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N5160 > CV readings > Flashcards

CV readings Flashcards

1
Q

Patients with shock had inadequate ____ _____and there is a lack of _______ delivery to major ______

A

tissue perfusion ; oxygen; organ

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2
Q

Shock must be treated immediately to prevent _________ or ________

A

multisystem organ failure; death

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3
Q

The components of blood pressure are _______and _______

A

Cardiac output; Systemic vascular Resistance

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4
Q

Patients with shock will have either an inadequate ____________ or a low _____ due to arterial vaso_______

A

Cardiac index; SVR; dilation

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5
Q

Shock is classified as : ________,________,_______,_______

A

Hypovolemic, Cardiogenic, extra-cardiac obstructive, distributive

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6
Q

Hypovolemic shock is a result of _______ preload secondary to _______ and _________

A

decreased; dehydration ; hemorrhage

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7
Q

Cardiogenic shock is a result of _________ due to various causes such as _______,_______,______

A

heart failure “Pump failure”; myopathy; cardiac valves issues; arrhythmias.

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8
Q

Extra-cardiac obstructive shock is secondary to _______ or ________

A

Tension pneumothorax ; pulmonary emboli; Pulmonary HTN

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9
Q

3 types of distributive shock are:

A

Septic; anaphylaxis, neurogenic

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10
Q

Distributive shock results from excessive _______, therefore there is low ________. Patients will have Cardiac index (normal, low or elevated) ______

A

Vasodilation; SVR. normal or elevated

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11
Q

Hypovolemic, cardiogenic and extra-cardiac obstructive result from poor ______and the patients usually have an elevated _______as a ______mechanism

A

Cardiac index; SVR; compensatory

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12
Q

Pharmacologic agents that increase BP by causing arteriole vasoconstriction are called___

A

Vasopressors

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13
Q

Agents that increase cardiac contractility and therefore _______ are called_________

A

Cardiac index; inotropes

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14
Q

Examples of Catecholamines are :_______ ______ ______ ______ ______ ________

A

Dobutamine, isoproterenol, dopamine, epinephrine, norepinephrine, phenylephrine.

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15
Q

Phosphodiesterase inhibitors (PDIs) are

A

Milrinone and inamrinone

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16
Q

Catecholamines or __________ agents ALL act on receptors of the _________nervous system or ______: Remember what ACRONYM

A

sympathomimetic ; sympathetic (or Adrenergic) SYMP-ADRE

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17
Q

Stimulation of the Beta 1 receptors of the heart will result in _______ inotropic meaning _______contractility and ________; also result in chronotropic meaning _______in heart rate ; dromotropic meaning ________in conduction of impulse

A

positive; increase; cardiac index; increase; increase

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18
Q

Stimulation of Beta 2 receptors of the heart will result in _______ ____ _____ which can result in _______ and a decrease in ________

A

Smooth muscle relaxation; vasodilation; SVR

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19
Q

Stimulation of alpha receptors of the heart will result in ___________and an increase in ________and ______ but can cause a reduction of ______to the increase in _______

A

vasoconstriction; SVR; BP; Cardiac index; afterload

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20
Q

For phosphodiesterase inhibitors –> the inhibition of ___________leads to the inhibition of the breakdown of ____ _____ _______. This results in increase in ______ ______ therefore increase ________and venous and arterial ______(decrease _____ and ____)

A

Phosphodiesterase; cyclic adenosine monophosphate; myocardial contractility; cardiac index; dilation; preload and SVR

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21
Q

There are 3 vasopressin receptors

A

V1, V2, V3

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22
Q

Activation of V1 receptors results in ________ of systemic, splanchnic, renal and coronary arteries via activation of ______ resulting in an increase in _______ ________

A

vasoconstriction; voltage-gated calcium channels; intracellular calcium

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23
Q

Activation of V2 receptors results in _______Effect of vasopressin

A

antidiuretic effect

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24
Q

Vasopression V3 receptors are located in the _________ _____ gland and Activation of V3 receptors results in secretion of __________ Hormone

A

anterior pituitary; adrenocorticotropin

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25
Q

Unlike ____________ the actions of vasopressin may be preserved in _________ and ________

A

catecholamines; hypoxia; acidosis

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26
Q

The Half life of catecholamines is ____ minutes and maximum concentration is achieved in ____ minutes

A

1-2 ; 10

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27
Q

Dobutamine acts on ____ and _____ receptors and with ______HR , ______CI, and ______SVR

A

B1 and B2, increase; increase; increase

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28
Q

Norepinephrine acts on _____ but more on ____ receptors. Will produce variable effects on _____, will have no effect or decrease _______, _______SVR and _____MAP

A

B1; alpha; HR; CI; Increase; increase

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29
Q

Milrinone half life in a patient with normal renal function is

A

2 hours

30
Q

Vasopression elimination half life is _______minutes

A

15 minutes

31
Q

What are determinates of myocardial oxygen consumption _____,_____,______

A

HR; ventricular wall tension; contractility

32
Q

Beta agonists and PDI can _______HR, and _______ thereby increasing ______ ______ ______

A

increase ; contractility ; myocardial oxygen demand.

33
Q

Alpha agonists and Vasopressin can also cause ______of coronary vessels leading to decrease in myocardial oxygen ______

A

Vasoconstriction; supply

34
Q

Increases in myocardial oxygen demand or decrease in myocardial oxygen supply can lead to ____________

A

myocardial ischemia.

35
Q

PDI may cause a reflex__________

A

Tachycardia

36
Q

Patient receiving any of the catecholamines and/or PDIs should be monitored for signs of _______

A

Myocardial ischemia

37
Q

Sympathomimetic amines such as ________and ________can cause direct tachyarrhythmias (atrial and ventricular) by increasing myocardial oxygen _______

A

Dobutamine; isoproterenol ;consumption

38
Q

Pure alpha agents such as _________ can cause a reflex _______ secondary to an increase in _____ _____

A

bradycardia; BP

39
Q

Because of the increase in ________alpha agonists can decrease _________and induce ________

A

afterload; cardiac index, heart failure

40
Q

Mixed alpha and beta effects medications such as ______ and _______ will generally ________(increase or decrease) CI in lower doses and ________ (increase or decrease) CI in higher doses

A

dopamine; epinephrine; increase; decrease

41
Q

Sympathomimetic agents can cause ________ blood sugar through ______and ________, ________levels should be monitored

A

high; glycolysis; gluconeogenesis; Blood glucose

42
Q

All vasoconstrictors can cause ________If they extravasate

A

severe tissue necrosis

43
Q

B2 agonists such as _______ _______ can decrease serum _______ which may induce _______ so serum _____ should be monitored

A

Dobutamine and isoproterenol; potassium; potassium

44
Q

For alpha agonists such as ______ _____ _______ extravasation can be prevented by injecting the alpha blocker _____________ subcutaneously into the area of infiltrate

A

Norepinephine, phenylephrine and dopamine: PHENTOLAMINE

45
Q

When using vasopressor, the use of low dose _________does not show any real benefits for renal function and should not be use

A

Dopamine

46
Q

Excessive Vasoconstriction may________blood flow to vital organs.

A

decrease

47
Q

Vasopressors such as epinephrine and norepinephrine can decrease ________blood flow and increase regional ________ _______

A

splanchnic; lactic acidosis

48
Q

Hypovolemic and septic shock patients should always be given ________ ________ prior to vasopressors and inotropes because if _______ is inadequate, vasopressors will cause further reduction in _______ and inotropes with worsen tachyarrhythmias and induce ______

A

Fluid resuscitation; preload; cardiac output; ischemia

49
Q

PDIs and sympatomimetics amines with beta effects that increase CI should used in caution with patients with severe ___________

A

aortic stenosis

50
Q

_______monitoring is imperative in the clinical use of sympathomimetic and PDIs

A

Cardiac

51
Q

if sympatomimetic amines are needed in patients on MAOIs, stated at ______ the usual dose

A

one tenth

52
Q

2 hemodynamic goals in septic shock and Acute Respiratory Distress Syndromen (ARDS)

A
  • Adequate perfusion pressure to ensure blood flow to vital organs
  • adequate oxygen delivery.
53
Q

In septic shock and ARDS, goal MAP is

A

60-65mmg HG

54
Q

In septic shock and ARDS, goal CI is

A

Greater than 4.5L/min

55
Q

In septic shock and ARDS, goal oxygen delivery

A

> 600 ml/min/m2

56
Q

In septic shock and ARDS, goal oxygen consumption

A

> 170ml/min/m2

57
Q

Early Goal directed therapy in the treatment of sepsis and shock recommends: Treatment in ED with _______ and colloids to maintain CVP ____ to _____; ___________ to achieve a MAP of _______ and transfusion of _______ or __________ to achieve a central venous oxygen saturation of (ScvO2) of _____ or greater

A

crystalloids; colloids; 8; 12; >65; RBCs; dobutamine; 70%

58
Q

In septic shock, ARDS, and other forms of non-cardiogenic shock, ________is secondary to ______volume depletion and excessive ________

A

hypotension; intravascular; vasodilation.

59
Q

Vasopressors recommended for septic shock _______and _________ . Studies have demonstrated that ________ and _______ are effective when dopamine fails. However_______is reserved for _______ ________

A

Dopamine and norepinephrine. Norepinephrine and epinephrine; refractory hypotension

60
Q

Recommended vasopressin dose

A

0.03 units/minute

61
Q

The inotrope that he been mostly widely studies in sepsis is _____________ and it’s used also to increase

A

Dobutamine ; oxygen delivery

62
Q

ACCM recommends the use of _______ as first choice in septic patients with ______and ________venous saturation and adequate ______following fluid resuscitation.

A

Dobutamine ; low CI and low; MAP

63
Q

ACCM recommends the use of _______ as first choice in septic patients with ______and ________venous saturation and adequate ______following fluid resuscitation. May also be used in patients with signs of hypoperfusion as evidenced by ________ or elevated ________

A

Dobutamine ; low CI and low; MAP; low urine output ; lactic acid

64
Q

An important point to stress is that __________ and _______ should be titrated separately to different goals

A

Vasopressors; inotropes

65
Q

Vasopressors are titrated to maintain an ________ while inotropes are titrated to the desired effect on _________(desired ________or central venous saturation > __%)

A

adequate MAP; oxygen delivery; Cardiac index ; 70%

66
Q

Unlike PDIs, Tolerance does occur with the use of _________ within ___ to ___ hours

A

Dobutamine; 48-72

67
Q

Inoptropic support should be _____term because _____term treatment with inotropes is associated with ________ _________

A

short; long; increased mortality.

68
Q

PDI and Dobutamine may be used in combination when _______ cannot be obtained with either agent alone

A

Cardiac index

69
Q

Postpartum cardiomyopathy is usually treated with

A

ACEI

70
Q

____________is a thiazide diuretic and will potentiate the effects of lisinopril, amlodipine, and losartan.

A

Hydrochlorothiazide

71
Q

Top causes of metabolic acidosis

A

Hypoxia
Uremia
DKA
Lactic acidosis

N5160 (7 decks)

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