Therapeutics of Shock

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Author:
alvo2234
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213496
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Therapeutics of Shock
Updated:
2013-04-14 21:56:19
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Ademolu
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Description:
PT II exam III
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  1. types of shock
    • cardiogenic
    • hypovolemic
    • distributive
  2. shock presentations
    • systemic inflm response syndrome
    • SBP < 90 or a decrease > 60 from baseline
    • oliguria (incr BUN, Scr, urine <0.5ml/kg/hr)
    • metabolic acidosis
    • cutaneous vasoconstriction
    • mental confusion (agitation, stupor, or coma)
  3. SIRS presentations include
    • HR > 90 (tachycardia)
    • RR > 20 bpm or PaCO2 < 32 mmgHg
    • WBC > 12,000, <4,000 or bands > 10%
    • Temp < 36(96.8) or > 38(100.4)
  4. the most common type of shock
    hypovolemic shock
  5. hypovolemic shock manifestation and compensation
    • decrease IV volume, venous return, CO
    • increase contractility, HR, SVR
  6. 1000 ml of NS infused leads to how much expansion
    250 ml
  7. 1000 ml of LR infused leads to how much expansion
    250 ml
  8. 1000 mL D5W infused leads to how much expansion
    100 mL
  9. 500 ml of albumin 5% infused leads to how much expansion
    500 mL
  10. 100 ml of albumin 25% infused leads to how much expansion
    500 mL
  11. 500 ml of hetastarch 6% infused leads to how much expansion
    500 mL
  12. manifestations of cardiogenic shock
    • decreased CO and BP
    • increased SVR
    • increased HR
    • cold extremeties
    • pulmonary congestion
  13. what is distributive shock
    peripheral vascular dilation causes fall in SVR which leads to a normal or increased CO and low BP
  14. causes of distributive shock
    • septic shock
    • anaphylactic shock
    • neurogenic shock
    • acute adrenal insufficiency
  15. b1 agonism
    increase HR, CO, and contractility
  16. b2 agonism
    decrease SVR
  17. a1 agonism
    increase SVR and MAP
  18. dopamine agonism
    increase urine output
  19. vasopressin hemodynamic effect
    increase SVR, MAP, urine output
  20. renal dose of dopamine
    low dose (< or = 3 mcg/kg/min)
  21. intermediate dose of dopamine
    3-10 mcg stimulates B receptors in the heart
  22. high dose of DA
    > 10 mcg/kg/min stimulates alpha receptors in the systemic and pulmonary system
  23. indications for DA
    cardiogenic and septic shock
  24. DA is an alternative to NE in which pts
    ONLY in pts with low risk for tachycardia or pts with bradycardia
  25. AE of DA
    • tachyarrhythmia
    • ischemic limb necrosis
    • decrease gastric emptying
  26. pressor of choice for septic shock
    NE
  27. IND for NE
    hypotension refractory to fluid resuscitation
  28. AE of NE
    • tachyarrhythmia (less compared to DA)
    • myocardial ischemia
    • tissue necrosis and sloughing
  29. what is the first line alt to NE in septic shock
    Epinephrine (can be added or sub)
  30. AE of Epinephrine
    • tachyarrhythmia
    • hyperlactemia
    • decrease splanchnic blood flow
  31. what drug is the second alt to NE in refractory septic shock
    phenylephrine (especially in pts who cant tolerate tachycardia)
  32. AE of Phenylephrine
    • HTN
    • palpitations
    • paresthesia
  33. Vasopressin MOA
    • acts on Vasopressin 1 and 2 receptors
    • direct peripheral vasoconstriction
  34. indication of vasopressin
    add on agent to vasopressors in refractory septic shock
  35. which vasopressor is not indicated as a monotherapy
    vasopressin
  36. AE of vasopressin
    • drowsiness
    • confusion
    • water intoxication
    • splanchnic ischemia
  37. Dobutamine MOA
    • binds to B1-increase CO, SV and decrease SVR
    • weakly binds to B2- slight peripheral vasodilation
  38. indications of dobutamine
    • cardiogenic shock
    • septic shock
  39. AE of dobutamine
    • tachycardia (less compared to DA)
    • myocardial ischemia
    • tachyphylaxis
    • hypokalemia
    • hypotension
  40. Milrinone brand name
    primacor
  41. milrinone MOA
    inhibits cAMP breakdown in the hear to increase CO and in vascular smooth muscle to decrease SVR
  42. indication for primacor
    • acute decompensated HF -- cardiogenic shock
    • preferred to dobutamine in pts on chronic B-blocker therapy
  43. if a pt presents with acute decompensated HF and is on b-blockers which drug is preferred to tx
    milrinone
  44. AE of Milrinone
    • hypotension
    • thrombocytopenia
    • tachycardia
  45. indication for vasodilators (Nipride, NTG)
    acute decompensated HF -- cardiogenic shock
  46. AE of sodium nitroprusside
    • hypotension
    • cyanide
    • thiocyanate toxicity
    • reflex tachycardia
  47. AE of NTG
    • hypotension
    • HA
    • tachyphylaxis
    • reflex tachycardia

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