Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/66

Click to flip

66 Cards in this Set

  • Front
  • Back
What is the formula for MAP?
2/3 DBP + 1/3 SBP
What is the formula for BP?
CO x SVR
What is the formula for CO?
SV x HR
What is the definition of preload?
how much blood is going to the left ventricle (LV)
What is left ventricular end diastolic volume (LVEDV)?
volume right before systole reflects how much blood is going to be pumped out of the heart
What can be used to estimate LVEDV?
pulmonary capillary wedge pressure (PCWP)
What is the definition of afterload?
resistance of the LV
What is used to estimate afterload?
SVR
What is the formula for cardiac index (CI)?
CO/BSA
What does a central venous catheter (CVC) measure?
BP and fluid status
What is a pulmonary arterial catheter useful for? (4)
1)volume status
2)volume performance
3)estimating O2 delivery and uptake
4)differentiating shock syndromes
What complications can be caused w/ the use of a pulmonary arterial catheter?
1)premature atrial or ventricular contractions
2)pulmonary artery rupture
CO normal value
4.7L/min
CI normal value
2.8-4.5 L/min/m2
SV normal value
60-100 mL
SVR normal value
900-1400 dynes*sec/cm5
PCWP normal value
6-15 mmHg
CVP normal value
2-6 mmHg
MAP normal value
80-100 mmHg
CI <2.2 means what?
hypoperfusion
PCWP >18 means what?
pulmonary edema
CI<2.2 AND PCWP >18 means what?
cardiogenic shock
CI<2.2 AND PCWP <18 means what?
hypovolemic shock
What are the pharmacologic goals for hemodynamic monitoring?
1)increase tissue perfusion
a)increase MAP >65mmHg
b)increase in CO
2)normalization of oxidative metabolism
a)return of aerobic metabolism
Examples of crystalloids
1)NS
2)LR
What are the advantages of crystalloids?
1)low cost
2)widely available
What are the disadvantages of crystalloids?
1)only 25-33% remian in intravascular space
Examples of colloids?
1)albumin 5%
2)hetastarch 6%
What are the advantages of colloids?
1)range from 80-100% remain in intravascular space
What are the disadvantages of colloids?
1)very expensive
2)may not be readily available
What are the treatment goals of managing hemodynamic instability?
1)maintain adequate circulation for tissue perfusion
a)MAP> 60-65 mmHg
b)SBP > 90 mmHg
c)CI > 2.2 L/min/m2
d)normal HR (<90bpm)
e)adequate UO (>0.5-1mL/kg/hr)
Physiological and hemodynamic effects of receptors: alpha1
1)arterial and venous vasoconstriction
2)increase SVR, increase MAP
beta1
1)increase contractility, chronotropy
2)increase CO, increase HR
beta2
1)arterial and venous vasodilation
2)decrease SVR
DA
1)vasodilation
2)insignificant increase in UO
VP
1)vasoconstriction, fluid retention, increase cortisol
2)increase SVR, increase MAP
What are pharmacological agents classified as vasopressors? (5)
1)dopamine
2)norepinephrine
3)epinephrine
4)phenylephrine
5)vasopressin
What are pharmacological agents classifed as inotropes? (4)
1)dopamine
2)dobutamine
3)milrinone
4)levosimendan
What are the effects of DA dose 0.5-3mcg/kg/min?
1)increase renal and mesenteric blood flow
2)inhibition of proximal tubule Na+ reabsorption
What are the effects of DA dose 3-10mcg/kg/min?
1)stimulation of beta receptors
a)increase CO, HR, contractility
What are the effects of DA dose 10-20mcg/kg/min?
1)stimulation of alpha1 receptors
a)increase in SVR, MAP
Dopamine adverse effects (5)
1)tachyarrhythmias
2)increase MVO2
3)peripheral ischemia
4)increase afterload and preload
5)pulmonary congestion
What receptors does norepinephrine act on?
1)stimulation of alpha1 receptors
-increase peripheral vasoconstriction => increase SVR
2)No effect on beta receptors
-increase inotropy, chronotropy
-smaller extent than a1 effects
What is the effect of pH on norepinephrine?
decrease activity in acidosis (need to increase dose)
norepinehrine dosing
2-50mcg/min titrated to MAP >65mHg
What are the adverse effects of norepinephrine? (4)
1)increase afterload
2)peripheral ischemia
3)increase MVO2
4)cardiac arrhythmias
What receptors does phenylephrine have an effect on?
1)stimulation of alpha1 receptors
-increase in peripheral vasoconstriction
2)no effect on beta receptors
phenylephrine dosing
30-300mcg/min (max 200mcg/min) titrated to MAP >65mmHg
phenylephrine adverse effects (6)
1)increase afterload
2)peripheral ischemia
3)myocardial ischemia
4)reflex bradycardia
5)peripheral bradycardia
6)hypertension
What receptors does epinephrine act on?
1)stimulation of alpha1 receptors
-increase peripheral vasoconstriction
2)stimulation of beta receptors
-increase in inotropy, chronotropy
-increase in peripheral vasodilation
epinephrine dosing
1)0.01-0.05mcg/kg/min
-beta1,2
-increase SVR, MAP????
2)>0.05mcg/kg/min
-alpha1, beta1
-increase in CO, HR, contractility???
What are the side effects of epinephrine? (4)
1)increase MVO2
2)tachyarrhythmias
3)ischemia
4)lactic acidosis
What receptors does vasopressin act on?
1)stimulation of VP1
-peripheral vascoconstriction
2)stimulation of VP2
-sodium and water retention
-decrease UO
3)stimulation of VP3
-increase ACTH and cortisol production
Indication for vasopressin
adjunct to other vasopressors in septic shock
Benefits of vasopressin along with other vasopressors
decrease dose of other vasopressors
Vasopressin dosing
0.01-0.04units/min
What are the side effects of vasopressin? (2)
1)decrease CO
2)myocardial and splanchnic ischemia
Inotrope pharmacology
-stimulation of beta receptor converts AMP -> cAMP which activates PKa which releases Ca++ from sarcoplasmic reticulum which binds to Tnc
-phosphodiesterase inhibitors inhibit cAMP -> AMP
What receptors does dobutamine act on?
1)stimulation of beta receptors
-increase inotropy and chronotropy
-small increase in peripheral vasodilation
2)stimulation of alpha1
-increase peripheral vasoconstriction
-to a MUCH SMALLER EXTENT than beta effects
dobutamine dosing
2.5mcg/kg/min (max 20) titrated to desired CI
what are the adverse effects of dobutamine? (3)
1)increase MVO2
2)ventricular arrhythmias
3)hypotension
Milrinone MOA
1)phosphodiesterase type 3 inhibitor
-inhibit breakdown of cAMP in myocardium and vasculature
-increase contractility and peripheral vasodilation
milrinone bolus dose (optional)
50mcg/kg/IV over 10min
milrinone infusion dosing
0.25-0.75mcg/kg/min
milrinone dosing for renal adjustment
0.2-0.43mcg/kg/min base on CrCl
milrinone adverse effects (5)
1)ventricular arrhythmias
2)hypotension
3)reflex tachycardia
4)thrombocytopenia
5)headache