exam 4 Flashcards
1
Q
causes of dysrhythmias
A
automaticity (spontaneous depolarziations)
re-entry (propogation of more than one pathway)
2
Q
Pacemaker/Nodal = “slow” = dependent on ___________ for phase 0
A
calcium
3
Q
nodal
phase 0: ______ in
phase 3: ___________ out
phase 4:
A
calcium IN
potassium OUT
phase 4: LEAKY
no phase 1 or 2!
4
Q
blocking K is ____________
A
refractory
5
Q
blocking Na is ___________
A
velocity
6
Q
blocking Ca is ___________
A
nodal
7
Q
increase in heart rate = increase in _______
A
slope
8
Q
sodium blockers/membrane stabilizers
Blocking sodium moves the threshold potential farther away from the resting potential*
A
Class 1
9
Q
example of Class I
A
lidocaine
10
Q
beta blockers
A
Class 2
11
Q
It is BETTER to use a beta-1 selective blocker (____________), instead of beta-1 and beta-2 (labetalol), which can cause a bronchospasm*
A
metoprolol is better!!!
12
Q
beta ___ can cause bronchospasm
A
beta 2 (labetalol)
13
Q
which classes reduce mortality risk
A
CLass 2 (beta blockers)
Class 3 (potassium blockers-amio)
14
Q
refractory prolongers
A
Class III
potassium blockers
15
Q
example of a class III drug
A
amio
16
Q
- MOA
o Dilates coronary arteries (anti-angina)
o Blocks sodium and reduces currents of potassium and calcium
o Prolongs AP, refractory, and conduction
o Alpha + beta antagonist = vasodilation
A
class 3
17
Q
adverse effects of amio (class III)
A
o Hypotension r/t vasodilation
o Pulmonary toxicity (lipophilic, slow elimination)
o Marked QT prolongation
o Resistant to catecholamines
o Reduces oxygen concentrations
bradycardia, AV block
o Altered thyroid function
o LV depression
18
Q
calcium channel blockers
A
class 4
19
Q
indicated for Afib, aflutter, paroxysmal SVT (supraventricular/atrial issues)
A
class 4
20
Q
which classes decrease nodal depolarization
A
class 2 and 4
21
Q
Effective if rapid bolus though central line only
A
adenosine
22
Q
o Treats supraventricular/atrial issues
A
digoxin
23
Q
Useful in ventricular dysrhythmias + digitalis toxicity induced ventricular dysrhythmias*
A
phenytoin
24
Q
o Useful in
Torsades de Pointes
digitalis-induced dysrhythmias
ventricular ectopy
A
magnesium
25
Produces decreased lusitropic (myocardial relaxation) effects and potent coronary vasoconstriction
vasopressin
26
What is the negative issue with many antidysrhythmic?
cardiac depressant effects
27
what ultimately propels GFR
pressure
28
↑ Increase in arterial pressure stretches afferent arteriolar wall, reflex constriction occurs
↓ Arterial pressure leads to arteriolar dilation
myogenic
29
↓ Decrease in RBF ↓ GFR afferent arteriolar dilation ↑ increased GFR and RBF restored filtration
Renin released AT II ↑ GFR
tubuloglomerular
30
Inhibit reabsorption of NaCl in LOOP, PROXIMAL + DISTAL tubules
↓ SNS in peripheral smooth muscle due to ↓ total body Na+ stores
o Resulting in vasodilation
thiazide diuretics
31
good for elderly
can cause Gout/hyperuricemia
thiazide diuretics
32
example of thiazide diuretic
diuril
33
* Most effective, fastest class
* Stimulates production of prostaglandins
o Resulting in vasodilation
o Increases RBF
loop diuretics
34
Inhibit reabsorption of NaCl in ASCENDING loop
loop diuretics
35
BP drop in ________
(due to SNS) prostaglandins and vasodilation
LASIX
36
massive lasix doses ___________ to NMBs
resistant
37
examples of loop diuretics
* Lasix, Bumex, Demadex, Ethacrynic Acid
38
* Large molecular weight molecule increases plasma osmolarity
* Exerts a “pull”
osmotic diuretics
39
works in the LOOP + PROXIMAL tubule
osmotic diuretics
40
used for neurosx
can cause rebound HTN + pulm edema
osmotic diuretics
41
* Mannitol
* Urea
osmotic diuretics
42
* Used in combination with loop diuretics
* Weak
* Works in the DISTAL tubules and COLLECTING ducts
potassium-sparing
43
CONTRAINDICATORS
ACE inhibitors and NSAIDs
potassium-sparing diuretics
+ aldosterone antagonists?
44
* Spironolactone
aldosterone antagonists
(can lead to HYPERkalemia)
45
* Blocks reabsorption of both Na + HCO3
* Sodium then pulls water into the proximal tubule as an osmotic diuretic
carbonic anhydrase inhibitors
46
* Acidosis (Hyperchloremic metabolic acidosis)
* Drowsiness
* Paresthesia
* Renal calculi
carbonic anhydrase inhibitors
47
* Blocks ADH
Vasopression ANTAGONISTS
(Tolvaptan)
48
D1 receptors in PROXIMAL tubule + LOOP
Dopamine
(LOW dose only!)
49
Causes increased BNP and ANP
“indirectly” cause diuresis
neprilysin inhibitors
50
What category is mannitol?
osmotic diuretic
51
What diuretics can aggravate a diabetic condition/cause hyperglycemia, can also cause hypokalemia (digoxin toxicity)?
* Thiazide and loop diuretics
* Thiazide diuretics are used in combination with other drugs to control BP
52
Which diuretics can reduce the cerebral spinal fluid?
* Mannitol and lasix
(osmotic and loop diuretics)
53
What diuretic must be used with caution when taking NSAID or ACE inhibitor (which raises potassium)?
Potassium sparing diuretics (Triamaterene, Amiloride)
* Aldosterone antagonists (spironolactone)?
54
What 2 conditions increase aldosterone?
Liver Cirrhosis + CHF
so, give aldosterone antagonist (spironolactone)
55
histamine is in mast cells or ___________
basophils
56
* Immunologic mechanism
* Cells have an Ig__ antibody attached to the membrane
* When the antigen is exposed to the cell, degranulation (breakdown) of the cell occurs causing release of histamine and other mediators
* Negative feedback from H2 receptors found in skin and basophils (NOT found in lungs) limits reaction in the skin and blood
HISTAMINE MOA
IgE
no positive feedback in the lungs
57
where is histamine found
mast cell
brain (non mast cell)
enterochromaffin cells (stomach)
58
what type of reaction is anaphylaxis, antigen-antibody
type 1
59
re-exposure to histamine = ___________
bridging of IgE
60
re-exposure/bridging causes cascade of __________ INTO the cell
calcium
61
Increase vascular permeability, contract smooth muscle, wheal
platelet-activating factor
62
Located in brain (nerve endings), endothelium, smooth muscle, cardiac
BronchoCONSTRICTION
slowed HR
coronary artery vasoconstriction (vasospasm)
H1
63
RAPID (transient)
H1
64
SUSTAINED (slow)
H2
65
BronchoDILATION (not as much as H1 though)
Increase in HR
Increase in H ions (acid) from stomach
CNS stimulation
H2
66
Decreases norepi release
Decreases histamine (negative feedback)
H3 and H4
67
Located in the heart
H3
68
Located in the bone marrow
and blood (eosinophils, neutrophils)
H4
69
If you are concerned someone is going to have an allergic reaction
Pretreat with H1 blocker Benadryl and H2 blocker is Pepcid
Make sure you do not only give H2/Pepcid (since H3 will be blocked)
70
hives =
urticaria
71
true allergic reaction causes
pulm HTN and increased inotropy
true
72
reactive airways are _____ greater sensitivity
100-1000x
73
o Not IgE mediated
o Can be fatal
o Resembles anaphylaxis!
anaphylacTOID
74
risk factors for anaphylaxis
* IV drugs
* Allergies
* History of reaction
* Asthma or COPD
* Women (2.5x more likely)
* History of previous anesthetic
75
Do NOT inhibit the release of histamine; instead, they BLOCK the receptors
o Benadryl, Dramamine, Bonine, Phenergen
H1 blockers
76
* Tagamet, Pepcid
H2 blockers
77
anaphylaxis:
Physiologic antagonist = ______
epi
78
anaphylaxis:
Prevent RELEASE of histamine
Beta 2 agonists (Cromolyn)
79
anaphylaxis:
Receptor blockers
antihistamines
80
top 3 drugs that cause anaphylaxis
NMBs
abx (b lactam, cephalosporins + penicillins)
latex
* Morphine, Demerol, codeine (histamine)
* Induction agents
* Local anesthetics (preservatives)
* Blood products (preservatives in the blood)
* Protamine
81
Assessment of Type 1 Reaction
Erythema (flushing) Urticaria (hives), with or without angioedema
Mild
grade 1
82
Assessment of Type 1 Reaction
Moderate severity Cutaneous signs
Hypotension and tachycardia
Difficult to ventilate
Grade 2
83
Assessment of Type 1 Reaction
Life-threatening
Hypotension, tachy or brady
Dysrhythmias
Bronchospasm
grade 3
84
Assessment of Type 1 Reaction
Cardiac/resp arrest
PEA
grade 4
85
treatment for anaphylaxis
remove agent
trendelenburg
intubate
epi + albuterol
fluids
vaso
beta blockade
antihistamines
86
what 2 drugs can be used with pretreatment for histamine
ephedrine
decadron
87
mineralocorticoid
aldosterone
88
o Function
Maintain extracellular fluid volume, plasma concentrations of ions, conservation of sodium (to attract water)
mineralcorticoids
89
what are stimulators of mineralcorticoids
Hyperkalemia
Hyponatremia
ACTH (adrenocorticotrophic hormone)
AT II
90
Glucocorticoids
cortisol
91
Essential for life, not stored in the body
Glucocorticoids
92
anti-emetic
Increase the number + sensitivity of beta-adrenergic receptors
Decrease immune response
Anti-inflammatory effects
Affects carbs, proteins, and fats
cortisol
93
cortisol insufficiency cause of death
Unexplained hypovolemic shock
UNRESPONSIVE to catecholamines
94
drug interactions with glucocorticoids
Etomidate suppresses cortisol synthesis
Opioids (large doses)
Volatile agents
95
cortisol is also known as
hydrocortisone
96
Items that come in contact with mucous membranes or non-intact skin
Items that are soiled by blood, body fluids, or pathogens
HIGH-level disinfection
semi-critical risk
97
Items that touch intact skin or do not come in contact with skin
Intermediate or Low-Level Disinfection
Non-Critical Risk
98
what is not killed by disinfection
spores
prions
99
Decreasing the number of microorganisms on an inanimate surface to acceptable for public health purposes
sanitization
100
The process of killing microorganisms, not spores, with hot water or steam
pasteurization
101
An agent applied to living tissue to kill or prevent growth of microorganisms
Antiseptic
102
Target=only bacteria
alcohol
103
Target=bacteria (gram+ and gram-), fungi, viruses
(no effect on TB)
Quaternary ammonium compounds
104
If bottles are open, it supports growth of pseudomonas
Quaternary ammonium compounds
105
Target=bacteria (gram+ and gram-),
moderate effect on fungi and viruses,
spores’ activity is DECREASED (inhibited, not killed)
chlorhexidine
106
Neural toxicity (do not use with epidural catheter)
Sensorineural deafness (do not use with middle ear surgery)
chlorhexidine
107
Preferred/best choice for CVL placement over betadine
Residual/persistent effect: keeps working after it is placed
chlorhexidine
108
Most active antiseptic for intact skin*
iodine
109
Target=bacteria, viruses, and after 15 minutes spores
iodine
110
Target=bacteria, mycobacteria, fungi, lipid containing viruses, spores (with prolonged exposure)
iodophors
111
Target=bacteria (especially gram+)
Decreased bacteria by only 30-50% initially, but continued to decrease down to 4% (96% elimination)!
hexachlorophene
112
* Caused brain damage in neonates after daily bathing
* Neurotoxic effects, cerebral irritability if absorbed
* Do not use routinely while pregnant
hexachlorophene
113
An agent or treatment applied to an inanimate surface to destroy most microorganisms or viruses, but NOT spores
disinfectant
114
what temp for pasteurization
NOT SPORES
Target=bacteria, gram- rods, mycobacteria TB, fungi, viruses
68 C for 30 minutes
115
The process that kills or removes all types of microorganisms, including spores, fungi, and viruses
sterilization
116
what is only chemical used for sterilization
ethylene oxide
(all organisms at room temp)
117
Can be absorbed* irritation and allergic reactions
Associated with latex allergy, spina bifida
May fail in the presence of organic debris or biofilm
ethylene oxide
118
Target=bacteria, fungi, viruses, 2-4 days for spores
formaldehyde
119
Target=bacteria, mycobacteria TB, fungi, viruses, spores
Cidex
120
Alternative to autoclaves
Target=bacteria (gram+ and gram-), fungi, spores
insta pot
121
Target=bacteria (gonococci- eye drops in neonates at risk)
wounds, burns
silver nitrate
122
which drugs kill spores
sterilization
insta pot
ethylene oxide
cidex
iodine (after 15 minutes)
formaldehyde (after 2-4 days)
iodophors (with prolonged exposure)
chlorhexidine (spores activity is decreased)
123
limitations to depressant medications
* Infants
* Elderly
* Decreased LOC
* Intracranial pathology
* Severe pulm dx
* Hypovolemia
* Full stomachs
124
Implicated as teratogenic (do not use in FIRST trimester pregnancies
benzos
125
Prostaglandin INHIBITION may decrease platelet aggregation
nsaids
126
o Blocks calcium channels
o Decreases norepi
o Decreases glutamate
Decreases excitability of dorsal horn neurons
elderly can become more sedated
gabapentin
127
vagolytic
PREVENTS bradycardia (causes tachycardia)
128
treatment for central anticholinergic syndrome
physostigmine
129
o Decreasing the amount of H ions
o Leading to a gradual, slow increase in pH
H2 blockers
130
Enhances the effects of Ach on the intestinal smooth muscle to speed gastric emptying, increase LES tone, relax the pylorus and duodenum, and lower gastric VOLUME
reglan
131
Increase the gastric pH by neutralizing the H ions with a base
increases gastric volume slightly (negative)
antacids
132
MOST effective in controlling both gastric pH and gastric volume
Limits the last step in secretion of H ions (hydrogen-potassium ATPase)
Membrane enzyme proton pump on gastric parietal cells
PPIs
