Shock Drugs

Question 1

Angiotensin II (giapreza)

Answer 1

↑BP, MAP, & SVR
-used for septic and other distributive shock
-Given via central line
-Monitor for thromboembolic events. Provide VTE prophylaxis

Question 2

Dobutamine (8 things)

Answer 2

↑Myocardial contractility
↑CO, CV, CVP
↓ SVR and PAWP
↓ventricular filling pressures
-Used for cardiogenic shock
-Give via central line
-Monitor BP and HR
-Stop infusion if tachydysrhythmias develop

Question 3

Dopamine (8 things)

Answer 3

+ inotropic effects:
-↑myocardial contractility, automaticity and AV conduction
-↑HR, CO, BP, and MAP
-↑MVO2
-can cause progressive v/c at ↑ doses
-Used for cardiogenic shock (#1!!!!!)
-Give via central line
-monitor for tachydysrhythmias
-Monitor for peripheral v/c at moderate to high doses

Question 4

Epinephrine (low dose)

Answer 4

-↑ HR, contractility, CO
-↓ SVR
-Used for cardiogenic and anaphylactic shock, sometimes septic if levo didn’t work
-Monitor for HR >110 beats/min
-Monitor for dyspnea, p. edema
-Monitor for chest pain, dysrhythmias and renal failure due to ischemia

Question 5

Epinephrine (high dose)

Answer 5

-↑SVR, SV
-↑CVP, PAWP
-↑Systolic, ↓diastolic BP
-Used for cardiac arrest, pulseless vtach, vfib, and asystole
-Monitor for HR >110 beats/min
-Monitor for dyspnea, p. edema
-Monitor for chest pain, dysrhythmias and renal failure due to ischemia

Question 6

Hydrocortisone

Answer 6

-↓inflammation, reverses cap permeability
-↑ BP, HR
-Used for septic shock requiring vasopressor therapy to maintain BP
-Used for anaphylatic shock if HoTN persists after therapy
-Monitor for hypokalemia, hyperglycemia
-Consider use as continuous infusion

Question 7

Nitroglycerin

Answer 7

-Venous dilation
-Coronary artery dilation
-↓ Preload, MVO2, SVR, BP
-Used for cardiogenic shock
-Monitor BP and HR, reflex tachycardia may occur
-Glass bottle recommended for infusion

Question 8

Norepinephrine

Answer 8

-Renal and splanchnic v/c
-↓/↑ CO
-↑ BP, MAP, CVP, PAWP, SVR
-Used for cardiogenic shock after MI
-Used for septic shock- 1st drug of choice for BP unresponsive to fluid resuscitation
-Give via central line
-Monitor for dysrhythmias due to ↑ MVO2 requirements

Question 9

Phenylephrine

Answer 9

-Vessel constriction of stomach organs, renal and pulmonary
-↑ HR, BP, SVR
-increases/decreases CO
-Used for neurogenic shock
-Monitor for reflex bradycardia, HA, restlessness
-Monitor for renal failure from decreased renal blood flow

Question 10

Sodium nitroprusside

Answer 10

-↑ /↓ CO
-↓preload and afterload
-↓CVP and PAWP
-↓ BP
-Arterial and venous vasodilation
-Used for cardiogenic shock with increased SVR
-Monitor BP
-Protect solution from light (wrap in opaque covering)
-Give with D5W only
-Monitor serum cyanide levels (metabolic acidosis, ↑ HR, altered LOC)

Question 11

Vasopressin

Answer 11

-ADH
-Non-adrenergic v/c
-↑ MAP and UO
-Used for all shock states (especially septic shock) who are refractory to other vasopressors
-Given with levo in low doses
-Infusions not titrated
-Monitor hemodynamic pressures and UO