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Maddy - CPR II - some pharm > Fatigue and Weakness > Flashcards

Fatigue and Weakness Flashcards

(49 cards)

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1
Q

normal serum osmolarity

- what is the limit of hyponatremia

A

normal: 280-290
hyponatremia: <135

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2
Q

osmotic stimuli for ADH

A

increases in serum osmolality detected by osmoreceptors

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3
Q

non-osmotic stimuli for ADH

A
    • decrease in BP detected by baroreceptors
  • nausea
  • hypoxia
  • pain
  • mediations (opiates, antipsychotics, antidepressants)
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4
Q

hyponatremia results primarily from:

A

increase in total body water

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5
Q

if pt has hypo-osmotic hyponatremia, what should you measure

A

random urine sodium level and urine osmolality

- obtain serum uric acid if suspecting SIADH

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6
Q

low serum uric acid is associated w/

A

SIADH

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7
Q

what is hyperglycemic sodium correction

A

Na decreases 1.6 mEq/L for every 100 mg/dL increase in glucose

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8
Q

what must you rule out when diagnosing SIADH

A

cortisol deficiency and hypothyroidism

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9
Q

essential diagnostic criteria for SIADH

A
  • decreased ECF osmolality
  • inappropriate urine concentration
  • clinical euvolemia
  • elevated urine Na+ under normal salt and water intake
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10
Q

most common malignancy associated with ectopic ADH prodcution

A

small cell lung cancer

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11
Q

what drugs are associated w/ causing SIADH

A
  • antidepressants
  • anticonvulsants
  • anticancer drug cyclophosphamide
  • opiates
  • MDMA (ectasy)
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12
Q

sx of hyponatremia (when serum sodium gets to <125)

A
  • HA
  • fatigue/lethargy
  • dizziness
  • nausea
  • confusion
  • gait instability
  • psychosis
  • seizures
  • coma from cerebral edema
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13
Q

complications of hyponatremia

A
  • increased falls
  • death
  • osmotic demyelination syndrome
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14
Q

why does osmotic demyelination occur

A

rapid serum Na+ correction in chronic hyponatremia

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15
Q

general rule of thumb for tx hyponatremia

A

serum Na+ should be corrected over same time period it took to become low

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16
Q

tx for acute hyponatremia (less than 48 hrs)

A

can have rapid correction of serum sodium w/ little risk of ODS

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17
Q

tx for chronic hyponatremia (more than 48 hrs or unknown)

A
  • be careful of rapid correction b/c risk of ODS

- raise serum Na+ by 8-10 mEq/day with no more than 18 in first 48 hours

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18
Q

tx for symptomatic pts w/ hyponatremia

A
  • 100 mL IV bolus hypertonic saline over 10 mins

- continuous IV hypertonic saline

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19
Q

sx of osmotic demyelination syndrome (ODS)

A
  • dysarthria
  • dysphagia
  • paraparesis or quadriparesis
  • behavioral disturbances
  • pseudobulbar palsy
  • seizures
  • lethargy
  • confusin
  • coma
  • death
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20
Q

preferred imaging modality for dx ODS

21
Q

pathophysiology of ODS

Study These Flashcards
A

too fast Na+ correction –> axonal shear damage occurs –> disruption of BBB –> demyelination

22
Q

what cells are in charge of secretion and reabsorption of K+

Study These Flashcards
A

secretion: principle cells
reabsorption: a-intercalated cells

23
Q

describe potassium transport along the nephron

Study These Flashcards
A

PCT: 65% reabsorption
TAL: 25% reabsorption
DCT: 0-120% secretion
Collecting Duct: 5% reabsorption

24
Q

clinical manifestations hyperkalemia

Study These Flashcards
A
  • cardiac arrhythmias
  • skeletal muscle weakness
  • metabolic acidosis
  • decreased ammoniagenesis and decreased ammonium excretion in kidneys
25
describe the electrophysiology of why potassium causes cardiac arrhythmias and neuromuscular weakness/paralysis
long term hyperkalemia --> resting membrane potential remains more positive than normal --> leads to inactivation of sodium channels --> net decrease in membrane excitability --> impaired cardiac conduction and/or neuromuscular weakness/paralysis
26
ECG changes at 6-7 mmol/l K+
peaked T waves
27
ECG changes at 7-8 mmol/l K+
- flattened P wave - prolonged PR - depressed ST - peaked T wave
28
ECG changes at 8-9 mmol/l K+
- atrial standstill - prolonged QRS - peaked T wave
29
ECG changes at >9 mmol/l K+
sinusoid wave pattern (v fib)
30
what meds can cause hyperkalemia
- B2 blockers - a1 agonists - digoxin - succinylcholine - minoxidil
31
what extrinsic events can cause cells to release intracellular potassium leading to hyperkalemia
- burns - trauma - radiation - tumor lysis syndrome - rhabdomyolysis
32
how does insulin deficiency cause hyperkalemia
insulin stimulates Na/K ATPase and drive K+ intracellularly, so without it you'll have excess K+ outside the cell
33
how does aldosterone affect K+ levels
low aldosterone --> hyperkalemia | high aldosterone --> ^^potassium secretion (hypokalemia)
34
how does GFR affect K+ levels
low GFR --> hyperkalemia
35
how does a ureterojejunostomy affect K+ levels
bowel reabsorbs K+ excreted in the urine --> hyperkalemia
36
causes of pseudohyperkalemia
- RBC hemolysis during venipuncture - sampling clotted blood samples - leukocytosis
37
how does leukocytosis cause pseudohyperkalemia
leukemia pts have fragile WBCs which can then rupture during centrifugation and release K+
38
how does fractional excretion of K+ determine renal or extrarenal etiology
FEK < 10%: renal | FEK > 10%: extrarenal
39
tx for peaked T waves caused by hyperkalemia
calcium gluconate
40
tx for transcellular shift of K+ causing hyperkalemia
- insuline and dextrose - B2 agonist - bicarbonate infusion
41
tx for potassium removal in pts w/ hyperkalemia
- loop diuretic or thiazide - exchange resins - hemodialysis
42
compare central and obstructive sleep apnea
central: caused by failure of respiratory center in brainstem obstructive: upper airway obstruction resulting in decreased air flow
43
how does OSA lead to heart disease
OSA --> decreased PO2 and increased PCO2, increase BP, oxidative stress, inflammation, intrathoracic pressure, LV wall tension, decreased myocardial O2 delivery --> heart dz
44
how do diagnose OSA
polysomnography
45
compare apnea and hypopnea
apnea: complete obstruction for 10 seconds hypopnea: partial obstruction for 10 seconds
46
compare mild, moderate, and severe OSA
mild: AHI 5-14 events/hour moderate: AHI >15-29 events/hour severe: AHI >30 events/hour
47
calculating AHI
adding all the apneas and hypopneas and dividing by total sleep time
48
tx OSA
- weight loss | - cpap
49
compare systolic and diastolic HF
systolic: EF < 40% diastolic: EF > 50%

Maddy - CPR II - some pharm (18 decks)

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