Shock drug therapy

ICDs have been found to be significantly more effective than antiarrhythmic agents such as amiodarone or sotalol for reducing the risk of sudden cardiac death 45,46 therefore, ICDs are preferred therapy.44 However, many patients with ICDs receive concurrent antiarrhythmic drug therapy to reduce the frequency with which patients experience the discomfort of shocks and to prolong battery life of the devices. Combined pharmacotherapy with amiodarone and a 3-blocker is more effective than monotherapy with sotalol or (i-blockers for reduction in the frequency of ICD shocks.47... 

The intraaortic balloon pump (IABP) is typically employed in patients with advanced HF who do not respond adequately to drug therapy, such as those with intractable myocardial ischemia or patients in cardiogenic shock. 

Toxic effects of NO find their expression in infections and inflammations (septic shock, rheumatoid arthritis, e. g.) by induction of NO-synthases. The aim of drug therapy therefore is to develop selective inhibitors for NO-synthase (NOS), induced by cytokines. ... 

Initiating factors, often multifactorial, include ectopic beats, ischemia, alteration in conduction or refractoriness, electrolyte disturbances, drugs, and autonomic perturbations. Factors that result in sudden death because of a ventricular arrhythmia are complex and understood poorly. Any simphstic medical approach that alters the arrhythmic substrate (such as drug therapy or even catheter ablation) may fail to reduce risk and may make things worse. Alternatively, a defibrillation shock, timed properly, can stop ventricular fibrillation. 

Immediate (Occur within 1 to 30 minutes after initiation of drug therapy) Urticaria, diffuse flush, angloedema Hypotension, shock Asthma, laryngeal edema Accelerated (occur 1 to 72 hours)... 

Pentylenetetrazol (188) is a drug with profound stimulatory activity on the central nervous system. As such, the agent was at one time used in shock therapy for treatment of mental disease. Although it has since been supplanted by safer methods, the agents still occupy an important role in various experimental animal models in pharmacology. Addition of hydrazine to the imino ether (186) obtained from caprolactam affords 187. Treat-... 

Appropriate empiric anti-infective therapy decreases 28-day mortality compared to inappropriate empiric therapy (24% versus 39%).22 23,30 Additionally, appropriate therapy administered within 1 hour of sepsis recognition also decreases complications and mortality.22-23,30 Empiric anti-infective therapy should include one, two, or three drugs, depending on the site of infection and causative pathogens (Table 79-3). Anti-infective clinical trials in sepsis and septic shock patients are scarce and have not demonstrated differences among agents therefore, factors that determine selection are ... 

The answer is a. (Hardman, p 224.) Epinephrine is the drug of choice to relieve the symptoms of an acute, systemic, immediate hypersensitivity reaction to an allergen (anaphylactic shock). Subcutaneous administration of a 1 1000 solution of epinephrine rapidly relieves itching and urticaria, and this may save the life of the patient when laryngeal edema and bronchospasm threaten suffocation and severe hypotension and cardiac arrhythmias become life-endangering. Norepinephrine, isoproterenol, and atropine are ineffective therapies Angioedema is responsive to antihis-... 

The parenteral use of complexes of iron and carbohydrates has resulted in anaphylactic-type reactions. Deaths associated with such administration have been reported therefore, use iron dextran injection only in those patients in whom the indications have been clearly established and laboratory investigations confirm an iron-deficient state not amenable to oral iron therapy. Because fatal anaphylactic reactions have been reported after administration of iron dextran injection, administer the drug only when resuscitation techniques and treatment of anaphylactic and anaphylactoid shock are readily available. 

Patients with decompensated cardiac failure requiring the use of IV inotropic therapy (such patients should first be weaned from IV therapy before initiating carvedilol) bronchial asthma (see Warninas) or related bronchospastic conditions second- or third-degree AV block sick sinus syndrome or severe bradycardia (unless a permanent pacemaker is in place) cardiogenic shock clinically manifest hepatic impairment hypersensitivity to the drug. 

For parenteral therapy, nafciUin and oxacillin offer comparable efficacy and antimicrobial spectra of activity. Although both drugs undergo hepatic metabolism, only nafcillin requires dose adjustment in patients with combined hepatic and renal insufficiency. Other pharmacokinetic data for nafcillin and oxacillin appear in Table 45.1. Indications for nafcillin or oxacillin include severe staphylococcal infections like cellulitis, empyema, endocarditis, osteomyelitis, pneumonia, septic arthritis, and toxic shock syndrome. 

Some Japanese researchers at the Kyoto University of Medicines have developed a new method for removal of large stones (mineral deposits) in kidney and bladder by using micro-explosive charges without any surgery [118-120]. Recently, applications of underwater shock waves have been extended to various clinical therapies for example, in orthopedic surgery for bone formation [121, 122], in cancer therapy, for enhancement of chemotherapeutic effects [123] and in drug delivery [124, 125]. 

---