Shock

Question 0

Normal Saline

0.9% NaCl

Answer 0

-preferred IV fluid for hypotention tx
MOA
-fluid resuscitation
ADE
-can cause hyperchloremic metabolic acidosis

Question 1

Metronidazole

Answer 1

Effective against
-*anaerobic Gr- bact.
-esp effective against *B.frag
Commonly used
-intra-abdominal/gut/pelvic infection
-usually polymicrobial
-must supplement w/ anti-aerobe agent (ceft- or -mycin)
MOA
-low MW, therfore enters cells via passive diffusion
-produces bactericidal free radicals which break/destabilize DNA

Question 2

Epinephrine

Norepinephrine

Answer 2

Epi: dose-dependent
-less than high dose: beta1 (contractility), beta2 (vasodilation)
-high dose: beta1, alpha1 (vasoconstriction)
NE: pure alpha1 (phenylephrine)
-preferred as the alpha1 agonist bc its pure effect
Preferrred vasopressors for shock pt in hypotension
1. NE = 1st choice pressor
2. Epi
3. vasopressin
In CPR/resuscitation
1. EPI = 1st choice (desired alpha1 effect: vasoconstriction)
2. vasopressin
ADE
-cardiac arrhythmia, angina, HA, tremor
-dopamine extravasation- fluid builds up outside vein, dop vasocontricts cutting off blood flow, ulcer develops-bind to transpeptidase enzyme (aka PBP=penicillin binding protein) inibiting cross-linking of the peptidoglycan in cell wall

Question 3

DOBUTamine

DOPamine

Answer 3

-both are mixed alpha & beta agonists
-effect depends on dose
DOBUTamine: *beta1 (contractility)
-DOBUTamine will aid in INC CO
-only in pts in ongoing hyperfusion + low CP, not responding to first-line tx
DOPamine: dose-dependent
-less than high dose: beta1 (contractility) & beta2 (vasodilation), but D1 is unique (renal vasodilation)
-high dose: keeps its beta1, but strong alpha1 appears as loses beta2. also loses D1

Question 4

Isoproterenol

Answer 4

MOA

-pure beta-agonist (beta1 &2)

Question 5

Vasopressin
(ADH-antidiuretic hormone)
(AVP-arginine vasopressin)

Answer 5

-formed in hypothalmus; released from post. pituitary
MOA
-alpha1 agonist (potent vasoconstrictor)
1. *V1 receptor= INC SVR= INC arterial pressure
2. V2 receptor= regulates body’s ECF vol by affecting renal handling of h20