Cardiovascular Medications for Shock
General Considerations
- Correct Hypovolemia First: Always correct patient's hypovolemia before administering vasopressors.
Epinephrine
- Uses: Severe allergic reactions (anaphylaxis), advanced cardiac life support (Code Blue situations).
- Mechanism of Action:
- Stimulates alpha-1 receptors → vasoconstriction.
- Stimulates beta-1 receptors in heart → increases heart rate.
- Stimulates beta-2 receptors in lungs → bronchodilation.
- Side Effects: Hypertension, dysrhythmias, angina, nervousness, tremor.
- Monitoring: Vital signs, heart rhythm, EKG.
Norepinephrine
- Uses: Shock, severe hypotension.
- Mechanism of Action:
- Stimulates alpha-1 receptors → vasoconstriction.
- Minor beta-1 activity → increases cardiac output.
- Side Effects: Hypertension, dysrhythmias.
- Monitoring: Vital signs, heart rhythm.
Dopamine
- Uses: Shock, sepsis, heart failure, renal failure.
- Mechanism of Action:
- Stimulates alpha-1 receptors → vasoconstriction.
- Stimulates beta-1 receptors → increases cardiac output, heart rate.
- Stimulates dopaminergic receptors → increases renal perfusion.
- Side Effects: Dysrhythmias, angina.
- Monitoring: Vital signs, EKG.
Dobutamine
- Uses: Heart failure, cardiogenic shock.
- Mechanism of Action:
- Stimulates beta-1 receptors → increases cardiac output.
- Less effect on heart rate and blood pressure.
- Side Effects: Hypertension, dysrhythmias, angina.
- Monitoring: Vital signs, EKG, hemodynamic parameters (pulmonary artery wedge pressure, central venous pressure), possibly arterial line.
Albumin
- Type: Colloid, volume expander.
- Uses: Shock, hemorrhage, burns.
- Mechanism of Action: Draws fluid from extravascular space into intravascular space to maintain osmotic pressure in plasma.
- Side Effects: Fluid volume overload, pulmonary edema, hypertension.
- Contraindications: Heart failure.
- Monitoring: Signs of fluid overload (e.g., edema, pulmonary edema, lung crackles).
Next Lecture Topic: Medications for high cholesterol.
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