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Maddy - CPR II - some pharm > Fatigue and Weakness > Flashcards

Fatigue and Weakness Flashcards

1
Q

normal serum osmolarity

- what is the limit of hyponatremia

A

normal: 280-290
hyponatremia: <135

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2
Q

osmotic stimuli for ADH

A

increases in serum osmolality detected by osmoreceptors

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3
Q

non-osmotic stimuli for ADH

A
    • decrease in BP detected by baroreceptors
  • nausea
  • hypoxia
  • pain
  • mediations (opiates, antipsychotics, antidepressants)
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4
Q

hyponatremia results primarily from:

A

increase in total body water

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5
Q

if pt has hypo-osmotic hyponatremia, what should you measure

A

random urine sodium level and urine osmolality

- obtain serum uric acid if suspecting SIADH

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6
Q

low serum uric acid is associated w/

A

SIADH

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7
Q

what is hyperglycemic sodium correction

A

Na decreases 1.6 mEq/L for every 100 mg/dL increase in glucose

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8
Q

what must you rule out when diagnosing SIADH

A

cortisol deficiency and hypothyroidism

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9
Q

essential diagnostic criteria for SIADH

A
  • decreased ECF osmolality
  • inappropriate urine concentration
  • clinical euvolemia
  • elevated urine Na+ under normal salt and water intake
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10
Q

most common malignancy associated with ectopic ADH prodcution

A

small cell lung cancer

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11
Q

what drugs are associated w/ causing SIADH

A
  • antidepressants
  • anticonvulsants
  • anticancer drug cyclophosphamide
  • opiates
  • MDMA (ectasy)
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12
Q

sx of hyponatremia (when serum sodium gets to <125)

A
  • HA
  • fatigue/lethargy
  • dizziness
  • nausea
  • confusion
  • gait instability
  • psychosis
  • seizures
  • coma from cerebral edema
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13
Q

complications of hyponatremia

A
  • increased falls
  • death
  • osmotic demyelination syndrome
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14
Q

why does osmotic demyelination occur

A

rapid serum Na+ correction in chronic hyponatremia

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15
Q

general rule of thumb for tx hyponatremia

A

serum Na+ should be corrected over same time period it took to become low

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16
Q

tx for acute hyponatremia (less than 48 hrs)

A

can have rapid correction of serum sodium w/ little risk of ODS

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17
Q

tx for chronic hyponatremia (more than 48 hrs or unknown)

A
  • be careful of rapid correction b/c risk of ODS

- raise serum Na+ by 8-10 mEq/day with no more than 18 in first 48 hours

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18
Q

tx for symptomatic pts w/ hyponatremia

A
  • 100 mL IV bolus hypertonic saline over 10 mins

- continuous IV hypertonic saline

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19
Q

sx of osmotic demyelination syndrome (ODS)

A
  • dysarthria
  • dysphagia
  • paraparesis or quadriparesis
  • behavioral disturbances
  • pseudobulbar palsy
  • seizures
  • lethargy
  • confusin
  • coma
  • death
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20
Q

preferred imaging modality for dx ODS

A

MRI of head

21
Q

pathophysiology of ODS

A

too fast Na+ correction –> axonal shear damage occurs –> disruption of BBB –> demyelination

22
Q

what cells are in charge of secretion and reabsorption of K+

A

secretion: principle cells
reabsorption: a-intercalated cells

23
Q

describe potassium transport along the nephron

A

PCT: 65% reabsorption
TAL: 25% reabsorption
DCT: 0-120% secretion
Collecting Duct: 5% reabsorption

24
Q

clinical manifestations hyperkalemia

A
  • cardiac arrhythmias
  • skeletal muscle weakness
  • metabolic acidosis
  • decreased ammoniagenesis and decreased ammonium excretion in kidneys
25
Q

describe the electrophysiology of why potassium causes cardiac arrhythmias and neuromuscular weakness/paralysis

A

long term hyperkalemia –> resting membrane potential remains more positive than normal –> leads to inactivation of sodium channels –> net decrease in membrane excitability –> impaired cardiac conduction and/or neuromuscular weakness/paralysis

26
Q

ECG changes at 6-7 mmol/l K+

A

peaked T waves

27
Q

ECG changes at 7-8 mmol/l K+

A
  • flattened P wave
  • prolonged PR
  • depressed ST
  • peaked T wave
28
Q

ECG changes at 8-9 mmol/l K+

A
  • atrial standstill
  • prolonged QRS
  • peaked T wave
29
Q

ECG changes at >9 mmol/l K+

A

sinusoid wave pattern (v fib)

30
Q

what meds can cause hyperkalemia

A
  • B2 blockers
  • a1 agonists
  • digoxin
  • succinylcholine
  • minoxidil
31
Q

what extrinsic events can cause cells to release intracellular potassium leading to hyperkalemia

A
  • burns
  • trauma
  • radiation
  • tumor lysis syndrome
  • rhabdomyolysis
32
Q

how does insulin deficiency cause hyperkalemia

A

insulin stimulates Na/K ATPase and drive K+ intracellularly, so without it you’ll have excess K+ outside the cell

33
Q

how does aldosterone affect K+ levels

A

low aldosterone –> hyperkalemia

high aldosterone –> ^^potassium secretion (hypokalemia)

34
Q

how does GFR affect K+ levels

A

low GFR –> hyperkalemia

35
Q

how does a ureterojejunostomy affect K+ levels

A

bowel reabsorbs K+ excreted in the urine –> hyperkalemia

36
Q

causes of pseudohyperkalemia

A
  • RBC hemolysis during venipuncture
  • sampling clotted blood samples
  • leukocytosis
37
Q

how does leukocytosis cause pseudohyperkalemia

A

leukemia pts have fragile WBCs which can then rupture during centrifugation and release K+

38
Q

how does fractional excretion of K+ determine renal or extrarenal etiology

A

FEK < 10%: renal

FEK > 10%: extrarenal

39
Q

tx for peaked T waves caused by hyperkalemia

A

calcium gluconate

40
Q

tx for transcellular shift of K+ causing hyperkalemia

A
  • insuline and dextrose
  • B2 agonist
  • bicarbonate infusion
41
Q

tx for potassium removal in pts w/ hyperkalemia

A
  • loop diuretic or thiazide
  • exchange resins
  • hemodialysis
42
Q

compare central and obstructive sleep apnea

A

central: caused by failure of respiratory center in brainstem
obstructive: upper airway obstruction resulting in decreased air flow

43
Q

how does OSA lead to heart disease

A

OSA –> decreased PO2 and increased PCO2, increase BP, oxidative stress, inflammation, intrathoracic pressure, LV wall tension, decreased myocardial O2 delivery –> heart dz

44
Q

how do diagnose OSA

A

polysomnography

45
Q

compare apnea and hypopnea

A

apnea: complete obstruction for 10 seconds
hypopnea: partial obstruction for 10 seconds

46
Q

compare mild, moderate, and severe OSA

A

mild: AHI 5-14 events/hour
moderate: AHI >15-29 events/hour
severe: AHI >30 events/hour

47
Q

calculating AHI

A

adding all the apneas and hypopneas and dividing by total sleep time

48
Q

tx OSA

A
  • weight loss

- cpap

49
Q

compare systolic and diastolic HF

A

systolic: EF < 40%
diastolic: EF > 50%

Maddy - CPR II - some pharm (18 decks)

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