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121 Cards in this Set

  • Front
  • Back
body water
2/3 intracellular
1/3 extracellular
25% plasma
75% interstitial
Na in the plasma
142
Na in the intracellular fluid
12
K in the plasma
4.4
K in the intracellular fluid
140
Cl in the plasma
104
Cl in the intracellular fluid
4
Na regulates ______

Water regulates ________
ECF

osmolality
Regulation of Na balance
Diet

Kideny (renal blood flow and function, reabsorption is based on aldosterone and atriopeptin)
Na intake- typical diet
5-10 g/day (85-170 mmol/Day)
Na intake- recommended
65-100 mmol/day
Na intake- minimum

avoiding salty food
restricting salt
30 mmol/day

80
40-60
Na resorption in the proximal tubule
70%, Na/H exchange, Na/glucose exchange, AII (ACEI, ARB), NE (BB)
Na resorption in the loop
20%, loop diuretic
Na resorption in the distal tubule
5%, thiazide diuretic
Na resorption in the collecting duct
4%, aldosterone (spirolactone), atrioteptin
stimuli for ADH release
increased osmolalit, decrease in volume or bp, AII
Na balance is determined by
ECF (1l=440 mmol)
serum [Na] and osmolality are indicators of
water balance
[Na}=
amount in the ECF/H2O in the ECF

normal is 135-144 mmol/L

if low, extra water; if high, not enough water
signs of increased interstitial fluid volume
pitting edema, pulomary congestion, ascities
signs of decreased interstitial fluid volume
decreased skin turgor, dry mucus membranes
K (mmol/kg)
50-55
K % intracellular
98%
Daily Turnover
50-150 mmol/day
Excretion: % renal, % Gi
90, 10
ICF/ ECF distribution determined by:
Na/K ATPase
Insulin (Increases ICF bc of ATPase)
B2 adrenergic (increase ICF by ATPase)
exchange with H+
serum [K]
3.5-4.8 mmol/L
Hypokalemia: measured by
serum K
Hypokalemia: caused by
-poor diet
-intracellular shift (insulin, B2 agonist, Epi, alkalemia, xanthines)
-GI or sweat loss
-urinary loss
Urinary losses of K are caused by
-mineral corticoid excess (aldosterone, steroids)
-na excretion
-mg deficiency
-metabolic alkalosis
-high dose Rx penicillin, ampothericin B
Hypokalemia side effects
-muscle weakness (gut and skeletal)
-cardiac (u waves, digitalis, arrhythmias)
-renal (can't concentrate, metabolic alkalosis)
-gluocose intolerance (low insulin secretion)
if K is 3-3.5...
use dietary

supplements if on digitalis
if K is 2.5-3...
supp (40-100 mmol/day)
if K is 2.0-2.5...
clinical manifestations

supplements or IV if can't po or already on IV
if K is <2...
total deficit -400-900 mmol

state IV ASAP
Oral K salt subsitutes
KCL, K phosphate, K bicarb, K citrate, K acetate, K lactate, K gluconate w/ bicarb deficit
K supplements dosage forms
cheap, effective, unpalatable

wax matrix (8,10 mmol)
microencapsulated cap (8,10)
SR microcrystalloids (10,20)
Dietary sources of K
Lean meat or chicken
Fruits
Vegetables
Legumes
Salt Subsitute
cautions for K Rx
-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
IV therapy to replace K
-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
Nitric Oxide
vasodilate
endothelin
vasoconstricts
How does phospholamban work?
phospholamban inhibits SERCA. PKA actives phospholamban disinhibits SECA and Ca returns to SR
Stroke Volume
EDV-ESV
Ejection Fraction
SV/EDV
CO
HR*SV
Cardiac index
CO/BSA
S3 sounds
heard early in diastole as vetnricles passively stretch from filling and vibrate

heart disease
S4 sounds
heard late in disastole as ventricular walls, valves, and papillae vibrate

LVH, CHD, MI
CVD pt history
leg cramps, cold extremities, swelling, fluid retention, HA, personality changes, syncope, Med use
amplitude scale:
0
1
2
3
4
absent
barely palpable
easily palpable (normal)
full, strong
bounding, difficult to obliterate
circulatory insufficiency: arterial characteristics
-weak, thready, absent PULSE
-thin, shiny, sloughing, cool, pale, blue SKIN
-atrophied MUSCLES
-HAIR loss
-PAIN with exercise, extreme is ATC
Circulatory insufficiency: venous characteristics
-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
Peripheral Edema (pitting scale)
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
Heart failure
diuretic
BB
ACEI
ARB
aldosterone antagonist
Post MI
BB
ACEI
aldosterone antagonist
High coronary disease risk
Diuretic
bb
ACEI
CCB
Diabetes
Diuretic
BB
ACEI
ARB
CCB
Chronic Kidney Disease
ACEI
ARB
Recurrent Stroke
Diuretic
ACEI
Angina
BB
CCB
Atrial tachycardia, fibrillation
BB
NDHP CCB
cyclosporine HTN
CCB
DM with proteinuria
ACEI
ARB
CCB
DM II
ACEI
ARB
low dose diurectic
Dyslipidemia
Alpha blocker
BPH
alpha blocker
renal insufficiency
-caution in renovascular HTN and Cr >3 mg/dl
ACE I
tremor
BB
hyperthyroidism
BB
migraine
non-cardioselective BB
NDHP CCB
osteoporosis
thiazide
perioperative HTN
BB
Bronchospastic: not..
Not BB
Depression: not...
Not BB
Dyslipidemia: not...
BB
Diuretic
DM: not...
BB
high dose diuretic
Gout: not...
diuretic
Heart failure: not...
BB (except carvediol, metopolol, bisoprolol)

CCB (except amlodipine, felodipine)
Propanolol: selectivity, ISA
B1 and B2,
-ISA
timolol: selectivity, ISA
B1 and B2
-ISA
nadolol: selectivity, ISA
B1 and B2
-ISA
Pindolol: selectivity, ISA
B1 and B2
+ISA
cartelol: selectivity, ISA
B1 and B2
+ISA
penbutolol: selectivity, ISA
B1 and B2
+ISA
Atenolol: selectivity, ISA
B1
-ISA
Metoprolol: selectivity, ISA
B1
-ISA
Bisoprolol: selectivity, ISA
B1
-ISA
betaxolol: selectivity, ISA
B1
-ISA
Propanolol: Metabolism
Liver
Metoprolol: Metabolism
Liver
Labetolol: Metabolism
Liver
Acebetolol: Metabolism
liver and kidney
Atenolol: metabolism
kidney
Nadolol: metabolism
kidney
BB SE
bradycardia
tired
cold extremities
CNS
ACEI SE
Cough
rash
argeusia
hyperkalemia
Renal Failure (bilateral RAS)
Monitor with ACEI
K+
SCr
CCB SE
-constipation, bradycardia, AV block, CHF (NDHP)

-Edema, dizzy, HA, tachycardia (DHP)

-gingival hyperplasia (Nefidipine)
Alpha 1 antagonist SE
first dose hypotension
HA
Fatigue
drowsy
weak
vivid dreams
central alpha 2 agonist SE
sedation, decreased alterness, depression, dry mouth, bradycardia, Na and fluid retention, rebound HTN with withdrawal
ARB SE
cough
dizzy
angioedema
hyperkalemia
renal failure
rash
argeusia
monitor with ARB
K
SCr
Direct Vasodilators SE
Hypertrichosis (minoxidil)
Lupus (hydrazaline)
dermatitis
drug fever
peripheral neuropathy
hepatitis
HA
REFLEX SNS ACTIVATION (can increase angina)
Postganglionic sympathetic inhibitors SE
orthostatis
syncope
impotence
diarrhea
wt gain
Reserpine SE
Sedation
Depression
Na and fluid retention
Diarrhea
BB and pregnancy
atenolol, metoprolol, labetolol in late pregnancy
Diuretics and pregnancy
only for chronic HTN that existed before pregnancy
direct vasodilators and pregnancy
parenteral drug of choice
Hypertensive Crisis: Nifedipine
Don't Use
Oral
causes flushing, HA, reflex tachycardia
Hypertensive Crisis: Clonidine
Oral
25% reduction in BP in one hour
SE: sedation, dry mouth, orthostatics
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
Hypertensive Crisis: labetatol
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
Hypertensive Crisis: Prazosin
oral
SE: 1st dose hypotension
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
Hypertensive Crisis: Nitroglycerin
parenteral
vasodilator
good for MI
not for HTN encephalopathy
tachyphylaxis with prolonged use
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
Hypertensive Crisis: Esmolol
parenteral
fast-acting B1 blocker
metabolized by RBC
SE: diaphoresis, dizziness, nausea
Hypertensive Crisis: fenoldopam
Parenteral
post-synaptic dopaminergic agonist
vasodilator
SE: diuresis, natriuresis, increase renal blood flow, HA, NV, flushing, increased IOP
Hypertensive Crisis: phentolamine
parenteral
alpha blocker
best in catecholamine excess: pehochromocytoma, cocaine, amphetamine OD, MAOI crisis