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Jason's Cardiovascular Block > Valves and Kidney Drugs > Flashcards

Valves and Kidney Drugs Flashcards

1
Q

In stenosis, pressure is higher in the chamber behind? or in front of the valve?

A

behind the valve

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2
Q

What kind of overload is in stenosis? which chamber?

A

Pressure overload in the chamber behind the valve.

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3
Q

How do you get volume overload?

A

valve incompetence/regurgitation

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4
Q

What is innocent flow murmurs?

A

benign turbulence caused by high flow in children, fever, preg

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5
Q

2 Main causes of Valvular Heart Disease?

A

degenerative
congenital
Rheumatic fever (past)

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6
Q

What are the symptoms for mild/moderate valve lesions?

A

asymptomatic

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7
Q

When symptoms develop for regurg valve disease, is it reversible?

A

usually poor prognosis, irreversible canoes to LV

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8
Q

If you have symptoms for aortic stenosis, is it reversible?

A

Yes, LV changes can regress

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9
Q

What’s most important besides history to diagnose valvular heart disease?

A

Echocardiography because can show changes before irreversible

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10
Q

Valvular heart disease interventions. 4 of them

A

Replacements: metal/plastic
repair
balloon valvotomy
stent valves

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11
Q

What is the normal pressure gradient across valves?

A

0mm Hg

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12
Q

What is normal valve area?

A

> 2.5cm2

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13
Q

What kind of aortic stenosis usually in elderly?

A

calcific

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14
Q

What causes aortic leaflet damage? 2 reasons

A
  1. Endocarditis

2. Rheumatic fever

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15
Q

What causes aortic root dilation? 4 reasons.

A

Marfan’s
Aortic dissection
collagen vascular disorder (AS)
syphillis (past)

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16
Q

When does aortic regurgitation occur?

A

during diastole

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17
Q

what’s a consequence of aortic regurgitation?

A

volume overload for LV
increase EDV, EF, SV
Normal ESV

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18
Q

in aortic regurgitation, what does the pulse feel like?

A

collapsing pulse

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19
Q

Are decompensation changes in aortic regurgitation reversible

A

No.

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20
Q

How to treat acute severe aortic regurgitation?

A

early surgery due to cardiogenic shock/acute pulmonary oedema.

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21
Q

what does cardiomyopathy do to mitral valve?

A

changes the ventricular shape as who heart is bigger, not al structures are proportional = mitral regurg

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22
Q

what happens to left atrium in mitral regurgitation?

A

increase LA volume and pressure

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23
Q

Are heart changes reversible in mitral regurgitation?

A

Nope. Not after decompensation.

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24
Q

Why would you get left atrial fib?

A

left atrial pressure and volume increase, atrium stretches

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25
Q

Symptoms of Right heart failure?

A

pulmonary hypertension, congestion, oedema, hypoxia

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26
Q

When would the risk of a thrombus in the Left atrium be significant?

A

mitral regurgitation

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27
Q

When is the ‘atrial kick’ important? increases risk of what?

A

in Mitral Stenosis
Thrombosis
fibrillation

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28
Q

is left ventricular systolic function affected in Mitral Stenosis?

A

Nope. Aaaaalll Atria baby.

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29
Q

4 things kidney does

A

regulate water and salt
endocrine
excrete endogenous waste
excret exogenous waste

30
Q

Drug elimination has two things:

A

metabolism

excretion

31
Q

Where is K+ secreted? 2 spots

A

Collecting ducts

Distal tubule

32
Q

how do you treat aspirin overdose?

A

sodium bicarb

33
Q

3 kinds of drugs act on the kidney:

A
  1. diuretics
  2. urine pH
  3. alter secretion of organic molecules
34
Q

Diuretics do what exactly?

A

Increase Na+ and Cl- excretion

35
Q

4 types of diuretics are:

A
  1. loop
  2. thiazide
  3. K+ sparing
  4. osmotic
36
Q

Which is the most powerful class of ‘torrential’ diuretics?

A

Loop excretes 15-20% in Na+ in filtrate!

37
Q

T/F? loop diuretics work on descending limb of loop of Henle?

A

False. works on ascending limb

38
Q

What does loop diuretics inhibit?

A

Na+/K+/2Cl- carriers from lumen into cell

39
Q

How long do loop diuretics last?

A

3-6 hours

40
Q

how long does it take for loop diuretics to onset?

A

1 hour

41
Q

Where does loop diuretics act? on the inside of outside of the loop of Henle

A

outside

42
Q

3 bad things about loop diuretics?

A
  1. hypokalemia
  2. hypovolemia (elderly)
  3. metabolic alkalosis
43
Q

4 scenarios you’d most likely use loop diuretics?

A

Heart failure
acute pulmonary oedema
ascites (liver cirrhosis)
renal failure

44
Q

Two kinds of thiazides

A

True

Thiazide like: indapamide

45
Q

What diuretics are moderately powerful?

A

Thiazides

46
Q

Where and how do Thiazides work?

A

distal convoluted tubule

knock out Na+/Cl- cotransporter

47
Q

How long do Thiazides work for?

A

8-12 hours

48
Q

What diuretic side effects include gout and hypokalaemia?

A

Thiazides

49
Q

Adverse effects of Thiazides?

A

gout and hypokalaemia

50
Q

Would you ever combine a loop diuretic and Thiazides?

A

yes in severe resistant oedema

51
Q

Which drug has less adverse Thiazides effects?

A

The thiazide-like drugs: indapamide

52
Q

example of a K+ sparing diuretics?

A

spironolactone

53
Q

are K+ sparing diuretics any good?

A

by themselves. not really. used in combo with other K+ losing diuretics to counteract hypokalaemia.

54
Q

What aldosterone receptor antagonist has a slow onset?

A

Spironolactone

55
Q

How does spironolactone do its job?

A

Aldosterone receptor antagonist

56
Q

Half life of Spironolactone? what lasts longer?

A

half life of 10 min. metabolite lasts 16 hours

57
Q

Adverse effects of Spironolactone? 2 things:

A

hyper kalaemia

GI upset

58
Q

how would you clinically use Spironolactone?

A

in combo with loop or thiazides

59
Q

What diuretic class does triamterene and amiloride belong to? how do they work?

A

K+ sparing diuretics

block Na+ reabsorption

60
Q

What’s Mannitol used as pharmacologically?

A

Osmotic diuretics

61
Q

3 places Osmotic diuretics effect?

A

proximal tubules
descending limb
collecting ducts

62
Q

How do Osmotic diuretics work?

A

reduce passive water reaboroption

63
Q

When would you use Osmotic diuretics? 2 things:

A

raised intra cranial/ocular pressure

prevent acute renal failure

64
Q

3 compounds that are bad news for kidneys

A
  1. heavy metals
  2. antibiotics
  3. cancer drugs
65
Q

kidneys are susceptible to toxicity cause?

A
  1. receives 25% of blood supply
  2. concentration
  3. reactive species could damage
66
Q

how does mercury hurt the kidneys?

A

binds to thiol groups in proteins causes glomerulonephritis

67
Q

Which antibiotic used to treat gram -ve infections could cause renal toxicity?

A

Gentamicin via proteinuria, affects apical membrane of proximal tubule, messes with Ca2+ levels which effs up mitochondria

68
Q

who is more susceptible to gentamicin toxicity?

A

existing renal disease

69
Q

Cisplatin treats what and what’s bad about it?

A

Treats prostate cancer
nephrotoxicity via blood urea increase
proteinuria
electrolyte imbalance

70
Q

How does Cisplatin mess with the kidney?

A

activated in cells
binds to thiols
reactive species

Jason's Cardiovascular Block (15 decks)

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