CV readings Flashcards by Linsay AugustinCRNA

Patients with shock had inadequate ____ _____and there is a lack of _______ delivery to major ______

tissue perfusion ; oxygen; organ

How well did you know this?

Not at all

Perfectly

Shock must be treated immediately to prevent _________ or ________

multisystem organ failure; death

How well did you know this?

Not at all

Perfectly

The components of blood pressure are _______and _______

Cardiac output; Systemic vascular Resistance

How well did you know this?

Not at all

Perfectly

Patients with shock will have either an inadequate ____________ or a low _____ due to arterial vaso_______

Cardiac index; SVR; dilation

How well did you know this?

Not at all

Perfectly

Shock is classified as : ________,________,_______,_______

Hypovolemic, Cardiogenic, extra-cardiac obstructive, distributive

How well did you know this?

Not at all

Perfectly

Hypovolemic shock is a result of _______ preload secondary to _______ and _________

decreased; dehydration ; hemorrhage

How well did you know this?

Not at all

Perfectly

Cardiogenic shock is a result of _________ due to various causes such as _______,_______,______

heart failure “Pump failure”; myopathy; cardiac valves issues; arrhythmias.

How well did you know this?

Not at all

Perfectly

Extra-cardiac obstructive shock is secondary to _______ or ________

Tension pneumothorax ; pulmonary emboli; Pulmonary HTN

How well did you know this?

Not at all

Perfectly

3 types of distributive shock are:

Septic; anaphylaxis, neurogenic

How well did you know this?

Not at all

Perfectly

Distributive shock results from excessive _______, therefore there is low ________. Patients will have Cardiac index (normal, low or elevated) ______

Vasodilation; SVR. normal or elevated

How well did you know this?

Not at all

Perfectly

Hypovolemic, cardiogenic and extra-cardiac obstructive result from poor ______and the patients usually have an elevated _______as a ______mechanism

Cardiac index; SVR; compensatory

How well did you know this?

Not at all

Perfectly

Pharmacologic agents that increase BP by causing arteriole vasoconstriction are called___

Vasopressors

How well did you know this?

Not at all

Perfectly

Agents that increase cardiac contractility and therefore _______ are called_________

Cardiac index; inotropes

How well did you know this?

Not at all

Perfectly

Examples of Catecholamines are :_______ ______ ______ ______ ______ ________

Dobutamine, isoproterenol, dopamine, epinephrine, norepinephrine, phenylephrine.

How well did you know this?

Not at all

Perfectly

Phosphodiesterase inhibitors (PDIs) are

Milrinone and inamrinone

How well did you know this?

Not at all

Perfectly

Catecholamines or __________ agents ALL act on receptors of the _________nervous system or ______: Remember what ACRONYM

sympathomimetic ; sympathetic (or Adrenergic) SYMP-ADRE

How well did you know this?

Not at all

Perfectly

Stimulation of the Beta 1 receptors of the heart will result in _______ inotropic meaning _______contractility and ________; also result in chronotropic meaning _______in heart rate ; dromotropic meaning ________in conduction of impulse

positive; increase; cardiac index; increase; increase

How well did you know this?

Not at all

Perfectly

Stimulation of Beta 2 receptors of the heart will result in _______ ____ _____ which can result in _______ and a decrease in ________

Smooth muscle relaxation; vasodilation; SVR

How well did you know this?

Not at all

Perfectly

Stimulation of alpha receptors of the heart will result in ___________and an increase in ________and ______ but can cause a reduction of ______to the increase in _______

vasoconstriction; SVR; BP; Cardiac index; afterload

How well did you know this?

Not at all

Perfectly

For phosphodiesterase inhibitors –> the inhibition of ___________leads to the inhibition of the breakdown of ____ _____ _______. This results in increase in ______ ______ therefore increase ________and venous and arterial ______(decrease _____ and ____)

Phosphodiesterase; cyclic adenosine monophosphate; myocardial contractility; cardiac index; dilation; preload and SVR

How well did you know this?

Not at all

Perfectly

There are 3 vasopressin receptors

V1, V2, V3

How well did you know this?

Not at all

Perfectly

Activation of V1 receptors results in ________ of systemic, splanchnic, renal and coronary arteries via activation of ______ resulting in an increase in _______ ________

vasoconstriction; voltage-gated calcium channels; intracellular calcium

How well did you know this?

Not at all

Perfectly

Activation of V2 receptors results in _______Effect of vasopressin

antidiuretic effect

How well did you know this?

Not at all

Perfectly

Vasopression V3 receptors are located in the _________ _____ gland and Activation of V3 receptors results in secretion of __________ Hormone

anterior pituitary; adrenocorticotropin

How well did you know this?

Not at all

Perfectly

Unlike ____________ the actions of vasopressin may be preserved in _________ and ________

catecholamines; hypoxia; acidosis

The Half life of catecholamines is ____ minutes and maximum concentration is achieved in ____ minutes

1-2 ; 10

Dobutamine acts on ____ and _____ receptors and with ______HR , ______CI, and ______SVR

B1 and B2, increase; increase; increase

Norepinephrine acts on _____ but more on ____ receptors. Will produce variable effects on _____, will have no effect or decrease _______, _______SVR and _____MAP

B1; alpha; HR; CI; Increase; increase

Milrinone half life in a patient with normal renal function is

2 hours

Vasopression elimination half life is _______minutes

15 minutes

What are determinates of myocardial oxygen consumption _____,_____,______

HR; ventricular wall tension; contractility

Beta agonists and PDI can _______HR, and _______ thereby increasing ______ ______ ______

increase ; contractility ; myocardial oxygen demand.

Alpha agonists and Vasopressin can also cause ______of coronary vessels leading to decrease in myocardial oxygen ______

Vasoconstriction; supply

Increases in myocardial oxygen demand or decrease in myocardial oxygen supply can lead to ____________

myocardial ischemia.

PDI may cause a reflex__________

Tachycardia

Patient receiving any of the catecholamines and/or PDIs should be monitored for signs of _______

Myocardial ischemia

Sympathomimetic amines such as ________and ________can cause direct tachyarrhythmias (atrial and ventricular) by increasing myocardial oxygen _______

Dobutamine; isoproterenol ;consumption

Pure alpha agents such as _________ can cause a reflex _______ secondary to an increase in _____ _____

bradycardia; BP

Because of the increase in ________alpha agonists can decrease _________and induce ________

afterload; cardiac index, heart failure

Mixed alpha and beta effects medications such as ______ and _______ will generally ________(increase or decrease) CI in lower doses and ________ (increase or decrease) CI in higher doses

dopamine; epinephrine; increase; decrease

Sympathomimetic agents can cause ________ blood sugar through ______and ________, ________levels should be monitored

high; glycolysis; gluconeogenesis; Blood glucose

All vasoconstrictors can cause ________If they extravasate

severe tissue necrosis

B2 agonists such as _______ _______ can decrease serum _______ which may induce _______ so serum _____ should be monitored

Dobutamine and isoproterenol; potassium; potassium

For alpha agonists such as ______ _____ _______ extravasation can be prevented by injecting the alpha blocker _____________ subcutaneously into the area of infiltrate

Norepinephine, phenylephrine and dopamine: PHENTOLAMINE

When using vasopressor, the use of low dose _________does not show any real benefits for renal function and should not be use

Dopamine

Excessive Vasoconstriction may________blood flow to vital organs.

decrease

Vasopressors such as epinephrine and norepinephrine can decrease ________blood flow and increase regional ________ _______

splanchnic; lactic acidosis

Hypovolemic and septic shock patients should always be given ________ ________ prior to vasopressors and inotropes because if _______ is inadequate, vasopressors will cause further reduction in _______ and inotropes with worsen tachyarrhythmias and induce ______

Fluid resuscitation; preload; cardiac output; ischemia

PDIs and sympatomimetics amines with beta effects that increase CI should used in caution with patients with severe ___________

aortic stenosis

_______monitoring is imperative in the clinical use of sympathomimetic and PDIs

Cardiac

if sympatomimetic amines are needed in patients on MAOIs, stated at ______ the usual dose

one tenth

2 hemodynamic goals in septic shock and Acute Respiratory Distress Syndromen (ARDS)

- Adequate perfusion pressure to ensure blood flow to vital organs - adequate oxygen delivery.

In septic shock and ARDS, goal MAP is

60-65mmg HG

In septic shock and ARDS, goal CI is

Greater than 4.5L/min

In septic shock and ARDS, goal oxygen delivery

>600 ml/min/m2

In septic shock and ARDS, goal oxygen consumption

>170ml/min/m2

Early Goal directed therapy in the treatment of sepsis and shock recommends: Treatment in ED with _______ and colloids to maintain CVP ____ to _____; ___________ to achieve a MAP of _______ and transfusion of _______ or __________ to achieve a central venous oxygen saturation of (ScvO2) of _____ or greater

crystalloids; colloids; 8; 12; >65; RBCs; dobutamine; 70%

In septic shock, ARDS, and other forms of non-cardiogenic shock, ________is secondary to ______volume depletion and excessive ________

hypotension; intravascular; vasodilation.

Vasopressors recommended for septic shock _______and _________ . Studies have demonstrated that ________ and _______ are effective when dopamine fails. However_______is reserved for _______ ________

Dopamine and norepinephrine. Norepinephrine and epinephrine; refractory hypotension

Recommended vasopressin dose

0.03 units/minute

The inotrope that he been mostly widely studies in sepsis is _____________ and it's used also to increase

Dobutamine ; oxygen delivery

ACCM recommends the use of _______ as first choice in septic patients with ______and ________venous saturation and adequate ______following fluid resuscitation.

Dobutamine ; low CI and low; MAP

ACCM recommends the use of _______ as first choice in septic patients with ______and ________venous saturation and adequate ______following fluid resuscitation. May also be used in patients with signs of hypoperfusion as evidenced by ________ or elevated ________

Dobutamine ; low CI and low; MAP; low urine output ; lactic acid

An important point to stress is that __________ and _______ should be titrated separately to different goals

Vasopressors; inotropes

Vasopressors are titrated to maintain an ________ while inotropes are titrated to the desired effect on _________(desired ________or central venous saturation > __%)

adequate MAP; oxygen delivery; Cardiac index ; 70%

Unlike PDIs, Tolerance does occur with the use of _________ within ___ to ___ hours

Dobutamine; 48-72

Inoptropic support should be _____term because _____term treatment with inotropes is associated with ________ _________

short; long; increased mortality.

PDI and Dobutamine may be used in combination when _______ cannot be obtained with either agent alone

Cardiac index

Postpartum cardiomyopathy is usually treated with

ACEI

____________is a thiazide diuretic and will potentiate the effects of lisinopril, amlodipine, and losartan.

Hydrochlorothiazide

Top causes of metabolic acidosis

Hypoxia Uremia DKA Lactic acidosis

CV readings Flashcards

(71 cards)