47 - Syncope Flashcards
syncope aka _____
fainting
What drugs can cause syncope?
- antihypertensives
- alcohol
- PD (parkinson’s disease) drugs
- diuretics
- nitrates
- PDE5 inhibitors
Describe Vasovagal syncope
- occurs from an upright posture held for more than 30 seconds or with exposure to emotional stress, pain or medical setting
- associated with hypotension and relative bradycardia and is followed by fatigue
Vasovagal syncope:
Non-pharms
- increase salt intake (3-5g/day)
- increase fluids (up to 2.5 L/day)
- if they don’t have HTN or HF
- use physical counter-pressure maneuvers
- pacemaker therapy is convtroversial
Vasovagal syncope:
List 4 pharmacological options
- Fludrocortisone
- Midodrine
- Paroxetine
- Metoprolol
Vasovagal syncope:
When should you try Fludrocortisone?
if salt supplements are ineffective
*the goal of this drug is fluid retention so may precipitate HF
Vasovagal syncope:
How does midodrine work?
it is an alpha agonists - so increases venous return
Vasovagal syncope:
SSRIs are of uncertain benefit but _____ showed benefit
paroxetine
Vasovagal syncope:
BBs are no longer first line. Metoprolol may be effective in patients > _____ yo
42
Describe Orthostatic hypotension
drop in SBP > 20 mmHg or DBP > 10 mmHg when assuming an upright posture
Orthostatic hypotension:
non-pharms
- remove hypotensive and volume-depleting drugs if possible
- increase salt and fluid intake if not CI
- elevate the head of the bed
- avoid hemodynamic stress (getting up too quickly, eating large meals, being in sauna/hot bath, or intensive exercise)
Orthostatic hypotension:
List 4 pharmacological options
- Fludrocortisone
- MIdodrine
- Pyridostigmine
- Non-selective BBs (propranolol, timolol, nadolol)
Orthostatic hypotension:
Midodrine can cause what?
supine HTN and shivering
Orthostatic hypotension:
How does pyridostigmine work?
- acetylcholinesterase inhibitor
- can be given alone or in combo with midodrine
Orthostatic hypotension:
How does BBs help with orthostatic hypotension?
blocks vasodilatory B2 receptors and reduces or abolish the fall in BP upon standing in patients with orthostatic hypotension
