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Block 2; Week 3 > Harvey > Flashcards

Harvey Flashcards

1
Q

What is shock?

A

Life threatening condition.

Body isn’t getting enough blood flow.

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2
Q

What are the 3 main forms of shock?

A

Hypovolemic: like a hemorrhage…loss of tissue perfusion
Cardiogenic: Heart failure–>insufficient flow to tissues–>blood pressure decreases
Vasodilatory: Septic or anaphylactic shock–>causes dilation of the vascular smooth muscle of blood vessels

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3
Q

A positive inotropic effect changes what determinant of BP?

A

Changes stroke volume.

Changes Cardiac output.

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4
Q

What determines systolic pressure?

A

Afterload.
TPR determines afterload.
alpha 1 vs. beta 2 determines TPR.

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5
Q

What determines diastolic pressure?

A

TPR.

alpha 1 vs. beta 2

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6
Q

What determines pulse pressure?

A

Stroke Volume.
Remember…contractiliity determines SV.
Beta 1 determines contactility.

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7
Q 
What changes does NE cause w/ the following:
Mean Arterial Pressure
Systolic Pressure
Diastolic Pressure
Pulse Pressure
TPR
HR
A

Mean Arterial Pressure: increases
Systolic Pressure: increases (alpha 1 effect)
Diastolic Pressure: increases (alpha 1 effect)
Pulse Pressure: increases (SV up b/c beta 1)
TPR: increases (alpha 1 effect)
HR: decreases (baroreceptor reflex of increase parasymp w/ sense of increased MAP)

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8
Q 
What changes does Isoproterenol cause w/ the following:
Mean Arterial Pressure
Systolic Pressure
Diastolic Pressure
Pulse Pressure
TPR
HR
A

Mean Arterial Pressure: decreases (beta 2 effect)
Systolic Pressure: increases slightly (b/c of increased SV–>beta 1 effect)
Diastolic Pressure: decreases (beta 2 effect)
Pulse Pressure: increases (SV increased–>beta 1 effect)
TPR: decreases (beta 2 effect)
HR: increases (beta 1 effect)

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9
Q 
What changes does a low dose of epinephrine cause w/ the following:
Mean Arterial Pressure
Systolic Pressure
Diastolic Pressure
Pulse Pressure
TPR
HR
A

Mean Arterial Pressure: stays relatively constant
Systolic Pressure: increases slightly (b/c of SV increased…beta 1 effect)
Diastolic Pressure: decreases (b/c of beta 2)
Pulse Pressure: increases (b/c of SV up b/c of beta 1)
TPR: decreases (beta 2)
HR: increases (beta 1)

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10
Q

At low doses epinephrine acts more like ______ b/c the ______ effects dominate.
At high doses epinephrine acts more like ______ b/c the _______ effects dominate.

A

Isoproterenol: beta
NE: alpha

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11
Q 
What changes does a high dose of epinephrine cause w/ the following:
Mean Arterial Pressure
Systolic Pressure
Diastolic Pressure
Pulse Pressure
TPR
HR
A

Mean Arterial Pressure: increases (alpha 1)
Systolic Pressure: increases (alpha 1 & a little beta 1)
Diastolic Pressure: increases (alpha1)
Pulse Pressure: increases (SV–>beta 1)
TPR: increases (alpha 1)
HR: increases (beta 1–>but no reflex)

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12
Q

What are the differences in responses b/w high dose Epinephrine & phenylephrine?

A

High Dose Epinephrine: acts like NE
**alpha 1 & beta 1
Phenylephrine
*alpha 1

**main difference: increase in HR w/ Epi b/c of beta 1…possible reflex decrease in HR or no change w/ phenyl.
Bigger pulse pressure difference w/ Epi b/c of SV change b/c of contractility change b/c of beta 1.

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13
Q

How does dopamine act as low, intermediate, & high conc’ns?

A

Low: causes vasodilation of the kidney
Intermediate: acts like isoproterenol b/c agonist of beta 1 & 2
High: acts like NE: alpha 1 & beta 1 agonist.

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14
Q

What dose of dopamine would you need to increase renal blood flow?

A

A low dose. Causes vasodilation in the kidney.

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15
Q

What dose of dopamine would you need to increase cardiac output?

A

Intermediate dose.

Something that acts on Beta 1…here acts like isoproterenol

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16
Q

What dose of dopamine would you need to increase TPR & MAP?

A

High Dose.

Finally an alpha agonist. Acts like NE.

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17
Q

What is phenylephrine used for OTC? Why shouldn’t you take it if you have HTN?

A

It is an OTC decongestant.

But it is an alpha 1 agonist so you shouldn’t take it if you have hypertension.

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18
Q

What is NE an agonist of mainly?

A

alpha 1 & Beta1

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19
Q

What is Epi an agonist of mainly in low doses? High doses?

A

Low doses: mainly a beta 1 & beta 2 agonist

High doses: mainly an alpha 1 & beta 1 agonist

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20
Q

What is isoproterenol an agonist of?

A

beta 1 & beta 2

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21
Q

What is dobutamine an agonist of?

A

beta 1

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22
Q

What is phenylephrine an agonist of?

A

alpha 1

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23
Q

What is clonidine an agonist of?

A

alpha 2

24
Q

what is oxymetazoline an agonist of?

A

alpha 1 & alpha 2

25
Q

What is terbutaline an agonist of?

A

beta 2

26
Q

What is propranolol an antagonist of?

A

beta 1 & beta 2

27
Q

What is metoprolol an antagonist of?

A

beta 1

28
Q

What is phentolamine an antagonist of?

A

alpha 1 & alpha 2

29
Q

What is prazosin an antagonist of?

A

alpha 1

30
Q

What is cavadilol an antagonist of?

A

all 4 receptors!

31
Q

What is yohimbine an antagonist of?

A

alpha 2

32
Q

What’s the deal w/ tyramine?

A

It is a compound found in cheese, beer, bean curd etc that is taken up into the nerve terminal…it is metabolized by mAO…but if a person is taking a MAO inhibitor…a build up of tyramine in the nerve terminal will cause an increase in release of NE…could cause a hypertensive crisis–>stroke.

33
Q

What is something special that beta 1 antagonists can do?

A

They can inhibit renin secretion from the JGA cells of the kidney.

34
Q

What is NE used to treat?

A

severe hypotension & septic shock

35
Q

What is Epi used to treat?

A

anaphylactic shock
cardiogenic shock
cardiac arrest
local vasoconstriction

36
Q

What is isoproterenol used to treat?

A

cardiogenic shock
bradycardia
AV block

37
Q

What is dobutamine used to treat?

A

cardiogenic shock

acute heart failure

38
Q

What is dopamine used to treat?

A

cardiogenic shock
acute heart failure
acute renal failure

39
Q

What is phenylephrine used to treat?

A

topical vasoconstriction
shock
autonomic testing of Diabetics
decongestant

40
Q

What is clonidine used to treat?

A

HTN–>b/c it inhibits NE release

41
Q

What is propranolol used to treat?

A

HTN
angina
cardiac arrhythmias

42
Q

What is metoprolol used to treat?

A

HTN
angina
CHF

43
Q

What is phentolamine used to treat?

A

severe HTN

pheochromocytoma

44
Q

What is prazosin used to treat?

A

HTN

45
Q

What is cavadilol used to treat?

A

HTN

heart failure

46
Q

What is the deal with ACh & cardio treatment?

A

ACh is an agonist of like everything. But it isn’t administered as a part of treatment.
However, things that target the pathway in which ACh & NO cause vasodilation is targeted.

47
Q

What is digoxin & what are 2 things that it can be used to treat?

A

A cholinomimetic…like an agonist
It is used to treat atrial fibrillation b/c it decreases AV conduction.
It is also used to treat heart failure b/c it inhibits the sodium potassium pump & therefore allows more calcium to accumulate & greater contractility.

48
Q

What is atropine & what is it used to treat?

A

It is a cholinolytic.
It is used to treat bradycardia & heart block.
It blocks parasymp & therefore increases heart rate & AV conduction speed. It blocks specifically muscarinic receptors.

49
Q

What is trimethaphan & what is it used to treat?

A

It is a cholinolytic that targets nicotinic receptors.

It is used to treat HTN crisis…b/c it blocks sympathetic transmission & decreases sympathetic tone.

50
Q

What is hypovolemic shock & what is used to treat it?

A

It is shock b/c of loss of blood.
There is a sympathetic reflex that is initiated that increases alpha 1 & vasoconstriction to try to maintain BP in the face of less blood volume.
No drugs are used to treat this condition b/c the alpha effect is already maxed out.
Replacement of fluids is used.

51
Q

What is vasodilatory shock? What are its 2 types & what drugs are used to treat it?

A

It is shock produced by vasodilation. Low BP.
One type is sepsis: here you need an alpha effect–>NE or phenylephrine
Another type is anaphylaxis: here you need alpha but also beta 2 for the airways–>high dose Epi

52
Q

What is cardiogenic shock? What are the options for treatment?

A

Poor myocardial contractility.
This means low SV, Low CO, Low MAP. High venous pressure–>edema.
There is a body reflex of sympathetic activation–>vasoconstriction alpha 1.
You don’t want beta 2 b/c you want to maintain the high MAP.
Problem: high MAP increases after load. That poor heart!
Options:
Low Doses Epinephrine
Isoproterenol
Dopamine
Dobutamine
Best option is dobutamine b/c it only has beta 1. You don’t want alpha 1 b/c it is maxed out & you don’t want beta 2 b/c you want high MAP.

53
Q

What is angina? What can it be treated with?

A

too much myocardial work & O2 consumption.

treated w/ beta 1 antagonists.

53
Q

What is angina? What can it be treated with?

A

too much myocardial work & O2 consumption.

treated w/ beta 1 antagonists.

54
Q

What is heart failure & how is it treated?

A

sympathetic tone that is too much–>the poor heart is just working too hard.
beta 1 antagonists are called for here.

54
Q

What is heart failure & how is it treated?

A

sympathetic tone that is too much–>the poor heart is just working too hard.
beta 1 antagonists are called for here.

Block 2; Week 3 (11 decks)

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