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Perf tech 3 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

non pulsatile flow may affect

A

flow distribution to organs and within organs

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2
Q

hypothermia effect on hormonal and biochemical rxn

A

decreased rate of biochemical rxn and disrupts hormonal response

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3
Q

hemodilution effect

A

disrupts concentrations of hormones and electrolytes

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4
Q

difficult to pinpoint source of

A

stress hormones. may be an increase post bypass

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5
Q

deeper levels of anesthesia appear to reduce

A

or eliminate endocrine responses and decreases morbidity

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6
Q

type of anesthesia that further reduces endocrine response

A

spinal and epidural

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7
Q

pituitary type of fxn

A

neural (posterior) and endocrine (anterior)

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8
Q

posterior pituitary is the _____ and secretes______

A

neurosecretory and is modified nervous tissue. ADH oxytocin (does not produce these)

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9
Q

high concentrations of ADH cause

A

INCREASE perpheral resis. decrease contractility, decrease coronary BF, REDUCES RENAL BF, increase von willbrand factor,

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10
Q

what causes adh release?

A

increase plasma osmolarity, decrease BF or decrease BP or percieved decrease Bp, hypoglycemia, angiotensin 2, stress , pain

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11
Q

huge ADH release may be initiated by

A

initiation of bypass and transient decrease in BP, VENTING

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12
Q

prevention of ADH release

A

diuretic, pulsatile flow decrease post op only no effect on u.o.,anesthesia with large doses of synthetic opioids (fentanyl 50ug/kg), regional anesthesia

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13
Q

adh concentrations increase regardless

A

of anesthesia pointless!!

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14
Q

anterior portion secretes trophic hormones

A

ACTH,TSH, ovaries and testes, HGH

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15
Q

pituitary apoplexy

A

most damaging complication to pituitary, rare and occurs with pituitary adenomas,

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16
Q

pituitary apoplexy symptoms

A

droopy eyelids, opthamoplegia, non reactive dilated pupils, decreased visual acuity, hormonal defects

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17
Q

high concentrations of vasopressin

A

increase peripheral vascular resistance, decrease contractility, decrease coronary BF, increase vascular resistance, reduce renal BF, stimulates release of von willebrand factor

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18
Q

what stimulate vasopressin release

A

increase in plasma osmolarity, decrease in BV OR BP, hypoglycemia, angiotensin , stress, pain

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19
Q

steps to ADH release form CPB (7)

A
  1. )Hypothalamus osmoreceptor cells detect increased serum osmolarity
  2. ) posterior pituitary releases ADH due to increase serum osmolarity
  3. )vasopressin binds to kidneys allowing increased water reabsorption from urine
  4. ) increases urine osmolarity and decreases its volume
  5. )decreases serum osmolarity and increases volume
  6. )decreased serum osmolarity is detected by osmoreceptors in hypothalamus and ADH is reduced
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20
Q

ADH may be initiated by bypass due to

A

decrease in CBV and BP. Venting keeps LAP low stimulating low CBV

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21
Q

can we prevent adh release

A

no but it can be reduced.

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22
Q

pulsatile flow adh release

A

No significant decrease during bypass but decreases it 48 hours after. U.O. does not change

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23
Q

anesthesia can reduce adh release by

A

giving large doses of synthetic opioids. fentanyl (50ug/kg)

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24
Q

regional anesthesia can reduce adh in

A

non cardiac procedures

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25
Q

adh concentrations increase during cpb irrespective

A

of anesthesia or perfusion technique

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26
Q

damage to pituitary usually blamed

A

on ischemia, hemorrhage, and edema of gland. HGH hypophysectomy

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27
Q

treatment of pituitary apoplexy

A

HGH / hypophysectomy

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28
Q

epinephrine concentration increases

A

10 fold

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29
Q

nore epinephrine concentration

A

4 fold

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30
Q

catecholmine secretion can be reduced

A

deep anesthesia vs. light, propofol infusion (4 mg/kg/hr) vs single bolus injection (.1mg/kg), high dose opioid general (fentanyl or sufentanil) general anesthesia with spinal block (bupivacaine) vs. general anesthesia

31
Q

cortisol is released in reponse

A

to stress. increases stores of sugar in liver as glycogen. increases blood sugar

32
Q

adrenocorticotropic hormone

A

promotes increased production and release of corticosteroids and cortisol. acts as appetite suppressant, anxietiomimetic and pro inflammatory

33
Q

adrenal cortical hormones are increased and how is it attenuated

A

in the initiation of bypass. increase attenuated with deeper levels of anesthesia and addition of thoracic epidural

34
Q

carbohydrate metabolism regulated by

A

insulin, glucagon, cortisol, growth hormone, epinephrine

35
Q

hyperglycemia is worse with

A

hypothermia

36
Q

hypoinsulinemia is worse with

A

hypothermia

37
Q

type 1 dm do not require

A

insulin doses

38
Q

type 2 dm do require

A

insulin doses

39
Q

atrial natriuretic factor and is antagonist of what

A

incredibly efficacious vasodilator . antagonist of aldosterone

40
Q

anf peptides released by

A

cardiac atria

41
Q

anf release triggered by

A

atrial distension. b adrenergic stimulation, angiotensin 2, hypernatremia, endothelins

42
Q

ANF physiologic causes

A

increase GFR, inhibits renin release, reduced plasma concentrations of aldosterone, antagonize renal vasoconstrictors, reduce ABP

43
Q

ANF PREVENTS

A

scarring of ischemic myocardium and has other anti ischemic effects on cardiomyocytes and vascular endothelium

44
Q

ANF cancentrations are reduced during

A

hypothermia and cross clamping

45
Q

ANF conentrations rise during

A

rewarming and post bypass. mormal relation between factor conc. and pressure lost during bypass

46
Q

renin angiotensin aldosterone regulates

A

atrial pressure, intravascular volume, electrolyte balance

47
Q

what secretes renin

A

juxtaglomerular apparatus due to Na depletion, decreased BV, reduced renal perfusion

48
Q

ACE inhibitors and ARBS temporarily

A

breaks the linkage between Renin angiotensin aldosterone and hypo or hypertension during immediately post bypass

49
Q

eicosanoids metabolized by

A

lungs

50
Q

prostaglandins mostly related to

A

inflammation

51
Q

thromboxanes related to

A

injury

52
Q

Endoperoxide prostaglandins H2 produces

A

PGE2, PGF2alpha, PGD2

prostacyclin (PGI2) or thromboxane (TXA2)

53
Q

PGE

A

generally vasodilator

54
Q

PGF2alpha, PGD2

A

pulmonary vasoconstrictor

55
Q

PGI2

A

disaggregates platelets, potent vasodilator

56
Q

TXA2

A

platelet aggregator, potent vasoconstrictor

57
Q

Prostacyclin & thromboxane increase during bypass and

A

start to decrease after

58
Q

Aprotinin

A

protease inhibitor – reduces increase in thromboxane – no effect on prostacyclin – better preservation of platelet function

59
Q

“sick euthyroid syndrome

A

T3 and T4 levels are low but the thyroid gland is apparently “normal”
The result of disruption of the thyrotropic feedback loop
Mixed evidence whether giving thyroxine helps (trophic and pro-metabolic effects) or hurts (possible increased risk of MIs)

60
Q

Many things stimulate histamine release like…

A 
opioids (morphine / meperidine)
muscle relaxants (tubocurarine)
antibiotics
heparin
protamine
61
Q

calcium con concentration

A

Ionized (50%), bound to protein (40%), chelated (10%)

62
Q

calcium Blood concentration maintained by

A

parathormone and vitamin D (bones / kidney)

63
Q

calcium changes during bypass attributed to

A

type of fluids used and addition calcium. parathormone secretion not affected by bypass

64
Q

Give extra calcium only when the following three conditions are present

A

1) ready to terminate bypass
2) ionized calcium is reduced
3) need to increase contractility and blood pressure

65
Q

magnesium key players in these enzyme finctions

A 
transmembrane electrolyte gradients
energy metabolism
synthesis various messaging substances
function of ion channels
hormone secretion and action
66
Q

mag concentrations

A

Ionized (55%), bound protein (30%), chelated (15%)

67
Q

mag decreases during and is associated with

A

bypass. arrhythmias

68
Q

mag benefits

A

direct myocardial membrane effect
direct / indirect effect on cellular sodium and potassium
antagonism of calcium entry into the cell
prevention of coronary arterial spasms
antagonism of catecholamine action
improves myocardial oxygen supply / demand ration
inhibition of calcium current during plateau phase of myocardial action potential

69
Q

typical mag dose

A

2 grams post cross clamp

70
Q

Changes in potassium concentration caused by

A 
cardioplegia
anesthetic drugs
priming solutions
renal function
carbon dioxide tension
arterial pH
hypothermia (decrease as cool, increase as warm)
insulin treatment of hyperglycemia moves glucose and potassium into cell)
71
Q

Hyperkalemia not uncommon with

A

multi dose high k protocols

72
Q

Hypokalemia may be increasing

A

as the use of Custodial CP increases

73
Q

Albumin may help reduce

A

decrease in concentration

Perf tech 3 (14 decks)

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