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UNIVERSIDAD DE CARABOBO
FACULTAD DE CIENCIAS DE LA SALUD
ESCUELA DE MEDICINA “DR. WITREMUNDO TORREALBA”
SEDE ARAGUA – LA MORITA
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INOTROPICOS
Dr. MANUEL J RUIZ Z
Medico Internista - Intensivista
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En los últimos años diversos fármacos
vasopresores e inotrópicos han sido
introducidos a la práctica clínica,
incrementándose el arsenal terapéutico para
aquellos enfermos que presentan disfunción
cardiovascular aguda o descompensada.
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CLASIFICACION
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Origen: Digitalis purpurea (semillas ho!as
desecadas"
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DIGITALES
Naturaleza y propiedades químicas:
Cada Glucósido esta formado por lacombinación de una aglucona, ogenina, con 1 a 4 moléculas deazcar! "a acti#idad farmacológicareside en la aglucona! "os diferentes
azucares modi$can sus propiedadesfarmacocinéticas y %otencia!
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Farmacodinamia:
• #cción $notropica %ositiva
• &educe la 'recuencia entricular
• #ctúa directamente so)re el músculo liso
vascular so)re el cora*ón modificando tanto su
actividad mecánica como eléctrica
• #ctúa de forma indirecta a través del sistemanervioso modificando la capacitancia resistencia
vascular
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DIGITAL
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TOXICO
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Efectos +irectos:
• ontractilidad del -iocardio
• $notrópico %ositivo: #umenta la 'uer*a
elocidad de contracción• #umenta volumen de Eección entricular
('E"
• +isminue volumen al final de la sístole• +isminución progresiva de la presión
volumen diastólico 'inal
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Efectos +irectos:• #ctividad Eléctrica
• 'i)ras de %ur.in!e:
• +isminución del potencial de reposo que reduce lavelocidad de despolari*ación de la fase / la
velocidad de conducción
• +isminución de la duración del potencial de
acción (resultado: Efecto 0atmotropico negativo• #umenta la automaticidad (aumento de la
velocidad de la despolari*ación de la fase 1
+espolari*aciones 2ardias"
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&fectos 'ndirectos: ( %redominan a )osis *erapeuticas+
• umenta el tono #agal:•Nodulos:-utomatismo. )romotropismo(.+/atmotropismo(.+
• 0ensibiliza los baroreceptores arteriales
• fecta los ncleos #gales centrales y el ganglionodoso• 2odi$ca la e3citabilidad de las $bras #galeseferentes• umenta sensibilidad del nódulo 0 al efecto
cronotropico negati#o de la acetilcolina•!)isminuye la sensibilidad de los nodos 0 y a lasCatecolaminas y la acti#idad 0impatica &ferente
•)isminución 5e6e7a del tono simptico (por 8GC+
En síntesis: Lo más importante es la disminución
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Efectos +irectos:
• #ctividad Eléctrica
• Otras 'i)ras Especiali*adas:
• Efectos directos (3ódulos 4#, #":• #umenta el #utomatismo
•Efecto +romotropico (5%&E" 0atmotropico
3egativos
•'i)ras -usculares ventriculares auriculares (
especiali*adas" :
• 4imilar al de las 'i)ras de %ur.in!e
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&fectos )irectos:
• 2ecanismo de cción
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27
$nsuficiencia ardiaca ongestiva
2aquiarritmias 4:
• 'i)rilación #leteo #uricular
• 2aquicardia 4upraventricular
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9 Gasto cardiaco
9 *amao del
Corazón9 %resión enosa
9 olumen0anguíneo
9 )iuresis
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INSUFICIENCIA CARDIACA
ETAPAS Y TRATAMIENTO
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Estr!"# $%r&' Tr%()t*!# (r# + r,%t*-# /!*, )s#
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' A(#=# C*r!),%t#r*# + !#rt# (,%>#
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2
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$32O6$#$O3#"2o7icidad ardiaca
0"Efectos 8astrointestinales
" 3eurologicos (cefalea,dolor neuralgico, paestesias,
de)ilidad, fatiga,malestar, somnolencia"
+"-entales (+esorientación, confusión, afasia,alucinaciones,
delirio digitalico, raro convulsiones"
E" isión ()orrosa, coloreada9cromatopsia,am)liopia,diplopia
escotomas transitorios,neuritis retro)ul)ar"
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INTOICACIONDIAGNOSTICO A; ISTORIA CLINICA1
3.5 INTERROGATORIO 9SINTOMATOLOGIA;
9E+%+6 A't!+'ts1 E'r$+%+s !%r+*%!%s6 r'%,s6 "(%t*!%s6t*r#*+%s.Est%+#&'r%,;
9Dr#&%s1 D*&*t%,6 +*)rt*!#s6 %'t*%rr*t$*!#s6#tr%s;6 9F%!t#rs (r!*(*t%'ts1 D#s*s6
D*)rt*!#s6*(#?*% Ds"*+r%t%!*0'6 E,!tr#,*t#s A!*+#5<%s6IRA;
2.5 EAMEN FISICO1 Est%+# G'r%,6 *+r%t%!*0'6 V*s*0'6 E?. C%r+*#-%s!),%r =
Arr*t$*%s6 N)r#,#&*!#6 &*'!#$%st*%.
B; ELECTROCARDIOGRAMA
C; LABORATORIO
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INTOICACION
TRATAMIENTO
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