CVS常用药物概论-精选文档.ppt
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1、分類,Inotropes: 強心 Chronotropic: 增快心律 Pressors: 升壓 Vasodilator: 降壓 Antiarrhytmic agents:抗心律不整,常用藥物,Bosmine (Epinephrine) Levophed (Norepinephrine) Dopamine Dobutamine Primacor (Milrinone) Isuprel NTG Nitroglyceride Perdipine Amiodarone PGE1 DDAVP,Cardiovascular Anatomy,CONTRACTILITY,HEART RATE Rhythm,
2、PRELOAD,AFTERLOAD,L/Min,CARDIAC OUTPUT (CI=CO/m),Catecholamines,Natural Norepinephrine: a , b1 Epinephrine: a, b Dopamine: D, a1, b1 (also some NE release) Synthetic Isoproterenol: b Dobutamine: b1 (and mix of b2 stimulation and a1 inhibition and stimulation),NE E ISO,g/kg/min,160 mg in 100 ml, 50 k
3、g (mg/ml) 160*1000 : mg/ml g/ml 160 * 1000/100 : 100ml 1ml 160 *1000/100/60 : g/h g/min 160/6/50 = 0.533 g/kg/min,Thanks for your attention! Have a nice weekend!,Thanks for your attention! Have a nice weekend!,Thanks for your attention! Have a nice weekend!,ALPHA-ADRENERGIC MEDICATIONS,Can be divide
4、d into: Alpha1-adrenergic effects: Vascular smooth muscle contraction Alpha2-adrenergic effects: Vascular smooth muscle relaxation-this is a very mild effect only at low doses of an alpha-adrenergic agent like epinephrine.,BETA-ADRENERGIC MEDICATIONS,Can be divided into: Beta1-adrenergic effects: Di
5、rect cardiac effects Inotropy (improved cardiac contractility) Chronotropy (increased heart rate) Beta2-adrenergic effects: Vasodilation Bronchodilation,Epinephrine,1 contractility and H.R C.O. and myocardial oxygen demand. 1 splanchnic and renal blood flow butcoronary and cerebral perfusion pressur
6、e, SBP 2 vasodilation in skeletal muscle may lower diastolic pressure also relaxes bronchial smooth muscle,Dopamine vs Dobutamine,Selecting inotropic and vasopressor agents for specific hemodynamic disturbances in children,Hemodynamic pattern,Normal,Deceased,Elevated,Blood pressure or SVR,Myocardial
7、 dysfunction,Dobutamine or dopamine or amrinone,Epinephrine or dopamine (or dobutamine plus norepinephrine),Dobutamine plus nitroprusside,CHF,Dobutamine Primacor,Dopamine,Dobutamine plus nitroprusside,Bradycardia,None,Isoproterenol,None,Dobutamine Indications,Consider for pump problems (CHF) with sy
8、stolic blood pressure of 70 to 100 mm Hg and no signs of shock,Dobutamine Precautions,Avoid with systolic blood pressure 100 mm Hg and signs of shock May cause tachyarrhythmias, fluctuations in blood pressure, headache, and nausea Contraindication: Suspected or known poison/drug-induced shock Do not
9、 mix with sodium bicarbonate.,Dobutamine IV Infusion,Usual infusion rate: 2 to 20 g/kg /min Titrate so heart rate does not increase by 10% of baseline Hemodynamic monitoring is recommended for optimal use,Dopamine Indications,2nd drug for symptomatic bradycardia after atropine Use for hypotension (s
10、ystolic blood pressure = 70 - 100 mm Hg) with signs and symptoms of shock,Dopamine Precautions,May use in patients with hypovolemia but only after volume replacement Use with caution in cardiogenic shock with accompanying congestive heart failure May cause tachyarrhythmias, excessive vasoconstrictio
11、n Taper slowly. Do not mix with sodium bicarbonate,Dopamine Continuous Infusions,Titrate to patient response: Low Dose 1 to 5 g/kg per minute (“renal doses) Moderate Dose 5 to 10 g/kg per minute (“cardiac doses”) High Dose 10 to 20 g/kg per minute (“pressor doses”),Epinephrine Indications,Cardiac ar
12、rest: VF, pulseless VT, asystole, PEA Symptomatic bradycardia: After atropine, dopamine and TCP Severe hypotension, Anaphylaxis: Combine with large fluid volumes, corticosteroids, antihistamines,Epinephrine Precautions,Raising BP and increasing HR may cause myocardial ischemia, angina High doses do
13、not improve survival or neurologic outcome and may contribute to postresuscitation myocardial dysfunction Higher doses may be required to treat poison/drug-induced shock,Epinephrine in Cardiac Arrest,IV Dose: 1 mg (10 mL of 1:10 000 solution) administered every 3 to 5 minutes during resuscitation Fo
14、llow each dose with 20 mL IV flush. ETT: 2 to 2.5 mg (1:1000) diluted in 10 mL normal saline.,Isoproterenol Indications,Use cautiously as temporizing measure if external pacer is not available for treatment of symptomatic bradycardia Refractory torsades unresponsive to MgSO4 Temporary control of bra
15、dycardia in heart transplant patients Poisoning from -adrenergic blockers,Isoproterenol Precautions,Do not use for treatment of cardiac arrest Increases myocardial oxygen requirements Do not give with epinephrine; can cause VF/VT Do not administer with poison/drug induced shock (exception: -blocker
16、poisoning) Higher doses are Class III (harmful) except for -adrenergic blocker poisoning,Isoproterenol IV Infusion,Infuse at 2 to 10 g/min Titrate to adequate heart rate In torsades, titrate to increase heart rate until VT is suppressed,Lidocaine Indications,Cardiac arrest from VF/VT Stable VT, wide
17、-complex tachycardias of uncertain type, wide-complex PSVT (Class Indeterminate),Lidocaine Precautions,Prophylactic use in AMI patients is not recommended Reduce maintenance dose (not loading dose) in presence of impaired liver function or left ventricular dysfunction Discontinue infusion immediatel
18、y if signs of toxicity develop,Lidocaine in Cardiac Arrest From VF/VT,Initial dose: 1 to 1.5 mg/kg IV For refractory VF may give additional 0.5 to 0.75 mg/kg IV push, repeat in 5 to 10 minutes; maximum total dose: 3 mg/kg. ETT: 2 to 4 mg/kg.,Lidocaine,Perfusing Arrhythmia For stable VT, wide-complex
19、 tachycardia of uncertain type, significant ectopy: 1 to 1.5 mg/kg IVP Repeat 0.5 to 0.75 mg/kg every 5 to 10 minutes Maximum total dose: 3 mg/kg. Maintenance Infusion 2 to 4 mg/min,Magnesium Sulfate Indications,Cardiac arrest only if torsades de pointes or suspected hypomagnesemia is present Refrac
20、tory VF (after lidocaine) Torsades de pointes with a pulse Life-threatening ventricular arrhythmias due to digitalis toxicity,Magnesium Sulfate Precautions,Occasional fall in blood pressure with rapid administration. Use with caution if renal failure is present.,Magnesium Sulfate Administration,Card
21、iac Arrest (for hypomagnesemia or TdP) 1 to 2 g (2 to 4 mL of a 50% solution) diluted in 10 mL of D5W IVP Torsades de Pointes (not in cardiac arrest) Loading dose of 1 to 2 g mixed in 50 to 100 mL of D5W, over 5 to 60 minutes IV Follow with 0.5 to 1 g/h IV (titrate dose to control the torsades),Nitr
22、oglycerin Indications,Initial antianginal for suspected ischemic pain For initial 24 to 48 hours in patients with AMI and CHF, large anterior wall infarction, persistent or recurrent ischemia, or hypertension Continued use (beyond 48 hours) for patients with recurrent angina or persistent pulmonary
23、congestion Hypertensive urgency with ACS,Nitroglycerin Precautions/Contraindications,Limit normotensive BP drop to 10% Limit hypertensive BP drop to 30% Avoid BP drop below 90 mm Hg Do not mix with other drugs Sit or lie pt down when receiving med Do not shake aerosol spray (affects metered dose) Co
24、ntraindications Hypotension Severe bradycardia or severe tachycardia RV infarction Viagra within 24 hours,Nitroglycerin Administration,IV Bolus/Infusion IV bolus: 12.5 to 25 g Infuse at 10 to 20 g/min Route of choice for emergencies Titrate to effect Sublingual Route 1 tablet (0.3 to 0.4 mg); repeat
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