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Physiology and Pharmacology

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Answer
show under perfusion of: Tissues - acidosis Brain - lethargy, cerebral damage Kidneys - acute tubular necrosis, renal failure  
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show Cardiac failure - chronic, ischaemic - reduction in CO to the point that it does not satisfy requirements Hypovolaemia - actual e.g. haemorrhage or functional e.g. vasodilation  
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Effects of cardiac failure   show
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show Hypovolaemic shock - haemorrhage Septic shock - toxic vasodilation Cardiogenic shock - myocardial infarction  
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Influences on cardiac output   show
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Effects of ischaemia on frank starling curve   show
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show Increased oxygen demand when this cannot be met - tachycardiac or increased contractility Reduced oxygen supply - coronary atherosclerosis and small vessel disease  
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Other causes of hypoxia   show
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Circle of cardiac failure   show
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Consequences of ischaemia   show
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show Positive inotropic agent - with no increase in oxygen demand Cheat - vasodilate to increase cardiac output and limit work to match cardiac oxygen  
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Treatments for failure   show
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show Must increase cardiac output Oxygen demand less critical - may use ion pumping and increase oxygen supply Must not vasodilate  
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show Sympathomimetics Glycosides Calcium sensitising agents Indirect - vasodilators  
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show Increased calcium all the time - cannot be taken up into SR Reduced contractility as less Ca to release and stiff walls Increased diastolic pressure  
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show Increased Ca in systole as more taken up into SR Increased contractility as more Ca to be released Decreased diastolic pressure  
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show vasodilators - for chronic ischaemic failure Vasoconstrictors for acute shock  
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show Sympathetic stimulation - direct or indirect Altered contractile mechanism - calcium sensitization  
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Phosphodiesterase inhibitors   show
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show Tachycardia Increased cardiac contractility Splanchnic vasoconstriction Skeletal muscle vasodilation at low conc and vasoconstriction at high conc - saturates beta due to high affinity then see alpha effects due to higher potency  
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show Increased cardiac output - beta 1 adrenergic Generalised vasoconstriction - alpha adrenergic and dopaminergic Vasodilation of gut and kidney - dopaminergic  
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Dopamine analogues   show
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Calcium sensitizers   show
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Glycoside actions   show
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Mechanism of glycosides   show
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Endogenous glycosides   show
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Endogenous inotropes   show
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