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Pharmacology > Shock > Flashcards

Shock Flashcards

1
Q

What are the Types of Shock?

A
  • Distributive Shock
  • Septic Shock
  • Anaphylactic Shock
  • Neurogenic Shock
  • Hypovolemic Shock
  • Cardiogenic Shock
  • Obstructive Shock
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2
Q

Distributive Shock.

A

A.K.A vasodilatory shock
It is inadequate perfusion to the tissue!
The blood vessels dilate resulting in loss of vessel tone and ultimately systemic vasodilation. LEading to decreased blood flow to the organs.

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3
Q

What are the Three Types of Distributive Shock?

A
  1. Septic
  2. Anaphylactic
  3. Neurogenic
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4
Q

Septic Shock.

A

Caused by a pathogenic infection present in the blood or injury. This leads to a severe drop in blood pressure resulting in systemic vasodilation.

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5
Q

Anaphylactic Shock.

A

Caused by a severe allergic reaction causing the body to go into shock. Anaphylaxis causes the immune system to release a flood of immune mediators that can result in a sudden drop in BP and narrow the airways.

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6
Q

Neurogenic Shock.

A

Caused by a spinal cord injury or damage to the nervous system. The heart rate, blood pressure and temperature are subsequently unstable due to the damage.

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7
Q

What Occurs During Distributive Shock? (Three steps)

A

Step One: Inflammation is caused by a pathogen, allergen or injury.
Step Two: The inflammation leads to an overwhelming release of immune mediators that cause an overpowering response.

Step Three: In response, the vessels will vasodilate causing low perfusion volume and yields a fluid shift (due to capillary leakage)

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8
Q

What are the Three Stages of Inflammation?

A
  1. Vascular Response
  2. Cellular Stage
  3. Remodelling and Maturation
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9
Q

Vascular Response.

A

An allergen introduced within the system triggers inflammation. The purpose of vascular changes is to increase blood flow to the local area, venous and arteriole vasodilation will cause increased capillary flow.

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10
Q

What is the Role of Histamine?

A

When an allergen attaches to a mast cell it releases histamine. The role of histamine is to bind to H1 receptors on the endothelial cells and stimulate vasodilation.

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11
Q

Role of Nitric Oxide.

A

Nitric Oxide is released as well as histamine. Nitric Oxide is released and contributes to vasodilation.

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12
Q

How Does The Body React To Histamine?

A
  • Swelling and Inflammation
  • Adrenaline Release
  • Bronchoconstriction
  • Dilation of the blood vessels
  • Increased Heart Rate
  • Increased vessel and capillary permeability
  • Stimulation of gastric acid secretion
  • Blood Clotting
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13
Q

Signs and Symptoms of Reaction.

A

Heat to extremities, redness, swelling, pain, difficulty breathing, tachycardia

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14
Q

Cellular Stage.

A

In this stage, phagocytes are released and travel to the site of inflammation. White blood cells are increased in production and kill the pathogens responsible for inflammation.

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15
Q

Mechanism of Action For Phagocytosis.

A
  • The pathogen/antigen binds to the receptor of the phagocyte
  • The phagocyte engulfs the pathogen through endocytosis. Once inside the cell, the phagosome fuses with lysosomes
  • The phagolysosome is now able to kill and digest other microbes
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16
Q

Remodelling and Maturation.

A

At this stage, the tissues start to repair. As healing progresses, the tissue continues to remodel, strengthen and improve its cellular organization.

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17
Q

How to Treat Inflammation.

A
  • Antihistamines
  • Leukotriene Modifiers
  • Glucocorticoids
  • Xolair
18
Q

How do Antihistamines Treat Inflammation?

A

Histamine antagonists.

- Therefore, inhibiting the inflammatory response!

19
Q

How do Leukotriene Modifiers Treat Inflammation?

A

Leukotrine anatagonists.
- Medications that block the effect of leukotrienes or stop your body from producing them. By inhibiting Leukocytes (white blood cells), therefore inhibiting the release of; neutrophils, basophils, lymphocytes, and monocytes

20
Q

How do Glucocorticoids Treat Inflammation?

A

Inhibits immune response.
- Glucocorticoids regulate adaptive immunity by inhibiting lymphocyte activation and promoting lymphocyte apoptosis. At high concentrations, glucocorticoids also inhibit the production of B cells and T cells.

21
Q

How does Xolair (Omalizumab) function?

A

Reduces IgE.
- Immunoglobulin E are antibodies produced by the immune system. They are attached to mast cells and signal a reaction when an antigen binds to the receptor site. By reducing IgE, the reaction is reduced.

22
Q

Acute Progressive Allergic Reaction.

A

Allergy- Anaphylaxis- Anaphylactic Shock

23
Q

Treatment for Acute Progressive Allergic Reaction.

A
  1. Adrenergics: adrenaline will increase BP and increase perfusion
    • Epinephrine IM every 5 minutes, 3 doses max
  2. Antihistamines: Benadryl (Diphenhydramine) via IV
  3. Glucocorticoids: Hydrocortisone and Methypredsione via IV
  4. Support airway, breathing and circulation
24
Q

Circulatory Shock.

A

Hypoperfusion to organs and tissue leads to an insufficient supply of nutrients and oxygen to meet the body’s demands. Therefore putting the body into shock.

Remember: hypoxia causes altered cellular function and overall cellular necrosis due to a lack of nutrients and required needs.

25
Q

Types of Circulatory Shock.

A
  1. Hypovolemic (low blood volume)
  2. Cardiogenic Shock (Low Cardiac Output)
  3. Obstructive Shock (Inability for the heart to fill with blood, mainly caused by an obstruction)
26
Q

Hypovolemic Shock.

A

LOW BLOOD VOLUME! A significant decrease in blood or plasma volume leads to inadequate filling of the vascular compartment and results in decreased cardiac output.

27
Q

What causes Hypovolemic Shock?

A

Blood Loss! Caused hemorrhage, trauma or surgery

28
Q

What occurs when there is a blood loss?

A

Acute bleed or any blood volume loss will allow the body to initiate compensatory mechanisms

  • The heart will pump faster in order to increased heart rate and cardiac contractility.
  • The blood vessels also vasoconstriction
  • The hypothalamus will increase ADH release in an attempt to decrease urine output and to vasoconstrictor the blood vessels
29
Q

Signs and Symptoms of Hypovolemic Shock.

A

Initial S&S: due to compensation

  • Tachycardia
  • Thirst
  • Cool Peripherals (due to vasoconstriction)

Progressing S&S:

  • Hypotension
  • Thready pulse
  • Low Respiratory Rate
  • Oliguria
  • Altered LOC

Signs of Cellular Dysfunction:

  • Edema
  • Electrolyte imbalance
  • Hyperglycemia
30
Q

Treatments for Hypovolemic Shock.

A

IV fluids!

-Colloids, crystalloids and whole blood

31
Q

Colloids.

A

Colloids are protein solutions that maintain a high osmotic pressure in the blood. They expand plasma volume
Albumin 5% or 25%
- Dextran and Hetastarch

32
Q

Crystalloids.

A

Are fast-acting! Crystalloid fluids function to expand intravascular volume without disturbing ion concentration or causing significant fluid shifts between intracellular, intravascular, and interstitial spaces.
- NS or LR

33
Q

Cardiogenic Shock.

A

The heart is unable to pump enough blood to meet the body’s demands. There is adequate total blood volume but the heart is unable to pump sufficiently.

34
Q

Clinical Presentaion of Cardiogenic Shock.

A

Low cardiac output, low systolic blood pressure, hypoperfusion, hypoxia

35
Q

Pathological Sequelae of Cardiogenic Shock.

A

Low Cardiac Output- reflex taxhycradia- activation of compensation- low coronary artery perfusion- severe inflammatory response

36
Q

What Causes Cardiogenic Shock?

A

Myocardial Infarction!!

  • STEMI
  • Arrhythmias
  • Cardiomyopathy
  • Congenital Heart Disease
  • Open Heart Surgery
37
Q

Signs and Symptoms of Cardiogenic Shock.

A
  • Hypoperfusion
  • Cyanosis
  • Oliguria
  • LOC changes
  • Low BP with narrow pulse pressure
  • High JVP
38
Q

Treatment for Cardiogenic Shock.

A
  1. Optimize Cardiac Output (reduce preload and afterload)
  2. Reduce Volume (Administer diuretics)
  3. Vasodilate
  4. Improve Contractility (Phosphodiesterase Inhibitors, Catecholamines)
39
Q

Obstructive Shock.

A

Mechanical obstruction to blood flow through the central circulation

40
Q

What Causes Obstructive Shock?

A

Caused by a large embolism or cardiac tamponade

41
Q

Treatment for Obstructive Shock.

A
  • Treat tamponade

- Treat with anticoagulants or thrombolytics

Pharmacology (27 decks)

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