Electrophysiology & Vasoactive Agents Quiz Flashcards
(160 cards)
1
Q
What is a cation?
A
Positively charged Ions that have lost electrons
2
Q
What is an anions?
A
Negatively charged ions that have gained electrons
3
Q
H+ is what Ion?
A
Hydrogen
4
Q
Na+ is what Ion?
A
Sodium
5
Q
K+ is what Ion?
A
Potassium
6
Q
Ca++ is what Ion?
A
Calcium
7
Q
Cl- is what Ion?
A
Chlorine
8
Q
PO₄³⁻ is what Ion?
A
Phosphate
9
Q
What is an Ion?
A
Any atom or molecule that has a charge
10
Q
What are Cardiac Muscle Cells called?
A
Myocytes
11
Q
What is a positively charge particles located in nucleus?
A
Protons
12
Q
What is are neutral particles that are located in the nucleus called?
A
Neutrons
13
Q
What are negatively charged particles orbiting the nucleus called?
A
Electrons
14
Q
How many particles are atoms composed of?
A
3 particles
15
Q
What are the 3 particles that make up an atom?
A
Protons, Neutrons, and electrons
16
Q
What is an ionic bond?
A
When cations and anions bond together they create a
17
Q
The division of ionic bonds causes the formation of?
A
Electrolytes
18
Q
What are the two cardiac cells called?
A
Myocytes and Pacemaker (nodal) cells
19
Q
What are Nodal Cells?
A
They are pacemaker cells
20
Q
How many phases of the cardiac cycle are there?
A
There are 5 phases.
21
Q
What phase is the resting phase of the cardiac cycle?
A
Phase 4
22
Q
What phase is the depolarization phase of the cardiac cycle?
A
Phase 0
23
Q
What phase of the cardiac cycle is the repolarization (notch waveform)?
A
Phase 1
24
Q
What phase of the cardiac cycle is the Plateau Phase?
A
Phase 2
25
What phase of the cardiac cycle is the repolarization (complete) phase?
Phase 3
26
What ion channels open in phase 0 of the cardiac cycle?
Sodium Channels open allowing sodium in.
27
What Ion Channels close and open in Phase 1 of the cardiac cycle?
Sodium Channels close and Potassium Channels open allowing potassium out of the cell.
28
What Ion Channels open in phase 2 of the cardiac cycle?
Potassium channels are still open allowing potassium out, but calcium channels open to allow calcium into the cell.
29
What ion channels open and close during phase 3 of the cardiac cycle?
Potassium channels are still open and calcium channels close.
30
What channels close during phase 4 of the cardiac cycle?
All channels are closed allowing rest
31
What do cardiac pacemaker cells make up and are responsible for?
They make up the conductive network and are responsible for the propagation of electrochemical signaling
32
What do cardiac Myocytes make up and responsible for?
Make up the heart muscle and are responsible for the contraction and movement of blood
33
What is a concentration gradient?
A variance between the number of ions on either side of the cell membrane
34
What creates an electrical form of potential energy?
The difference in ion concentrations in and out of the cell
35
What is Unique to the heart, long thin cells capable of shortening, composted of smaller fibrils, large number of mitochondria for increased ATP production and resistant to fatigue?
Cardiac Myocytes
36
What is able to generate impulses spontaneously, unique to the heart, transmits impulses through the heart?
Pacemaker cells
37
What phase of the cardiac cycle is at -90mv?
Phase 4. The resting phase
38
What are the Phases of the pacemaker cycle?
Phases 4, 0, and 3
39
What is phase 4 of the pacemaker cycle called?
Phase 4 resting phase
40
What is the depolarization phase of the pacemaker cycle called?
Phase 0
41
What is the repolarization phase of the pacemaker cycle called?
Phase 3
42
At what mv is depolarization triggered in the pacemaker cycle?
-40mv
43
What mv is the resting phase of the pacemaker cycle?
-60mv
44
What ion influx causes depolarization of the pacemaker cycle?
Ca++
45
What Ion channels open to normalize the concentration gradient during repolarization of the pacemaker cycle?
K+
46
The pacemaker cycle occurs at the rate of what in the SA nodal cells, AV nodal cells, and Purkinje system?
SA: 60-100
AV: 40-60
Purkinje: <40
47
What is our pro-dominant extracellular ion?
Na+ (sodium)
48
What is the pro-dominant intracellular ion?
K+ (Potassium)
49
What ion channels do Cardizem effect?
Calcium Channels
50
What Ion channels does Amiodarone effect?
Potassium Channels
51
What Ion channels does lidocaine effect?
Sodium Channels
52
Nodal cells are leaky to what Ion?
Calcium
53
Beta 1 agonists increase the permeability of what ion?
Calcium
54
Unstable myocardium sign is?
A wide QRS complex
55
What are the 3 stages to stabilize Hyperkalemia?
Stabilize myocardium, shift intracellular, and elimination of K+
56
How doe you stabilize the myocardium in hyperkalemia?
Treat with CaCl (Calcium Chloride) and/or NaHCO₃ (sodium bicarbonate)
57
How do you shift the potassium intracellularly in Hyperkalemia?
Treat with insulin 0.1 units/kg
58
How do you eliminate K+ in Hyperkalemia?
Cause the patient to urinate or have bowel movements to help get rid of it or dialysis. For example lasix to urinate and Kayexalate.
59
Sodium Channel Blocker toxicity treatment?
Sodium Bicarbonate, possibly seizure control, and airway management
60
Hypokalemia and Hyperkalemia can lead to torsades de pointes because?
Of the widening QRS interval.
61
A QTC >500 is more likely to?
Lead to torsades de pointes
62
What drug has the least effect on QTC interval?
Lidocaine
63
What drug has the most QTC prolongation effects?
Amiodarone
64
Sympathetic stimulation releases?
Adrenergic neurotransmitters (Epi and NorEpi)
65
What drug stimulates Beta 1 receptors?
Epinephrine
66
Stimulation of the Beta 1 receptors releases what?
Intracellular cAMP
67
cAMP is what?
Cyclic adenosine monophosphate
68
Increased cAMP levels reduce what and promote what?
Reduce time for action potential to occur.
Promotes a more complete contraction of the Myocyte.
69
Parasympathetic stimulation releases what?
Antagonistic neurotransmitters (Acetylcholine)
70
Acetylcholine binds to what? Which causes what?
Muscanaric receptors and causes decreased cAMP levels intracellular
71
Decreased cAMP levels intracellular causes what?
A reduce in heart rate, force of contraction, and conduction velocity
72
Stimulation of the vagus nerve increases?
Parasympathetic activity.
73
Sodium Channel Blockade effects what phase of the cardiac cycle?
Phase 0, Depolarization phase
74
Signs and symptoms of a Na+ channel blockade?
Depolarization is prolonged, QRS widened, QT prolonged, heart rate reduced, reduced membrane excitability, and refractory period is prolonged.
75
Higher extracellular Na+ levels allow?
The body to tolerate a greater fluctuation in serum levels
76
What can cause a sodium channel blockade?
TCA overdose, Cocaine toxicity, Diphenhydramine overdose.
77
Minor variations of what Ion can cause significant ECG changes?
K+
78
Ion that has a very prominent role in the cardiac cycle?
K+
79
What ECG sign is the most common with HyperK?
Peaked T waves
80
Sign wave is a sign of?
Impending death due to potassium increase outside the cell
81
First treatment rendered if a sign wave is notable on ECG?
Treat with Calcium Chloride or Sodium Bicarbonate
82
HyperK treatments?
Calcium Chloride, Sodium Bicarbonate, Insulin infusion, dextrose infusion, albuterol, diuretics, hemodialysis
83
What is Hypokalemia commonly caused by?
Diuretics, diarrhea, dialysis
84
Signs of hypokalemia?
A delay in repolarization, prolonged QT segments, ST segment depression, T wave inversion with the “U” wave, PR prolongation
85
Treatment for Hypokalemia?
Administration of LR, comfort measures for pain and muscle spasms. Sometimes IV potassium.
86
What is primarily caused by hyperparathyroidism?
Hypercalcemia
87
Hypercalcemia effects was phase of the cardiac cycle? What does it do to the phase?
Phase 2 (plateau phase.) shortens which means a shortened QT segment.
88
Calcium plays a crucial role in what?
Both myocardial contraction and signal conduction
89
Common target for pharmaceutical intervention do dysrhythmias and management of cardiac output?
Calcium channels
90
The primary cation for initiation of impulses in the SA node?
Calcium
91
What functions very similar to calcium?
Magnesium
92
Primarily caused by hypoparathyroidism?
Hypocalcemia
93
What phase is effected by hypocalcemia?
Phase 2 (Plateau phase) prolongs and causes prolonged QT segment
94
Hypocalcemia increases?
Contraction and excitability of non-cardiac muscle cells
95
Treatment for Torsades De Pointes?
Mag Sulfate 1-2 grams IVP, cardioversion
96
Calcium channel blockade effects what phase?
Phase 2 (Plateau phase) causes an extension of the action potential
97
What are the 2 major kinds of calcium channel blockers?
dihydropyrodines, non-dihydropyrodines
98
Signs and symptoms of an overdose on a Non-dihydropyridine calcium channel blockers?
Hypotension, Bradydysrhythmias (Esp AV blockers), Ventricular Dysrhythmias, Junctional Dysrhythmias, Asystole
99
Signs and symptoms of a Dihydropyridine calcium channel blocker?
Tachycardia and vasodilatory shock.
100
What will calcium channel blocker toxicity typically result in?
Hyperglycemia
101
Beta blocker toxicity signs and symptoms?
Hypotension, bradydysrhythmias (es. AV blocks), Junctional Dysrhythmias, and ventricular Dysrhythmias
102
Beta blockers bind to what and and block what?
Beta receptor sites and block stimulation from catecholamines
103
Cardioselective beta blocking agents target what beta receptor?
Beta 1
104
Beta blockers do what?
Reduce SA node firing rate. Conduction through AV node is slowed and arterial repolarization is prolonged
105
ECG findings of beta blocker overdose?
P wave activity is reduced, PR segment is prolonged, QRS width depend on origin of impulse, and QT segment is prolonged
106
Treatment of a beta blocker overdose?
Glucagon 2-5mg IVP (Recent evidence shows to be ineffective) High dose insulin therapy, Pacing can be attempted but reduced success rate.
107
4 major classes of Vasoactive drugs?
Inopressor, Inodilator, Vasopressor, Vasodilator
108
Right ventricle is a
Low pressure circuit
109
Left ventricle is a
High pressure circuit
110
Central venous pressure (think preload)
Right side
111
Diastolic pressure (Think afterload)
Left side
112
Alpha 1 receptors target?
Venal and arterial system
113
Beta 1 receptors target?
Ventricles
114
Beta 2 receptors target?
Bronchioles
115
Ino means?
Targets heart in some form
116
Inopressors do what?
Increases contraction of heart and increases vasoconstriction
117
What drugs are inopressors?
NorEpi, Epi, Dopamine
118
Norepinephrine’s common name?
Levophed
119
Does for norepi?
2-20 mcg/min
120
NorEpi is
The frontline agent for most shock states especially sepsis
121
NorEpi stimulates what receptors and how?
Alpha 1 agonist by vasoconstriction, has mild beta effects but minimal on heart rate. Lower doses can cause venoconstriction which augments preload.
122
How do you mix levophed and what is the concentration?
4mg in a 250mL D5W. concentration is 16 mcg/mL
123
Epinephrine is the?
Frontline agent in anaphylaxis
124
Epi effects what receptors and how?
Alpha 1 and Beta 1 and 2 agonism. Effects vasoconstriction, inotropy, and heart rate. Can be proarrhythmic due to the beta agonism
125
What is the dose to Epi?
2-20 mcg/min
126
How do you mix Epi and what is the concentration?
1mg of 1:1 Epi in 100mL of D5W. Concentration is 10 mcg/mL
127
Dopamines concentration?
800mg/250mL of D5W
128
Dose to Dopamine?
2-20 mcg/kg/min
129
Why is dopamine not primarily used anymore?
It’s difficult to use effectively as its effects change as you increase dosage
130
What receptors does dopamine effect?
Alpha 1, beta 1, beta 2 agonism.
131
What’s the dosage of dopamine to effect Alpha 1 receptors?
Up to 10 mcg/kg/min
132
What’s the dosage of Dopamine to get Beta receptor effects?
10 mcg/kg/min and higher
133
What drugs are vasopressors?
Phenylephrine (Neosynephrine) and Vasopressin (ADH)
134
What does phenylephrine effect and cause?
Strong alpha 1 agonism and causes potent vasoconstriction without effect on the heart
135
What dos vasopressin effect and cause?
Targets V receptors and causes potent vasoconstriction. Also stimulates the retention of solute-free water.
136
What drugs are inodilators?
Dobutamine and Milrinone (primacor)
137
Dosage of dobutamine?
2-10 mcg/kg/min
138
Milrinone dosage?
0.375-0.75 mcg/kg/min
139
Dobutamine effects what receptor and causes what?
Very strong beta 1 agonism, increases heart rate, force of contraction and causes vasodilation.
140
When is dobutamine indicated?
Heart failure and cardiogenic shock
141
What does Milrinone do and effect?
Phosphodiasterase inhibitor and increases force of contraction and vasodilation
142
When is Milrinone indicated?
Indicated in heart failure and cariogenic shock (Mainly seen with pediatrics)
143
What drugs are vasodilators?
Nitroglycerin, Nicardipine, and Nitroprusside
144
What does Nitro do?
Strong venodilator and mild arterial dilation. Effects arteries with increased dosages.
145
What’s the dosage for Nitro?
5-400 mcg/min
146
What does nicardipine effect and do?
Arterial selective calcium channel blocker. Strong arterial dilator
147
Dosage of Nicardipine?
5-15 mg/hr must titrate cautiously
148
Common name for nicardipine?
Cardene
149
Common name for nitropprusside?
Nitropress
150
What does nitroprusside do?
Very potent arterial dilator
151
What does nitroprusside breakdown to and what to watch for?
Breaks down to nitric oxide. Watch for cyanide toxicity
152
With this medication a arterial line placed is highly recommended
Nitropress
153
How many Anti arrhythmic drug classes are there?
4
154
What is class 1 effect? antiarrythmics
Na+ (Lidocaine, Procainmide)
155
What does class 2 effect? Antiarrythmics
Beta blockers (Metoporol, Esmolol, Labetalol)
156
What does class 3 effect? Antiarrythmics
K+ (Amiodarone)
157
What does class 4 effect? Antiarrythmics
Ca++ (Cardizem, verapamil)
158
Hyperkalemia is seen in patients with?
Rhabdomyolysis, Burns, Profound acidosis, Crush patients for compartment syndrome.
159
Nitro dose to cause venodilation?
5-50 mcg/min
160
Nitro to cause arterial dilation?
50-100 mcg/min starting range.
