Perfusion 6 Flashcards
Effect of ACE and ARBs
decrease BP by vasodilating
Treatment for MI
Organic nitrates Angioplasty Oxygenation Antiplatelets Glycoprotein IIbIIIa inhibitors Morphine
Adrenal Medulla
Catecholamines:
- adrenaline,
- Noradrenaline
Adrenal Cortex:
Steroid Hormones:
- glucocorticoids: cortisol
- mineralcorticoids (aldosterone)
- Androgens (androstenedione)
Renal Insufficiency in Athletes happens when?
When athletes have repeat stress (depletion of cortisol)
Signs and Symptoms of renal insufficiency in athletes
Salt craving,
fatigue
hypoglycemia
hyponatremia
Primary Renal Insufficiency:
Addisons disease
Secondary Renal Insufficiency
head injury: low aldosterone and cortisol will show up. Dehydration and hypotension.
tx: give dethamexasone (glucocorticosteroids)
SE could see masking of inflammation, anxiety, hypertension, high blood glucose
Cushings disease and high glucocorticosteroid therapy
can kill the adrenal gland, can develop with the tx of lupus
Keto Diet
yields acidic key tones which can damage the renals, liver. pts on this diet should be monitored by the physician
Primary Pulmonary HTN
idiopathic, rare, complex and hereditary. linked to low NO production
Secondary Pulmonary HTN
comes second to a disease ec. COPD
Tx of Pulmonary HTN
Nipride given through ET tube for local efficacy on lungs
Drugs affecting Preload
diuretics
Drugs affecting Afterload
vasodilators
Right Sided Heart Failure
S&S
peripheral edema, weight gain, organ congestion, (liver, renal, GI), ischemia, LOC changes and fatigue.
will also present with JVD
Left Sided HF
S&S
pulmonary edema, hypoxia, cyanosis, can hear crackles on auscultation, cough. exercise intolerant.
pt will be restless and nervous looking
Tell Tale signs of HF
Hypotension and hypoxemia Enzyme release (troponin and CKMB)
What do the enzymes released during HF do?
they attempt to protect airways from dilation (SNS) so they cause constrictions which causes pulmonary hypertension. we have CO with no where to go. hypertrophy happens in ventricles
HF Medication Classes
Adrenergic Antagonists DIrect acting Vasodilators Calcium Channel Antagonists ACE inhibitors Diuretics Cardiac glycosides P inhibitors Adrenergic
Cardiac Glycosides
from plant Digitalis
- all meds have -digi
- increases contractility via more Calcium in cell. decreased HR because of slowing nodal transmission.
meds: digoxin, digitoxin
Narrow TI, must monitor
antidote is digibind
se: N&V
Phosphodiesterase inhibitors
block enzyme phosphodiesterase (increase cAMP)
- increased contractility in myocardial cells, vasodilation
causes contraction to last longer
meds: milrinone, amirinone
Adrenergic agonists
B1 specific: dobutamine
Dopamine HCL-precurser to NE, stimulates catecholemines
will increase contractility and increase CO, will inhibit CO if too much in blood.
Acute Heart Failure
Loop Diuretics (lasix) DIrect acting vasodilators/Organic Nitrates (nipride, Nitroglycerine) B1 Agonists (dobutamine)
Biggest Cause of Cardiogenic shock?
Left ventricular failure
Dilated Cardiomyopathy
Heart wall gets weak and ventricle gets bigger, ventricle fills with more blood and can’t contract.
Chronic Heart Failure discharge meds
Cardiac glycosides
ACE/ARBs
SVT
Atrial Fibrillation:
SVT (repeat stimulation of SA node)
AV Node dysfunction leads to…
Heart Block, V fib
PNS Stimulation leads to (vagus nerve)
Bradycardia
Arrhythmia Tx
decrease Sa/AV node conduction:
digoxin, ablation
slowing repolarization
-lidocaine (na channel blocker),
amiodarone (K channel blocker)
Ablation
pt gets their re-entry mechanism cauterized
Vtach/Vfib Treatment order
CPR/Get airway and IV
Defibrillate
Epi (1mg every 5 mins)
Amiodarone (300 mg bolus)
Asystole treatment order
CPR and get IV/airway
Epi (1 mg every 5 mins)
Consider pacing
SVT tx
Cardioversion
adenosine
antiarrhythmics
can apply ice
Bradycardia treatment order
Get airway and IV
Assess HR for CPR
atropine (.5 mg every 3-5min)
or adrenergic infusions:
-Dopamine IV
-Epi IV
pacing
