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Perf Tech 3 > 4. Endocrine Response- Exam 1 > Flashcards

4. Endocrine Response- Exam 1 Flashcards

1
Q

Deeper levels of anesthesia appear to do what to the endocrine response.

A

reduce or eliminate endocrine responses. Also appear to reduce mortality

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2
Q

the pituitary has what functions

A

Both neural (posterior lobe) and endocrine (anterior lobe) function

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3
Q

Posterior pituitary is the “______” portion—it’s essentially modified nervous tissue

A

neurosecretory

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4
Q

what does the pituitary secrete (not produce)

A

ADH (vasopressin)

Oxytocin

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5
Q

High concentrations of ADH:

  1. May increase ______ and ______
  2. May decrease ______ and ______
  3. Reduces _____
  4. Stimulates release of _______
  5. May improve ______
A
  1. May increase peripheral vascular resistance and renal vascular resistance
  2. May decrease cardiac contractility and coronary blood flow
  3. Reduces renal blood flow
  4. Stimulates release of von Willebrand factor
  5. May improve hemostasis
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6
Q

What Stimulates Vasopressin Release (6)

A
  1. Increase plasma osmolarity
  2. Decreased blood volume or decreased blood pressure or perceived decreased blood pressure
  3. Hypoglycemia
  4. Angiotensin II
  5. Stress
  6. Pain
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7
Q

bypass increases ADH release- how long does it persist

A

Persists hours post op

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8
Q

how does bypass initiate ADH release

A
  • Initiation of bypass
  • transient decrease in CBV and blood pressure
  • Venting keeps left atrial pressure low simulating low CBV (potent stimulant)
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9
Q

how can the release of ADH be prevented

A

Magnitude of increase can be reduced-not eliminated

  1. Pulsatile flow
  2. Anesthesia with large doses of synthetic opioids. –Fentanyl (50 μg/kg) or sufentanil
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10
Q

Anterior Pituitary secretes ______ hormones

A

trophic

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11
Q

Anterior Pituitary secretes trophic hormones that regulate what 4 things

A

Adrenal cortex** (ACTH)
Thyroid** (TSH)
Ovaries/Testes
Growth (HGH)

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12
Q

what is the Most damaging complication to pituitary

A

Pituitary Apoplexy

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13
Q

Pituitary Apoplexy symptoms

A

Ptosis (droopy eyelids)
opthalmoplegia (paralysis muscles controlling eye) nonreactive & dilated pupils
decreased visual acuity
hormonal defects

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14
Q

Pituitary Apoplexy is caused by

A

Damage to pituitary usually blamed on ischemia, hemorrhage, and edema of gland

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15
Q

Pituitary Apoplexy treatment

A

Hormonal replacement (HGH) / hypophysectomy

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16
Q

Adrenal medulla produces what 2 catecholamines

A

Epinephrine & norepinephrine

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17
Q

besides the adrenal medulla, where is NE produced

A

Peripheral sympathetic & central nerve terminal

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18
Q

Epinephrine concentration increases ___ fold over and Norepinephrine concentration increases __ fold preoperative levels

A

10 fold

4 fold

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19
Q

when are peak levels of epi and NE seen

A

after initiation of bypass- when cooled to 32C

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20
Q

how can the increase in epi and NE be prevented (4)

A

magnitude of increase can be reduced- not eliminated

  1. Deep anesthesia
  2. Propofol infusion during bypass (4 mg/kg/hr)
  3. High dose opiod general anesthesia (fentanyl or sufentanil) plus thoracic epidural
  4. General anesthesia with high spinal block (bupivacaine)
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21
Q

Adrenal Cortical Hormones include

A

Cortisol

Adrenocorticotropic hormone

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22
Q

describe Cortisol

A
  • Corticosteroid
  • released in response to stress
  • increases blood sugar and stores of sugar in liver as glycogen
  • suppresses immune system
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23
Q

describe Adrenocorticotropic hormone

A
  • Corticotropin
  • promotes increased production & release of corticosteroids and cortisol
  • Acts as an appetite suppressant, anxietomimetic, and (conversely) a pro-inflammatory
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24
Q

Carbohydrate metabolism regulated by what 5 things

A 
insulin
glucagon
cortisol
growth hormone
epinephrine
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25
Q

Hyperglycemia occurs when Glucose concentration increases. What may worsen this response and how long are levels elevated?

A

worse with hypothermia

Stays elevated for many hours post-CPB

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26
Q

hypoinsulinemia occurs when Insulin levels decrease. What may worsen this

A

worse with hypothermia

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27
Q

whats the difference between type 1 DM and type 2 DM insulin resistance?

A

Type I DON’T require increased insulin doses

Type II DO require increased insulin doses

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28
Q

define type 1 DM

A

Critter doesn’t produce or kidneys don’t respond toVasopressin (Antidiuretic Hormone/ADH)
–absolute insulin deficiency

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29
Q

define type 2 DM

A

These critters produce variable amounts of insulin

–relative deficiency of insulin (Non-Insulin-Dependent)

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30
Q

Atrial Natriuretic Factor:
Incredibly efficacious _______
Almost the exact physiologic antagonist of ______
Peptides released from _______

A

Incredibly efficacious vasodilator
Almost the exact physiologic antagonist of aldosterone
Peptides released from cardiac atria

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31
Q

Atrial Natriuretic Factor Release is triggered by what 5 things

A 
atrial distention (such as a-fib)
Β-adrenergic stimulation
Angiotensin-II
Hypernatremia
Endothelins (the most potent vasoconstrictors known)
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32
Q 
Atrial Natriuretic Factor Cause:
increased \_\_\_\_\_\_ rate
inhibits \_\_\_\_\_ release
reduced plasma concentrations of \_\_\_\_\_\_\_
antagonize renal \_\_\_\_\_\_\_\_
reduce \_\_\_\_\_\_\_\_ pressure
A 
increased glomerular filtration rate
inhibits renin release
reduced plasma concentrations of aldosterone
antagonize renal vasoconstrictors
reduce arterial blood pressure
33
Q

Interestingly, ANF helps prevent “______” of ischemic myocardium and has other anti-ischemic effects on cardiomyocytes and cardiac vascular endothelium

A

scarring

34
Q

when are concentrations of ANF reduced during bypass

A

hypothermia

cross clamping

35
Q

when are concentrations of ANF increased during bypass

A

rewarming

post bypass

36
Q

what does the Renin-Angiotensin-Aldosterone regulate

A

atrial pressure
intravascular volume
electrolyte balance

37
Q

what does the Juxtaglomerular apparatus secrete?

A

renin

38
Q

when does the Juxtaglomerular apparatus increase secretion of renin

A

sodium depletion
decreased blood volume
reduced renal perfusion

39
Q

Renin catalyzes conversion of what? where does this happen?

A

angiotensinogen to angiotensin I in blood

increased activity

40
Q

Angiotensin-converting enzyme converts to what? where does this happen?

A

angiotensin II

blood walls of pulmonary vasculature (primary)

41
Q

what does increased concentration of angiotensin II do?

A

increased blood pressure by direct vasoconstriction

stimulates release of aldosterone for adrenal glands

42
Q

what does increased concentration of aldosterone do?

A

stimulates readsorption of sodium and secretion of potassium and hydrogen ion by renal distal tubules

43
Q

Research utilizing ACE-inhibitors and ARBS suggest that CPB temporarily “______” between Renin-Angiotensin-Aldosterone and ________ during and immediately post-bypass

A

breaks the linkage

hypo- or hypertension

44
Q

Eicosanoids are metabolized by?

A

lungs

45
Q

Prostaglandins mostly related to?

A

inflammation

46
Q

Thromboxanes mostly related to?

A

injury

47
Q

Endoperoxide prostaglandins H2 produce what?

A

PGE2, PGF2alpha, PGD2

prostacyclin (PGI2) or thromboxane (TXA2)

48
Q

what is PGE2

A

vasodilator

49
Q

what is PGF2alpha and PGD2

A

pulmonary vasoconstrictor

50
Q

what is PGI2

A

disaggregates platelets, potent vasodilator

51
Q

what is TXA2

A

platelet aggregator, potent vasoconstrictor

52
Q

what are Prostacyclin & thromboxane trends during CPB

A

increase during bypass and begin to decrease shortly thereafter

53
Q

what is Aprotinin and what does it do

A

protease inhibitor
reduces increase in thromboxane
no effect on prostacyclin
better preservation of platelet function

54
Q

Thyroid response to low [T3] + [T4] or low temp:
Anterior Pituitary produces ____
______ releases TRH
Anterior Pituitary produces and releases ____
Thyroid follicles release ____
Increased [T3] + [T4] in the blood restores ______

A 
TRH
Hypothalamus 
TSH
T3 and T4
homeostasis
55
Q

what thyroid condition can CPB induce

A

sick euthyroid syndrome

56
Q

what is the sick euthyroid syndrome

A

The result of disruption of the thyrotropic feedback loop.

–T3 and T4 levels are low but the thyroid gland is apparently “normal”

57
Q

what is Histamine

A

Potent vasodilator

58
Q

what stimulates the release of Histamine (5)

A 
opioids (morphine / meperidine)
muscle relaxants (tubocurarine)
antibiotics
heparin
protamine
59
Q

when do concentrations of Histamine increase

A

Concentration increases with administration of heparin – remains elevated

60
Q

Calcium:
Ionized (__%)
bound to protein (__%)
chelated (__%)

A

Ionized (50%)
bound to protein (40%)
chelated (10%)

61
Q

blood concentration of calcium is maintained by what

A

maintained by parathormone and vitamin D

bones / kidney

62
Q

During bypass major changes in calcium concentrations are caused by

A

type of fluids used and addition calcium

63
Q

is Parathormone secretion affected by bypass

A

nope

64
Q

If Ca++ levels are too high what happens

A

Thyroid releases calcitonin
Increased Ca++ deposition in bones
Decreased Ca++ uptake by intestines
Decreased Ca++ reabsorption from urine

65
Q

If Ca++ levels are too low what happens

A

Parathyroid releases PTH
Increased release of Ca++ from the bones
Increased Ca++ uptake by the intestines
Increased Ca++ reabsorption from urine

66
Q

Give extra calcium only when the following three conditions are present (per your book):

A

1) ready to terminate bypass
2) ionized calcium is reduced
3) need to increase contractility and blood pressure

67
Q

what is the Second most abundant intracellular cation

A

magnesium

68
Q

magnesium is the Key factor in enzyme systems such as (5):

A 
transmembrane electrolyte gradients
energy metabolism
synthesis various messaging substances
function of ion channels
hormone secretion and action
69
Q

Magnesium:
Ionized (__%)
bound protein (__%)
chelated (__%)

A

Ionized (55%)
bound protein (30%)
chelated (15%)

70
Q

is it possible have normal [plasma] of magnesium but intracellular depletion

A

yep

71
Q

what are magnesium trends during CPB and what are they associated with?

A

Decreases during bypass

–Decreased levels may associated with cardiac dysrhythmias

72
Q

magnesium helps suppress arrhythmias by:

  • direct ____________ effect
  • direct / indirect effect on ____ and ______
  • antagonism of ______ entry into the cell
  • prevention of _____
  • antagonism of _______ action
  • improves ________ ration
  • inhibition of _______ current during plateau phase of myocardial action potential
A 
myocardial membrane
cellular sodium and potassium
calcium
coronary arterial spasms
catecholamine
myocardial oxygen supply / demand
calcium
73
Q

is supplemental magnesium is good

A

yep

74
Q

dose of magnesium? when do you give it?

A

Typically ~ 2 grams post-cross clamp removal

75
Q

Changes in potassium concentration caused by what 8 things

A
  • cardioplegia
  • anesthetic drugs
  • priming solutions
  • renal function
  • carbon dioxide tension
  • arterial pH
  • hypothermia (decrease as cool, increase as warm)
  • insulin treatment of hyperglycemia moves glucose and potassium into cell)
76
Q

Hyperkalemia not uncommon with what?

A

multi-dose high-K protocols

77
Q

Hypokalemia may be increasing as the use of what increases

A

Custodial CP

78
Q

what may help reduce decrease in potassium concentration

A

Albumin

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