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A 69 y/o presents with chest pain and is found to have an anterior wall MI. Appropriate therapy is initiated, however he becomes profoundly hypotensive.
Pat SwanGanz cat P reveals as follow;
R atrium : 20
R ventricle :44/19
Pulmonary artery: 46/24
PCWP: 20
Cardiac index : 1.9 L/min/BSA2
You pick med form Class 1B antiarrhythmia to help your pat. Which of the following additional responses is most likely an extension of its pharmacologic effect med beside being 1B?
a)Angioedema
b)Vasodilation
c)Vasoconstriction
d)Increased R atrial P
e)AV conduction block
f)Na & water retention
g)PDE-5
_________________________________________72sec_________________________________
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I think its tocainide because it causes pulmonary fibrosis and since there is increased PCWP and increased pressure in all the right heart chambers because there is an outflow issue due to the pulm fibrosis?
Is that right?
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This pat has cardiogenic shock & low cardiac output.
So?
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ok sorry I messed up.
Normal PCWP is 8-15 i think. so pulmonary edema with increased PCWP means its due to left heart failure going backwards to effect the lungs and then cause right heart failure. Since this is post MI, that makes sense.
Since its a 1B drug which is for post MI arrythmias that makes sense too....so I guess its lidocaine that was used.
Is that right? how do we dd between 1b drugs...by their side effects?
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Q) A 32 y/o M pat present to you in ER. He admit taking "club drugs" (gamma hydroxybutyrate/ecstasy,/ketamine) conjunction Viagra and Cialis and have been in risky sexual practices and scared to catch HIV.
Can you tell me how Viagra works?
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well viagra is sildenafil which is a PDE5 inhibitor so that causes increases cGMP so there is VD so that blood fills the corpus cavernosum and erection occurs.
ohhh and I guess I didn't understand the initial question. I thoguth you were asking about other side effects of 1b drugs. Was the question what other drug the patient was taking that caused him to have hypotension upon taking the 1b drug...which would increase the hypotension exponentially.
sorry my fault for not understanding the initial question.
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PDE-5...inhibitor increase cGMP
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Dont be sorry I forgot to add extra info
Here the option for you pat here?
a)Vasopressin
b)Furosemide
c)Poprostenol
d)Milrinone
