Vasoactive drugs

If fluid challenge does not achieve desired end points, pharmacologic support is necessary with inotropic and vasoactive drugs. 

Vasoactive drugs should be started as soon as possible, priorto endoscopy, and maintained 1A... 

Vasoactive drug therapy (somatostatin, octreotide, or terlipressin) to stop or slow bleeding is routinely employed early in patient management to allow stabilization of the patient and to permit endoscopy to proceed under more favorable conditions. These agents decrease splanchnic blood flow and reduce portal and variceal pressures, without significant adverse effects. 

Endoscopy, vasoactive drug endoscopy, CBC CBC, evidence of heart rate and portal pressure Acute control acute bleed. 

When fluid resuscitation is insufficient to maintain tissue perfusion, the use of inotropes and vasoactive drugs is necessary. Selection and dosage are based on the pharmacologic properties of various catecholamines and how they influence hemodynamic parameters (Table 45-5). 

Severe shock < 90 > 20 < 2.0 Vasoactive drugs, inotropic drugs, circulatory assist devices... 

The fetoplacental unit includes maternal and fetal placental circulations, other placental functions, umbilical cord and amniotic fluid. If chemicals — for example, vasoactive drugs — reduce the placental circulation or cause umbilical vasoconstriction, then marked prolonged action may cause fetal death from anoxia, but an action for less than 2 h in rodents may cause fetal growth retardation or... 

The isolated cell preparation is an important system for the in vivo NMR spectro-scopist in terms of gaining a better understanding of the NMR spectra obtained in the intact animal. For example, H spectra of isolated neuronal and glial cells may help us to determine the contribution that these two cell types make to the H spectra of intact brain. The response of tumor cells to anoxia, ischemia, etc. may aid interpretation of the spectra obtained from similar cells in a solid tumor in an animal or human patient following certain clinical interventions, such as chemotherapy or alteration of tumor perfusion with vasoactive drugs. 

EBL is the recommended form of endoscopic therapy for acute esophageal variceal bleeding and should be used in conjunction with vasoactive drug therapy Secondary prophylaxis of variceal bleeding... 

Riviere, J. E., Monteiro-Riviere, N. A., and Inman. A. Determination of lidocaine concentrations in skin after transdermal iontophoresis Effects of vasoactive drugs. Pharm. Res. 9 211, 1992. 

Develop standardized dose and rate charts for products such as vasoactive drugs (e.g., infusion rate expressed as micrograms per kilogram per minute)... 

Interactions of sympathomimetics with other vasoactive drugs are complex. Some drugs block the reuptake mechanism for noradrenaline in adrenergic nerve terminals and potentiate the pressor effects of noradrenaline e.g. cocaine, tricyclic antidepressants or highly noradrenaline-selective reuptake inhibitors such as roboxetine. Others deplete or destroy the intracellular stores within adrenergic nerve terminals (e.g. reserpine and guanethidine) and thus block the action of indirect S5unpathomimetics. 

In poisoning by a cerebral depressant or after spinal cord trauma, the principal cause of hypotension is low peripheral resistance due to reduced vascular tone. The cardiac output can be restored by simply tilting the patient head-down and by increasing the venous filling pressure by infusing fluid. Vasoactive drugs (noradrenaline, dobutamine) may be beneficial. 

D Amico, G., Pietrosi, G., Tarantino, I., Pagliaro, L. Emergency sclerotherapy versus vasoactive drugs for variceal bleeding in cirrhosis a Cochrane meta-analysis. Gastroenterology 2003 124 1277-1291... 

Goulis, J., Burroughs, A.K. Role of vasoactive drugs in the treatment of bleeding oesophageal varices. Digestion 1999 60 (Suppl. 3) 25-34... 

In two men, aged 16 and 32 years, with falciparum malaria who were given four intravenous doses of sodium artesunate 60 mg, neither of whom had received diuretics or vasoactive drugs, there was a diuresis (6 1/day) accompanied by a natriuresis (31). 

Buflomedil hydrochloride is a vasoactive drug with a variety of actions. It is an alpha-adrenoceptor antagonist and a weak calcium channel blocker. It inhibits platelet aggregation and improves erythrocyte deformability. However, its mechanism of action in peripheral vascular disease is not known. 

Levine HJ, Gaasch WH. Vasoactive drugs in chronic regurgitant lesions of the mitral and aortic valves. J Am Coll Cardiol 1996 28(5) 1083-91. 

Isosorbide-5-mononitrate has been tested with and without propranolol in a placebo-controlled study in 30 patients with liver cirrhosis and esophageal varices (22). The aim of the study was to assess the severity of previously reported adverse effects (that is renal dysfunction and hepatic encephalopathy) when vasoactive drugs are used to prevent variceal bleeding. Neither isosorbide-5-mononitrate nor propranolol alone or together had any adverse effect on subclinical hepatic encephalopathy or renal function in patients with well-compensated cirrhosis. Severe headache in those taking isosorbide caused three patients to withdraw. 

Sundaram, M., Yao, S.Y.. Ng. A.M., Griffiths, M., Cass, C.E.. Baldwin, S.A., and Young, J.D. (1998) Chimeric constructs between human and rat equilibrative nucleoside tr ansporters (hENTl and rENTl) reveal hENTl structiual domains interacting with coronary vasoactive drugs. The Journal of Biological Chemistry, 273 (34), 21519-21525. 

Uusaro A, Takala J. Vasoactive drugs and splanchnic perfusion in septic shock. Crit Care Med 1998 26 1458-1460. 

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