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18 Cards in this Set
- Front
- Back
Major determinants BP
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MAP = HR x SV x TPR
TPR = f(vessel length, blood viscosity, vessel radius(^-4) |
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3 major types of shock
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Hypovolemic
Cardiogenic Distributive |
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Causes Cardiogenic shock
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1. Massive PE
2. Cardiomyopathy 3. Arrthymias 4. Cardiac tamponade |
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Causes distributive shock
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1. Septic shock
2. Anaphlyaxis 3. Neurogenic shock (post CNS/PNS injury) |
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Causes hypovolemic shock
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1. Hemorhage
2. Fluid loss |
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Table hemodynamic Profile of Shock
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D1 receptor
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Location: kidney vascular bed
Activation: increase renal blood flow and GFR |
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alpha 1 receptor
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Location: vasculature
Activation: vasoconstriction |
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beta 1 receptor
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Location: heart
Activation: Inotropic & chronotropic |
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beta 2 receptor
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Location: vasculature; bronchi
Activation: vasodilation, bronchodilation |
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Drugs and Receptor Sites of Action
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Drugs used in shock (all)
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phenylephrine
Norepinephrine Epinephrine Dopamine Dobutamine |
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Phenylephrine
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Phenylephrine – pure alpha 1 agonist. Vasoconstriction increasing SVR.
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Norepinephrine
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Norepinephrine – both alpha 1 & beta 1 agonists. Vasoconstriction (alpha 1) & CO increase (beta 1). Used to treat septic shock.
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Epinephrine
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Epinephrine – beta 1, some beta 2 & some alpha 1 agonist. Effect is dose dependent.
1. Low dose = mostly beta 1 agonist (inotropic & chronotropic) (Beta 2 offsets alpha 1 fx) 2. High dose = Mostly alpha 1 agonist (vasoconstriction) & beta 1 agonist (ionotropic & chronotropic) |
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Dopamine
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Dopamine – Mixed D1, beta 1, Alpha 1 activity that is dose dependent
1. Low dose (1-2mcg/kg/min) – D1 receptor agonist = selective vasodilation renal, mesenteric, cerebral, coronary beds. 2. Mid dose – unclear effects 3. High dose (5-10mcg/kg/min) – D1 & Beta 1 agonist = increase CO (iono/chronotropy) 4. Higher dose (>10mcg/kg/min) – Alpha 1 agonist = vasoconstriction (increase SVR) |
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Dobutamine
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Dobutamine – Mostly Beta 1 agonist. Minimal, mixed alpha 1 & Beta 2 activity. Dominated by beta 1 increase CO (iono/chronotropic of heart). The minimal alpha 1 / beta 2 activity result in vasodilation & decreased SVR
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Drugs management shock table
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