Cardiac - Htn, PE, Chf, Dissection

Question 1

What is the principal sympathetic neurotransmitter?

Via what receptor?
Acts where?

Drives what physiologic principal?

Answer 1

Norepinephrine

Alpha-1
Vascular smooth m. In small-diameter arterioles

SVR which amplifies afterload

Question 2

Pt with BP > 180/110 with visual changes, HA, AMS, seizures can have what?

Diagnose how?

Answer 2

PRES

MRI

Question 3

What is a potential complication in lowering BP in a pt with on evidence of acute TOD (target organ damage) in the ED?

Answer 3

Cerebral hypoperfusion —> refer to study on sublingual nitro

P. 1011 Ch 74

Question 4

What is the bolus dose of labetalol?

Time of onset? Duration of action?

MOA?

Answer 4

20-80mg q10min

2-5min, 3-6 hr

Beta is 7x > a1 for IV, and 3x for PO

Question 5

What is the goal BP reduction of MAP and goal BP level?

Answer 5

20-25% in the 1st hour

160/100 by 2-6 hours

Question 6

Goal BP for aortic dissection?

Which agents to use?

Answer 6

< 110 SBP

Esmolol 1st, then nicardipine or nitroprusside

Question 7

Acute ischemic stroke, what is the BP goal?

At 24 hours?

Answer 7

Only indicated if BP is > 220/120

15% of BP

Question 8

SE of sodium nitroprusside and other NO donors?

Answer 8

Increased ICP

Question 9

What is the BP goal in spontaneous ICH?

Answer 9

< 140-150

Question 10

HTN encephalopathy med choices?

Answer 10

Labetalol

Nicardipine

Question 11

What defines AKI?

Answer 11

Increase in Cr of 0.3 or more in 48 hours
1.5x baseline in 7 days
Urine volume < .5 mL/kg/hr > 6 hrs

Question 12

What measurements indicate a pre-renal cause of AKI?

Answer 12

BUN/CR > 20
FeNa < 1%
FEurea < 35%

FEurea = (Serum Cr x Urine Ur x 100) / (Serum urea x Urine Cr)

Question 13

What med to use in HTN AKI that is prerenal?
Why?

Alternatives?

What to avoid? Why?

Answer 13

Fenoldopam (dopamine 1A receptor agonist) bc it leads to improved perfusion of corticomedullary region and assoc w/dec need for dialysis

Clevidipine, nicardipine

Enalaprilat bc it causes greater vasodilation in efferent than afferent arterioles causing inc risk of worsening GFR

Question 14

What BP level is Pre-eclampsia defined?

1st line?

MOA?

Answer 14

> 160

Mag Sulfate

Relax smooth m via Ca antagonism —> dec in peripheral and cerebral vascular resistance

Question 15

What is the 1st abnormality to appear with acute HTN retinopathy?

Answer 15

Focal intraretinal periarteriolar transudates

Question 16

What is a proximal DVT?

Distal?

Answer 16

Popliteal vein or higher

Isolated calf vein thrombosis

Question 17

What defines UE DVT?

Superficial?

Answer 17

Axillary vein thrombosis

Brachial vein

Question 18

DDx of DVT?

Answer 18

Venous insufficiency
Cellulitis
Muscle strain
Hematoma
Baker’s cyst
Lymphedema

Question 19

What is the PE heparin dose?

Answer 19

80 U/kg bolus

Then 18 U/kg/hr

Question 20

D-diner [ ] varies directly with clot Burden. Derived from what?

Half-life of what? Means what?

Answer 20

Fibrin breakdown

8 hours, less sensitive for old clots

Question 21

Definition of Submassive PE?

Answer 21

PE w/out systemic HoTN but must have RV dyfx or myocardial necrosis:

RV Dysfunction: RV dilation, BNP > 500, EKG changes (RBBB, STE/D)
Or
Troponin > 0.4

Question 22

Treatment for Submassive or massive PE?

Answer 22

100mg alteplase over 2 hours