test 3 cont

Question 1

vasopressin also called

Answer 1

-anti-diuretic hormone

Question 2

vasopressin does what

Answer 2

Regulates renal water excretion (POTENT)

Question 3

high concentrations of vasopressin causes

Answer 3

 increase peripheral vascular resistance
 decrease cardiac contractility
 decrease coronary blood flow
 increase renal vascular resistance (hold onto water)
 decrease renal blood flow
 Stimulates release of von Willebrand factor which is key in the clotting cascade (improve hemostasis)

Question 4

What Stimulates Vasopressin Release?

Answer 4

increase plasma osmolarity
decrease blood volume or decreased blood pressure
Hypoglycemia
Angiotensin
Stress
Pain
General anesthesia & surgery (MODERATE)
Angiotensin converting enzyme (ACE) inhibitors

Question 5

what happens to ADH when put on bypass

Answer 5

 huge increase in ADH with bypass

Question 6

the increase in ADH because of bypass may be initiated by

Answer 6

 ↓ in Blood volume with CPB initiation
 ↓ LA pressure (volume depletion)
 Transient Hypotension

Question 7

prevention of increase in vasopressin on pump

Answer 7

 Anesthesia with large doses of synthetic opioids but doesn’t completely prevent
-HELP DECREASE THE MAGNITUDE OF THE INCREASE, BUT NOT ELIMINATE THE INCREASE COMPLETELY!

Question 8

Catecholamines

Answer 8

 Epinephrine and norepinephrine released from the adrenal medulla and Peripheral sympathetic & central nerve terminal (NE
only)
 Potent vasoconstrictor (Alter intra-organ blood flow)

Question 9

What happens to catecholamines during CPB

Answer 9

 Overall increase during cardiopulmonary bypass
 Epinephrine - increases 10 fold over Pre-CPB
 Norepinephrine - increases 4 fold over Pre-CPB

Question 10

How do you decrease the response of the catecholamines during CPB

Answer 10

-decrease the temp

Question 11

prevention of the catecholamines

Answer 11

 Deep anesthesia versus light
 Propofol infusion during bypass versus single bolus injection diazepam
 High dose opiod general anesthesia (fentanyl or sufentanil) plus thoracic epidural versus high dose opiod anesthesia alone
-ANESTHESIA PLAYS A MAJOR ROLE
-magnitude of increase can be reduced but not eliminated

Question 12

epinephrine concentrations max

Answer 12

• right before we come off bypass

- eliminate spike using pulsatile flow

Question 13

norepinephrine concentrations max

Answer 13

• after bypass

- pulsatile perfusion decrease peak

Question 14

Adrenal Cortical Hormones

Answer 14

 Cortisol

 Adrenocorticotropic hormone

Question 15

Cortisol

Answer 15

 Corticosteroid
 Released in response to stress
 Increases blood sugar
-sugar in liver as glycogen

Question 16

Adrenocorticotropic hormone

Answer 16

 Corticotropin

-initiates the release of corisol

Question 17

initiation of bypass, what happens to [] of Cortisol and

Adrenocorticotropic Hormone

Answer 17

-increase

Question 18

Increase in Cortisol and

Adrenocorticotropic may be attenuated by

Answer 18

 Deeper levels of anesthesia

 Addition of thoracic epidural

Question 19

Glucose is a carbohydrate metabolism regulated by

Answer 19

 insulin
 glucagon
 cortisol
 growth hormone
 epinephrine

Question 20

on bypass, what happens to: glucose and insulin

Answer 20

 Glucose concentration increases
 Insulin levels decrease (insulin resistance)
 All influenced by hypothermic bypass

Question 21

atrial natriuretic factor

Answer 21

 Release triggered by atrial distention

• released by cardiac atria
• helps control fluid balance

Question 22

what does the renin-angiotensin-aldosterone do

Answer 22

 Regulates arterial blood pressure, intravascular volume, electrolyte balance

Question 23

when is renin released and what secretes it?

Answer 23

 Juxtaglomerular apparatus secretes renin
 In response to:
-sodium depletion
-decreased blood volume
-reduced renal perfusion

Question 24

renin does what to angiotensinogen

Answer 24

-catalyzes conversion to angiotensin I (increased activity) (happens in blood)

Question 25

angiotensin I to II via

Answer 25

- angiotensin-converting enzyme (ACE) - happens in the lungs - lose this whole process on bypass

Question 26

aldosterone stimulates the reabsorption of what

Answer 26

-sodium-> increasing volume

Question 27

angiotensin II does what

Answer 27

 increased blood pressure by direct vasoconstriction |  stimulates release of aldosterone for adrenal glands

Question 28

aldosterone does what

Answer 28

 stimulates reabsorption of sodium and secretion of | potassium and hydrogen ion by renal distal tubules

Question 29

eicosanoids are what

Answer 29

-prostaglandins and thromboxanes

Question 30

what is PGE and what does it do

Answer 30

- vasodilator | - prostaglandin

Question 31

what is TXA2

Answer 31

-platelet aggregator and a vasoconstrictor

Question 32

Histamine is

Answer 32

 Potent vasodilator

Question 33

what stimulates histamine release

Answer 33

```  opioids (morphine / meperidine)  muscle relaxants (tubocurarine)  antibiotics  heparin  protamine [] increases with heparin given ```

Question 34

what causing an increase in the release of calcium

Answer 34

 decreased ionized calcium concentration  Hypocalcemia  hypomagnesemia

Question 35

On bypass, changes in calcium are caused by

Answer 35

 Type of priming solutions  Blood products  Use of albumin

Question 36

Magnesium

Answer 36

 Second most abundant intracellular cation - doesn't have a hormone to increase it's levels - keep membrane stability - not enough magnesium leads to things not working as good as they should

Question 37

what does calcium and magnesium bind to?

Answer 37

-albumin

Question 38

what happens to [magnesium] while on bypas

Answer 38

```  Decreases during bypass  Hemodilution  Chelation by albumin, blood products  Once low – takes a while to come back up  No hormonal support to increase -HELPS SUPPRESS ARRHYTHMIAS ```

Question 39

Potassium levels

Answer 39

shoot for 4.5