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Perf tech 3 > Endocrine > Flashcards

Endocrine Flashcards

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1
Q

non pulsatile flow may affect

A

flow distribution to organs and within organs

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2
Q

hypothermia effect on hormonal and biochemical rxn

A

decreased rate of biochemical rxn and disrupts hormonal response

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3
Q

hemodilution effect

A

disrupts concentrations of hormones and electrolytes

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4
Q

difficult to pinpoint source of

A

stress hormones. may be an increase post bypass

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5
Q

deeper levels of anesthesia appear to reduce

A

or eliminate endocrine responses and decreases morbidity

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6
Q

type of anesthesia that further reduces endocrine response

A

spinal and epidural

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7
Q

pituitary type of fxn

A

neural (posterior) and endocrine (anterior)

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8
Q

posterior pituitary is the _____ and secretes______

A

neurosecretory and is modified nervous tissue. ADH oxytocin (does not produce these)

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9
Q

high concentrations of ADH cause

A

INCREASE perpheral resis. decrease contractility, decrease coronary BF, REDUCES RENAL BF, increase von willbrand factor,

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10
Q

what causes adh release?

A

increase plasma osmolarity, decrease BF or decrease BP or percieved decrease Bp, hypoglycemia, angiotensin 2, stress , pain

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11
Q

huge ADH release may be initiated by

A

initiation of bypass and transient decrease in BP, VENTING

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12
Q

prevention of ADH release

A

diuretic, pulsatile flow decrease post op only no effect on u.o.,anesthesia with large doses of synthetic opioids (fentanyl 50ug/kg), regional anesthesia

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13
Q

adh concentrations increase regardless

A

of anesthesia pointless!!

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14
Q

anterior portion secretes trophic hormones

A

ACTH,TSH, ovaries and testes, HGH

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15
Q

pituitary apoplexy

A

most damaging complication to pituitary, rare and occurs with pituitary adenomas,

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16
Q

pituitary apoplexy symptoms

A

droopy eyelids, opthamoplegia, non reactive dilated pupils, decreased visual acuity, hormonal defects

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17
Q

high concentrations of vasopressin

A

increase peripheral vascular resistance, decrease contractility, decrease coronary BF, increase vascular resistance, reduce renal BF, stimulates release of von willebrand factor

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18
Q

what stimulate vasopressin release

A

increase in plasma osmolarity, decrease in BV OR BP, hypoglycemia, angiotensin , stress, pain

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19
Q

steps to ADH release form CPB (7)

A
  1. )Hypothalamus osmoreceptor cells detect increased serum osmolarity
  2. ) posterior pituitary releases ADH due to increase serum osmolarity
  3. )vasopressin binds to kidneys allowing increased water reabsorption from urine
  4. ) increases urine osmolarity and decreases its volume
  5. )decreases serum osmolarity and increases volume
  6. )decreased serum osmolarity is detected by osmoreceptors in hypothalamus and ADH is reduced
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20
Q

ADH may be initiated by bypass due to

A

decrease in CBV and BP. Venting keeps LAP low stimulating low CBV

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21
Q

can we prevent adh release

A

no but it can be reduced.

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22
Q

pulsatile flow adh release

A

No significant decrease during bypass but decreases it 48 hours after. U.O. does not change

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23
Q

anesthesia can reduce adh release by

A

giving large doses of synthetic opioids. fentanyl (50ug/kg)

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24
Q

regional anesthesia can reduce adh in

A

non cardiac procedures

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25
adh concentrations increase during cpb irrespective
of anesthesia or perfusion technique
26
damage to pituitary usually blamed
on ischemia, hemorrhage, and edema of gland. HGH hypophysectomy
27
treatment of pituitary apoplexy
HGH / hypophysectomy
28
epinephrine concentration increases
10 fold
29
nore epinephrine concentration
4 fold
30
catecholmine secretion can be reduced
deep anesthesia vs. light, propofol infusion (4 mg/kg/hr) vs single bolus injection (.1mg/kg), high dose opioid general (fentanyl or sufentanil) general anesthesia with spinal block (bupivacaine) vs. general anesthesia
31
cortisol is released in reponse
to stress. increases stores of sugar in liver as glycogen. increases blood sugar
32
adrenocorticotropic hormone
promotes increased production and release of corticosteroids and cortisol. acts as appetite suppressant, anxietiomimetic and pro inflammatory
33
adrenal cortical hormones are increased and how is it attenuated
in the initiation of bypass. increase attenuated with deeper levels of anesthesia and addition of thoracic epidural
34
carbohydrate metabolism regulated by
insulin, glucagon, cortisol, growth hormone, epinephrine
35
hyperglycemia is worse with
hypothermia
36
hypoinsulinemia is worse with
hypothermia
37
type 1 dm do not require
insulin doses
38
type 2 dm do require
insulin doses
39
atrial natriuretic factor and is antagonist of what
incredibly efficacious vasodilator . antagonist of aldosterone
40
anf peptides released by
cardiac atria
41
anf release triggered by
atrial distension. b adrenergic stimulation, angiotensin 2, hypernatremia, endothelins
42
ANF physiologic causes
increase GFR, inhibits renin release, reduced plasma concentrations of aldosterone, antagonize renal vasoconstrictors, reduce ABP
43
ANF PREVENTS
scarring of ischemic myocardium and has other anti ischemic effects on cardiomyocytes and vascular endothelium
44
ANF cancentrations are reduced during
hypothermia and cross clamping
45
ANF conentrations rise during
rewarming and post bypass. mormal relation between factor conc. and pressure lost during bypass
46
renin angiotensin aldosterone regulates
atrial pressure, intravascular volume, electrolyte balance
47
what secretes renin
juxtaglomerular apparatus due to Na depletion, decreased BV, reduced renal perfusion
48
ACE inhibitors and ARBS temporarily
breaks the linkage between Renin angiotensin aldosterone and hypo or hypertension during immediately post bypass
49
eicosanoids metabolized by
lungs
50
prostaglandins mostly related to
inflammation
51
thromboxanes related to
injury
52
Endoperoxide prostaglandins H2 produces
PGE2, PGF2alpha, PGD2 | prostacyclin (PGI2) or thromboxane (TXA2)
53
PGE
generally vasodilator
54
PGF2alpha, PGD2
pulmonary vasoconstrictor
55
PGI2
disaggregates platelets, potent vasodilator
56
TXA2
platelet aggregator, potent vasoconstrictor
57
Prostacyclin & thromboxane increase during bypass and
start to decrease after
58
Aprotinin
protease inhibitor – reduces increase in thromboxane – no effect on prostacyclin – better preservation of platelet function
59
“sick euthyroid syndrome
T3 and T4 levels are low but the thyroid gland is apparently “normal” The result of disruption of the thyrotropic feedback loop Mixed evidence whether giving thyroxine helps (trophic and pro-metabolic effects) or hurts (possible increased risk of MIs)
60
Many things stimulate histamine release like...
``` opioids (morphine / meperidine) muscle relaxants (tubocurarine) antibiotics heparin protamine ```
61
calcium con concentration
Ionized (50%), bound to protein (40%), chelated (10%)
62
calcium Blood concentration maintained by
parathormone and vitamin D (bones / kidney)
63
calcium changes during bypass attributed to
type of fluids used and addition calcium. parathormone secretion not affected by bypass
64
Give extra calcium only when the following three conditions are present
1) ready to terminate bypass 2) ionized calcium is reduced 3) need to increase contractility and blood pressure
65
magnesium key players in these enzyme finctions
``` transmembrane electrolyte gradients energy metabolism synthesis various messaging substances function of ion channels hormone secretion and action ```
66
mag concentrations
Ionized (55%), bound protein (30%), chelated (15%)
67
mag decreases during and is associated with
bypass. arrhythmias
68
mag benefits
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
69
typical mag dose
2 grams post cross clamp
70
Changes in potassium concentration caused by
``` 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) ```
71
Hyperkalemia not uncommon with
multi dose high k protocols
72
Hypokalemia may be increasing
as the use of Custodial CP increases
73
Albumin may help reduce
decrease in concentration

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