Medications for cardiovascular support
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This document discusses several vasoactive drugs used for cardiovascular support, including their mechanisms of action, dosages, and adverse effects. Dopamine has dose-dependent effects on heart rate, contractility and blood pressure through dopaminergic, beta, and alpha receptors. Norepinephrine increases blood pressure through alpha and beta-1 receptors. Dobutamine has positive inotropic and chronotropic effects through beta-1 and weak beta-2 receptor agonism. Vasopressin stimulates vasoconstriction through vascular V1 receptors and is used to treat vasodilatory shock. All of these drugs can potentially cause arrhythmias, changes in blood pressure, or tissue damage if not carefully dosed.
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Vasoactive drugs
This document discusses vasoactive drugs, which affect vasomotor tone by causing vasoconstriction or vasodilation. It describes several classes of vasoactive drugs including vasodilators like hydralazine and nitroglycerin that work by different mechanisms in the arteries and veins. Vasoconstrictors like phenylephrine and vasopressin are also discussed. Many vasoactive drugs have direct effects on the heart by acting on receptors in the cardiovascular system. Inodilators like milrinone cause both vasodilation and increased cardiac contractility. Specific drugs such as dopamine, norepinephrine, and epinephrine are explained in terms of their vascular and cardiac effects.
Chf pharmacology of digitalis
Digitalis is obtained from the leaves of Digitalis purpurea. It has positive inotropic effects on the heart by enhancing myocardial activity and contractility. This increases cardiac output and shifts the stroke volume-preload curve towards normal in patients with congestive heart failure (CHF), improving cardiac function and relieving symptoms. Digitalis is used to treat CHF and cardiac arrhythmias, but it has contraindications like tachycardia, hypokalemia, and myocardial infarction.
Vasoactive drugs
Vasoactive drugs act on the heart and circulatory system by affecting adrenergic receptors. They can be classified as vasopressors, inotropes, or vasodilators. Common vasoactive drugs include adrenaline, noradrenaline, dopamine, dobutamine, milrinone, vasopressin, nitroglycerine, and nitroprusside. Each drug has distinct mechanisms of action and indications for use. Careful consideration of dosing and side effects is important when using these powerful cardiovascular medications.
Congestive heart failure
Heart failure results from reduced cardiac output and elevated sympathetic discharge, leading to vasoconstriction and sodium and water retention. Drugs used to treat heart failure include diuretics, ACE inhibitors, beta blockers, aldosterone receptor antagonists, and vasodilators. Diuretics are first-line to reduce preload and relieve edema. ACE inhibitors and ARBs reduce afterload while beta blockers attenuate sympathetic activation. Aldosterone receptor antagonists prevent remodeling and reduce mortality.
9 cardiac glycosides
This document discusses treatments for congestive heart failure (CHF), focusing on digitalis glycosides and other positive inotropic agents. It provides details on:
- The mechanisms of action and molecular effects of digitalis glycosides, which increase cardiac contractility and output, lowering venous pressure and edema.
- Other positive inotropic drugs used in acute CHF like dobutamine and phosphodiesterase inhibitors.
- Drugs that reduce cardiac preload and edema like diuretics and angiotensin converting enzyme inhibitors, which lower blood pressure and sympathetic tone.
The document explains the benefits, side effects and clinical uses of various CHF drugs in detail through multiple sections and diagrams.
Positive inotropic (ahmed salah)
Positive inotropic drugs like adrenaline and noradrenaline increase myocardial contractility and cardiac output. Adrenaline acts on beta-1, beta-2, and alpha-1 receptors to increase heart rate, contractility, and blood pressure. It is used in low cardiac output states, shock, and bronchodilation. Noradrenaline is a potent vasoconstrictor that raises blood pressure through alpha-1 receptor activation with less tachycardia than adrenaline. Both drugs require close hemodynamic and ECG monitoring due to risks of hypertension, arrhythmias, and other side effects.
Inotrope use in icu patient fink
Dobutamine and dopamine are commonly used inotropic agents that increase cardiac output by increasing stroke volume, though dopamine can increase afterload at higher doses. Epinephrine and norepinephrine also increase contractility through beta-1 agonism but have greater vasopressor effects. Dobutamine is preferred over dopamine when treating cardiogenic shock due to its more predictable cardiac effects. In septic shock, dobutamine with norepinephrine is recommended to increase cardiac output while maintaining blood pressure, though epinephrine is an alternative. The effects of inotropes on tissue oxygen utilization must also be considered, as agents like dopamine may impair splanchnic perfusion despite increasing cardiac output.
Cardiac Glycosides (Medicinal Chemistry) MANIK
This document discusses cardiotonics, which are drugs that increase the force of contraction of the heart muscle. Cardiotonics have several effects on the heart including improving excitability, automaticity, conduction velocity and refractory period. The main indications for cardiotonics are congestive heart failure, atrial fibrillation, atrial flutter, and paroxysmal atrial tachycardia. Cardiac glycosides are considered cardiotonics and work by inhibiting the sodium-potassium pump in heart cells, increasing intracellular sodium and calcium levels which strengthens muscle contraction. Digoxin and digitoxin are two commonly used cardiac glycosides that are obtained from plant sources and used to treat congestive
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Vasoactive drugs
This document discusses vasoactive drugs, which affect vasomotor tone by causing vasoconstriction or vasodilation. It describes several classes of vasoactive drugs including vasodilators like hydralazine and nitroglycerin that work by different mechanisms in the arteries and veins. Vasoconstrictors like phenylephrine and vasopressin are also discussed. Many vasoactive drugs have direct effects on the heart by acting on receptors in the cardiovascular system. Inodilators like milrinone cause both vasodilation and increased cardiac contractility. Specific drugs such as dopamine, norepinephrine, and epinephrine are explained in terms of their vascular and cardiac effects.
Chf pharmacology of digitalis
Digitalis is obtained from the leaves of Digitalis purpurea. It has positive inotropic effects on the heart by enhancing myocardial activity and contractility. This increases cardiac output and shifts the stroke volume-preload curve towards normal in patients with congestive heart failure (CHF), improving cardiac function and relieving symptoms. Digitalis is used to treat CHF and cardiac arrhythmias, but it has contraindications like tachycardia, hypokalemia, and myocardial infarction.
Vasoactive drugs
Vasoactive drugs act on the heart and circulatory system by affecting adrenergic receptors. They can be classified as vasopressors, inotropes, or vasodilators. Common vasoactive drugs include adrenaline, noradrenaline, dopamine, dobutamine, milrinone, vasopressin, nitroglycerine, and nitroprusside. Each drug has distinct mechanisms of action and indications for use. Careful consideration of dosing and side effects is important when using these powerful cardiovascular medications.
Congestive heart failure
Heart failure results from reduced cardiac output and elevated sympathetic discharge, leading to vasoconstriction and sodium and water retention. Drugs used to treat heart failure include diuretics, ACE inhibitors, beta blockers, aldosterone receptor antagonists, and vasodilators. Diuretics are first-line to reduce preload and relieve edema. ACE inhibitors and ARBs reduce afterload while beta blockers attenuate sympathetic activation. Aldosterone receptor antagonists prevent remodeling and reduce mortality.
9 cardiac glycosides
This document discusses treatments for congestive heart failure (CHF), focusing on digitalis glycosides and other positive inotropic agents. It provides details on:
- The mechanisms of action and molecular effects of digitalis glycosides, which increase cardiac contractility and output, lowering venous pressure and edema.
- Other positive inotropic drugs used in acute CHF like dobutamine and phosphodiesterase inhibitors.
- Drugs that reduce cardiac preload and edema like diuretics and angiotensin converting enzyme inhibitors, which lower blood pressure and sympathetic tone.
The document explains the benefits, side effects and clinical uses of various CHF drugs in detail through multiple sections and diagrams.
Positive inotropic (ahmed salah)
Positive inotropic drugs like adrenaline and noradrenaline increase myocardial contractility and cardiac output. Adrenaline acts on beta-1, beta-2, and alpha-1 receptors to increase heart rate, contractility, and blood pressure. It is used in low cardiac output states, shock, and bronchodilation. Noradrenaline is a potent vasoconstrictor that raises blood pressure through alpha-1 receptor activation with less tachycardia than adrenaline. Both drugs require close hemodynamic and ECG monitoring due to risks of hypertension, arrhythmias, and other side effects.
Inotrope use in icu patient fink
Dobutamine and dopamine are commonly used inotropic agents that increase cardiac output by increasing stroke volume, though dopamine can increase afterload at higher doses. Epinephrine and norepinephrine also increase contractility through beta-1 agonism but have greater vasopressor effects. Dobutamine is preferred over dopamine when treating cardiogenic shock due to its more predictable cardiac effects. In septic shock, dobutamine with norepinephrine is recommended to increase cardiac output while maintaining blood pressure, though epinephrine is an alternative. The effects of inotropes on tissue oxygen utilization must also be considered, as agents like dopamine may impair splanchnic perfusion despite increasing cardiac output.
Cardiac Glycosides (Medicinal Chemistry) MANIK
This document discusses cardiotonics, which are drugs that increase the force of contraction of the heart muscle. Cardiotonics have several effects on the heart including improving excitability, automaticity, conduction velocity and refractory period. The main indications for cardiotonics are congestive heart failure, atrial fibrillation, atrial flutter, and paroxysmal atrial tachycardia. Cardiac glycosides are considered cardiotonics and work by inhibiting the sodium-potassium pump in heart cells, increasing intracellular sodium and calcium levels which strengthens muscle contraction. Digoxin and digitoxin are two commonly used cardiac glycosides that are obtained from plant sources and used to treat congestive
Congestive heart failure (chf) medicinal chemistry
A condition in which the heart is unable to pump sufficient blood
to meet the metabolic demand of the body and also unable to receive it back because every time after a systole.
Drugs for heart failure
This document discusses drugs used to treat congestive heart failure (CHF). CHF occurs when the heart cannot pump enough blood to meet the body's needs. Key drugs mentioned include digitalis glycosides like digoxin, which increase the force of heart contractions; diuretics like furosemide that reduce fluid buildup; ACE inhibitors and ARBs that lower blood pressure and prevent further heart damage; and inotropic drugs like dobutamine that strengthen heart contractions. Adverse effects, mechanisms of action, and guidelines for use are provided for several common CHF medications.
Anti anginal drugs.
This presentation discusses angina pectoris and its treatment. It is caused by an imbalance between myocardial oxygen supply and demand. There are three main types of angina - stable, variant, and unstable - depending on the triggers and severity. The main classes of drugs used to treat angina are organic nitrates, beta-blockers, and calcium channel blockers. Nitrates work by dilating blood vessels to reduce preload and afterload. Beta-blockers decrease heart rate and contractility to lower oxygen demand. Calcium channel blockers dilate coronary arteries and reduce afterload. The presentation discusses the mechanisms and effects of representative drugs from each class.
Drugs used in congestive heart failure-1
This document discusses drugs used to treat congestive heart failure. It begins by defining congestive heart failure and describing the two main types: systolic and diastolic dysfunction. It then discusses the pathophysiology of CHF and outlines two main treatment goals: relieving symptoms and improving cardiac function, and arresting disease progression. The main drug classes used are described in detail, including diuretics, renin-angiotensin system inhibitors, vasodilators, and beta-blockers. Diuretics are first-line treatment to reduce fluid retention, while ACE inhibitors, ARBs, and beta-blockers provide both symptomatic relief and prolong survival by modifying disease progression. Vasodilators are used
Anti-Anginal Drugs
This document discusses different types of angina and treatments. It describes 3 main types of angina: atherosclerotic angina which is caused by partially blocked arteries and accounts for 90% of cases; vasospastic angina which involves coronary artery spasms and can occur at rest; and unstable angina which is a medical emergency and precursor to heart attack. The major treatment strategies aim to increase oxygen delivery to the heart and reduce oxygen demand. Traditional pharmacological therapies discussed include nitrates, calcium channel blockers, and beta blockers which all work to relax blood vessels or reduce heart rate to improve oxygen supply. Newer drugs like ranolazine and ivabradine are also mentioned.
Ionotrops 3
This document discusses ionotropes, which are drugs that increase the force of contraction of the myocardial muscle. Positive ionotropes stimulate smooth muscle contraction in capillaries and arteries, causing vasoconstriction and increased blood pressure, improving tissue perfusion and oxygenation. The document categorizes ionotropes based on their effects on contractility, heart rate, systemic vascular resistance, mean arterial pressure and other factors. It also discusses how different ionotropes work through receptors and second messengers like cAMP to increase contractility. The combinations of various ionotropes with different receptor specificities and hemodynamic effects are described.
Uppers downers and squeezers
This document provides an overview of inotropes and vasoactive drugs, explaining how they work to increase cardiac output by enhancing contractility, heart rate, preload, and manipulating vascular resistance through their effects on adrenergic receptors and other mechanisms. It discusses various drugs like adrenaline, noradrenaline, dobutamine, vasopressin, GTN, and others, explaining their receptor targets, clinical applications, and nursing considerations for safe administration. The goal is to help nurses better understand these important hemodynamic medications and feel more confident in their use.
Shock And Vasoactive Drugs
This document discusses various types of shock and medications used to treat shock. Shock is defined as inadequate tissue perfusion and oxygenation. Types of shock include septic, cardiogenic, hemorrhagic, and neurogenic shock. Common pressor medications discussed are dopamine, epinephrine, norepinephrine, dobutamine, and vasopressin. Each medication has different effects mediated through alpha and beta receptor stimulation, with some causing vasoconstriction and others increasing cardiac output. Norepinephrine is emerging as a preferred agent for treating septic shock.
Digitalis Lecture
This document discusses drugs used to treat congestive heart failure. It lists several classes of drugs including inotropes like digoxin, diuretics like furosemide, ACE inhibitors like enalapril, and ARBs like losartan. It provides details on digoxin including its neurohormonal effects, toxicity risks, and studies showing its effects on worsening of CHF and overall mortality.
Lec60[1]
1. Several substances act as vasoconstrictors or vasodilators to regulate blood flow, including norepinephrine, epinephrine, angiotensin II, vasopressin, histamine, bradykinin, ions like calcium and potassium.
2. During exercise, sympathetic nervous system discharge causes widespread vasoconstriction except in active muscles, along with increased heart rate, arterial pressure and cardiac output to elevate blood flow to muscles.
3. Coronary blood flow supplies the heart and increases during exercise to meet heightened cardiac demand, with the left coronary artery mainly supplying the left ventricle and right coronary artery mainly supplying the right ventricle.
Vasoactve drugs
1) Vasoactive drugs include vasopressors, ionotropes, and other drugs that act on vascular smooth muscle and cardiac muscle.
2) Norepinephrine is the first-line vasopressor for treating septic shock as it increases cardiac index and blood pressure while preserving organ perfusion. Dopamine can also be used but has greater risks.
3) Ionotropes like dobutamine are used to increase cardiac contractility in conditions with low cardiac output such as cardiogenic or hypodynamic septic shock.
Pharmacology of vasoconstriction drug
This document discusses vasoconstrictor drugs used in dentistry including epinephrine, norepinephrine, and levonordefrin. It explains that vasoconstrictors decrease blood flow to the injection site, lower anesthetic blood levels, reduce risk of toxicity, increase duration of local anesthetics, and decrease bleeding. It provides details on the mechanisms and effects of different adrenergic receptors and considers the selectivity, potency, benefits and interactions of various vasoconstrictor drugs. The document also lists conditions where vasoconstrictor use should be avoided or minimized such as certain heart diseases.
Antianginal Drugs
This document summarizes different types of antianginal drugs. It discusses the pathophysiology of angina pectoris and different causes of chest pain. It then describes various classes of antianginal drugs including nitrates, beta blockers, calcium channel blockers, potassium channel openers, and other drugs. For each class, it discusses mechanisms of action, pharmacokinetics, uses, and adverse effects. The document provides an overview of treatment approaches for angina pectoris and ischemic heart disease.
Drugs used in chf ii
The document discusses drugs used to treat heart failure, including aldosterone antagonists like spironolactone and eplerenone. It notes that aldosterone contributes to disease progression and antagonists can provide benefits, though are contraindicated in renal insufficiency due to risk of hyperkalemia. Sympathomimetic drugs like dobutamine and dopamine are discussed as having positive inotropic effects to combat pump failure. Phosphodiesterase inhibitors like inamrinone and milrinone are described as increasing myocardial cAMP and having inotropic and vasodilating effects. The mechanisms and pharmacological actions of cardiac glycoside digoxin are explained in detail.
Antianginals
This document discusses antianginal drugs used to treat angina pectoris. It defines angina and describes different types. Antianginal drugs work by increasing myocardial oxygen supply or decreasing demand. Nitrates and calcium channel blockers increase supply by dilating coronary arteries. Beta blockers decrease demand by lowering heart rate and contractility. Combination therapy using these classes is common. The document also discusses mechanisms, administration, effects, and side effects of these major antianginal drugs.
Starling Case Report
The treatment for Mr. Starling's congestive heart failure condition included furosemide to reduce edema, captopril to decrease blood pressure, intravenous fluids to increase blood pressure, and dobutamine to increase contractility. While these treatments provided some improvement, his cardiac output was not improved so he was evaluated for cardiac transplantation. He ultimately received a heart transplant which involved removing his failing heart and implanting a donor heart to treat his end stage heart failure.
Anti Anginal drugs
This document discusses angina pectoris, or chest pain caused by reduced blood flow to the heart. It defines three main types of angina - stable, unstable, and Prinzmetal's variant - based on the characteristics and triggers of the chest pain. The document then reviews several classes of drugs used to treat angina, including nitrates, beta-blockers, calcium channel blockers, and nicorandil. It provides details on the pharmacological mechanisms and clinical uses of individual drugs within these classes, such as nitroglycerin, metoprolol, verapamil, and nicorandil. Adverse effects are also outlined for each medication.
Anti anginal drugs
This document discusses anti-anginal drugs. It describes the types of angina and the pharmacological goals of decreasing preload, afterload, and heart rate. The main classes of anti-anginal drugs discussed are nitrates, beta blockers, calcium channel blockers, and potassium channel openers. Nitrates work by relaxing blood vessels to reduce preload and afterload. Beta blockers have negative effects on heart rate and contractility. Calcium channel blockers block calcium channels in the heart and blood vessels. Potassium channel openers open potassium channels to cause vessel dilation. The document provides details on specific drugs in each class and their uses for stable, variant, and unstable angina.
Antianginal Drugs
The document discusses different types of angina pectoris and treatments for angina. It defines typical angina, variant angina, and unstable angina. It then explains drugs that can be used to treat angina by decreasing oxygen demand and/or increasing oxygen supply, including nitrates, calcium channel blockers, and beta blockers. Nitrates are described as being effective for treating acute angina by dilating blood vessels and reducing workload on the heart. Calcium channel blockers and beta blockers are also outlined as treatments that decrease oxygen demand. Combination therapies are noted to provide additive effects in managing angina.
Class antianginal
This document discusses the patterns of angina pectoris and their characteristics. It describes stable angina, which produces reproducible chest pain relieved by rest. Unstable angina occurs with less exertion or at rest and is less responsive to nitroglycerin. Prinzmetal angina is an uncommon variant occurring at rest, often in young individuals, triggered by substances like alcohol. The document also outlines various drug classes used to treat angina, including nitrates, calcium channel blockers, beta blockers, and other adjunctive therapies. It provides details on the mechanisms and side effects of these drug classes.
Inotropes and Vasopressors.pptx
This document provides an overview of inotropes and vasopressors. It discusses how inotropes such as dobutamine work to increase cardiac contractility as positive inotropes, while drugs like calcium channel blockers act as negative inotropes. Vasopressors like norepinephrine work mainly through alpha receptors to increase blood pressure. The document reviews the mechanisms and indications for various inotropes and vasopressors. It also discusses factors like preload, afterload and contractility that influence cardiac output, and how drugs can be used to optimize these factors in conditions like cardiogenic shock. Monitoring of parameters like blood pressure, cardiac output and central venous pressure is important when using these
Vasopressors and inotropes
This document summarizes different vasopressors and inotropes used to treat hypotension. It describes the receptor activities, physiological effects, indications, and complications of various drugs including phenylephrine, norepinephrine, epinephrine, dopamine, dobutamine, vasopressin, and phosphodiesterase inhibitors. It provides guidance on selecting agents and titrating doses based on the underlying cause of hypotension and the patient's clinical status.
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Congestive heart failure (chf) medicinal chemistry
A condition in which the heart is unable to pump sufficient blood
to meet the metabolic demand of the body and also unable to receive it back because every time after a systole.
Drugs for heart failure
This document discusses drugs used to treat congestive heart failure (CHF). CHF occurs when the heart cannot pump enough blood to meet the body's needs. Key drugs mentioned include digitalis glycosides like digoxin, which increase the force of heart contractions; diuretics like furosemide that reduce fluid buildup; ACE inhibitors and ARBs that lower blood pressure and prevent further heart damage; and inotropic drugs like dobutamine that strengthen heart contractions. Adverse effects, mechanisms of action, and guidelines for use are provided for several common CHF medications.
Anti anginal drugs.
This presentation discusses angina pectoris and its treatment. It is caused by an imbalance between myocardial oxygen supply and demand. There are three main types of angina - stable, variant, and unstable - depending on the triggers and severity. The main classes of drugs used to treat angina are organic nitrates, beta-blockers, and calcium channel blockers. Nitrates work by dilating blood vessels to reduce preload and afterload. Beta-blockers decrease heart rate and contractility to lower oxygen demand. Calcium channel blockers dilate coronary arteries and reduce afterload. The presentation discusses the mechanisms and effects of representative drugs from each class.
Drugs used in congestive heart failure-1
This document discusses drugs used to treat congestive heart failure. It begins by defining congestive heart failure and describing the two main types: systolic and diastolic dysfunction. It then discusses the pathophysiology of CHF and outlines two main treatment goals: relieving symptoms and improving cardiac function, and arresting disease progression. The main drug classes used are described in detail, including diuretics, renin-angiotensin system inhibitors, vasodilators, and beta-blockers. Diuretics are first-line treatment to reduce fluid retention, while ACE inhibitors, ARBs, and beta-blockers provide both symptomatic relief and prolong survival by modifying disease progression. Vasodilators are used
Anti-Anginal Drugs
This document discusses different types of angina and treatments. It describes 3 main types of angina: atherosclerotic angina which is caused by partially blocked arteries and accounts for 90% of cases; vasospastic angina which involves coronary artery spasms and can occur at rest; and unstable angina which is a medical emergency and precursor to heart attack. The major treatment strategies aim to increase oxygen delivery to the heart and reduce oxygen demand. Traditional pharmacological therapies discussed include nitrates, calcium channel blockers, and beta blockers which all work to relax blood vessels or reduce heart rate to improve oxygen supply. Newer drugs like ranolazine and ivabradine are also mentioned.
Ionotrops 3
This document discusses ionotropes, which are drugs that increase the force of contraction of the myocardial muscle. Positive ionotropes stimulate smooth muscle contraction in capillaries and arteries, causing vasoconstriction and increased blood pressure, improving tissue perfusion and oxygenation. The document categorizes ionotropes based on their effects on contractility, heart rate, systemic vascular resistance, mean arterial pressure and other factors. It also discusses how different ionotropes work through receptors and second messengers like cAMP to increase contractility. The combinations of various ionotropes with different receptor specificities and hemodynamic effects are described.
Uppers downers and squeezers
This document provides an overview of inotropes and vasoactive drugs, explaining how they work to increase cardiac output by enhancing contractility, heart rate, preload, and manipulating vascular resistance through their effects on adrenergic receptors and other mechanisms. It discusses various drugs like adrenaline, noradrenaline, dobutamine, vasopressin, GTN, and others, explaining their receptor targets, clinical applications, and nursing considerations for safe administration. The goal is to help nurses better understand these important hemodynamic medications and feel more confident in their use.
Shock And Vasoactive Drugs
This document discusses various types of shock and medications used to treat shock. Shock is defined as inadequate tissue perfusion and oxygenation. Types of shock include septic, cardiogenic, hemorrhagic, and neurogenic shock. Common pressor medications discussed are dopamine, epinephrine, norepinephrine, dobutamine, and vasopressin. Each medication has different effects mediated through alpha and beta receptor stimulation, with some causing vasoconstriction and others increasing cardiac output. Norepinephrine is emerging as a preferred agent for treating septic shock.
Digitalis Lecture
This document discusses drugs used to treat congestive heart failure. It lists several classes of drugs including inotropes like digoxin, diuretics like furosemide, ACE inhibitors like enalapril, and ARBs like losartan. It provides details on digoxin including its neurohormonal effects, toxicity risks, and studies showing its effects on worsening of CHF and overall mortality.
Lec60[1]
1. Several substances act as vasoconstrictors or vasodilators to regulate blood flow, including norepinephrine, epinephrine, angiotensin II, vasopressin, histamine, bradykinin, ions like calcium and potassium.
2. During exercise, sympathetic nervous system discharge causes widespread vasoconstriction except in active muscles, along with increased heart rate, arterial pressure and cardiac output to elevate blood flow to muscles.
3. Coronary blood flow supplies the heart and increases during exercise to meet heightened cardiac demand, with the left coronary artery mainly supplying the left ventricle and right coronary artery mainly supplying the right ventricle.
Vasoactve drugs
1) Vasoactive drugs include vasopressors, ionotropes, and other drugs that act on vascular smooth muscle and cardiac muscle.
2) Norepinephrine is the first-line vasopressor for treating septic shock as it increases cardiac index and blood pressure while preserving organ perfusion. Dopamine can also be used but has greater risks.
3) Ionotropes like dobutamine are used to increase cardiac contractility in conditions with low cardiac output such as cardiogenic or hypodynamic septic shock.
Pharmacology of vasoconstriction drug
This document discusses vasoconstrictor drugs used in dentistry including epinephrine, norepinephrine, and levonordefrin. It explains that vasoconstrictors decrease blood flow to the injection site, lower anesthetic blood levels, reduce risk of toxicity, increase duration of local anesthetics, and decrease bleeding. It provides details on the mechanisms and effects of different adrenergic receptors and considers the selectivity, potency, benefits and interactions of various vasoconstrictor drugs. The document also lists conditions where vasoconstrictor use should be avoided or minimized such as certain heart diseases.
Antianginal Drugs
This document summarizes different types of antianginal drugs. It discusses the pathophysiology of angina pectoris and different causes of chest pain. It then describes various classes of antianginal drugs including nitrates, beta blockers, calcium channel blockers, potassium channel openers, and other drugs. For each class, it discusses mechanisms of action, pharmacokinetics, uses, and adverse effects. The document provides an overview of treatment approaches for angina pectoris and ischemic heart disease.
Drugs used in chf ii
The document discusses drugs used to treat heart failure, including aldosterone antagonists like spironolactone and eplerenone. It notes that aldosterone contributes to disease progression and antagonists can provide benefits, though are contraindicated in renal insufficiency due to risk of hyperkalemia. Sympathomimetic drugs like dobutamine and dopamine are discussed as having positive inotropic effects to combat pump failure. Phosphodiesterase inhibitors like inamrinone and milrinone are described as increasing myocardial cAMP and having inotropic and vasodilating effects. The mechanisms and pharmacological actions of cardiac glycoside digoxin are explained in detail.
Antianginals
This document discusses antianginal drugs used to treat angina pectoris. It defines angina and describes different types. Antianginal drugs work by increasing myocardial oxygen supply or decreasing demand. Nitrates and calcium channel blockers increase supply by dilating coronary arteries. Beta blockers decrease demand by lowering heart rate and contractility. Combination therapy using these classes is common. The document also discusses mechanisms, administration, effects, and side effects of these major antianginal drugs.
Starling Case Report
The treatment for Mr. Starling's congestive heart failure condition included furosemide to reduce edema, captopril to decrease blood pressure, intravenous fluids to increase blood pressure, and dobutamine to increase contractility. While these treatments provided some improvement, his cardiac output was not improved so he was evaluated for cardiac transplantation. He ultimately received a heart transplant which involved removing his failing heart and implanting a donor heart to treat his end stage heart failure.
Anti Anginal drugs
This document discusses angina pectoris, or chest pain caused by reduced blood flow to the heart. It defines three main types of angina - stable, unstable, and Prinzmetal's variant - based on the characteristics and triggers of the chest pain. The document then reviews several classes of drugs used to treat angina, including nitrates, beta-blockers, calcium channel blockers, and nicorandil. It provides details on the pharmacological mechanisms and clinical uses of individual drugs within these classes, such as nitroglycerin, metoprolol, verapamil, and nicorandil. Adverse effects are also outlined for each medication.
Anti anginal drugs
This document discusses anti-anginal drugs. It describes the types of angina and the pharmacological goals of decreasing preload, afterload, and heart rate. The main classes of anti-anginal drugs discussed are nitrates, beta blockers, calcium channel blockers, and potassium channel openers. Nitrates work by relaxing blood vessels to reduce preload and afterload. Beta blockers have negative effects on heart rate and contractility. Calcium channel blockers block calcium channels in the heart and blood vessels. Potassium channel openers open potassium channels to cause vessel dilation. The document provides details on specific drugs in each class and their uses for stable, variant, and unstable angina.
Antianginal Drugs
The document discusses different types of angina pectoris and treatments for angina. It defines typical angina, variant angina, and unstable angina. It then explains drugs that can be used to treat angina by decreasing oxygen demand and/or increasing oxygen supply, including nitrates, calcium channel blockers, and beta blockers. Nitrates are described as being effective for treating acute angina by dilating blood vessels and reducing workload on the heart. Calcium channel blockers and beta blockers are also outlined as treatments that decrease oxygen demand. Combination therapies are noted to provide additive effects in managing angina.
Class antianginal
This document discusses the patterns of angina pectoris and their characteristics. It describes stable angina, which produces reproducible chest pain relieved by rest. Unstable angina occurs with less exertion or at rest and is less responsive to nitroglycerin. Prinzmetal angina is an uncommon variant occurring at rest, often in young individuals, triggered by substances like alcohol. The document also outlines various drug classes used to treat angina, including nitrates, calcium channel blockers, beta blockers, and other adjunctive therapies. It provides details on the mechanisms and side effects of these drug classes.
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Inotropes and vasopressors
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This document discusses antihypertensive drugs. It begins by defining hypertension and outlining its pathophysiology, including potential mechanisms like the renin-angiotensin-aldosterone system. It then classifies antihypertensive drugs and provides examples in each category, describing their mechanisms of action. The categories discussed are centrally acting drugs, adrenergic receptor blockers, vasodilators, drugs blocking the renin-angiotensin-aldosterone axis like ACE inhibitors and angiotensin receptor blockers, calcium channel blockers, and diuretics. Specific drugs like clonidine, prazosin, and hydrochlorothiazide are explained in more detail.
Vassopressors and Inotropes
This document discusses vasopressors and inotropes, including their physiology, principles of use, individual drugs, and complications. It describes the adrenergic receptor subtypes and how drugs like norepinephrine, epinephrine, dopamine, dobutamine, vasopressin, and inamrinone/milrinone act on them. Norepinephrine is the first-line treatment for septic shock while dobutamine is preferred for cardiogenic shock. Potential complications include hypoperfusion, dysrhythmias, local effects, hyperglycemia. The document provides dosing guidelines and discusses implications for septic shock management.
Sympathomimetic drugs
Sympathomimetic drugs act on adrenergic receptors to mimic the effects of the sympathetic nervous system. Noradrenaline is the major neurotransmitter released by postganglionic sympathetic neurons. Catecholamines such as adrenaline, noradrenaline, and dopamine can be synthesized naturally or synthetically. They are released from neurons via exocytosis and cleared via reuptake or metabolism.
Adrenergic drugs include direct-acting sympathomimetics that activate receptors directly, indirect drugs that promote neurotransmitter release, and mixed drugs. Their effects are mediated via alpha and beta receptors. Common therapeutic uses include treating anaphylaxis, asthma, cardiac issues, and bleeding. Side effects can
Heart failure
Heart disease is a leading cause of death worldwide. key aspects of heart failure are discussed in this powerpoint presentation.
Common Emergency & Critical medications
Emergency medications are used to treat life-threatening conditions and save patients' lives. They work quickly to control symptoms and stabilize vital functions. This document outlines several emergency drugs including adrenaline, noradrenaline, dopamine, dobutamine, nitroglycerin, and others. It describes their mechanisms of action, indications, side effects, and important nursing considerations for safe administration. Understanding these critical care medications is important for emergency treatment of patients.
Inotropes and their choice
This document discusses inotropic agents, which are drugs that affect the strength of contraction of the heart muscle. It describes positive inotropes that increase contraction and negative inotropes that decrease contraction. The choice of inotrope depends on its pharmacological effects and the specific cardiovascular condition. Positive inotropes discussed include calcium, calcium sensitizers like levosimendan, catecholamines, cardiac glycosides, and others. Negative inotropes include beta blockers, calcium channel blockers, and antiarrhythmics. The mechanisms and effects of various catecholamines like dopamine, dobutamine, epinephrine, and dopexamine are also outlined.
Inotropes & vasopressors
This document discusses inotropes and vasopressors used to support the failing heart or peripheral vasculature. It defines inotropes as drugs that increase cardiac contractility and vasopressors as drugs that induce vasoconstriction. Common inotropes and vasopressors discussed include epinephrine, norepinephrine, dopamine, and dopexamine. It provides details on the physiology and pharmacology of these drugs, including their effects on different adrenergic receptors and cardiovascular functions.
Vasoactive agents
This document discusses vasoactive agents and their receptor physiology and clinical applications. It begins by outlining the objectives of understanding vasopressor and inotropic receptor physiology and appropriate clinical use. It then provides background on vasopressors, inotropes, and drugs that have both effects. The majority of the document then discusses the receptor physiology and mechanisms of action of various adrenergic, dopaminergic, and vasopressin receptors. It also covers individual drug classifications, effects, indications, and considerations for agents like epinephrine, norepinephrine, dopamine, dobutamine, milrinone, vasopressin, levosimendan, and vasodilators. Studies comparing agents
Pharmacologycal approaches of Heart Failure
This document discusses pharmacological approaches for treating heart failure. It describes how heart failure progresses and the sites where drugs can act. The main treatment approaches are positive inotropes like cardiac glycosides to improve contractility, diuretics to reduce edema, and ACE inhibitors to reduce preload and afterload. It then provides details on the mechanisms of action, pharmacokinetics, indications, interactions and side effects of various drug classes used to treat heart failure, including cardiac glycosides, beta agonists, phosphodiesterase inhibitors, diuretics and ACE inhibitors. It also discusses how drugs can modulate cardiac contractility dysfunction at the cellular level.
inotropesandtheirchoice2-141011140848-conversion-gate01 (1).pdf
The document discusses inotropes, which are drugs that affect the strength of contraction of heart muscle. It describes positive inotropes, which increase contraction strength, and negative inotropes, which weaken contraction. The choice of inotrope depends on its pharmacological effects and the specific cardiovascular condition being treated. Common positive inotropes described include calcium, calcium sensitizers like levosimendan, catecholamines, cardiac glycosides, and phosphodiesterase inhibitors. Common negative inotropes include beta blockers and calcium channel blockers. The document then provides more details on various inotropes, their mechanisms of action, effects, uses, and dosages.
anti hypertensive pharmacology.pptx
This document discusses types of hypertension, treatment of hypertension, and antihypertensive drugs. It describes the two main types of hypertension as essential and secondary. Treatment is necessary to prevent damage to blood vessels and the heart from high blood pressure. Several classes of antihypertensive drugs are discussed in detail, including diuretics, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, beta blockers, and others. The mechanisms of action and important effects of specific drugs like captopril, enalapril, lisinopril, and losartan are summarized as well.
Class drug therapy of shock
1. Shock is defined as inadequate tissue perfusion resulting in cellular dysfunction. It can occur with normal or low blood pressure and results from various causes like sepsis, hemorrhage, cardiac failure, etc.
2. Early goal-directed therapy for septic shock involves rapid fluid resuscitation, antibiotics, and vasopressors to maintain adequate perfusion. Dopamine, norepinephrine, and epinephrine are commonly used vasopressors.
3. Cardiogenic shock results from inadequate cardiac output, usually from acute myocardial infarction or myocarditis. It requires fluids, inotropes like dobutamine, and revascularization when possible.
Adrenergic drugs 2017
This document discusses adrenergic drugs and their uses. It defines alpha and beta adrenergic receptors, their locations, and functions. Examples of direct and indirect acting sympathomimetic drugs are provided along with their overall actions on the heart, blood vessels, blood pressure, respiration, eyes, and metabolism. Specific drugs discussed in more detail include adrenaline, dopamine, dobutamine, ephedrine, and phenylephrine. Therapeutic uses of adrenergic drugs are outlined for conditions like hypotension, cardiac issues, bronchial asthma, mydriasis, uterine relaxation, attention deficit disorders, and obesity.
7.Adrenergic agonists.ppt
This document discusses adrenergic agonists, which are drugs that activate adrenergic receptors stimulated by norepinephrine or epinephrine. It describes the different types of adrenergic receptors (α1, α2, β1, β2, β3) and the effects of activating each receptor type, such as vasoconstriction, cardiac stimulation, vasodilation, and bronchodilation. It then covers specific adrenergic agonists like epinephrine, isoproterenol, dopamine, phenylephrine, terbutaline, and ephedrine, describing their receptor selectivity, therapeutic uses, and potential adverse effects.
Adrenergic drugs
This document discusses the overall actions of adrenaline and noradrenaline on various body systems. It describes how these drugs act on adrenergic receptors to increase heart rate and contractility, increase blood pressure through vasoconstriction and increased peripheral resistance, and cause bronchodilation. The document also outlines the therapeutic uses of adrenergic drugs in conditions like hypotension, asthma, obesity, and uterine relaxation.
Adrenergic (l)
This document discusses catecholamines and their roles in the sympathetic nervous system. It details the pathways of catecholamine synthesis from tyrosine to epinephrine. It describes catecholamine receptors, uptake and metabolism. It lists target organs and effects of norepinephrine, epinephrine, and dopamine. Adrenergic drugs used to stimulate or block catecholamine receptors are also outlined.
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inotropesandtheirchoice2-141011140848-conversion-gate01 (1).pdf
inotropesandtheirchoice2-141011140848-conversion-gate01 (1).pdf
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This document discusses mechanical ventilation and the weaning process. It outlines the 7 stages of weaning and indicators for readiness to wean, including parameters like respiratory rate, tidal volume, rapid shallow breathing index, and maximum inspiratory pressure. It describes methods for spontaneous breathing trials and criteria for weaning failure. Difficult weaning can be caused by respiratory, cardiac, psychological, ventilator or nutritional factors. Daily assessment is important to evaluate readiness and avoid complications from prolonged mechanical ventilation.
PC mode 1
PC mode uses pressure control ventilation where the ventilator controls the inspiratory pressure and the patient controls the respiratory rate and inspiratory time. The tidal volume depends on the inspiratory pressure set, lung compliance, and airway resistance. Key settings include inspiratory pressure, respiratory rate, inspiratory time, and PEEP. Plateau pressure and driving pressure should be monitored to avoid overinflation and volutrauma. PEEP is used to prevent alveolar collapse and improve oxygenation but can impact hemodynamics at higher levels by decreasing venous return and cardiac output.
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This document discusses nutrition guidelines for critically ill patients. It recommends starting enteral nutrition within 24-48 hours of admission to provide 25 kcal/kg/day and over 1.2 g/kg/day of protein. Enteral nutrition is preferred over parenteral nutrition when possible. Guidelines suggest not stopping nutrition without a definite medical cause and consulting nutrition support teams.
Review 1 nutrition_case
1. The patient is a 75-year-old male admitted to the EICU for septic shock due to pneumonia and colitis. He received TPN for nutrition support from admission until signs of bowel recovery were seen.
2. Enteral nutrition was started with 500 kcal/day of tube feeding once bowel sounds returned, but was reduced due to distension. IV fluids were given initially until TPN was started providing over 1300 kcal per day.
3. Laboratory findings and the patient's clinical status including hemodynamics, mottling, and ventilator settings are discussed to determine the adequacy and progression of nutrition support and management of septic shock. Further suggestions may be considered.
Mechanical ventilation 1
This document discusses different types of mechanical ventilation and ventilation modes. It begins by outlining four types of respiratory failure that may require mechanical ventilation. It then discusses goals of mechanical ventilation related to oxygenation and ventilation. The document goes on to explain various ventilation modes including volume control, pressure control, pressure support, and APRV. It provides details on settings for tidal volume, minute ventilation, and initial mechanical ventilation settings. Overall, the document provides an overview of mechanical ventilation types, goals, modes, and initial settings.
Mechanical ventilation 2
1. Mechanical ventilation settings like PEEP aim to reduce ventilator-induced lung injuries from atelectrauma and overdistension while improving oxygenation.
2. The optimal PEEP level can be determined through methods like the ARDSnet table, transpulmonary pressure measurements, lung compliance curves, and stress indexes. Higher PEEP recruits more alveoli but may affect hemodynamics.
3. Pressure-volume curves can help identify the lower inflection point and lower deflection point to guide PEEP setting, along with recruitment maneuvers. Slow-flow curves more accurately detect inflection points.
Mechanical ventilation 3
1. Mechanical ventilation can be associated with significant morbidity and mortality if prolonged. Weaning patients from mechanical ventilation in a timely manner is important.
2. There are seven stages of weaning which include assessing patient readiness, conducting spontaneous breathing trials, and using various ventilator modes like pressure support to gradually reduce support.
3. Spontaneous breathing trials for 30 minutes to 2 hours are generally preferred for weaning but gradual reduction over days may be better in some cases. Daily assessment of readiness and trials are recommended with prompt reintubation if trials fail.
Mv trouble shooting
1. Mechanical ventilation troubleshooting involves identifying the cause of a patient's sudden respiratory distress by analyzing monitor alarms, physical signs, and ventilator graphs.
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20201202 cardiogenic shock
Cardiogenic shock is a serious condition where the heart cannot pump enough blood to vital organs, causing hypotension and end-organ damage. The most common cause is acute myocardial infarction with left ventricular dysfunction. In-hospital mortality from cardiogenic shock is high, around 27-51%. Treatment involves stabilization, vasopressor support, mechanical circulatory support if needed, and identifying and treating the underlying cardiac cause, such as through coronary angiography and PCI. Despite aggressive treatment, cardiogenic shock remains a medical emergency with high mortality.
20201118 sepsis and septic shock
1. The document discusses definitions of sepsis, severe sepsis, septic shock from 1992, 2001, and 2016. It describes the criteria for systemic inflammatory response syndrome, sepsis, and septic shock.
2. Guidelines for management of sepsis from the Surviving Sepsis Campaign are summarized, including early goal directed therapy, resuscitation bundles, and antimicrobial therapy recommendations.
3. Key aspects of the updated 2018 Surviving Sepsis Campaign guidelines are highlighted, such as initial fluid resuscitation, hemodynamic support, antimicrobial administration, and duration of therapy.
20201021 pcas care
This document discusses post-cardiac arrest syndrome (PCAS), which refers to the pathology caused by complete whole body ischemia and reperfusion following cardiac arrest. PCAS involves (1) post-cardiac arrest brain injury, (2) post-cardiac arrest myocardial dysfunction, (3) systemic ischemia/reperfusion response, and (4) persistent precipitating pathology. The document outlines recommendations for targeted temperature management, hemodynamic goals, prognostication of outcome, and organ donation for patients experiencing PCAS.
20200624 aki
This document discusses acute kidney injury (AKI). It notes that AKI is common in ICU patients and associated with increased mortality. Sepsis and postoperative/toxic causes are common. It defines AKI and discusses causes including prerenal, postrenal, and intrarenal. For intrarenal causes, it mentions glomerulonephritis, vasculitis, interstitial nephritis, acute tubular necrosis, and sepsis-induced AKI. It reviews diagnosis and novel biomarkers. Prevention and treatment sections discuss volume expansion, diuretics, vasopressors, vasodilators, sedation, hormonal manipulation, metabolic interventions, statins, and renal replacement therapy.
[03] 20200708 acid base
This document provides an overview of acid-base principles and disorders. It discusses the normal ranges for pH, PCO2, and HCO3 and defines acid-base disorders. Primary acid-base disorders are classified as respiratory or metabolic based on changes in PCO2 or HCO3. Secondary responses to primary disorders and mixed acid-base disorders are also covered. Evaluation of acid-base disorders follows a stepwise approach identifying the primary disorder and any secondary responses. Metabolic acidosis is further evaluated using anion gap, delta gap, and urine anion gap. Causes and treatments of various acid-base disorders are outlined.
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Medications for cardiovascular support
- 1. Medications for Cardiovascular Support Jo You Hwan Department of Emergency Medicine Seoul National University Bundang Hospital
- 2. Vasoactive Drugs (1) Heart rate : chronotropic effect Myocardial contractility : inotropic effects Arterial pressure : vasoconstrictive effects Reduce afterload : vasodilator effects
- 3. Vasoactive Drugs (2) Alpha adrenergic receptor - α1 : located in vascular walls vasoconstriction Beta adrenergic receptor - β1 : heart increases in inotropy and chronotropy - β2 : blood vessels vasodilation
- 5. Dopamine (1) Low dose (≤3 μg/kg/min) - dopaminergic Rc in renal & splanchnic circulations → increase blood flow Intermediate dose (3 to 10 μg/kg/min) - β-Rc in heart and peripheral circulations → myocardial contractility, HR↑, peripheral vasodilation → Cardiac output ↑ High dose (>10 μg/kg/min) - α-Rc in systemic and pulmonary circulations → systemic and pulmonary vasoconstriction
- 6. Dopamine (2) Adverse effects - Tachyarrhythmias ∙ Sinus tachycardia : most common ∙ Ventricular tachycardia - local tissue necrosis in cases of extravasation - Allergic reaction
- 7. Norepinephrine (1) α and β1-receptors → increase in arterial and venous vascular tone and increase in inotropic and chronotropic activity of the Ht Cardiac output - may increase or decrease - depending on vascular resistance, the functional state of the left ventricle, and reflex responses Usually induces renal and mesenteric vasoconstriction - in sepsis, improves renal blood flow and urine output.
- 8. Norepinephrine (2) Dosage - 1~2 (4) μg/min → dose up - Mix with dextrose solution only Adverse effects - local tissue necrosis in cases of extravasation - intense systemic vasoconstriction
- 9. Dobutamine (1) Potent β1-receptors and weak β2-receptors agonist - positive inotropic and chronotropic effects - peripheral vasodilatation → Decreased left ventricular filling pressure Stroke volume↑ ∙ inotropic effect ∙ ventricular afterload↓(peripheral vasodilation) Arterial pressure is unchanged or may fall
- 10. Dobutamine (2) Dosage - 2 to 20 μg/kg/min Adverse effects - increase in heart rate → may induce or exacerbate myocardial ischemia - ectopic dysrhythmias - headache, paresthesias, tremors, nausea, angina, and dyspnea.
- 11. Vasopressin (1) Antidiuretic hormone - maintain serum osmolality - renal vasopressin V2 receptors Stimulates contraction of smooth muscle V1 receptors - Vascular V1 receptors are coupled to phospholipase C (release of calcium from sarcoplasmic reticulum) → Vasoconstriction Cardiac output may decrease.
- 12. Vasopressin (2) Management of vasodilatory shock, such as septic shock - relative vasopressin deficiency Dosage - 0.01 to 0.03(0.04) IU/min Adverse effects - decrease CO - peripheral vascular constriction or collapse - dysrhythmias