbine an antagonist of?
alpha 2
What’s the deal w/ tyramine?
It is a compound found in cheese, beer, bean curd etc that is taken up into the nerve terminal…it is metabolized by mAO…but if a person is taking a MAO inhibitor…a build up of tyramine in the nerve terminal will cause an increase in release of NE…could cause a hypertensive crisis–>stroke.
What is something special that beta 1 antagonists can do?
They can inhibit renin secretion from the JGA cells of the kidney.
What is NE used to treat?
severe hypotension & septic shock
What is Epi used to treat?
anaphylactic shock
cardiogenic shock
cardiac arrest
local vasoconstriction
What is isoproterenol used to treat?
cardiogenic shock
bradycardia
AV block
What is dobutamine used to treat?
cardiogenic shock
acute heart failure
What is dopamine used to treat?
cardiogenic shock
acute heart failure
acute renal failure
What is phenylephrine used to treat?
topical vasoconstriction
shock
autonomic testing of Diabetics
decongestant
What is clonidine used to treat?
HTN–>b/c it inhibits NE release
What is propranolol used to treat?
HTN
angina
cardiac arrhythmias
What is metoprolol used to treat?
HTN
angina
CHF
What is phentolamine used to treat?
severe HTN
pheochromocytoma
What is prazosin used to treat?
HTN
What is cavadilol used to treat?
HTN
heart failure
What is the deal with ACh & cardio treatment?
ACh is an agonist of like everything. But it isn’t administered as a part of treatment.
However, things that target the pathway in which ACh & NO cause vasodilation is targeted.
What is digoxin & what are 2 things that it can be used to treat?
A cholinomimetic…like an agonist
It is used to treat atrial fibrillation b/c it decreases AV conduction.
It is also used to treat heart failure b/c it inhibits the sodium potassium pump & therefore allows more calcium to accumulate & greater contractility.
What is atropine & what is it used to treat?
It is a cholinolytic.
It is used to treat bradycardia & heart block.
It blocks parasymp & therefore increases heart rate & AV conduction speed. It blocks specifically muscarinic receptors.
What is trimethaphan & what is it used to treat?
It is a cholinolytic that targets nicotinic receptors.
It is used to treat HTN crisis…b/c it blocks sympathetic transmission & decreases sympathetic tone.
What is hypovolemic shock & what is used to treat it?
It is shock b/c of loss of blood.
There is a sympathetic reflex that is initiated that increases alpha 1 & vasoconstriction to try to maintain BP in the face of less blood volume.
No drugs are used to treat this condition b/c the alpha effect is already maxed out.
Replacement of fluids is used.
What is vasodilatory shock? What are its 2 types & what drugs are used to treat it?
It is shock produced by vasodilation. Low BP.
One type is sepsis: here you need an alpha effect–>NE or phenylephrine
Another type is anaphylaxis: here you need alpha but also beta 2 for the airways–>high dose Epi
What is cardiogenic shock? What are the options for treatment?
Poor myocardial contractility.
This means low SV, Low CO, Low MAP. High venous pressure–>edema.
There is a body reflex of sympathetic activation–>vasoconstriction alpha 1.
You don’t want beta 2 b/c you want to maintain the high MAP.
Problem: high MAP increases after load. That poor heart!
Options:
Low Doses Epinephrine
Isoproterenol
Dopamine
Dobutamine
Best option is dobutamine b/c it only has beta 1. You don’t want alpha 1 b/c it is maxed out & you don’t want beta 2 b/c you want high MAP.
What is angina? What can it be treated with?
too much myocardial work & O2 consumption.
treated w/ beta 1 antagonists.
What is angina? What can it be treated with?
too much myocardial work & O2 consumption.
treated w/ beta 1 antagonists.
What is heart failure & how is it treated?
sympathetic tone that is too much–>the poor heart is just working too hard.
beta 1 antagonists are called for here.
What is heart failure & how is it treated?
sympathetic tone that is too much–>the poor heart is just working too hard.
beta 1 antagonists are called for here.
