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Drugs for treating shock

Drugs for treating shock. Shock. shock: a syndrome characterized by collapse of the circulatory system. vital tissues do not receive enough blood to function properly cells cannot carry on normal metabolism. Symptoms of shock. shock is a collection of signs and symptoms, many nonspecific:

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Drugs for treating shock

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  1. Drugs for treating shock

  2. Shock • shock: a syndrome characterized by collapse of the circulatory system

  3. vital tissues do not receive enough blood to function properly • cells cannot carry on normal metabolism

  4. Symptoms of shock • shock is a collection of signs and symptoms, many nonspecific: • skin: pale, cool, or clammy • respiratory: breathing rapid and shallow

  5. CV: low b.p., low cardiac output, weak pulse • neurologic: restlessness, anxiety, lethargy, confusion

  6. Classification of shock • 1. cardiogenic • failure of the heart to pump sufficient blood to tissues

  7. due to: left heart failure, ischemia, MI, arrhythmias, pulmonary embolism, myocardial/pericardial infection

  8. 2. hypovolemic • loss of blood volume

  9. due to: hemorrhage, burns, profuse sweating, excessive urination, vomiting, diarrhea

  10. 3. septic • multiple organ dysfunction as a result of pathogenic organisms in the blood

  11. due to: widespread inflammatory response to bacterial, fungal or parasitic infections

  12. 4. anaphylactic • acute allergic reaction

  13. due to: severe reaction to allergens (penicillin, nuts, shellfish, animal proteins)

  14. Treatment of shock • initial treatment includes basic life support while identifying the underlying cause

  15. maintain ABC of life support: airway, breathing, circulation

  16. administer fluids/electrolytes and blood products if patient has lost a significant amount of blood

  17. Drug categories in treating shock • There are 3 categories of drugs that play a role in treating shock: • vasoconstrictors • cardiotonic drugs • fluid replacement agents

  18. Vasoconstrictors used to treat shock • early stages of shock: body compensates for initial fall in b.p. by ↑ activity of sympathetic nervous system

  19. this sympathetic activity results in vasoconstriction which: • ↑ b.p. • ↑ heart rate and force of myocardial contractions

  20. Purpose: maintain blood flow to vital organs (heart, brain) and ↓ blood flow to other organs (kidneys, liver)

  21. Body’s ability to compensate is limited • Severe hypotension may develop

  22. vasoconstrictors are used to maintain b. p. • given IV they immediately raise b. p. • patients monitored continuously during infusion to avoid HT due to overtreatment

  23. Specific Vasoconstrictors used to treat shock • 1. epinephrine: a nonselective adrenergic agent • b.p. rises due to stimulation of alpha1 receptors in smooth muscle of blood vessels

  24. cardiac output increases due to stimulation of beta1 receptors in heart • airway opens due to stimulation of beta2 receptors in the bronchi

  25. 2. norepinephrine (Levarterenol, Levophed) has both alpha and beta1 activity • 3. methoxamine hydrochloride (Vasoxyl) selective to alpha receptors

  26. Cardiotonic drugs used to treat shock • aka inotropic agents • as cardiogenic shock progresses, the heart begins to fail:

  27. cardiac output ↓, lowering amount of blood reaching vital tissues and worsening shock

  28. cardiotonic drugs are used in the treatment of shock to ↑ the force of contraction and increase cardiac output

  29. Specific Cardiotonic drugs used to treat shock • 1. digoxin (Lanoxin)

  30. 2. dobutamine (Dobutrex): a beta1 adrenergic agent that is often drug of choice for short term (1/2 life of only 2 min.) treatment of shock

  31. has the ability to cause heart to beat more forcefully without significantly increasing heart rate • increase in cardiac output assists in maintaining blood flow to vital organs

  32. 3. dopamine (Dopastat, Intropin) • mechanism of action is dependent on dose

  33. low doses: selectively stimulates beta1 receptors in kidneys that cause vasodilation and an ↑ blood flow to kidneys (used in treating hypovolemic and cardiogenic shock)

  34. moderate doses: stimulates beta1 receptors, causing heart to beat with more force and increasing cardiac output

  35. higher doses: stimulates alpha receptors causing vasoconstriction and raising b.p.

  36. Fluid replacement agents used to treat shock • Used to replace blood or other fluids lost during hypovolemic shock

  37. Fluid replacement agents are generally placed into the following 3 categories: • blood, colloids, crystalloids

  38. Blood • Whole blood indicated for treatment of acute, massive blood loss when there is a need to replace plasma volume and supply RBC’s

  39. Colloids • Used when up to 1/3 of adult blood volume is lost

  40. colloids are proteins that stay suspended in the blood for a long period and draw water from the body’s cells and tissues into the blood vessels

  41. colloids include: normal serum albumin, plasma protein fractions, dextran and hetastarch

  42. Crystalloids • IV solutions that contain electrolytes in amounts resembling those of natural plasma

  43. Unlike colloids, crystalloid solutions leave the blood and enter cells

  44. used to replace fluids lost, and to increase urine output

  45. include: normal saline, lactated Ringer’s, hyperotonic saline, 5% dextrose in water

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