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Critical Care > Meds For Shock > Flashcards

Meds For Shock Flashcards

1
Q

Medications to improve contractility and examples

A

Positive inotropes:
dobutamine (Dobutrex)
dopamine (Intropin)

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2
Q

What are each of the ranges of dopamine used for?

A

Low dose = renal dose
Mid range = to increase squeeze of heart
High dose = alpha - vasoconstrict

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3
Q

Why are drugs that improve preload given?

A

For volume resuscitation (to improve volume)

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4
Q

Types of drugs given to improve preload and examples

A

Vasopressors:
norepinephrine (Levophed)
dopamine (Intropin)
phenylephrine (Neo-synephrine)
Vasopressin

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5
Q

Which type of patient should not have vasopressors and why?

A

Hypovolemic patients - so all types of shock except distributive shock: septic, anaphylactic, neurogenic

Need to replace fluid volume first

For distributive shock, the problem is vasodilation, so need to treat that first

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6
Q

Meds given for shock that reduce preload, and examples

A

Diuretics: furosemide
Vasodilators:
NTG
nitroprusside (Nipride)
Morphine (yes, it’s also a vasodilator)

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7
Q

Meds given to reduce afterload for shock

A

Nitroprusside

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8
Q

Meds given to increase afterload and examples

A

Dopamine (in high doses)
Norepinephrine (Levophed)
Epinephrine (Adrenalin)
Phenylephrine (Neo-Synephrine)

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9
Q

Action of Intropin (dopamine)

A

Increase contractility

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10
Q

Explain the doses of Intropin (dopamine) in depth

A

< 3 mcg/kg/min - stimulates Dopaminergic receptors producing renal, mesenteric, coronary, and cerebral vessel dilation, increasing urinary output

3-10 mcg/kg/min - stimulates beta1 receptors, producing increase in cardiac output

> 10 mcg/kg/min - stimulates alpha receptors producing vasoconstriction of pulmonary and systemic vessels, causing increased afterload

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11
Q

Side effects of intropin (dopamine)

A

Increased HR
Increased myocardial oxygen needs, resulting in angina and arrhythmias

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12
Q

Nursing considerations of intropin (dopamine)

A

Monitor HR closely, for chest pain and arrhythmias
Infuse through stable IV line to prevent infiltration
If infiltrates - infuse Regitine ASAP

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13
Q

Action of dobutamine (Dobutrex)

A

Increase contractility: Stimulates beta1 receptors with weak stimulation of beta2 receptors

Vasodilation
Reduces filling pressures and pulmonary interstitial edema
Reduces systemic vascular resistance

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14
Q

Side effects of dobutamine (Dobutrex)

A

Increased HR
Increased myocardial oxygen needs, resulting in angina or arrhythmias
Decreased BP

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15
Q

Nursing considerations for dobutamine (Dobutrex)

A

Monitor HR 7 BR closely
Monitor for chest pain and arrhythmias

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16
Q

Action of furosemide (lasix)

A

Decrease preload

Increases elimination of sodium and water, thus reducing vascular volume

17
Q

SE of furosemide (lasix)

A

Electrolyte imbalances

18
Q

Nursing considerations for furosemide (lasix)

A

Monitor electrolytes and BP
Provide moisturizer for lips

19
Q

Action of nitroglycerin

A

Dilates veins and arteries
Decreases preload and afterload
Decreases cardiac workload and oxygen needs

20
Q

SE of nitroglycerin

A

Hypotension
HA
Palpitations
Nasal congestion
Tolerance for nitrates

21
Q

Nursing considerations for nitroglycerin

A

Monitor BP, rhythm, dizziness, orthostatic hypotension
Can be used in pts who cannot take ACE inhibitors
Use extreme caution if SBP < 90 mmHg and with RVI
Patient must be supine during administration

22
Q

Action of Nitroprusside

A

Dilates veins and arteries
Decreases preload and afterload
Decreases cardiac workload and oxygen needs

23
Q

SE of nitroprusside

A

Hypotension
HA
Palpitations
Nasal congestion
Tolerance for nitrates
Hypoxemia (nitride induced intra pulmonary Thiocyanate toxicity)

24
Q

Nursing considerations for nitroprusside

A

Monitor BP, rhythm, dizziness, orthostatic hypotension
Can be used in pts who cannot take ACE inhibitors
Use extreme caution if SBP < 90 mmHg and with RVI
Patient must be supine during administration

Monitor for Thiocyanate toxicity (Metabolic acidosis, Confusion, Hyperreflexia, Seizures)

Daily levels if used > 72 hours

25
Q

Action of norepinephrine (Levophed)

A

Stimulates alpha receptors to cause vasoconstriction

26
Q

SE of norepinephrine (Levophed)

A

Hypertension
Ventricular dysrhythmias
Chest pain
HA
Anxiety

27
Q

Nursing considerations for norepinephrine (Levophed)

A

Continuous ECG monitoring (watch for vent. dysrhythmias)
Monitor for chest pain, VS hourly
Report severe elevations in BP

*Tissue necrosis can occur in high doses or prolonged administration or extravasation
Monitor peripheral pulses hourly and report change in strength of pulses
Treat extravasating with phentolamine (Regitine)

28
Q

Action of Phenylephrine (Neosynephrine)

A

Stimulates alpha receptors to cause vasoconstriction

29
Q

SE of Phenylephrine (Neosynephrine

A

HTN
Ventricular dysrhythmias
Chest pain
HA
Anxiety

30
Q

Nursing considerations for Phenylephrine (Neosynephrine)

A

Continuous ECG monitoring (watch for ventricular dysrhythmias)
Monitor for chest pain routinely, VS hourly
Report severe elevations in BP

Critical Care (35 decks)

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