Shock

Adrenergic medications

Drugs to elevate blood pressure and improve perfusion

-Improve cardiac performance

-Used to increase output of hear . Raise BP / increase urine flow

Catchecolamines in the stages of shock

Adrenergic compounds, including epinephrine and norepinephrine, that stimulate the sympathetic nervous system to enhance cardiac output, vasoconstriction, and glucose metabolism for survival

Beta 1

Heart muscle

-Increases HR, Contraction, Conduction through the AV node, BP

Beta 2

Lungs

-Bronchodilation

Alpha 1

Vasoconstriction

Levophed

Alpha 1 and some Beta 1 effects (NOREPINEPHRINE)

-Action: Potent peripheral arterial vasoconstriction = increase BP, HR, force of contraction / CO

-Use: Emergency injectable to raise and maintain dangerously low BP A

-Contras: Cardiac dys, angina, htn, hyperthyroidism, CVA, Narrow-Angle Glaucoma due to increased intraocular pressure, hypersensitivity

-BBW: Extravasation at IV site (will leak into surrounding tissues, causing necrosis, if not in a large vein or central line)

Adverse effects of norepinephrine

-DECREASED URINARY OUTPUT

-Diminished renal perfusion / output

-Decreased perfusion to liver with liver damage

-Cardiac dysrhythmias due to B1 activity

-Increase in myocardial O2 demand due to B1 activity

-Hyperglycemia, hypokalemia, hypophosphatemia due to B1 activity

-Severe htn and reflex Brady

-Limb ischemia

Vasopressors

Medications that induce vasoconstriction to elevate blood pressure by constricting blood vessels; all-or-nothing meds that are often used in critical care settings to manage severe hypotension or shock.

4 stages of shock

1. Initial: Dec O2, Inc Lactic

2. Compensated: Inc aldosterone, vasoconstriction, HR, and catecholamines

3. Progressive: Oliguria, AMS, pallor / cool skin, dec BP, e- imbalance

4. Refractory: Irreversible cellular damage and organ failure, DEATH

EpiPen

A medical device containing epinephrine, used for the emergency treatment of severe allergic reactions (anaphylaxis) by rapidly constricting blood vessels, relaxing airway muscles, and increasing heart rate

-“Blue to the sky, orange to the thigh” / can be injected through clothing

Epinephrine

Nonselective alpha-beta adrenergic agonists

-Action: increased BP, tachycardia, bronchodilation, vasoconstriction, speed of conduction through AV node

-Use: anaphylactic shock and cardiac arrest

-Contras: Cardiac dysrhythmias, htn, hyperthyroidism, DM< Parkinson’s, older age

-BBW: Rx of tissue damage with extraversion

Epinephrine side effects

Tachycardia/palpitations, tremors or shakiness, anxiety / nervousness / restlessness / apprehension, head and dizzy, sweating

-Serious: Severe hypertension, angina / MI, PE, dysrhythmias (vfib), PE, cerebral hemorrhage from a rapid increase in BP

Epinephrine vs norepinephrine

Epinephrine is a nonselective alpha-beta adrenergic agonist that primarily treats anaphylaxis and cardiac arrest, whereas norepinephrine primarily acts on alpha-adrenergic receptors to increase blood pressure and is used in treating hypotension