Cardiac - Htn, PE, Chf, Dissection Flashcards
What is the principal sympathetic neurotransmitter?
Via what receptor?
Acts where?
Drives what physiologic principal?
Norepinephrine
Alpha-1
Vascular smooth m. In small-diameter arterioles
SVR which amplifies afterload
Pt with BP > 180/110 with visual changes, HA, AMS, seizures can have what?
Diagnose how?
PRES
MRI
What is a potential complication in lowering BP in a pt with on evidence of acute TOD (target organ damage) in the ED?
Cerebral hypoperfusion —> refer to study on sublingual nitro
P. 1011 Ch 74
What is the bolus dose of labetalol?
Time of onset? Duration of action?
MOA?
20-80mg q10min
2-5min, 3-6 hr
Beta is 7x > a1 for IV, and 3x for PO
What is the goal BP reduction of MAP and goal BP level?
20-25% in the 1st hour
160/100 by 2-6 hours
Goal BP for aortic dissection?
Which agents to use?
< 110 SBP
Esmolol 1st, then nicardipine or nitroprusside
Acute ischemic stroke, what is the BP goal?
At 24 hours?
Only indicated if BP is > 220/120
15% of BP
SE of sodium nitroprusside and other NO donors?
Increased ICP
What is the BP goal in spontaneous ICH?
< 140-150
HTN encephalopathy med choices?
Labetalol
Nicardipine
What defines AKI?
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
What measurements indicate a pre-renal cause of AKI?
BUN/CR > 20
FeNa < 1%
FEurea < 35%
FEurea = (Serum Cr x Urine Ur x 100) / (Serum urea x Urine Cr)
What med to use in HTN AKI that is prerenal?
Why?
Alternatives?
What to avoid? Why?
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
What BP level is Pre-eclampsia defined?
1st line?
MOA?
> 160
Mag Sulfate
Relax smooth m via Ca antagonism —> dec in peripheral and cerebral vascular resistance
What is the 1st abnormality to appear with acute HTN retinopathy?
Focal intraretinal periarteriolar transudates
What is a proximal DVT?
Distal?
Popliteal vein or higher
Isolated calf vein thrombosis
What defines UE DVT?
Superficial?
Axillary vein thrombosis
Brachial vein
DDx of DVT?
Venous insufficiency Cellulitis Muscle strain Hematoma Baker’s cyst Lymphedema
What is the PE heparin dose?
80 U/kg bolus
Then 18 U/kg/hr
D-diner [ ] varies directly with clot Burden. Derived from what?
Half-life of what? Means what?
Fibrin breakdown
8 hours, less sensitive for old clots
Definition of Submassive PE?
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
Treatment for Submassive or massive PE?
100mg alteplase over 2 hours
