Preload, 전부하

• 이완기 말 심실이 최대로 가득 찼을 때의 압력 = Volume, 용적 부하, Ventricle filling

Afterload, 후부하

• 좌심실이 혈액을 박출해내기 위한 저항 = 압력부하

• 고혈압, 혈관수축 시 증가 = 심장의 workload 증가

Preload 과다

• Fluid overload

• Edema, swelling, pulmonary edema, jugular vein distension

Afterload 과다

• Hypertension

• HLD, DM 등 atherosclerosis(동맥경화)로 인해 혈관 탄력성 감소)

• Organ damage, bleeding

Preload 과소

• Dehydration(탈수) -> 증상 : hypotension, tachcardia, dry skin

Afterload 과소

• Hypotension, shock, organ ischemia

Baroreceptor : BP & heart rate management

• Detect changes in arterial blood pressure

• Send signals to brain to optimize cardiac output

• If BP too high ➡️ bradycardia

• If BP too low ➡️ tachcardia

Chemoreceptor : Oxygen and respiratory management

• Detects oxygen level and maintain acid-base balance

• If oxygen too low or CO2 high ➡️ increase respiratory rate and depth

분류

약물명

주의사항

CCB

(칼슘채널블락)

Type 1 :

Heart muscle에도 작용(Non-dihydropyridines)

Dilitiazem, verapamil

Cardiac Suppression 증상 주의(심근수축력⬇️ 심박수⬇️ 혈압⬇️)

Type 2(Dihydropyridines) :

Vascular smooth muscle에만 작용

Amlodipine, nifedipine, nicardipine

금기 : heart failure(LV dysfunction), digitalis toxicity

Vasodilator

Coronary artery & venous dilation

Nitroglycerin

기립성 저혈압 주의

낙상 고위험 약물

IV pump로 정확한 용량 주입

이뇨제와 함께 투약 시 낙상 확률 증가

= 교육 중요!!

Potent arterial & venous dilation

Nitroprusside

Direct arterial dilation

Hydralazine

βB

Non selective

(옛날 약- β1,β2 모두 block)

propranolol,

sotalol, timolol, nadolol, penbutolol

심박동수를 감소시키므로 서맥(bradycardia), 전도차단(AV block, BBB) 주의

​

Cardiac suppression 증상 주의

​

Non- selective 일 경우 bronchospasm 위험

Cardio(β1) selective

metoprolol, atenolol, esmolol, nebivolol

Alpha + Beta blocker

labetalol, carvedilol

ACEi & ARBs

ACEi

Lisinopril, captopril, benazepril

• Angiotensin : Vasoconstrictor

• Aldosterone : sodium retention

• Antidiuretic hormone : increase water reabosorption

​

Angioedema(혈관부종), cough(기침), hyperkalemia(고칼륨혈증), acute kidney failure

ARBs

Losartan, Valsartan, Telmisartan, candesartan

loop diuretics

Thiazide diuretics

Potassium sparing diuretics

Mechanisim

Inhibit Na+ Cl reabosorption from the loop of henle&distal tubule

Inhibit Sodium reabosorption in the distal tubule

Excrete sodium and water, keeping potassium from distal tubule

Use

Very potent, rapid effect

Long term use(slow effect)

Heart failure, diuretic induced hypokalemia

Caution

electrolyte ⬇️

Ototoxicity(이독성)

Metabolic alkalosis

electrolyte⬇️

Medical interations(lithium, Digoxin, steroids, anticoagulants etc.)

Kidney disease, hepatic disease, hyperkalemia

Generic name

Furosemide(Lasix) Bumetanide, Torsemide

Hydrochlorothiazide, Chlorhalidone, Indapamide, Metolazone

Spironolactone, Eplerenone, Triamterene

B : Bananas

F : Fish

C : Cantaloupe, Carrots

O : Oranges

A : Avocado

P : Pork, Potatoes

M : Mushrooms

S : Spinach(시금치), Strawberries

R : Raisins(건포도)

B : Beef

T : Tomato