The document discusses the pharmacotherapy of shock, including the pathophysiology, types, and management of shock with a focus on drug therapy. It defines shock and describes the determinants and hemodynamic states involved. The main classes of shock are outlined as hypovolemic, distributive, cardiogenic, and obstructive. Management of shock aims to improve tissue perfusion and oxygenation through the use of inotropic agents to enhance cardiac output and vasopressors or vasodilators to modulate vascular resistance. Dopamine is discussed as having dose-dependent effects including renal and splanchnic vasodilation at low doses and inotropy and vasoconstriction at higher doses.

1. Pharmacotherapy of Shock www.freelivedoctor.com

13. Question 04/21/10 Which one of the folowing is the most common cause of severe Lactic acidosis (blood lactate concentration >5 mmol/L)? a. Ethanol intoxication b. Severe liver disease c. Circulatory shock d. Ischemic bowel e. Acute asthma www.freelivedoctor.com

15. Pulmonary Artery Catheter Waveforms 04/21/10 Right Atrium Right Ventricle Pulmonary Artery PCWP www.freelivedoctor.com

16. Hemodynamic Characteristics in Different Types of Shock 04/21/10 / www.freelivedoctor.com Type Preload CO PVR SVR Hemmorrhagic Anaphylactic Cardiogenic Septic (Hyperdynamic) Septic (Hypodynamic)

17. Question 04/21/10 The wavefrom shown in this figure was observed while attempting to advance a pulmonary arterial catheter, with the Balloon inflated, from the proximal pulmonatry artery to a “ wedged” position. Which one of the following bv Which one of the following best explains the terminal portion of the depicted waveform? a. Pulmonary hypertension b. Mitral regurgitation c. Severe left ventricular dysfunction d. Obstruction of the catheter tip e. Pericardial tamponade www.freelivedoctor.com

19. Effects of Inotropic Agents and Vasodilators 04/21/10 Drug Receptor CO SVR Dose Range 0 - (  g/kg/min) 1 www.freelivedoctor.com Epinephrine        0.02 – 0.5 Norepinephrine     0 - 0.05 – 0.5 Dopamine    DR  2 -12 Dobutamine     2 - 12 Dopexamine      DR 0 - 0.9 - 5 Vasopressin Angiotensin III 5 - 20 Amrinone PDI 5 -10

20. Effects of Inotropic Agents and Vasodilators 04/21/10 2 Drug CO SVR Dose Range (  g/kg/min) www.freelivedoctor.com Nifedipine 0 - 0.5 - 10 Nitroglycerin 0 - 3 - 5 Nitroprusside 0 - 0.5 - 5 Prostacyclin 10 - 40