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Perf Tech III (Exam 1) > Topic 4: Endocrine > Flashcards

Topic 4: Endocrine Flashcards

1
Q

When we are on bypass (heart and lungs are being bypassed)- what does it mean for drug administration?

A

Heart and lungs not perfused

  • not able to secrete normal hormones
  • not part of drug metabolism
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2
Q

Deeper levels of anesthesia appear do what?

A
  • To reduce or eliminate endocrine responses

- Also appear to reduce mortality

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3
Q

Posterior lobe aka

A

Neurohypophysis

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4
Q

Anterior Lobe aka

A

Adenohypophysis

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5
Q

Pituitary Gland has what two functions?

A

neural and endocrine

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6
Q

Posterior pituitary is what portion of the gland?

A

the “neurosecretory” portion—it’s essentially modified nervous tissue

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7
Q

Posterior pituitary secretes what?

A

ADH (vasopressin)

Oxytocin

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8
Q

Oxytocin does what?

released by what?

A

Positive feedback loop during labor
Milk letdown during lactation
The “Cuddle” hormone

released by post pituitary

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9
Q

High concentrations of ADH (Vasopressin) do what to – peripheral vascular resistance?

A

May increase peripheral vascular resistance

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10
Q

High concentrations of ADH (Vasopressin) do what to –cardiac contractility?

A

May decrease cardiac contractility

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11
Q

High concentrations of ADH (Vasopressin) do what to coronary blood flow?

A

May decrease coronary blood flow

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12
Q

High concentrations of ADH (Vasopressin) do what to renal vascular resistance?

A

Increases renal vascular resistance

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13
Q

High concentrations of ADH (Vasopressin) do what to renal blood flow?

A

Reduces renal blood flow

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14
Q

High concentrations of ADH (Vasopressin) do what to von Willebrand factor?

A

Stimulates release of von Willebrand factor

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15
Q

High concentrations of ADH (Vasopressin) do what to hemostasis?

A

May improve hemostasis

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16
Q

ADH (Vasopressin) is a potent regulator of what?

A

Regulates renal water excretion (POTENT)

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17
Q

What Stimulates Vasopressin Release?

A 
Increase plasma osmolarity
Decreased BV or decreased (or perceived) BP 
Hypoglycemia
Angiotensin II
Stress
Pain
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18
Q

Venting keeps what low?

A

left atrial pressure low simulating low CBV (potent stimulant)

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19
Q

Can Vasopressin release be stopped while on bypass?

A

Magnitude of increase can be reduced but not eliminated

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20
Q

Pulsatile Flow effect on Vasopressin release?

A

No significant decrease during bypass – significant decrease immediately after – back to normal 48 hours post-op
-Strangely, no effect on U.O.

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21
Q

How to prevent large Vasopressin release with Drugs?

A 
Anesthesia with large doses of synthetic opioids
Fentanyl (50 μg/kg) or sufentanil
Regional anesthesia (Works for non-cardiac procedures)
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22
Q

ADH concentrations increase markedly during CPB ___ of anesthesia or perfusion technique

A

irrespective

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23
Q

Anterior portion secretes what kind of hormones?

A

trophic hormones that regulate:

  • Adrenal cortex** (ACTH)
  • Thyroid** (TSH)
  • Ovaries/Testes
  • Growth (HGH)
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24
Q

Most damaging complication to pituitary

A

Pituitary Apoplexy

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25
Q

Pituitary Apoplexy is most common in what pts?

A

Rare, more common in patients with pituitary adenomas (benign tumor) usually diagnosed post hoc

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26
Q

Pituitary Apoplexy symptoms

A 
Ptosis (droopy eyelids) 
opthalmoplegia (paralysis muscles controlling eye) 
nonreactive & dilated pupils  
decreased visual acuity  
hormonal defects
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27
Q

Pituitary Apoplexy treatment

A

Hormonal replacement (HGH) / hypophysectomy

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28
Q

Damage to pituitary usually blamed on what?

A

ischemia, hemorrhage, and edema of gland

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29
Q

produce norepinephrine?

A

Adrenal medulla

Peripheral sympathetic & central nerve terminal

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30
Q

Epinephrine concentration increases how much over CPB from preoperative levels?

A

10 fold

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31
Q

Norepinephrine concentration increases how much over CPB from preoperative levels?

A

4 fold

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32
Q

EPI PEAK on bypass

A

When target temperature reached

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33
Q

NOREPI PEAK in bypass

A

After release of cross-clamp and rewarming

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34
Q

Prevention of Catecholamine release?

A

As with vasopressin, magnitude of increase can be reduced but not eliminated…and the adrenal medulla is just one honking big sympathetic nerve

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35
Q

Reduce Catecholamine release with Propofol?

A

Propofol infusion during bypass (4 mg/kg/hr) versus single bolus injection diazepam (0.1 mg/kg)
-Significant reduction of [catecholamine]

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36
Q

Reduce Catecholamine release with anesthesia?

A

Deep anesthesia versus light
-Greater depth (regardless of type) gives significant reduction of [catecholamine] and decreased mortality (documented in peds)

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37
Q

Reduce Catecholamine release with opiod general anesthesia?

A

High dose opiod general anesthesia (fentanyl or sufentanil) plus thoracic epidural versus high dose opiod anesthesia alone
–Significant reduction of [catecholamine] during and after bypass

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38
Q

Reduce Catecholamine release with spinal block ?

A

General anesthesia with high spinal block (bupivacaine) versus general anesthesia alone
-Significant reduction of [catecholamine]

39
Q

Reduce Catecholamine release with pulsatile vs non-pulsatile flow?

A

Pulsatile versus non-pulsatile flow

-Older studies – minimal difference due to “technique” and definition of “pulsatile”?

40
Q

Cortisol

A

Corticosteroid (adrenal cortical hormone)
released in response to stress
increases blood sugar, increases stores of sugar in liver as glycogen
suppresses immune system

41
Q

Cortisol increases what?

A

increases blood sugar

increases stores of sugar in liver as glycogen

42
Q

Adrenocorticotropic hormone

A

Corticotropin /
promotes increased production & release of corticosteroids and cortisol
Acts as an appetite suppressant, anxietomimetic, and (conversely) a pro-inflammatory

43
Q

Adrenocorticotropic hormone promotes what?

A

promotes increased production & release of corticosteroids and cortisol

44
Q

Adrenocorticotropic hormone acts as what?

A

Acts as an appetite suppressant, anxietomimetic, and (conversely) a pro-inflammatory

45
Q

Adrenal Cortical Hormones (Cortisol and Adrenocorticotropic) Increase may be attenuated by what?

A

Deeper levels of anesthesia

Addition of thoracic epidural

46
Q

Carbohydrate metabolism regulated by: (5)

A 
insulin
glucagon
cortisol
growth hormone
epinephrine
47
Q

Glucose concentration increases?

A

Hyperglycemia—worse with hypothermia

Stay elevated for many hours post-CPB

48
Q

hypoinsulinemia

A

Insulin levels decrease—worse with hypothermia

49
Q

Insulin resistance: Type I DM

A

do not require increased insulin doses

50
Q

Insulin resistance: Type II DM

A

do require increased insulin doses

51
Q

Atrial Natriuretic Factor does what? antagonist of what?

A

Incredibly efficacious vasodilator
Almost the exact physiologic antagonist of aldosterone
Peptides released from cardiac atria

52
Q

Atrial Natriuretic Factor released from what?

A

Peptides released from cardiac atria

53
Q

Atrial Natriuretic Factor release triggered by? (5)

A
  • atrial distention (such as a-fib)
  • Β-adrenergic stimulation
  • Angiotensin-II
  • Hypernatremia
  • Endothelins (the most potent vasoconstrictors known)
54
Q

the most potent vasoconstrictors known

A

Endothelins

55
Q

Atrial Natriuretic Factor does what? (5)

A
  • increased glomerular filtration rate
  • inhibits renin release
  • reduced plasma concentrations of aldosterone
  • antagonize renal vasoconstrictors
  • reduce arterial blood pressure
56
Q

Interestingly, ANF helps prevent ______ myocardium and has other ______ on cardiomyocytes and cardiac vascular endothelium

A

“scarring” of ischemic

anti-ischemic effects on

57
Q

ANF concentrations reduced when on CPB?

A

Concentrations reduced during bypass
hypothermia
cross clamping

58
Q

ANF concentrations rise when?

A

Concentrations rise during rewarming and post bypass

59
Q

What happens to the relation between Atrial Naturetic factor concentration and atrial pressure during bypass and early post operative period?

A

normal relation lost during bypass and early post operative period

60
Q

Renin-Angiotensin-Aldosterone regulates what?

A

atrial pressure, intravascular volume, electrolyte balance

61
Q

what secretes renin ? why is renin secretion increased?

A

Juxtaglomerular apparatus secretes renin

-increased secretion due to sodium depletion, decreased blood volume, reduced renal perfusion

62
Q

Aldosterone (increased concentration) stimulates what?

A

stimulates readsorption of sodium and secretion of potassium and hydrogen ion by renal distal tubules

63
Q

Angiotensin II (increased concentration) increases what? (2)

A
  • increased blood pressure by direct vasoconstriction

- stimulates release of aldosterone for adrenal glands

64
Q

Research utilizing ACE-inhibitors and ARBS suggest that CPB temporarily breaks the linkage between what during and immediately post-bypass?

A

“breaks the linkage” between Renin-Angiotensin-Aldosterone and hypo- or hypertension

65
Q

Eicosanoids metabolized by ?

A

lungs

66
Q

Prostaglandins mostly related to ?

A

inflammation

67
Q

Thromboxanes mostly related to?

A

injury

68
Q

Endoperoxide prostaglandins H2 produces?

A

PGE2, PGF2alpha, PGD2

prostacyclin (PGI2) or thromboxane (TXA2)

69
Q

PGE generally

A

vasodilator

70
Q

PGF2alpha, PGD2

A

pulmonary vasoconstrictor

71
Q

PGI2

A

disaggregates platelets, potent vasodilator

72
Q

TXA2

A

platelet aggregator, potent vasoconstrictor

73
Q

Prostacyclin & thromboxane increase when?

A

during bypass and begin to decrease shortly thereafter

74
Q

Aprotinin is what? affect on prostacyclin?

A

protease inhibitor – reduces increase in thromboxane – no effect on prostacyclin – better preservation of platelet function

75
Q

CPB can induce “sick euthyroid syndrome”, what levels are low?

A

T3 and T4 levels are low but the thyroid gland is apparently “normal”

76
Q

CPB can induce “sick euthyroid syndrome” resulted from what?

A

The result of disruption of the thyrotropic feedback loop

77
Q

“sick euthyroid syndrome” does giving thyroxine help?

A

Mixed evidence whether giving thyroxine helps (trophic and pro-metabolic effects) or hurts (possible increased risk of MIs)

78
Q

things that stimulate histamine release? (5)

A

-opioids (morphine / meperidine)
-muscle relaxants (tubocurarine)
-antibiotics
-heparin
-protamine
Concentration increases with administration of heparin – remains elevated

79
Q

Ionized Ca %

A

50%

80
Q

bound to protein Ca%

A

40%

81
Q

chelated Ca%

A

10%

82
Q

Blood concentration of Ca maintained by?

A

parathormone and vitamin D (bones / kidney)

83
Q

Give extra calcium only when the following three conditions are present (per your book):

A

1) ready to terminate bypass
2) ionized calcium is reduced
3) need to increase contractility and BP

84
Q

Second most abundant intracellular cation

A

Mg

85
Q

Mg key factor in enzyme systems (5)?

A
  • transmembrane electrolyte gradients
  • energy metabolism
  • synthesis various messaging substances
  • function of ion channels
  • hormone secretion and action
86
Q

Mg Ionized, bound and chelated

%’s?

A

Ionized (55%), bound protein (30%), chelated (15%)

87
Q

is it possible have normal [plasma] but intracellular depletion of Mg?

A

YES

88
Q

Mg does what during bypass?

A

Decreases during bypass

Decreased levels may associated with cardiac dysrhythmias

89
Q

Mg does what?

A

Helps suppress arrhythmias

  • direct myocardial membrane effect
  • direct / indirect effect on cellular sodium and potassium
  • antagonism of calcium entry into the cell
  • prevention of coronary arterial spasms
  • antagonism of catecholamine action
  • improves myocardial oxygen supply / demand ration
  • inhibition of calcium current during plateau phase of myocardial action potential
90
Q

Mg is antagonist of what?

A
  • antagonism of calcium entry into the cell (inhibition of calcium current during plateau phase of myocardial action potential)
  • antagonism of catecholamine action
91
Q

Supplemental magnesium typical dose?

A

Typically ~ 2 grams post-cross clamp removal

92
Q

Changes in potassium concentration caused by?

A
  • cardioplegia
  • anesthetic drugs
  • priming solutions
  • renal function
  • carbon dioxide tension
  • arterial pH
  • hypothermia (decrease as cool, increase as warm)
  • insulin treatment of hyperglycemia moves glucose and potassium into cell)
93
Q

Albumin may help reduce decrease in what concentration?

A

K

Perf Tech III (Exam 1) (5 decks)

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