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18 Cards in this Set

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Major determinants BP
MAP = HR x SV x TPR

TPR = f(vessel length, blood viscosity, vessel radius(^-4)
3 major types of shock
Hypovolemic
Cardiogenic
Distributive
Causes Cardiogenic shock
1. Massive PE
2. Cardiomyopathy
3. Arrthymias
4. Cardiac tamponade
Causes distributive shock
1. Septic shock
2. Anaphlyaxis
3. Neurogenic shock (post CNS/PNS injury)
Causes hypovolemic shock
1. Hemorhage
2. Fluid loss
Table hemodynamic Profile of Shock
D1 receptor
Location: kidney vascular bed
Activation: increase renal blood flow and GFR
alpha 1 receptor
Location: vasculature
Activation: vasoconstriction
beta 1 receptor
Location: heart
Activation: Inotropic & chronotropic
beta 2 receptor
Location: vasculature; bronchi
Activation: vasodilation, bronchodilation
Drugs and Receptor Sites of Action
Drugs used in shock (all)
phenylephrine
Norepinephrine
Epinephrine
Dopamine
Dobutamine
Phenylephrine
Phenylephrine – pure alpha 1 agonist. Vasoconstriction increasing SVR.
Norepinephrine
Norepinephrine – both alpha 1 & beta 1 agonists. Vasoconstriction (alpha 1) & CO increase (beta 1). Used to treat septic shock.
Epinephrine
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)
Dopamine
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)
Dobutamine
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
Drugs management shock table