Lewis C. Mills

Vasopressors for treating shock.

Shock must be treated by correcting the cause, for any treatment of hypotension or shock, as such, is only an adjunctive measure; but the hemodynamic manifestations also need treatment. Vasopressors are helpful and effective under the right circumstances. Unless the blood volume is normal, the use of drugs that block the sympathetic nervous system (e.g., phenoxybenxamine) can be extremely hazardous and hasten death. However, the effect of adrenergic blocking drugs in endotoxic shock and other types of toxic shock is still to be determined; use of such drugs should be considered experimental until the results have been studied more extensively. Clinically, the most common forms of vascular shock are associated with blood loss, myocardial infarction, and endotoxemia. Characteristic hemodynamics of each situation are presented tabularly, and the physicians need to understand the differences is emphasized. The pharmacology of vasopressors, relating primarily to hemodynamic considerations and the response to vasopressors when severe reduction in blood pressure is associated with the shock syndrome is discussed. Drugs that stimulate the adrenergic receptors in the heart and blood vessels, with the exception of isoproteronol, are commonly referred to as vasopressors. The adrenergic stimulators may be classified into 3 groups: alpha (phenylephrine hydrochloride), beta (epinephrine), and alpha-beta (l-norepinephrine). Because alpha stimulators do not usually increase cardiac output, alpha-beta and beta-adrenergic stimulators are generally the most useful for treating shock. Routine use of adrenergic stimulators with the exclusion of other therapies, however, is generally unwarranted.

Vasopressor agents in shock.

These authors discuss what to consider when vasopressors seem indicated and what factors to use in evaluating their efficacy.

USE OF d‐AMPHETAMINE TO CURB THE INCREASED APPETITE AND OVER‐EATING INDUCED BY RESERPINE THERAPY†

It is ironic that reserpine, which is widely used as an antihypertensive agent, also stimulates the appetite. In a series of 47 hypertensive patients whom we treated with reserpine, nearly two-thirds reported an increase in appetite; about half of them gained 5 pounds or more (1). In many cases, e.g., psychoneurotic or hypertensive subjects who are already overweight, prescribing the drug may further stimulate the appetite. Advising these patients to restrict their food intake and expecting them to follow the advice usually amounts to little more than wishful thinking. Although they may start zealously to adhere to a low-calorie diet, before long their good intentions are forgotten. For those who will not adhere faithfully to a low-calorie diet, some type of supportive measure is needed. Since much has been written about anorexigenic agents as an aid in treating obesity, we undertook this study in order to determine whether one of these agents, d-amphetamine, would offset the orexigenic effect of reserpine.