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@MY Anesthesia!! > Cardio 3 > Flashcards

Cardio 3 Flashcards

1
Q

what two mechanisms do organs have for controlling their own blood supply?

A

1) myogenic mechanism (walls of vessels are stretched, and put out sm mm dilators to increase flow and reduce press)
2) metabolic mech
(match supply w/ demand; dials up blood flow when metabolic waste products dilate nearby vessels to allow more flow)

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2
Q

what hormone causes coronary auto regulatory vasodilation?

A

adenosine

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3
Q

Coronary blood flow formula?

A

CBF = (art DP - LVEDP)/ coronary resist

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4
Q

which part of the heart muscle is MOST vulnerable to ischemia?

A

ENDOCARDIUM

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5
Q

what is NORMAL Cerebral Blood Flow (CBF)?

A

50mL/100g/min

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6
Q

what’s Cerebral Perfusion Pressure, and how does it relate to CBF?

A

CPP = MAP - CVP
(as long as CVP>ICP)

CBF=CPP/CVR

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7
Q

Cushing reflex?

A

maintain MAP in face of high ICP…still push blood in despite high ICP…..bradycardia follows….HERNIATE NEXT!!!

(DON’T WANT TO SEE THIS….CATASTROPHE)

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8
Q

PaO2

A

….augment CBF

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9
Q

PaCO2 on same graph

A

STRAIGHT LINE

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10
Q

renal blood flow regulated by what two mechs?

A

1) myogenic

2) tubuloglomerular feedback (TGF)

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11
Q

what is TGF?

A

autoreg function mediated by macula densa; sense higher NaCl, promote constriction of afferent arteriole to decrease Blood flow

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12
Q

post-prandial hyperemia?

A
  • augmented blood flow to splanchnic circulation
  • mucosal metal
  • vasoactive GI hormones
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13
Q

splanchnic circulation contains how much of Blood vol?

A

15%

–source of systemic volume in times of need

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14
Q

uterine vascular autoregulation

A

NOT THERE. vessels are maximally dilated; perfusion is PRESSURE dependent

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15
Q

DIGOXIN mechanism?

A
  • blocks Na/K pump
  • INCREASE intracell Na
  • Na/Ca exchanger that drives Ca outside (bc decreased Na gradient to come back in) decr
  • More Ca intracell
  • INCREASED contractility
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16
Q

what does digoxin do at AV node?

A

decreases conduction

K decreases

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17
Q

digoxin toxicity

A

-tachydysrhyth
-bradycardia
-potentiated by hypo/hyperkalemia
DIURETICS - WATCH!!

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18
Q

MC EKG finding of digoxin?

A

PVC

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19
Q

what other finding on EKG that’s typical of digoxin?

A
  • “hockey stick”

- scooped out QT

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20
Q

treatment of Ventricular arrhythmias with Dig?

A
  • lidocaine
  • amiodarone
  • Potassium (upper normal)
  • LOW ENERGY only if cardiovert
  • can give Ab
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21
Q

Adenosine to treat what?

A
  • WPW

- SVT (narrow)

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22
Q

How adenosine work?

A
  • coronary vasodilation

- AV NODAL SUPPRESSION

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23
Q

antagonism of adenosine?

A

METHYLXANTHINES

  • caffeine
  • theophylline
  • amrinone
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24
Q

SE to adenosine?

A

bronchospasm!!

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25
Q

amiodarone chemically similar to what endogenous hormone?

A

thyroxine

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26
Q

Amiodarone does WHAT to nodes?

A

depresses both SA and AV

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27
Q

heart toxicities of Amio?

A
  • hypoTN
  • Sinus Brady
  • heart block
  • QRS/QT prolongation
  • depress contractility
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28
Q

other SE of amio?

A
  • hypoTHYroid
  • thyrotoxicosis
  • pulm fibrosis
  • CNS (periph neuron)
  • LFT incr
  • BLUE SKIN
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29
Q

QT prolong drugs!

A
  • zofran
  • haldol
  • antiarrhythmics (sotalol, amio, procainamide)
  • antifungals
  • ABX: TMPSMX, erythro, pentamidine
  • ANTI-depress: amitrip, doxepin
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30
Q

alpha 1 receptors located where in relation to synapse?

A

-POSTsynaptic

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31
Q

how coupled with protein?

A
  • Gq protein coupled
  • activate Phospholipase C
  • PIP2 to IP3 plus DAG
32
Q

Alpha 2 receptors located where in relation to synapse?

A

-PREsynaptic

33
Q

coupled how?

A
  • Gi Protein coupled
  • INHIBITS Adenyl Cyclase
  • ATP to cAMP
34
Q

all beta receptors located WHERE in relation to synapse

A

POST-synaptic

35
Q

all Beta receptors coupled how?

A
  • Gs protein
  • activates Adenyl Cyclase
  • atp to cAMP
36
Q

what is dromotropy?

A

increase impulse conduction

beta 1

37
Q

what is word for increase contraction?

A

inotropy

38
Q

Dobutamine as pressor, hits what receptors?

A

B1, B2

-INCREASE CO

39
Q

what can happen if use dobutamine alone?

A

get hypotension; use with another agent if already hypotense

40
Q

SE of using for a while

A
  • tachyphylaxis

- arrhythmogenic

41
Q

Dopamine - which receptors?

A

LOW - DA

High - a1, a2, B1

42
Q

why use Epi for anaphylaxis?

A

prevents mast cell degranulation

43
Q

metabolic SE of epi?

A

hyperglycemia

44
Q

What is reflexive effect of NE?

A

brady

45
Q

how is NE metabolized?

A
  • MAO

- COMT

46
Q

NE unique for redistributing blood where?

A
  • brain

- heart

47
Q

Vasopressin effects on what receptors?

A

V1, V2

48
Q

Selegiline = what kinda drug?

A

MAOI

49
Q

what drug should NOT be used with MAOI’s?

A

ephedrine

indirectly acting sympathomimetic Amine

50
Q

Isoproterenol

A 
synthetic catecholamine
NO ALPHA
-b1, b2
-DECREASE after load
-DECREASE Pulm Vasc Resist
51
Q

GOOD pressor for NEUROGenic shock

A

-dopamine

52
Q

mechanism of MILRINONE?

A
  • increases myocytes’ intracell cAMP by inhibiting PDE3 from breaking it down
  • get INCREASED:
  • -inotropy
  • -lusitropy
  • -chronotropy
  • -dromotropy
  • -automaticity
53
Q

what does milrinone do is vascular beds?

A

vasodilation

-Also good for DECREASED Pulm VASC RESIST

54
Q

nitroglycerin mech?

A
  • direct vasodilator (veins»arteries)

- relieves coronary spasm

55
Q

nitroprusside becomes?

A

NO (so relaxes smooth muscle)

56
Q

what’s harmful toxin from it?

A

-cyanide

57
Q

hydrazine mech?

A

K+ channel ACTIVATION on sm mm; causes depolar and relaxation

58
Q

bad rare SE of hydralazine?

A
  • lupus like syndrome

- agranulocytosis

59
Q

CCB work where?

A

cardiac effect OR vasc smooth muscle

  • -vasodilation
  • -slow nodal conduction and inhibit contractility
60
Q

which 2 CCB better for vasodilating effects?

A
  • nifed

- nicard

61
Q

CCB more cardiac effects?

A

Verapamil

also Dilt

62
Q

Verapamil + BB?

A

BAD = can cause death

63
Q

ACE good for heart how?

A
  • cardiac remodeling

- renal protection

64
Q

ACE SE?

A

-hyperkalemia
(bc it’s inhibit aldost??)
-ANGIOedema [bradykinin; cough, too]

65
Q

ACE in preggers?

A

NO NO NO!!!

category D

66
Q

hypokalemia on EKG:

A
  • depressed T
  • U-wave prominent (big hill AFTER t-wave)
  • somewhat prolonged PR
67
Q

sxs of hypoKalemia?

A
  • myalgia
  • FLACCID PARALYSIS
  • hyporeflexia
  • resp weakness
68
Q

HYPERkalemia on EKG?

A
  • peak T-wave
  • prolong PR
  • VFIB
69
Q

Tx for hyperkalemia?

A
  • Ca Gluc
  • Insulin + Glucose
  • furosemid
  • Kayexalate
  • hemodialysis
70
Q

HYPOcalcemia Ekg

A

LOW level - LONG QT

71
Q

HYPERcalcemia EKG

A

HIGH Ca

SHORt QT

72
Q

Ca too low, can cause what heart ailment?

A

-CHF

73
Q

TOO much Ca to heart?

A

arrhythmias

74
Q

Tx for hypercalcemia?

A
  • diuresis
  • calcitonin
  • dialysis
75
Q

HYPO Magnesium?

A
  • chvostek’s sign

- Trousseau’s phenom

76
Q

HYPERmagnesemia?

A
  • -TALL t-waves

- -depressed ST

77
Q

Tx INCR mag?

A
  • calc gluc
  • diuretics
  • dialysis

@MY Anesthesia!! (14 decks)

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