47 - Syncope Flashcards Preview

PEBC > 47 - Syncope > Flashcards

Flashcards in 47 - Syncope Deck (18):
1

syncope aka _____

fainting

2

What drugs can cause syncope?

-antihypertensives
-alcohol
-PD (parkinson's disease) drugs
-diuretics
-nitrates
-PDE5 inhibitors

3

Describe Vasovagal syncope

-occurs from an upright posture held for more than 30 seconds or with exposure to emotional stress, pain or medical setting

-associated with hypotension and relative bradycardia and is followed by fatigue

4

Vasovagal syncope:
Non-pharms

-increase salt intake (3-5g/day)
-increase fluids (up to 2.5 L/day)
*if they don't have HTN or HF

-use physical counter-pressure maneuvers
-pacemaker therapy is convtroversial

5

Vasovagal syncope:
List 4 pharmacological options

-Fludrocortisone
-Midodrine
-Paroxetine
-Metoprolol

6

Vasovagal syncope:
When should you try Fludrocortisone?

if salt supplements are ineffective

*the goal of this drug is fluid retention so may precipitate HF

7

Vasovagal syncope:
How does midodrine work?

it is an alpha agonists - so increases venous return

8

Vasovagal syncope:
SSRIs are of uncertain benefit but _____ showed benefit

paroxetine

9

Vasovagal syncope:
BBs are no longer first line. Metoprolol may be effective in patients > _____ yo

42

10

Describe Orthostatic hypotension

drop in SBP > 20 mmHg or DBP > 10 mmHg when assuming an upright posture

11

Orthostatic hypotension:
non-pharms

-remove hypotensive and volume-depleting drugs if possible
-increase salt and fluid intake if not CI
-elevate the head of the bed
-avoid hemodynamic stress (getting up too quickly, eating large meals, being in sauna/hot bath, or intensive exercise)

12

Orthostatic hypotension:
List 4 pharmacological options

-Fludrocortisone
-MIdodrine
-Pyridostigmine
-Non-selective BBs (propranolol, timolol, nadolol)

13

Orthostatic hypotension:
Midodrine can cause what?

supine HTN and shivering

14

Orthostatic hypotension:
How does pyridostigmine work?

-acetylcholinesterase inhibitor
-can be given alone or in combo with midodrine

15

Orthostatic hypotension:
How does BBs help with orthostatic hypotension?

blocks vasodilatory B2 receptors and reduces or abolish the fall in BP upon standing in patients with orthostatic hypotension

16

Tips:
Use fludrocortisone if patient healthy and _____

normotensive

17

Tips:
Use BB if patient > ____ yo

40

18

Tips:
Use midodrine if _____ fails

fludrocortisone

Decks in PEBC Class (130):