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Hugh's Foundation and Cardiovascular > Cardio Week 6 > Flashcards

Cardio Week 6 Flashcards

1
Q

What is contained in the posterior mediastinum?

A

Oesophagus descending thoracic aorta Thoracic duct sympathetic trunks

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1
Q

In which type of valvular disease is it possible to wait until the appearance of symptoms to intervene?

A

Aortic stenosis

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1
Q

What are some common causes of haemorrhagic necrosis?

A
  1. Venous occlusion
  2. Reperfusion of necrotic tissue
  3. Dual circulation or natural collateral circulation
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2
Q

What are aminoglycosides?

A

Antibiotics they target protein synthesis by binding to and distorting the codon reading frame on the ribosome.

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4
Q

Usually the appearance of symptoms in valvular disease indicates the progression of irreversible, pathological changes to the heart. In which type is this not the case?

A

Aortic stenosis - and LVH can regress.

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5
Q

What are some side effects of ACE inhibitor and angiotensin receptor blockers?

A

Dry cough

First use hypotension

Loss of appetite

Hyperkalaemia

Acute renal failure

Foetal malformations

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5
Q

Why is warfarin described as a “moody” drug?

A
  1. Short half-life
  2. Binds to plasma protein
  3. Highly dependent on dietary vitamin K
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6
Q

What is an example of antimicrobial resistance via drug inactivation due to convalent modification

A

Gentamicin (an aminoglycoside) acetyltransferase - acetylates the gentamicin

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7
Q

What are examples of antimicrobial resistance mediated by altering of target?

A
  1. Alternate PBP (mecA) - methicillin doesn’t recognise
  2. Switch terminal D-ala with monosaccaride to prevent vancomycin blocking cell wall synthesis (VRE)
  3. VISA - vancomycin intermediate resistant Staphlococcus aureus. Over produces peptidoglycan to soak up vancomycin
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8
Q

Why can’t you treat Pseudomonas aeruginosa with co-amoxyclav?

A

Because P. aeruginosa has a chromosomally encoded beta-lactamase that clavulanic acid can’t inhibit and therefore it goes on to hydrolyse the amoxycillin. However you can use Ticarcillin + clavulanic acid as Ticarcillin is resistant to P. aeruginosa’s chromosomal beta-lactamase (you also need clavulanic acid because Ticarcillin is susceptible to plasmid encoded beta-lactamases which clavulanic acid will inhibit).

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9
Q

What does damage to blood vessels lead to in the clotting cascade?

A
  1. Vasocontriction
  2. Platelet adhesion and activation
  3. Fibrin formation
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9
Q

What is the end result of the coagulation cascade

A

Activation of thrombin from prothrombin which cleaves fibrinogen into fibrin

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11
Q

What is the function of clavulanic acid?

A

It is a suicide inhibitor of plasmid encoded beta-lactamases

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12
Q

How is vitamin K relevant to coagulation?

A

Vitamin K is a substrate for Vitamin K reductase that is essential for the formation of coagulation factors II, VII, IX and X.

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13
Q

What is an example of a platelet inhibitor?

A

Aspirin - inhibits cyclo-oxygenase to prevent thromboxane production (thromboxane is a potent activator of platelets)

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14
Q

What are some drug actions that will decrease preload?

A

Diuretics

Venodilators - nitrates

Aldosterone receptor antagonists

Aquaretics

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15
Q

What are some fibrinolytic drugs?

A

Streptokinase, alteplase

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15
Q

Rheumatic fever almost always causes this type of valvular disease…

A

Mitral stenosis

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16
Q

What are some drug actions that will decrease afterload?

A

Angiotensin receptor antagonists

Beta-adrenoceptor antagonist

Arterial vasodilator

ACE inhibitor

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16
Q

How does valve stenosis cause a pressure difference across valves?

A

Narrower space for blood to travel through therefore it requires greater pressure to get the blood through

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17
Q

Bowel infarcts are usually haemorrhage T/F? Why?

A

True, commonly due to venous occlusion

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19
Q

What is an examples of antimicrobial resistance via drug inactivation via hydrolysis

A

Chromosomal encoded beta-lactamase in P. aeruginosa hydrolyases beta-lactams

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21
Q

What is the mecA protein?

A

An altered penicillin binding protein that isn’t recognised by beta-lactams therefore affording resistance to penicillin/methicillin to the pathogens that have it. This is the mechanism in methicillin resistance and the protein is called mecA.

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23
Q

Define Thrombosis

A

Pathological haemostatic plug formation in the absence of blood loss

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24
At what level does the superior vena cava enter the right atrium?
Posterior to the 3rd costal cartilage
26
What causes the 4th heart sound?
Forceful atrial contraction to overcome stiff ventricle, occurs during diastole due
27
Describe the action of heparin
- Anti-coagulant - Enhances activity of antithrombin III which inactivates Factor Xa and thrombin - Injectable
28
What are some stimuli for platelet activation?
1. Collagen 2. Thrombin 3. Thromboxane 4. ADP
29
Why is Amrinone useful when beta1-adrenoceptors are desensitised due to over activation?
Amrinone mechanism to increase intracellular Ca is not mediated via those receptors. Rather it inhibits phosphodiesterases \> less cAMP to AMP \> more active PKA \> more phosphorylation of Ca channels \> more intracellular Ca.
30
What is the ligamentum arteriosum?
Connects the aorta to the pulmonary trunk - remanence of shunt that allowed blood to bypass the pulmonary circulation in utero.
31
At what level to the left and right brachiocephalic veins meet?
Posterior to the 1st costal cartilage
32
Which vitamin is important in coagulation?
K
33
Who is the co-ordinator of secondary haemostasis
Thrombin - cleaves fibrinogen to fibrin
34
What is the course of the vagus nerve in the mediastinum?
-Descending in the carotid sheath, posterorlateral to common carotid artery -R: Along trachea L: Lateral aortic arch -Posterior to lung root -Along ant. of oesophagus where L & R join to form the oesophageal plexus
35
What does the descending aorta supply in the thoracic cavity?
Intercostal space (posterior intercostal arteries) Bronchial arteries Pericardium
36
Volume overload is caused by what?
Valve regurgitation
37
What is the course of the phrenic nerve in the mediastinum?
Descending on the scalenus anterior Passes between the subclavian artery and vein Passes anterior to the lung root Pierces the diaphragm
38
What are some examples of emboli?
1. Thrombus 2. Atherosclerotic rupture 3. Gas 4. Vegetative mass from bacteria aka septic emboli 5. Tumour emboli 6. Fat emboli
39
What are examples of antimicrobial resistance mediated by prevent drug getting to its target?
Reduced entry into cell - eg modification of outer membrane in gram -ve to prevent entry of aminoglycosides Increase efflux of drug from cell
40
How long can neurones survive without blood supply?
3-4 minutes
41
How does valve stenosis cause a pressure difference across valves?
Narrower space for blood to travel through therefore it requires greater pressure to get the blood through
42
In which type of valvular disease do you hear no second heart sound but murmur instead?
Aortic regurgitation
43
What are some side effects of heparin?
Haemorrhage, thrombocytopaenia and osteoporosis
44
How long can cardiac muscle survive without blood supply?
20 minutes
45
An inhibitor of vitamin K reductase is?
Warfarin
46
What are the goals of treatment for cardiac failure?
1. Decrease cardiac work and improve cardiac function 2. Decrease signs and symptoms 3. Increase survival
47
What is the mechanism of vasoconstriction in response to blood vessel damage?
Platelets adhere to the damaged wall and are activated and release ADP and 5-HT - potent vasoconstrictors
48
What is the mechanism of glycosides on the heart?
Increase contractility by increase intracellular Ca by inhibiting ATPase which reduces the amount of Ca pumped out of the cell.
49
What does Amrinone do?
Inhibits phosphodiesterases that break down cAMP therefore Ca channels are more activated = increased intracellular Ca = Increased contractility
50
What can you use to reduce preload?
Diuretics Venodilators Aldosterone inhibitors Angiotensin Receptor Antagonists ACE inhitiors
51
What are the 3 essential features of accurate clinical trials?
1. Randomisation (reduce compounding error) 2. Blinding (reduce observational bias/error) 3. Intention to treat (reduce selection error) - treat people like they're still in their original group (control or treatment) regardles of whether they stick with it.
52
What are they four functions of the kidneys?
1. Regulate electrolyte and water volume 2. Endocrine production 3. Exogenous waste excretion 4. Endogenous waste excretion
53
What are the structural components of the kidney?
1. Glomerulus 2. Proximal tubule - 60-70% of water and NaCl reabsorbed 3. Loop of Henle - water, K+ and 20-30% of NaCl reabsorbed 4. Distal tubule - 5-10% of NaCl reabsorbed and K+ secreted 5. Collecting ducts - K+ secreted and rest of NaCl is reabsorbed
54
What is the significance of probenecid?
It is a drug that prevents to secretion of banned substances used by unethical athletes.
55
What are diuretics?
Drugs that decrease NaCl reabsorbion thereby increase its secretion and water's secretion.
56
What are the 4 classes of diuretics?
Loop diuretics Thiazide diuretics Potassium-sparing diuretics Osmotic diuretics
57
What is the mechanism of action of loop diuretics?
They inhibit Na/Cl/K carriers into the cell in the loop of Henle. Leads to reduced water reabsorption due to reduction of hypertonicity in interstitum and greater [Na] in the distal tubule.
58
What is the duration of action of loop diuretics? What are some side effects?
3-6 hours. Hypokalaemia (due to increased Na+ in distal tubule = more Na reabsorbed and more K+ secreted via Na/K ATPase) Hypovolaemia
59
Why are thiazide diuretics less potent than loop diuretics when they both act on Na/Cl co-transport?
Because thiazide diuretics act in the distal tubule where less Na/Cl is reabsorbed.
60
Thiazide diuretics have a slower, less urgeny effect compared to loop diuretics T/F?
True The duration is 8-12 hours
61
When are K sparing diuretics mainly used?
With loop or thiazide diuretics to prevent hypokalaemia
62
What is spironolactone? What is its mechanism of action?
It is a K-sparing diuretic and a aldosterone receptor antagonist - stops stimulation of Na reabsorption thereby preventing K secretion.
63
Why is the kidney susceptible to toxins?
1. Toxins can be at a high concentration 2. The kidney filters 25% of blood 3. The kidney can metabolise 4. Contribution from extrarenal events.

Hugh's Foundation and Cardiovascular (7 decks)

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