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Pharm 2 > Lecture 1 > Flashcards

Lecture 1 Flashcards

1
Q

DEF: Analgesia

A

The diminution or elimination of pain

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2
Q

DEF: Conscious Sedation

A

Minimally depressed state of consciousness that:

  • Retains ability to independently maintain airway and
  • Respond appropriately to stimuli/commands
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3
Q

DEF: Minimal Sedation

A

Minimally depressed state that:

  • Retains ability to independently maintain airway
  • Respond normally to tactile/verbal stimulation
  • Cardio unaffected
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4
Q

DEF: Moderate Sedation

A

Pt responds PURPOSEFULLY to verbal commands

  • Retains ability to maintain airway
  • Cardio usually maintained
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5
Q

DEF: Deep Sedation

A

Pt cannot be easily aroused
BUT responds purposefully to REPEATED or PAINFUL stimuli
- May not be able to maintain airway- may need assistance
- Cardio usually maintained

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6
Q

DEF: General Anesthesia

A

Pt not arousable, even w/ painful stimuli

  • Independent airway often impaired- require assistance via positive pressure ventilation
  • Cardio function may be impaired
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7
Q

Enteral Administration Types

A

Oral, Sublingual, Rectal

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8
Q

Parenteral Administration Types

A

IM, IV, IN, Inhalation, submucosal, subcutaneous, intraosseous
- Bypass GI tract

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9
Q

Heart orientation in chest

A
  • Rotated 30 deg to the left lateral side

- R. Ventricle is most anterior

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10
Q

Tricuspid Valve

A

Between R. atrium and R. ventricle

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11
Q

Mitral Valve

A

Between L atrium and L ventricle

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12
Q

Normal heart’s “pacemaker”

A

Sinoatrial Node

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13
Q

Normal Cardiac Conduction Pathway

A

SA Node–> AV Node –> Bundle of HIS–> splits left and right here–> Purkinje Fibers –> to cardiac muscle cells

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14
Q

Intrinsic Rate of SA Node

A

60-100 bpm

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15
Q

Intrinsic Rate of AV Node

A

40-60 bpm

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16
Q

Intrinsic Rate of Bundle of His

A

40-60 bpm

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17
Q

Intrinsic Rate of Purkinje Fibers

A

20-40 bpm

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18
Q

If SA Node fails to initiate an impulse, what happens?

A

AV Junction (Consists of AV Node and Bundle of His) takes over as the pain pacemaker and heart rate will have a rate of 40-60 bpm

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19
Q

Characteristics of AV Junction as the Pacemaker

A
  • Rate of 40-60 bpm

- Rhythms have a missing or inverted P-Wave!

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20
Q

What if both SA Node and then AV Junction fail??

A

The ventricles will fire impulses themselves at a rate of 20-40 bpm

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21
Q

What is the effect on the QRS complex of the heart relying on the ventricles for the pulse rather than the SA node or AV Junction?

A

QRS complex will be wide - >120ms

Normal is 80-120ms

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22
Q

AKA “fast response AP’s”

A

Non-Pacemaker AP’s

Have rapid depolarization

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23
Q

AKA “slow response AP’s”

A

Pacemaker AP’s
Have slow depolarization
Found in SA and AV nodes

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24
Q

Opening of what channels start depolarization in Non-Pacemaker cardiac cells

A

Na Channels

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25
Q

Opening of what channels start depolarization in Pacemaker Cells

A

Ca Channels

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26
Q

Which cardiac cells have a true resting membrane potential and what is it?

A

Non-pacemaker cells

-90 mV

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27
Q

Explain the Non-pacemaker cell AP graph

A

Phase 4 - resting potential at -90mV due to K leaving cell–>
Cell gets rapidly depolarized to -70mV–>
Phase 0 - Rapid depolarization - Fast Na channels open and K channels close –> membrane potential gets more positive
Phase 1 - Initial repolarization due to opening of transient K channels
Phase 2 - Plateau phase- due to L-type Ca channels still open – prolongs AP
Phase 3 - K channels open and Ca channels close allowing full repolarization back to Phase 4

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28
Q

Non pacemaker cell Phase 1

A

Initial repolarization due to opening of transient K channels which cause short-lived hyperpolarization

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29
Q

Non pacemaker cell Phase 0

A

Depolarization caused by opening of Fast Na channels at -70
L Ca channels also open at -40
and K channels close

30
Q

Non pacemaker Phase 2

A

Plateau phase - due to L Ca channels still open–> causes plateau

31
Q

Non pacemaker Phase 3

A

Opening of K channels and closing of L Ca channels–> Repolzarization

32
Q

Non pacemaker Phase 4

A

-90 mV - most negative - due to K channels open and K leaving cell

33
Q

AP in Non-pacemaker cells primarily determined by what channels

A

Fast Na channels, L type Ca channels, and K conductance

34
Q

Depolarizing current in SA node AP’s carried by what ion?

A

Slow Ca currents

35
Q

Explain the Pacemaker cell AP graph

A

Phase 4 - spontaneous depolarization up from -60 to -40 due to funny currents of slow inward Na, then T Ca channels open, then L Ca channels open–> until action potential reached around -40 (K channels close too)
Phase 0 - Depolarization! Primarily via L Ca channels
Phase 3 - Repolarization - via K channels openning and L Ca channels closing

36
Q

Pacemaker cell Phase 0

A

Depolarization! Via L Ca channels!

37
Q

Pacemaker cell Phase 4

A

K channels closing, Funny currents from slow Na inward, then T Ca channels open, and the L Ca channels open further depolarizing until reached AP threshold

38
Q

Pacemaker cell Phase 3

A

Repolarization due to K channels opening and L Ca Channels closing

39
Q

AP in Pacemaker cells primarily determined by changes in which Ion conductance

A

Ca and K

40
Q

Hyperkalemia effect on cardiac rate

A

Bradycardia!!

41
Q

DEF: Preload

A

The end diastolic volume in the left and right ventricles
The stretching of the muscle cells to their extend after passive filling and then atrial contraction and right before ventricular contraction

42
Q

DEF: Afterload

A

The pressure in the left venticle during ejection- essentially the load against which the heart ejects blood
The greater the aortic pressure, the greater the afterload

43
Q

DEF: Normal Sinus Rhythm

A

60-100 bpm
Each QRS preceded by normal, upright P wave
QRS complexes

44
Q

Draw out normal sinus rhythm

A

__–__v^v__^___

45
Q

Causes of longer duration QRS

A

Hyperkalemia

Bundle Branch Block

46
Q

DEF: P Wave

A

Depolarization of the atria

47
Q

DEF: PR Interval

A

Time it takes for electrical impulse to get from SA node thru the AV node
Normal: .12-.20 sec

48
Q

DEF: QRS Complex

A

Rapid depolarization of the ventricles

Normal: 0.08-.12 sec

49
Q

DEF: T Wave

A

Repolarization of the ventricles

50
Q

DEF: QT Interval

A

Depolarization and Repolarization of the ventricles

Normal:

51
Q

Effect of Myocardial Ischemia on EKG

A

Depression of ST segment or

Flattening or inverting of T wave

52
Q

Effect of STEMI on EKG

A

ST segment elevation

53
Q

DEF: METs

A

Metabolic Equivalents of Tasks
1 MET is 3.5mL of O2 per kg of body weight
Must be able to meet 4 METs to climb a flight of stairs or walk two blocks
BASICALLY a measure of ability to complete daily tasks

54
Q

METs

A

Can’t climb flight of stairs

At greater risk of cardiovascular problem

55
Q

Someone with METs

A

Administer less Epi?

Make sure don’t have quick or large changes in pulse or BP

56
Q

DEF: Ejection Fraction

A

% of blood leaving heart each time it contracts

57
Q

Normal Ejection Fraction

A

55-70%

58
Q

Evidence of Systolic Heart Failure

A

Ejection Fraction

59
Q

DEF: Baroreceptor Reflex

A

Homeostatic mech to maintain BP

60
Q

How does Baroreceptor Reflex work?

A

Provides a negative feedback loop–> if senses elevated BP, it sends signal to heart to decrease rate so as to dec BP
A dec in BP causes dec baroreceptor activation and thus causes heart rate to inc due to lack of signals from baroreceptor
Baroreceptor slows down HR by activation or Parasymps and Inactivation or Symps

61
Q

Baroreceptor locations

A

Aortic arch and carotid sinus

62
Q

Drug eluting vs. Bare metal stent

A

Drug eluting stents release drug to reduce restenosis

63
Q

Use of anti-platelet therapy with Drug eluting vs bare metal stents

A

Okay to treat bare metal stent pt 1 mo after placement if only on aspirin. Have to wait 6 mo to a year for drug eluting to take only aspirin

64
Q

What provides innervation to the heart?

A

Vagus N.

65
Q

Parasympathetic predominance on heart leads to

A

Slowing the HR

66
Q

Parsympathetics on the Heart

A

Release Ach–> goes to Muscarinic receptors–> opens K channels–> slows heart depolarization

67
Q

Sympathetic predominance on the heart leads to

A

Increasing the HR

68
Q

Sympathetics on the Heart

A

Release NE and E –> goes to B1 receptors–> opens Na and Ca channels–> inc rate of depolarization –> Inc HR

69
Q

Parasympathetics use which receptors on heart?

A

Muscarinic

70
Q

Sympathetics use with receptors on heart?

A

B1

Pharm 2 (11 decks)

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