CV Pharmacology Final Exam Flashcards
Describe pericardial restraint.
A change in volume or pressure on one side of the heart can influence pressure and volume on the other side.
Name 3 symptoms of acute pericarditis.
- chest pain
- pericardial friction rub
- ECG changes
- deep insp. worsens pain
- sitting forward relives pain
An acute influx of as little as _____ of fluid into the pericardium can produce symptomatic cardiac tamponade.
100 ml
Name 2 signs that occur during the respiratory cycle consistent with cardiac tamponade that signals ventricular dysynchrony.
- Kussmauls sign(distention of jugular veins)
2. Pulsus paradoxus( decrease in SBP > 10 mmHg during insp.)
In contrast to skeletal muscle, cardiac muscle requires _____ to contract.
calcium
Describe the Frank-Starling Law of the heart.
The ability of the heart to change its force of contraction and therefore stroke volume in response to changes in venous return(^venous return -> ^ventricular filling -> ^preload)
Name the contractile unit of the cardiac myocyte, consisting of I and A bands.
Sarcomere
Which protein troponin produces the conformational change exposing the specific myosin binding site on actin?
Calcium -> troponin C
Which semilunar valve is often damaged by high pressure _____? Which AV valve is subject to abuse d/t high pressure?
- Aortic
- Mitral
Which main coronary artery supplies the AV node in 90% of the population, and the SA node in 60% of the population?
Right main coronary artery
What defines the time available for coronary vascular perfusion?
Diastole
What is the equations for coronary perfusion pressure(CPP)?
CPP=DBP - PCWP
What is the most potent endogenous vasodilator?
Adenosine
Does Nitric Oxide case (vasodilation or vasoconstriction), and does it (inhibit or promote) platelet aggregation and adhesion?
- vasodilation
- inhibits
Pressure volume loops are 2D plots on continuous pressure vs. volume in the RV or LV?
LV
What is the “normal” CVP?
2 - 8 mmHg
What medications should be used for a Tamponade induction?
- ketamine(increases HR, contractility and SVR)
- BZD
- fentanyl
- careful titration of agent
REMEBER: THE COMBO OF VASODILATION AND MYOCARDIAL DEPRESSION FROM THE ANESTHETIC, IN ADDITOIN TO DECREASED VENOUS RETURN FROM PPV CAN PRODUCE LIFE-THREATENING HYPOTENSION.
What two structures secrete lubricating fluid into the parricidal space?
- Parietal pericardium
2. Visceral pericardium
If perfusion pressure falls by ____% or below the physiological pressure limits, the auto regulatory mechanisms begin to fail and blood flow fails
> 30%
When damage to the endothelium occurs, it produces no ______ and less _____.
- nitric oxide
- prostacyclin
What is the most ominous sign of CAD?
USA that occurs during rest is the most ominous sign of CAD. USA is poorly controlled by medications at this point and carries a significant risk of MI(Valley note)
“Critical stenosis” is a ____% decrease in diameter of a large distributing artery.
75%
What identifies ischemia intraoperatively?(Valley questions)
ST segment depression of > than 1 mm provides evidence of ischemia
The most important factor and primary determinant of myocardial O2 consumption is?
HR
What is the most important interventions to prevent or minimize ischemia?
avoid tachycardia
Cardiac pump function is affected by the SNS and the PNS in what 3 ways?
- changing the strength of contraction
- changing the heart rate
- modulation of coronary blood flow
What part of the SNS increases chronotropy and isotropy(cardiac accelerator fibers)?
T1-T4
What are the cardiovascular reflexes of a Valsalva maneuver?
decreased HR, contractility, vasodilation
What are the cardiovascular reflexes of a Baroreceptor reflex?
decreased HR, contractility, vasodilation
What are the cardiovascular reflexes of a Oculocardiac reflex?
bradycardia, systole, dysrhythmias, hypotension
What are the cardiovascular reflexes of a Celiac reflex?
bradycardia, hypotension, apnea
What are the cardiovascular reflexes of a Bainbridge reflex?
increased HR, decreased BP, decreased SVR, diuresis
What are the cardiovascular reflexes of a Cushing reflex?
SNS resulting in hypertension
What are the cardiovascular reflexes of a Chemoreceptor reflex?
increased respiratory drive, increased BP
The only organ innervated by sympathetic preganglionic neurons is the ___ ___.
Adrenal Medulla
Postganglionic nerves release ___ as a NT and are ___.
- norepinephrine
- adrenergic
Preganglionic nerves release ___ as a NT and are ___.
- acetylcholine
- cholinergic
Stimulation of the AV node is from:
a. sympathetic
b. parasympathetic
c. both a and b
d. only sympathetic
c. both a and b
Stimulation of the SA node is from:
a. sympathetic
b. parasympathetic
c. both a and b
d. only sympathetic
c. both a and b
Ephedrine:
a. Catecholamine uptake inhibitors
b. Beta-adrenergic antagonists
c. Direct acting sympathomimetics
d. Indirect acting sympathomimetics
e. Alpha-adrenergic antagonist
d. Indirect acting sympathomimetics
Labetolol:
a. Catecholamine uptake inhibitors
b. Beta-adrenergic antagonists
c. Direct acting sympathomimetics
d. Indirect acting sympathomimetics
e. Alpha-adrenergic antagonist
b. Beta-adrenergic antagonists
Epinephrine:
a. Catecholamine uptake inhibitors
b. Beta-adrenergic antagonists
c. Direct acting sympathomimetics
d. Indirect acting sympathomimetics
e. Alpha-adrenergic antagonist
c. Direct acting sympathomimetics
Cocaine:
a. Catecholamine uptake inhibitors
b. Beta-adrenergic antagonists
c. Direct acting sympathomimetics
d. Indirect acting sympathomimetics
e. Alpha-adrenergic antagonist
a. Catecholamine uptake inhibitors
Phenylephrine:
a. Catecholamine uptake inhibitors
b. Beta-adrenergic antagonists
c. Direct acting sympathomimetics
d. Indirect acting sympathomimetics
e. Alpha-adrenergic antagonist
c. Direct acting sympathomimetics
Esmolol:
a. Catecholamine uptake inhibitors
b. Beta-adrenergic antagonists
c. Direct acting sympathomimetics
d. Indirect acting sympathomimetics
e. Alpha-adrenergic antagonist
b. Beta-adrenergic antagonists
Dopamine:
a. Catecholamine uptake inhibitors
b. Beta-adrenergic antagonists
c. Direct acting sympathomimetics
d. Indirect acting sympathomimetics
e. Alpha-adrenergic antagonist
c. Direct acting sympathomimetics
Phentolamine:
a. Catecholamine uptake inhibitors
b. Beta-adrenergic antagonists
c. Direct acting sympathomimetics
d. Indirect acting sympathomimetics
e. Alpha-adrenergic antagonist
e. Alpha-adrenergic antagonist
Norepinephrine:
a. Catecholamine uptake inhibitors
b. Beta-adrenergic antagonists
c. Direct acting sympathomimetics
d. Indirect acting sympathomimetics
e. Alpha-adrenergic antagonist
c. Direct acting sympathomimetics
Tricyclic Antidepressants:
a. Catecholamine uptake inhibitors
b. Beta-adrenergic antagonists
c. Direct acting sympathomimetics
d. Indirect acting sympathomimetics
e. Alpha-adrenergic antagonist
a. Catecholamine uptake inhibitors
Metoprolol:
a. Catecholamine uptake inhibitors
b. Beta-adrenergic antagonists
c. Direct acting sympathomimetics
d. Indirect acting sympathomimetics
e. Alpha-adrenergic antagonist
b. Beta-adrenergic antagonists
___ is the NT employed at all preganglionic sites in the SNS and PNS junctions.
Acetylcholine
Epinephrine and Norepinephrine are released when SNS stimulation of the ___ ___ occurs.
Adrenal Medulla
Respond to acetylcholine:
a. Adrenergic
b. Cholinergic
b. cholinergic
Dopaminergic receptors:
a. Adrenergic
b. Cholinergic
a. adrenergic
Beta receptors:
a. Adrenergic
b. Cholinergic
a. adrenergic
Nicotinic receptors:
a. Adrenergic
b. Cholinergic
b. cholinergic
Respond to NE and E:
a. Adrenergic
b. Cholinergic
a. adrenergic
Alpha receptors:
a. Adrenergic
b. Cholinergic
a. adrenergic
Muscarinic receptors:
a. Adrenergic
b. Cholinergic
b. cholinergic
Increased HR:
a. Beta 2 receptors
b. Muscarinic receptors
c. Beta 1 receptors
d. Alpha 1 receptors
e. Nicotinic receptors
f. Alpha 2 receptors
c. Beta 1 receptors
Decreased HR:
a. Beta 2 receptors
b. Muscarinic receptors
c. Beta 1 receptors
d. Alpha 1 receptors
e. Nicotinic receptors
f. Alpha 2 receptors
b. muscarinic receptors
Cardiac arteriole dilation:
a. Beta 2 receptors
b. Muscarinic receptors
c. Beta 1 receptors
d. Alpha 1 receptors
e. Nicotinic receptors
f. Alpha 2 receptors
a. Beta 2 receptors
Constriction of veins:
a. Beta 2 receptors
b. Muscarinic receptors
c. Beta 1 receptors
d. Alpha 1 receptors
e. Nicotinic receptors
f. Alpha 2 receptors
d. Alpha 1 receptors
Constriction of arterioles:
a. Beta 2 receptors
b. Muscarinic receptors
c. Beta 1 receptors
d. Alpha 1 receptors
e. Nicotinic receptors
f. Alpha 2 receptors
d. Alpha 1 receptors