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Perf tech II > test 3 cont > Flashcards

test 3 cont Flashcards

1
Q

vasopressin also called

A

-anti-diuretic hormone

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2
Q

vasopressin does what

A

Regulates renal water excretion (POTENT)

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3
Q

high concentrations of vasopressin causes

A

 increase peripheral vascular resistance
 decrease cardiac contractility
 decrease coronary blood flow
 increase renal vascular resistance (hold onto water)
 decrease renal blood flow
 Stimulates release of von Willebrand factor which is key in the clotting cascade (improve hemostasis)

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4
Q

What Stimulates Vasopressin Release?

A

increase plasma osmolarity
decrease blood volume or decreased blood pressure
Hypoglycemia
Angiotensin
Stress
Pain
General anesthesia & surgery (MODERATE)
Angiotensin converting enzyme (ACE) inhibitors

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5
Q

what happens to ADH when put on bypass

A

 huge increase in ADH with bypass

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6
Q

the increase in ADH because of bypass may be initiated by

A

 ↓ in Blood volume with CPB initiation
 ↓ LA pressure (volume depletion)
 Transient Hypotension

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7
Q

prevention of increase in vasopressin on pump

A

 Anesthesia with large doses of synthetic opioids but doesn’t completely prevent
-HELP DECREASE THE MAGNITUDE OF THE INCREASE, BUT NOT ELIMINATE THE INCREASE COMPLETELY!

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8
Q

Catecholamines

A

 Epinephrine and norepinephrine released from the adrenal medulla and Peripheral sympathetic & central nerve terminal (NE
only)
 Potent vasoconstrictor (Alter intra-organ blood flow)

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9
Q

What happens to catecholamines during CPB

A

 Overall increase during cardiopulmonary bypass
 Epinephrine - increases 10 fold over Pre-CPB
 Norepinephrine - increases 4 fold over Pre-CPB

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10
Q

How do you decrease the response of the catecholamines during CPB

A

-decrease the temp

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11
Q

prevention of the catecholamines

A

 Deep anesthesia versus light
 Propofol infusion during bypass versus single bolus injection diazepam
 High dose opiod general anesthesia (fentanyl or sufentanil) plus thoracic epidural versus high dose opiod anesthesia alone
-ANESTHESIA PLAYS A MAJOR ROLE
-magnitude of increase can be reduced but not eliminated

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12
Q

epinephrine concentrations max

A
  • right before we come off bypass

- eliminate spike using pulsatile flow

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13
Q

norepinephrine concentrations max

A
  • after bypass

- pulsatile perfusion decrease peak

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14
Q

Adrenal Cortical Hormones

A

 Cortisol

 Adrenocorticotropic hormone

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15
Q

Cortisol

A

 Corticosteroid
 Released in response to stress
 Increases blood sugar
-sugar in liver as glycogen

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16
Q

Adrenocorticotropic hormone

A

 Corticotropin

-initiates the release of corisol

17
Q

initiation of bypass, what happens to [] of Cortisol and

Adrenocorticotropic Hormone

A

-increase

18
Q

Increase in Cortisol and

Adrenocorticotropic may be attenuated by

A

 Deeper levels of anesthesia

 Addition of thoracic epidural

19
Q

Glucose is a carbohydrate metabolism regulated by

A 
 insulin
 glucagon
 cortisol
 growth hormone
 epinephrine
20
Q

on bypass, what happens to: glucose and insulin

A

 Glucose concentration increases
 Insulin levels decrease (insulin resistance)
 All influenced by hypothermic bypass

21
Q

atrial natriuretic factor

A

 Release triggered by atrial distention

  • released by cardiac atria
  • helps control fluid balance
22
Q

what does the renin-angiotensin-aldosterone do

A

 Regulates arterial blood pressure, intravascular volume, electrolyte balance

23
Q

when is renin released and what secretes it?

A 
 Juxtaglomerular apparatus secretes renin
 In response to:
-sodium depletion
-decreased blood volume
-reduced renal perfusion
24
Q

renin does what to angiotensinogen

A

-catalyzes conversion to angiotensin I (increased activity) (happens in blood)

25
Q

angiotensin I to II via

A
  • angiotensin-converting enzyme (ACE)
  • happens in the lungs
  • lose this whole process on bypass
26
Q

aldosterone stimulates the reabsorption of what

A

-sodium-> increasing volume

27
Q

angiotensin II does what

A

 increased blood pressure by direct vasoconstriction

 stimulates release of aldosterone for adrenal glands

28
Q

aldosterone does what

A

 stimulates reabsorption of sodium and secretion of

potassium and hydrogen ion by renal distal tubules

29
Q

eicosanoids are what

A

-prostaglandins and thromboxanes

30
Q

what is PGE and what does it do

A
  • vasodilator

- prostaglandin

31
Q

what is TXA2

A

-platelet aggregator and a vasoconstrictor

32
Q

Histamine is

A

 Potent vasodilator

33
Q

what stimulates histamine release

A 
 opioids (morphine / meperidine)
 muscle relaxants (tubocurarine)
 antibiotics
 heparin
 protamine
[] increases with heparin given
34
Q

what causing an increase in the release of calcium

A

 decreased ionized calcium concentration
 Hypocalcemia
 hypomagnesemia

35
Q

On bypass, changes in calcium are caused by

A

 Type of priming solutions
 Blood products
 Use of albumin

36
Q

Magnesium

A

 Second most abundant intracellular cation

  • doesn’t have a hormone to increase it’s levels
  • keep membrane stability
  • not enough magnesium leads to things not working as good as they should
37
Q

what does calcium and magnesium bind to?

A

-albumin

38
Q

what happens to [magnesium] while on bypas

A 
 Decreases during bypass
 Hemodilution
 Chelation by albumin, blood products
 Once low – takes a while to come back up
 No hormonal support to increase
-HELPS SUPPRESS ARRHYTHMIAS
39
Q

Potassium levels

A

shoot for 4.5

Perf tech II (16 decks)

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