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Cardiac shock

Phosphodiesterase
inhibitors
• It comes under the class in
Cardio stimulatory Drugs
• It is used to treat two types of
Shock
- cardiogenic
- septic
• Cardio stimulatory drugs (also
called "cardio tonic drugs")
enhance cardiac function by
increasing heart rate
(chronotropy) and myocardial
contractility (inotropy), which
increases cardiac output and
arterial pressure.
Cardiogenic shock:
• Cardiogenic shock is based upon an
inadequate circulation of blood due to primary
failure of the ventricles of the heart to function
effectively.
Cardiogenic shock is caused by the failure of the
heart to pump effectively.

Septic shock:
• Septicshock is a serious condition that occurs
when an overwhelming infection leads to life-
threatening low blood pressure. Any type of
bacteria can cause septic shock
Mechanism of action
• concentrations of cAMP play an important
second messenger role in regulating cardiac
muscle contraction. Activation of sympathetic
adrenergic to the heart releases the
neurotransmitter nor epinephrine and
increases circulating catecholamine
(epinephrine and nor epinephrine). These
catecholamine bind primarily to
beta1-adrenoceptors in the heart that are
coupled to Gs-proteins. This activates
adenylyl cyclase to form cAMP from ATP.
• Increased cAMP, through its coupling
with other intracellular messengers,
increases contractility (inotropy), heart
rate (chronotropy) and conduction
velocity (dromotropy). Cyclic-AMP is
broken down by an enzyme called
cAMP-dependent
phosphodiesterase (PDE).
• The isoform of this enzyme that is
targeted by currently used clinical
drugs is the type 3 form (PDE3).
Inhibition of this enzyme prevents
cAMP breakdown and thereby
increases its intracellular
concentration. This increases cardiac
inotropy, chronotropy and dromotropy.
Pharmacokinetics

• Metabolism-Hepatic
• Half life-2.3 hours
• Excretion-Urine within 24
hours
Specific Drugs
PDE3 inhibitors
• milrinone
• amrinone
Side Effects
• The most common and severe
side effect of PDE3 inhibitors
is ventricular arrhythmias.
some of which may be life-
threatening.
• Headaches
• hypotension
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