ASA/NTG

Question 1

what are some risk factors for CVD/CAD/CHD?

Answer 1

smoker, drinker, diabetes, HTN, genetics, diet, lifestyle, Age, Sex etc

Question 2

Ischemia?

Answer 2

CP experienced ( angina) when an area of the heart does not get adequate O2 due to restricted bf.

Question 3

athersclerosis

Answer 3

plaque build up and inflammation in the coronary vessels that restricts bf due to restricted lumen size.

Question 4

angina

Answer 4

pain associated with decreased O2 in the cardiac tissue do to blockages ( atherslcerosis) or spasms.

Question 5

Stable angina

Answer 5

angina that is brought on during times of exertion and stops with rest or medication use.

Question 6

prinzmetal or variant angina? when and who does it affect?

Answer 6

CP due to vasospasm of coronary vessels restricting bf. occurs most frequently in women, at night , when resting.

Question 7

Unstable angina

Answer 7

angina that comes on randomly and is not relieved by rest or med use. can progress to an AMI if not treated.

Question 8

AMI?

Answer 8

acute myocardial infarct occurs when a coronary vessel is occlude due to arthersclerosis plaque rupture. Platelets aggregate to the site of injury and build the clot, Thromboxane A2 –> agglunate ( stims VasoC) Myocytes deprived of O2 rich blood will begin to go necrotics–> realsing troponin into the bloodstream—> Hr will decrease as more and more myocytes lose function—> myocardial cell death

Question 9

what is Asprin

Answer 9

class: antithrombotic, antiplatlete
- prevents the clot from getting bigger

Question 10

NTG

Answer 10

venodilator and systemic vasodilatory, smooth muscle relaxant, and preload decreaser

Question 11

How does NTG work?

Answer 11

it is converted into its active agent Nitric oxide in the body and acts on the vascular endothelial cells to releases cyclic guanosine monophosphate which relaxes smooth muscle

Question 12

cardiac ischemia indications

Answer 12

suspected cardiac ischemia

Question 13

cardiac ischemia conditions:

Answer 13

ASA: >/= 18 yrs old, unaltered, able to chew and swallow

NTG: >/= 18 yrs, unaltered, Hr= >/=60-<159 bpm, normotension, previous NTG use or IV established

Question 14

Cardiac ischemia contraindications:

Answer 14

ASA:
- a/s to asa of NSAIDS
- Asthmatic and no prior use
- current active bleed
- CVA or TBI in the last 24hrs

NTG:
- a/s to nitrates
- phosphodiesterase use in the last 48 hours
- sbp drops 1/3 or more of initial value
- 12 lead ecg confirms RVI MI

Question 15

Treatment for cardiac ischemia:

Answer 15

ASA
- PO
- 160-162 mg
- max=162mg
- 1

NTG:
No STEMI, SBP>/=100 mmhg, 0.3 or 0.4 mg, Max= 0.4mg, 3 sprays, 5 mins
Yes stemi, SBP>/=100mmHG, 0.3-0.4mg, 0.4mg=max, 6 sprays, 5 mins apart.

Question 16

clinical considerations for cardiac ischemia?

Answer 16

suspected RVI should perfrome V4R to view elevation >1mm
- do not give pt NTG if RVU
_ put defibs on if pt is stemi pos
- 12 lead done <10mins of contact

Question 17

why is hr<60 bom a concern for NTG?

Answer 17

Stroke volume can be affected when giveing a preload reducer and bp can drop precipitously

Question 18

why is a hr >160bpm a concern for NTG?

Answer 18

ischemia is related to the HR, CO will be reduced by the SV and NTG can compound the hypotension further and cause cardiac cell irritability ( VF/VT)

Question 19

Why do erectile dysfunctions meds contraindicated for NTG?

Answer 19

• they have a similar action to NTG bc they cause enhanced Nitirc oxide which increases bf tothe corpus covernosum when stimulated. They also cause systemic vasodilation.

Question 20

what kind of effect would a combo of PD5 and NTG cause?

Answer 20

synergistic effect causing profound hypotension