Kyle Lecture Asthmatic/cardiac Flashcards

1
Q

Describe ion flow during ventricular action potential

A
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2
Q

3 Phases of SA node action potential

A

4-leaky Na channels, slight upslope
0-Na Ca influx
3-K efflux

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3
Q

Primary effect on action potential
Na channels blockade

A

Slows depolarization of fast AP cells

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4
Q

Primary effect on action potential
Beta blockade

A

Slows depolarization in slow AP cells

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5
Q

Primary effect on action potential
K channels blockade

A

Prolongs action potential

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6
Q

Primary effect on action potential
CA channel blockade

A

Slows depolarization in slow AP cells

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7
Q

Fast AP cells types

A

Atria, ventricle, HIS/purkinje

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8
Q

Slow AP cells

A

Sinus and AV nodes

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9
Q

Primary effect on EKG
Na channel block

A

Widens QRS complex

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10
Q

Primary effect on EKG
Beta blockade

A

Slows sinus rate and prolongs PR interval

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11
Q

Primary effect on EKG
K channel block

A

QT prolongation

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12
Q

Primary effect on EKG
Ca channel block

A

Slows sinus rate and prolongs PR
-same as beta

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13
Q

Differentiate strength of sodium channel blockade and primary impact on action potential

A

1a- moderate, increases AP -procainamide

1b- weak, decreases AP- lidocaine

1c- strong, no effect on APD but strong right shift on upstroke

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14
Q

Rate control in WPW/afib

A

Procainamide

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15
Q

Pill in the pocket, outpatient afib conversion

A

Flecainide

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16
Q

1a class specific side effects

A

Prolong QT, negative inotropy

17
Q

Metoprolol indications

A

Rate control afib
Suppress PAC/PVC
Suppression of VT

18
Q

Beta blockers with ISA

A

Pindolol
Acebutolol

19
Q

What don’t you give to an asthmatic?

A

Beta blockers

20
Q

Side effects of amiodarone

A

Pulmonary fibrosis
thyroid dysregulation
Elevated LFTs
Visual changes
Neurological symptoms
Hypotension

All K channel blockers prolong the QT!!!

21
Q

Which calcium channel blockers decrease inotropy and give two examples

A

Non-dihydropyridines

Diltiazem and verapamil

22
Q

Why does digoxin slow the heart?

A

Vagolytic effect

23
Q

Digoxin mechanism

A

Inhibits Na/K pump

Which increases intracellular Na the cell can use to exchange for calcium

24
Q

Classes of antiarrhythmics that cause torsades

A

1a

III

Anything that prolongs repolarization

25
Q

What do we hold before surgery?

A

ACE inhibitors

26
Q

Considerations for poorly controlled asthma perioperatively

A

Using rescue inhaler more than 1-2 a week

High risk bronchospasm

Anticholinergic/b2 agonist (duoneb)

Avoid desflurane

27
Q

How do we treat intraoperative bronchospasm?

A

100% O2-take off vent
Deepen anesthetic
B2 agonist

Low dose epi if unresponsive 5 mcg

28
Q

Isoproterenol expected reactions

A

Palpitations/flushing

Hypotension/tachycardia