- 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

- coronary vasodilation - AV NODAL SUPPRESSION

Cardio 3 Flashcards by Andrew Sullivan

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

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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what hormone causes coronary auto regulatory vasodilation?

adenosine

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Coronary blood flow formula?

CBF = (art DP - LVEDP)/ coronary resist

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

ENDOCARDIUM

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what is NORMAL Cerebral Blood Flow (CBF)?

50mL/100g/min

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

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

CBF=CPP/CVR

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Cushing reflex?

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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PaO2

….augment CBF

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PaCO2 on same graph

STRAIGHT LINE

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renal blood flow regulated by what two mechs?

1) myogenic

2) tubuloglomerular feedback (TGF)

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what is TGF?

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

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post-prandial hyperemia?

augmented blood flow to splanchnic circulation
mucosal metal
vasoactive GI hormones

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splanchnic circulation contains how much of Blood vol?

15%

–source of systemic volume in times of need

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uterine vascular autoregulation

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

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DIGOXIN mechanism?

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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what does digoxin do at AV node?

decreases conduction

K decreases

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digoxin toxicity

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

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MC EKG finding of digoxin?

PVC

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

“hockey stick”

- scooped out QT

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treatment of Ventricular arrhythmias with Dig?

lidocaine
amiodarone
Potassium (upper normal)
LOW ENERGY only if cardiovert
can give Ab

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Adenosine to treat what?

- SVT (narrow)

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How adenosine work?

coronary vasodilation

- AV NODAL SUPPRESSION

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antagonism of adenosine?

METHYLXANTHINES

caffeine
theophylline
amrinone

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SE to adenosine?

bronchospasm!!

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amiodarone chemically similar to what endogenous hormone?

thyroxine

Amiodarone does WHAT to nodes?

depresses both SA and AV

heart toxicities of Amio?

- hypoTN - Sinus Brady - heart block - QRS/QT prolongation - depress contractility

other SE of amio?

- hypoTHYroid - thyrotoxicosis - pulm fibrosis - CNS (periph neuron) - LFT incr - BLUE SKIN

QT prolong drugs!

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

alpha 1 receptors located where in relation to synapse?

-POSTsynaptic

how coupled with protein?

- Gq protein coupled - activate Phospholipase C - PIP2 to IP3 plus DAG

Alpha 2 receptors located where in relation to synapse?

-PREsynaptic

coupled how?

- Gi Protein coupled - INHIBITS Adenyl Cyclase - ATP to cAMP

all beta receptors located WHERE in relation to synapse

POST-synaptic

all Beta receptors coupled how?

- Gs protein - activates Adenyl Cyclase - atp to cAMP

what is dromotropy?

increase impulse conduction | beta 1

what is word for increase contraction?

inotropy

Dobutamine as pressor, hits what receptors?

B1, B2 -INCREASE CO

what can happen if use dobutamine alone?

get hypotension; use with another agent if already hypotense

SE of using for a while

- tachyphylaxis | - arrhythmogenic

Dopamine - which receptors?

LOW - DA | High - a1, a2, B1

why use Epi for anaphylaxis?

prevents mast cell degranulation

metabolic SE of epi?

hyperglycemia

What is reflexive effect of NE?

brady

how is NE metabolized?

- MAO | - COMT

NE unique for redistributing blood where?

- brain | - heart

Vasopressin effects on what receptors?

V1, V2

Selegiline = what kinda drug?

MAOI

what drug should NOT be used with MAOI's?

ephedrine | indirectly acting sympathomimetic Amine

Isoproterenol

``` synthetic catecholamine NO ALPHA -b1, b2 -DECREASE after load -DECREASE Pulm Vasc Resist ```

GOOD pressor for NEUROGenic shock

-dopamine

mechanism of MILRINONE?

- increases myocytes' intracell cAMP by inhibiting PDE3 from breaking it down - get INCREASED: - -inotropy - -lusitropy - -chronotropy - -dromotropy - -automaticity

what does milrinone do is vascular beds?

vasodilation | -Also good for DECREASED Pulm VASC RESIST

nitroglycerin mech?

- direct vasodilator (veins>>arteries) | - relieves coronary spasm

nitroprusside becomes?

NO (so relaxes smooth muscle)

what's harmful toxin from it?

-cyanide

hydrazine mech?

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

bad rare SE of hydralazine?

- lupus like syndrome | - agranulocytosis

CCB work where?

cardiac effect OR vasc smooth muscle - -vasodilation - -slow nodal conduction and inhibit contractility

which 2 CCB better for vasodilating effects?

- nifed | - nicard

CCB more cardiac effects?

Verapamil | also Dilt

Verapamil + BB?

BAD = can cause death

ACE good for heart how?

- cardiac remodeling | - renal protection

ACE SE?

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

ACE in preggers?

NO NO NO!!! | category D

hypokalemia on EKG:

- depressed T - U-wave prominent (big hill AFTER t-wave) - somewhat prolonged PR

sxs of hypoKalemia?

- myalgia - FLACCID PARALYSIS - hyporeflexia - resp weakness

HYPERkalemia on EKG?

- peak T-wave - prolong PR - VFIB

Tx for hyperkalemia?

- Ca Gluc - Insulin + Glucose - furosemid - Kayexalate - hemodialysis

HYPOcalcemia Ekg

LOW level - LONG QT

HYPERcalcemia EKG

HIGH Ca | SHORt QT

Ca too low, can cause what heart ailment?

-CHF

TOO much Ca to heart?

arrhythmias

Tx for hypercalcemia?

- diuresis - calcitonin - dialysis

HYPO Magnesium?

- chvostek's sign | - Trousseau's phenom

HYPERmagnesemia?

- -TALL t-waves | - -depressed ST

Tx INCR mag?

- calc gluc - diuretics - dialysis