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121 Cards in this Set
- Front
- Back
|
body water
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2/3 intracellular
1/3 extracellular 25% plasma 75% interstitial |
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Na in the plasma
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142
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Na in the intracellular fluid
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12
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K in the plasma
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4.4
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K in the intracellular fluid
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140
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Cl in the plasma
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104
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Cl in the intracellular fluid
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4
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Na regulates ______
Water regulates ________ |
ECF
osmolality |
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Regulation of Na balance
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Diet
Kideny (renal blood flow and function, reabsorption is based on aldosterone and atriopeptin) |
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Na intake- typical diet
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5-10 g/day (85-170 mmol/Day)
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Na intake- recommended
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65-100 mmol/day
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Na intake- minimum
avoiding salty food restricting salt |
30 mmol/day
80 40-60 |
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Na resorption in the proximal tubule
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70%, Na/H exchange, Na/glucose exchange, AII (ACEI, ARB), NE (BB)
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Na resorption in the loop
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20%, loop diuretic
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Na resorption in the distal tubule
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5%, thiazide diuretic
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Na resorption in the collecting duct
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4%, aldosterone (spirolactone), atrioteptin
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stimuli for ADH release
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increased osmolalit, decrease in volume or bp, AII
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Na balance is determined by
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ECF (1l=440 mmol)
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serum [Na] and osmolality are indicators of
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water balance
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[Na}=
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amount in the ECF/H2O in the ECF
normal is 135-144 mmol/L if low, extra water; if high, not enough water |
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signs of increased interstitial fluid volume
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pitting edema, pulomary congestion, ascities
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signs of decreased interstitial fluid volume
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decreased skin turgor, dry mucus membranes
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K (mmol/kg)
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50-55
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K % intracellular
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98%
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Daily Turnover
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50-150 mmol/day
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Excretion: % renal, % Gi
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90, 10
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ICF/ ECF distribution determined by:
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Na/K ATPase
Insulin (Increases ICF bc of ATPase) B2 adrenergic (increase ICF by ATPase) exchange with H+ |
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serum [K]
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3.5-4.8 mmol/L
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Hypokalemia: measured by
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serum K
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Hypokalemia: caused by
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-poor diet
-intracellular shift (insulin, B2 agonist, Epi, alkalemia, xanthines) -GI or sweat loss -urinary loss |
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Urinary losses of K are caused by
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-mineral corticoid excess (aldosterone, steroids)
-na excretion -mg deficiency -metabolic alkalosis -high dose Rx penicillin, ampothericin B |
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Hypokalemia side effects
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-muscle weakness (gut and skeletal)
-cardiac (u waves, digitalis, arrhythmias) -renal (can't concentrate, metabolic alkalosis) -gluocose intolerance (low insulin secretion) |
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if K is 3-3.5...
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use dietary
supplements if on digitalis |
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if K is 2.5-3...
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supp (40-100 mmol/day)
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if K is 2.0-2.5...
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clinical manifestations
supplements or IV if can't po or already on IV |
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if K is <2...
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total deficit -400-900 mmol
state IV ASAP |
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Oral K salt subsitutes
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KCL, K phosphate, K bicarb, K citrate, K acetate, K lactate, K gluconate w/ bicarb deficit
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K supplements dosage forms
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cheap, effective, unpalatable
wax matrix (8,10 mmol) microencapsulated cap (8,10) SR microcrystalloids (10,20) |
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Dietary sources of K
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Lean meat or chicken
Fruits Vegetables Legumes Salt Subsitute |
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cautions for K Rx
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-levels are higher if unable to excrete or if shift into ICF is compromised
-K spare diuretic, trimethoprim (spares K), Heparin (lowers aldosterone), -B blocker -low renal function -ACEI, ARB |
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IV therapy to replace K
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-up to 40 mmol/L
-higher conc into central vein -urgent: 10-20 mmol an hour in central vein, monitor ECG (T wave) for >20 mmol/hr, 40 mmol/hr in emergency |
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Nitric Oxide
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vasodilate
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endothelin
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vasoconstricts
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How does phospholamban work?
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phospholamban inhibits SERCA. PKA actives phospholamban disinhibits SECA and Ca returns to SR
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Stroke Volume
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EDV-ESV
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Ejection Fraction
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SV/EDV
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CO
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HR*SV
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Cardiac index
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CO/BSA
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S3 sounds
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heard early in diastole as vetnricles passively stretch from filling and vibrate
heart disease |
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S4 sounds
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heard late in disastole as ventricular walls, valves, and papillae vibrate
LVH, CHD, MI |
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CVD pt history
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leg cramps, cold extremities, swelling, fluid retention, HA, personality changes, syncope, Med use
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amplitude scale:
0 1 2 3 4 |
absent
barely palpable easily palpable (normal) full, strong bounding, difficult to obliterate |
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circulatory insufficiency: arterial characteristics
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-weak, thready, absent PULSE
-thin, shiny, sloughing, cool, pale, blue SKIN -atrophied MUSCLES -HAIR loss -PAIN with exercise, extreme is ATC |
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Circulatory insufficiency: venous characteristics
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-PAIN is constant
-red, thick, tender along vein lines= THROMBOSIS -VARICOSE VEINS- dilated, swollen, may be swollen -EDEMA: venous obstruction, valvular incompetence, bad lymphatic drainage |
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Peripheral Edema (pitting scale)
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1+: slight, disappears, 2mm
2+: deeper, disappears 10-15 sec, 4mm 3+: deep, >1 min, dependent extremity appears fuller and more swollen, 6 mm 4+: very deep, 2-5 min, dependent extremity is very distorted, 8 mm |
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Heart failure
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diuretic
BB ACEI ARB aldosterone antagonist |
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Post MI
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BB
ACEI aldosterone antagonist |
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High coronary disease risk
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Diuretic
bb ACEI CCB |
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Diabetes
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Diuretic
BB ACEI ARB CCB |
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Chronic Kidney Disease
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ACEI
ARB |
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Recurrent Stroke
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Diuretic
ACEI |
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Angina
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BB
CCB |
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Atrial tachycardia, fibrillation
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BB
NDHP CCB |
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cyclosporine HTN
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CCB
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DM with proteinuria
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ACEI
ARB CCB |
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DM II
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ACEI
ARB low dose diurectic |
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Dyslipidemia
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Alpha blocker
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BPH
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alpha blocker
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renal insufficiency
-caution in renovascular HTN and Cr >3 mg/dl |
ACE I
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tremor
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BB
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hyperthyroidism
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BB
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migraine
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non-cardioselective BB
NDHP CCB |
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osteoporosis
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thiazide
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perioperative HTN
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BB
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Bronchospastic: not..
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Not BB
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Depression: not...
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Not BB
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Dyslipidemia: not...
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BB
Diuretic |
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DM: not...
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BB
high dose diuretic |
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Gout: not...
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diuretic
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Heart failure: not...
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BB (except carvediol, metopolol, bisoprolol)
CCB (except amlodipine, felodipine) |
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Propanolol: selectivity, ISA
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B1 and B2,
-ISA |
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timolol: selectivity, ISA
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B1 and B2
-ISA |
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nadolol: selectivity, ISA
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B1 and B2
-ISA |
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Pindolol: selectivity, ISA
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B1 and B2
+ISA |
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cartelol: selectivity, ISA
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B1 and B2
+ISA |
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penbutolol: selectivity, ISA
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B1 and B2
+ISA |
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Atenolol: selectivity, ISA
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B1
-ISA |
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Metoprolol: selectivity, ISA
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B1
-ISA |
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Bisoprolol: selectivity, ISA
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B1
-ISA |
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betaxolol: selectivity, ISA
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B1
-ISA |
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Propanolol: Metabolism
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Liver
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Metoprolol: Metabolism
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Liver
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Labetolol: Metabolism
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Liver
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Acebetolol: Metabolism
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liver and kidney
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Atenolol: metabolism
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kidney
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Nadolol: metabolism
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kidney
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BB SE
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bradycardia
tired cold extremities CNS |
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ACEI SE
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Cough
rash argeusia hyperkalemia Renal Failure (bilateral RAS) |
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Monitor with ACEI
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K+
SCr |
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CCB SE
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-constipation, bradycardia, AV block, CHF (NDHP)
-Edema, dizzy, HA, tachycardia (DHP) -gingival hyperplasia (Nefidipine) |
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Alpha 1 antagonist SE
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first dose hypotension
HA Fatigue drowsy weak vivid dreams |
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central alpha 2 agonist SE
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sedation, decreased alterness, depression, dry mouth, bradycardia, Na and fluid retention, rebound HTN with withdrawal
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ARB SE
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cough
dizzy angioedema hyperkalemia renal failure rash argeusia |
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monitor with ARB
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K
SCr |
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Direct Vasodilators SE
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Hypertrichosis (minoxidil)
Lupus (hydrazaline) dermatitis drug fever peripheral neuropathy hepatitis HA REFLEX SNS ACTIVATION (can increase angina) |
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Postganglionic sympathetic inhibitors SE
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orthostatis
syncope impotence diarrhea wt gain |
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Reserpine SE
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Sedation
Depression Na and fluid retention Diarrhea |
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BB and pregnancy
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atenolol, metoprolol, labetolol in late pregnancy
|
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Diuretics and pregnancy
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only for chronic HTN that existed before pregnancy
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direct vasodilators and pregnancy
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parenteral drug of choice
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Hypertensive Crisis: Nifedipine
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Don't Use
Oral causes flushing, HA, reflex tachycardia |
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Hypertensive Crisis: Clonidine
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Oral
25% reduction in BP in one hour SE: sedation, dry mouth, orthostatics |
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Hypertensive Crisis: catopril
|
oral
onset 15-30 min, peak 30-90 min useful in SLE, renal vascular HTN, renin-secreting tumors SE: K, angioedema, first-dose hypotension |
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Hypertensive Crisis: labetatol
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B blocker with Alpha properties
oral and parenteral NO reflex SNS SE: orthostatis, NV, dizzy, flushing, HA Don't use: asthma, bradycardia, CHF Good in: CAD or MI |
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Hypertensive Crisis: Prazosin
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oral
SE: 1st dose hypotension |
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Hypertensive Crisis: Nitroprusside
|
parenteral
vasodilator, does not affect CO reflex SNS activation Agent for minuter-to minute control reversible to cyanide then thiocyanate SE: fatigue, N, anorexia, disorientated, psychotic, muscle spasms |
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Hypertensive Crisis: Nitroglycerin
|
parenteral
vasodilator good for MI not for HTN encephalopathy tachyphylaxis with prolonged use |
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Hypertensive Crisis: Hydralazine
|
parenteral
lowers DBP>SBP increases intracranial P, increase pressure wave so avoid in aortic dissection Reflex tachycardia Drug of choice in preggers |
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Hypertensive Crisis: Esmolol
|
parenteral
fast-acting B1 blocker metabolized by RBC SE: diaphoresis, dizziness, nausea |
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Hypertensive Crisis: fenoldopam
|
Parenteral
post-synaptic dopaminergic agonist vasodilator SE: diuresis, natriuresis, increase renal blood flow, HA, NV, flushing, increased IOP |
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Hypertensive Crisis: phentolamine
|
parenteral
alpha blocker best in catecholamine excess: pehochromocytoma, cocaine, amphetamine OD, MAOI crisis |
