Pharm 4

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Anonymous
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46595
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Pharm 4
Updated:
2010-11-01 19:09:46
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Pharm Exam
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Pharm 4
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  1. Cardiogenic Shock: Acute Heart Failure
    What is it?
    What are the causes?
    Cardiogenic shock is the stoppage of the heart.

    • Causes:
    • Acute MI
    • Cardiac Arrhythmias
    • Valve Issues
    • End-Stage Chronic Heart Failure
  2. Treatment for Cardiogenic Shock: Acute Heart Failure
    • Positive Ionotrophic Agents = Increase CO
    • 1) Beta-1-Adrengeric Receptors (DOBUTAMINE (selective beta-1-agonist), DOPAMINE (converts both norepinephrine & epinephrine and sustains blood flow to the kidneys through dopamine (DA) receptors)
    • 2) Phosphodiesterase 3 (PDE3) Inhibitors: MILRINONE (dihydropyridine); blocking PDE = accumulation of cAMP resulting in positive ionotropic effects
    • 3) Muscarinic Rec Antagonists: ATROPINE (blocks effects of the parasympathetic ns on the heart)
  3. Chronic/Congestive Heart Failure...
    CO is insufficient to meet the oxygen demands of the body
  4. Chronic/Congestive Heart Failure
    Causes (5)
    • #1: Coronary Artery Disease / MI
    • #2: Hypertension resulting in cardiac hypertrophy
    • Others:
    • Valve disease/dysfunction
    • Cardiomyopathy
    • Congenital defects
    • Endocarditis/myocarditis
  5. Chronic/Congestive Heart Failure
    • 1. Decreased blood distribution & reduced oxygenation of tissue = FATIGUE
    • 2. Back-up of blood w/in the venous circulation = "PITTING" EDEMA OF THE LOWER LIMBS
    • RIGHT HEART FAILURE DIASTOLIC
    • 3. Back-up of blood in the pulmonary circulation = PULMONARY EDEMA
    • 4. Accumulation of blood in the ventricles = ENLARGED HEART
    • 3 & 4 = LEFT HEART FAILURE/SYSTOLIC
  6. Symptoms of Heart Failure (7)
    • Skin cyanotic & clammy
    • Upright posture/leaning forward
    • Persistent cough
    • Rapid Breathing/Fast Heart Rate
    • Edema of the lower limbs
    • Anxiety/restlessness
  7. Chronic Heart Failure
    Treatment Goal?
    Increase CO b/c cause is CO is insufficient to meet the oxygen demands of the body
  8. Determinants of CO (4)
    • CHAP
    • Contractility: force of contraction
    • Heart Rate: frequency of contraction
    • Afterload: resistance against which the heart has to pump
    • Preload: volume of blood in heart prior to contraction
  9. Determinants of CO (4) in detail.
    • Contractility: force of contraction
    • -calcium dependent (involves ca dependent ca release)
    • -regulated by sympathetic ns (beta 1 receptors)
    • Heart Rate: frequency of contraction
    • -regulated by sympathetic ns (beta 1 receptors)
    • -increasing the heart rate in congestive heart failure is counter-productive (produces further mismatch btw filling & contraction)
    • Afterload: resistance against which the heart has to pump
    • -arterial smooth muscle
    • -regulated by sympathetic ns (alpha 1 receptors)
    • -regulated by renin-angiotensin system (angiotensin II)
    • Preload: volume of blood in the heart prior to contraction
    • -return of blood to the heart: VEINS
    • -total blood volume: KIDNEY
    • -regulated by the renin-angiotensin system (angiotensin II)
  10. Preload: definition/determinants
    • Volume of blood in the left ventricle prior to contraction (end diastolic ventricular volume/pressure)
    • Determinants:
    • 1) Venous return (VEINS)
    • 2) Blood volume (KIDNEY)
  11. Frank Starling Law
    • CO is determined by preload
    • (too much or too little preload = decreased CO)
    • congestive hf: accumulation of blood in the heart = increased preload & decreased CO

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