Shock Pharmacologics Flashcards
1
Q
Fluid Therapies
A
- Crystalloids are initial fluid choice: 30 mL/kg until stable
- Consider albumin if patients still requiring substantial amounts of crystalloids after initial resuscitation (otherwise, albumin doesn’t provide significant benefit and more costly)
- CVP marker for fluid status (8-12, 12-15 if mechanically ventilated)
- DONT USE HYDROXYETHYL STARCHES
2
Q
Vasopressor Options/First Line
A
- Goal: MAP >= 65
- Arterial catheter should be placed ASAP
- Norepi: first line - little change to HR/SV, may be more effective at reversing hypotension than dopamine
3
Q
Vasopressor
A
- Not recommended as single, initial vasopressor
- Used in addition to NE to raise MAP
- Increase BP in vasopressor refractory patients
- Fewer kidney failure patient receive renal replacement compared to NE
4
Q
Epi
A
- Can be used in addition or as a substitute for NE
- Decreases renal/splanchnic blood flow
5
Q
Phenylephrine
A
- Not recommended unless NE causes serious arrhythmias
- High CO and persistently low BP, salvage therapy
- Least likely to produce tachycardia (only alpha) but can decrease SV
6
Q
Dopamine
A
- Alternative to NE when low risk of tachyarrhythmias and absolute/relative bradycardia
- Don’t use low doses for renal perfusion
- May be more arrhythmogenic than NE, but may be useful with compromised systolic fxn
7
Q
Dobutamine
A
- Inotropic Therapy
- Can be initial or added to vasopressor therapy
- May be useful for myocardial dysfxn (high pressures and low CO) and ongoing signs of hypoperfusion despite having good volume/MAP
8
Q
Antimicrobial Therapy
A
- Cultures (from two different sites) prior to antibiotic therapy if possible
- IV antimicrobials should be given within the first hour with septic shock/severe sepsis patients (broad spectrum)
- Each hour delayed, decrease in 7.6% survival
9
Q
Corticosteroids
A
- IV hydrocortisone is reserved for patients with hemodynamic instability despite fluid resuscitation and vasopressor therapy
- Don’t administer in absence of shock
- Taper steroids once vasopressors are no longer required
- Combined with fludrocortisone may have better outcomes
10
Q
Glucose Control
A
- Initiate insulin when glucose > 180 (target =< 180)
- Blood glucose monitored every 1-2 hours until glucose/insulin infusion are stable, then every 4 hours thereafter
11
Q
DVT Prophylaxis
A
Daily DVT prophylaxis with LMWH or UFH
- Patients with CI to prophylaxis should receive intermittent compression devices
- Use combination or intermittent pneumatic compression devices and pharm
12
Q
Stress Ulcer Prophylaxis
A
- H2 blocker or PPI with patients with bleeding risk factors
- Bleeding risk factors: coagulopathy (INR > 1.5 or platelets <50,000), mechanical ventilation for > 48 hours and possibly hypotension
- No risk factors shouldn’t get prophylaxis
13
Q
Cardiac Term Definitions
A
- Inotropy: altered contractility
- Lusitropy: altered relaxation
- Chronotropy: altered contraction rate (SA node conduction)
- Dromotropy: altered AV node conduction
14
Q
Alpha 1 Agonism
A
- Agonist for alpha1 receptor GCPR that binds to PLC
- Converts PIP2 to IP3 that opens calcium channel in SR
- Increases calcium release within smooth muscles (contracts and increases BP)
15
Q
Epi Sites/Uses
A
- All alpha/beta receptors (NOT selective)
- For anaphylactic shock and cardiac arrest/asystole
- Improves breathing and clears airways as well
