6.3 Drugs for treating Shock bsc Nursing

Contains the slide for the Drugs for treating Shock bsc Nursing coorse bSn

1. Drugs for treating Shock Dr. Saroj suwal

2. Shock Syndrome characterize by collapse of Circulatory System Shock is a systemic state of low tissue perfusion, which is inadequate for normal cellular respiration.

3. Symptoms and signs

4. Types of Shock Hypovolemic: Due to loss of blood volume Two types hemorrhagic, non-hemorrhagic (GI or renal losses, burns, etc.)

5. Septic Shock Multiple organ Dysfunction due to organism in blood Cardiogenic: Failure to pump blood to issue Acute myocardial infraction resulting in massive damage to myocardium, CHF ,Pulmonary embolism

6. Anaphylactic shock due to acute allergic reactions Due to severe reaction to allergens Drugs: penicillin , radio contrast, lignocaine , anesthetic drugs, iron injectable . . etc. Blood transfusion Stings and snake bite New clothes Dusting smokes Suddenly climate change

7. Drugs Used for Shock 3 categories Vasoconstrictors Ephinephrine , norephinephrine Cardio Tonic Drugs Fluid Replacement agents

8. vasoconstrictors EPINEPHRINE NOR-EPINEPHRINE

9. EPINEPHRINE/ Adrenaline Is both hormone and neurotransmitter part of your sympathetic nervous system, which is part of your body’s emergency response system to danger — the “fight-or-flight” response Non selective adrenergic agent stimulates both the alpha- and beta- adrenergic systems causes systemic VASOCONSTRICTION gastrointestinal relaxation, stimulates the HEART, and dilates BRONCHI and cerebral vessels.

10. Activate adergenic systme Increase BP  due to alpha 1 receptor in smooth muscle of blood vessels Cardia output increase  due to stimulation of beta 1 receptor in heart Airway open  due to stimulation of beta 2

11. Uses of adrenaline Cardiac arrest/cardiopulmonary resuscitation (CPR ): e pinephrine stimulates your heart. Eye surgery: Epinephrine helps keep your pupils dilated. Septic shock: Epinephrine increases your blood pressure. Asthma:  Epinephrine  opens airways and decreases airway spasms. Anaphylaxis : Epinephrine relaxes airway muscles. It’s the first-response treatment for this severe, life-threatening allergic reaction.

12. Low levels of epinephrine? Health conditions that result from low levels of epinephrine include: Anxiety. Depression. Headaches. Sleeping problems. Low blood sugar (hypoglycemia). Changes in blood pressure, heart rate.

13. Non Epinephrine Norepinephrine is similar to adrenaline. chemical released from the sympathetic  nervous system   Stress Hormone It works by constricting (narrowing) the blood vessels and increasing  blood pressure  and blood glucose (sugar) levels. Norepinephrine is used to treat life-threatening low  blood pressure  ( hypotension )  Has both alpha and beta one activity

14. Nor epinephrine Most widely used vasopressor Potent alpha 1 agonist causing vasocontraction in tissue bed Inscrease SVR - - Increase blood pressue

15. Cardio tonic drugs Ionotropic agents – increase force of contraction of heart muscles Digoxin Dobutamine Dopamine

16. Ionotropic-> strengthing of contraction Chronotropic  heart rate Dermotropic  affect tissue of heart—rate of conductio n of heart

17. Digoxin cardiotonic glycoside obtained mainly from Digitalis lanata  used for congestive heart failure and supraventricular arrhythmias control ventricular rate

18. MOA has positive inotropic and negative on chronotropic activity 1. blockage of Na+/ K+ATPase Increase Na+ I n cell causing output of Ca+ Increase Ca+ concerntation leads to actin myofibrils contraction

19. Dobutamine Inotrope helps increase the strength of the heart muscle Used for cardiogenic shock and severe heart failure . is a sympathomimetic amine

20. Dobutamine MOA Has dual action  beta and alpha adregenic A stronger beta effects than alpha effects. Beta 1 adrenergic agent A It produces  inotropic state. B2 receptor systemic vasodilation and increases the Alpha 1receptor vasoconstriction Higher doses may cause an increase in heart rate, exacerbating myocardial ischemia

21. MOA- beta 1 adergenic effect

22. Dopamine immediate precursor to norepinephrine Neurotransmitter released from brain regulate two types of cardiac function , vascular and endocrine function   neurotransmitter —a chemical released by neurons (nerve cells) to send signals to other nerve cells. Endocrine:-Precursor for norepinephrine synthesis Each ampoule  contains 200 mg / 5ml Dopamine not effective  orally and does not cross blood brain barrier

23. Dopamine action   Dopamine receptors D1 , D2 rectpotors D1 and D2 receptors are the most abundant and widespread in brain areas (striatum ,limbic system, thalamus and hypothalamus) adrenergic receptors alpha and B1 receptors ( But not B2 )

24. Dopamine Acts differently in different at dose ( LOW, MEDIUM and HIGH Dose ) Acts on dopamine, alpha and beta receptors

25. uses septic shock, cardiogenic shock, to Reverse acute renal failure , pulmonary edema  contracts heart and decrease pulmonary load

26. Like dobutamine , Domaine is inactivated by higher PH. , alkaline fluid shouldn’t be infused along with dopamine

27. Low dose : renal dose Used for treating hypovolemic and cardiogenic shock At low doses (<3 mg/kg/min), dopamine activates dopaminergic ( D1 ) receptors that sub serve vasodilatation in various vascular beds  including the coronary and renal arteries .

28. Moderate dose 2 to 10 μg /kg/min  results in enhanced norepinephrine release  , stimulating cardiac receptors with an increase in inotropic and mild stimulation of peripheral vasoconstricting receptors. Stimulates beta 1 receptor  cause increase rate with force inscrease CO

29. High Dose - dopamine ( 10 to 20 μg /kg/min)  mediated by direct agonist effects on alpha1 -adrenergic receptors --  causes peripheral and pulmonary artery vasoconstriction,. These doses carry a significant risk of precipitating limb and end-organ ischemia and should be used cautiously Stimulates alpha receptor  vasoconstriction increase BP

30. Fluid Replacement Used to replace blood or other fluids during hypovolemic shock Generally replacement done are Blood , colloids, crystalloids-IV Fluids- NS,DNS,RL

31. Blood Whole Blood Blood from standard donation indicated for acute and massive blood loss Will replace plasma volume Supply RBC’s

32. Colloids Used when 1/3 blood volume is lost Are proteins that stay suspended in blood for long period Draw water from body’s cells and tissues into blood vessels Colloids are Serum albumin, plasma protein fractions, dextran

33. Crystalloids IV solutions that contain electrolytes that is same as contained in plasma Like colloids leave blood and enter into cell Used for replacing fluid lost Increase urine output Include NS, RL , Hypertonic Saline 5% dextrose

34. Tonicity of fluids term used to compare the osmotic pressure of different solutions Is equal to the sum of the concentrations of the solutes which have the capacity to exert an osmotic force across the membrane . Hypotonic Hypertonic isotonic

35. Tonicity of solutions hypotonic   solution that has an osmotic pressure lower than plasma. means water enters the cell makes it to expand and possibly explode isotonic solution is one that has an osmotic pressure the same as plasma. Water entering exiting is equal. A hypertonic solution that has an osmotic pressure higher than plasma. If the environment is hypertonic, the cell will shrink due to water leaving the cell.

36. Thanks - end