Advanced pathpharm week 5 Flashcards
1
Q
Define the term hemodynamics in relation to the flow of blood
A
the forces generated by the heart and the resulting motion of blood through the cardiovascular system
2
Q
Ohm’s Law Q (Blood flow) =
A
P(pressure difference from a to b)/R(resistance)
3
Q
How is blood flow monitored externally?
A
Blood Pressure and heart rate
4
Q
Blood moves from ______ pressure to _____ pressure
A
high; low
5
Q
Blood is oppsed by:
A
resistance
6
Q
Resistance is determined by:
A
Vessel length, radius, viscosity
7
Q
What can affect the radius of a blood vessels?
A
diseases such as arterio atherosclerosis, stress: catecholamines constrict blood vessels and increase BP
8
Q
99% of blood is made of:
A
RBC’s
9
Q
The hematocrit is composed of:
A
RBC’s and plasma
10
Q
T or F: An increase in RBC’s will cause an increased viscosity thus an increased resistance
A
TRUE
11
Q
What will a decrease in RBC’s cause?
A
a decrease in blood viscosity
12
Q
An increase in plasma/water will have what effect on viscosity?
A
a decreased viscosity
13
Q
TPR=
A
total resistance pressure throughout vascular system
14
Q
SVR=
A
resistance peripheral to heart and lungs
15
Q
T or F: TPR has a direct effect on BP
A
False. SVR will have the most direct effect on BP
16
Q
A decreased SVR will do what to BP?
A
cause a decreased BP
17
Q
An increased SVR will cause:
A
and increased BP
18
Q
An increased cardiac output (increased work for the heart to eject blood) is a result of an (increase/decrease) in SVR
A
increase
19
Q
Shock can cause an (increase/decrease) in SVR
A
decrease
20
Q
A measure of distance traveled in a given amount of time (speed) refers to:
A
velocity
21
Q
Define laminar flow:
A
nonturbulent streamline flow in parallel layers(laminae).
22
Q
In terms of blood flow “laminar flow” refers to
A
blood moving through the core centers of smooth vessels
23
Q
Define turbulent flow:
A
flow in which the velocity at any point varies erratically.
24
Q
What does “turbulent flow” mean when talking about blood flow?
A
created by cross flow caused by angles, rough areas, or obstructions in vessels
25
When assessing a patient for turbulent flow we listen for _________ and feel for__________.
bruits, thrills
26
What might a bruit in the abdomen signify?
a clot or aneurysm in the abdominal aorta
27
Where will the blood flow fastest in the vessel?
directly through the center
28
Where will blood flow slowest in a vessel?
Around the sides of a vessel
29
Define microcirculation:
Circulation of the blood in the smallest blood vessels.
30
T or F: Hemodynamics (pressure) is necessary in order to get blood through capillaries.
FALSE. Blood moves through capillaries according to concentration and osmosis/diffusion, but can effect hemodynamics.
31
What can cause a change in the microcirculation balance?
abnormal blood volume, abnormal resistance (turbulent flow), abnormal plasma, a leak in the vessel
32
What would happen in the absence of plasma proteins?
Plasma proteins regulate diffusion through capillaries by attracting fluid to them (high concentration of solutes). Without them blood flow through capillaries cannot be maintained. This will cause edema because fluid will still be moving to higher solute concentrations, but this will be into the interstitial space instead of through the vessel
33
Besides plasma proteins, what three other factors control microcirculation?
neuronal (SNS increases resistance and PNS decreases resistance), autoregulation, and hormonal
34
What role does ADH play in microcirculation?
controls the amount of water in the blood
35
What role does aldosterone play in microcirculation?
controls the amount of sodium in the blood
36
What role does atrial naturietic play in microcirculation?
gets rid of sodium by blocking sodium reapsorption
37
1.Which of the following will not cause an increase in vascular resistance: A. decreased viscosity, B. increased hematocrit, C. decreased number of blood vessels, D. decreased shear rate
A. decreased viscosity
38
Which of the following procedures would cause an increase in blood flow through a cylindrical tube? (Choose all that apply) a. increase tube diameter by 10%, b. decrease the tube length by 20%, c. decrease the blood viscosity by 30%, d. increase the driving pressure by 40%
ALL of the above.
39
Flow=
Cardiac output (L/min).
40
What is a normal flow rate?
Normal flow is 5-6 L/min
41
Pressure refers to:
Differences in pressure between Right atrium-aorta
42
Systolic pressure=
The maximum pressure blood exerts on vessels while the left ventricle is contracting and expelling blood
43
Diastolic pressure=
The minimum amount of pressure blood exerts on vessels while the heart is relaxed and ventricles are filling.
44
Cardiac output (CO)=
Heart Rate (HR) + Stroke volume (SV)
45
CO x Systemic vascular resistance (SVR)=
Mean Arterial Pressure (MAP)
46
Diastolic BP + [(Systolic BP- diastolic BP)/3]=
MAP
47
SVR measures:
the elasticity and diameter of vessels
48
CO measures:
volume and rate of blood flow as well as preload and after load
49
___________ Measures the stretch of the ventricular wall, related to volume (how full is the tank?)
Preload
50
____________: Resistance the blood in the ventricle must overcome to force open the valves and eject contents into circulation
Afterload
51
The perfusion pressure the organs get in the body is called the:
MAP (mean arterial pressure)
52
T or F: Secondary hypertension is a result of unknow causes.
FALSE. Primary(essential) hypertension arises from mainly unknow causes while seconday hypertension is caused by an alteration in hemodynamics brought on by another disease such as renal failure.
53
Why is Hypertension dangerous?
because it makes the heart work harder to pump blood to the body and contributes to hardening of the arteries, or atherosclerosis, and to the development of heart failure.
54
___________: is a problem with the rate or rhythm of the heartbeat.
Arrhythmia
55
How do arrhythmias like Atrial Fib effect hemodynamics?
causes the atria to quiver instead of contract. This significantly lowers cardiac output during the arrhythmia which effects blood flow and tissue perfusion.
56
___________________ is a disease of the arteries that supply blood and oxygen to the heart, causes decreased blood flow to the heart muscle.
Coronary artery disease
57
How does CAD effect hemodynamics?
If the arteries become blocked or severely narrowed, the heart becomes starved for oxygen and nutrients. This can lead to heart muscle death resulting in an inability to pump blood
58
This disease causes damage to the heart muscle and causes include artery or blood flow problems, infections, and alcohol and drug abuse.
cardiomyopathy
59
____________usually occurs when a blood clot blocks the flow of blood through a coronary artery — a blood vessel that feeds blood to a part of the heart muscle.
Myocardial Infarction (MI)
60
How do MI's interrupt hemodynamics?
The interrupted blood flow that occurs during a heart attack can damage or destroy a part of the heart muscle. If heart muscle is destroyed it cannot contract properly, which can mean blood cannot be pumped at all, or pumped poorly causing poor circulation and tissue perfusion.
61
______________occurs when the heart muscle doesn't contract with enough force, so there is less oxygen-rich blood that is pumped throughout the body.
Systolic dysfunction (or systolic heart failure)
62
____________occurs when the heart contracts normally, but the ventricle -- the main pumping chamber -- does not relax properly, reducing the amount of blood that can enter the heart and raising blood pressure in the lungs.
Diastolic dysfunction (or diastolic heart failure)
63
What happens to CO (Cardiac Output) during pregnancy?
CO is increased by 30-60% because the body has to pump for 2 bodies
64
T or F: During pregnancy Initially SV (stroke volume) is up, then down in the 2nd and 3rd trimesters
TRUE
65
T or F: Pregnancy causes a decrease in maternal RBC mass.
FALSE. Pregnancy causes an increase in RBC mass, which creates a higher blood volume.
66
T or F: Pregnancy puts women at risk for poor circulation d/t the increased viscosity and volume of RBC's in the blood.
FALSE. Hormones "tell" vessels to expand to accommodate for the extra blood volume so there are no obstructions of vessels.
67
Hypertensive Disorders include:
Gestational Hypertension, Chronic Hypertension, Preeclampsia/eclampsia
68
T or F: Gestational Hypertension, Chronic Hypertension, and Preeclampsia/eclampsia are considered 3 separate disorders with 3 separate etiologies.
FALSE. These 3 disorders can occur in isolation but are considered progressive manifestations of a single process with one etiology
69
_____________ is thought to lead to widespread activation/ dysfx of the maternal vascular endothemium
Placental ischemia ( damage and inflammation)
70
enhanced formation of endothelin and thromboxane, increased vascular sensitivity to angiotenin II ( more Na therefore more h2o) , and a decrease formation of vasodilators suchs as NO and prostacyclin all contribute to:
HTN by impairing renal pressure natriuresis and increasing TPR and maternal preeclampsia
71
What are 3 other factors that contribute to HTN and preeclampsia during pregnancy?
Pregancy hormones ( they change the permeability of the capillaries), change in intravascular coagulation ( d/t decrease in platelets), glomerular permeability (protien leak, proteninuria, proteninemia: loss of oncotic pressure, decreased intravascular vol)
72
What are the clinical manefestations of preecclampsia/ecclampsia?
BP > 140/90, edema, Proteinuria >300mg/24 hrs Or SBP up 30 mm/HG- 15 mmHg Dbp, Headaches, visual changes, abdominal pain, Labs: CBC, UA, e-lytes, PT, liver fx, PTT, BUN, Creatinine, Seizures, Coma
73
What are serious Complication d/t HTN? RTUM C
HELLP SYNDROME, ABRUPTIO PLACENTAE, PULMONARY EDEMA, ACUTE RENAL FAILURE, CEREBRAL HAEMORRHAGE, VISUAL DISTURBANCES & BLINDNESS,HEPATIC RUPTURE, ELECTROLYTIC IMBALANCE, POSTPARTUM COLLAPSE.
74
To what is HELLP referring?
a group of syndromes that occur in pregnant women who have H- Hemolytic anemia, EL=elevated liver enzymes, LP= low platelet count
75
What will increase preload?
blood products, fluids
76
What are 3 examples of products that will increase preload?
Packed RBC's, albumin, NS
77
What type of drugs will decrease preload?
Diurestics, ACE Inhibitors, dobutamine
78
Give examples of 3 diuretics:
Lasix, Bumex, Thiazides
79
Give examples of 3 ACE Inhibitors:
clonidine (Catapress), methyldopa, trimethaphan
80
Which 3 drugs will cause venous dilation?
Nitroglycerine (NTG), Calcium Channel Blockers (Ca+), Morphine
81
What type of drug increases afterload?
vasosuppressors
82
Give 1 example of a vasopressor that increases afterload:
dopamine at higher doses
83
What type of drug will decrease afterload?
Arterial dilators
84
Give 4 examples of arterial dilators that will decrease afterload:
ACE Inhibitors, Niprides (lesser extent Nitro), Ca+ Channel Blockers, Labetalol
85
T or F: Atropine, Dopamine, and Dobutamine will increase heart rate.
TRUE.
86
T or F: Beta Blockers and Ca+ Channel Blockers will decrease heart rate.
TRUE.
87
What type of drug will increase contractility?
Inotropics
88
What are 3 examples of inotropics?
Digoxin, dopamine/dobutamine, milrinone/amrinone
89
What type of drug will decrease contractility?
CA+ channel blockers
90
________ are drugs that decrease either preload or afterload:
Vasodilators
91
What are the two categories of vasodilators used to decrease either preload or afterload?
ACE inhibitors and Angiotensin II receptor agonists and Diuretics
92
Give 3 examples of ACE inhibitors and Angiotensin II receptor agonists:
organic nitrates, hudralazine, nitroprusside
93
Give 4 examples of diuretics:
loop diuretics, aldosterone receptor antagonists, beta blockers, and inotropics
94
What type of drug will increase peripheral resistance?
vasosuppressors
95
Levophed, Neosynephrine, Vasopressin, Epinephrine, and Dopamine (high dose) will all work to (increase/decrease) ________________.
increase, peripheral resistance
96
Peripheral Alpha Blockers, Direct Arterial Dilators, ACEI, ARBs, Ca+ Channel Blockers, and Nitroprusside, Nitrates will all work to (increase/decrease) what?
decrease peripheral resistance
