atherosclerosis Flashcards
1
Q
what is atherosclerosis
A
endothelial cell damage cause by mechanical stress, immune response and oxidative stress which causes plaque formation in arteries
2
Q
plaque pathogenesis steps
A
- endothelial cell damage so LDL’s enter tunica intima
- LDL’s become oxidized which activates the endothelial cells to create adhesion receptors for WBC’s
- monocytes enter tunica intima and turn into macrophages
- macrophages eat LDL’s and make foam cells
- foam cells burst but lipid contents remain
3
Q
what does plaque include
A
foam cells (macrophages, LDL), collagen, fibrin, calcium deposits
4
Q
what is the first sign of atherosclerosis
A
a fatty streak
5
Q
where do fatty streaks occur first
A
aorta & coronary arteries
6
Q
what lipids are used for energy
A
triglycerides
7
Q
what lipids are used for structure
A
cholesterol
8
Q
what happens to unused foods
A
turns into triglycerides and stored in adipose cells
9
Q
what are lipoproteins
A
lipid + protein carriers for transport to target tissues
10
Q
what are LDLs what do they transport and where
A
low density lipoproteins, transport cholesterol to cells
11
Q
what are VLDLs what do they transport
A
very low density lipoproteins, transport triglycerides to cells
12
Q
what are HDLs what to they transport and where
A
high density lipoproteins, transport cholesterol to liver
13
Q
ideal cholesterol in body
A
low LDL, low total cholesterol
14
Q
what kind of foods raise cholesterol
A
hydrogenated, fast food, deep fried
15
Q
what diet causes health issues
A
high saturated fat, high LDL and LVDL
16
Q
risk factors of atherosclerosis
A
hypertension, hypercholesterolemia, hyperlipidemia, smoking, family history, age
17
Q
what is dyslipidemia
A
high LDL & VLDL, hypercholesterolemia & hyperlipidemia
18
Q
drugs for dyslipidemia
A
statins, niacin, fibrates
19
Q
statins moa
A
HMG-coa reductase inhibitor
20
Q
statins function
A
decreases cholesterol synthesis and increase cholesterol metabolism
21
Q
statins examples
A
-statin suffix
22
Q
statins s/e
A
myopathy
23
Q
who cant use statins and why
A
pregnant women, category X- affects fetal CNS myelination
24
Q
what is oxidative stress
A
when more free radicals are released than can be detoxified
25
what can oxidative stress do to cells
can cause direct damage to cells due to electron reaction which can lead to decreased function
26
what can cause oxidative stress
ROS, cytotoxic substances
27
how does oxidative stress cause inflammation
oxidative stress causes endothelial cells to attract WBCs
28
how to balance oxidative stress
antioxidants
29
what do antioxidants do
support normal enzyme function and reduce reactive molecules ( =water byproduct)
30
antioxidants example
grapes
31
what does atherosclerosis cause
narrow blood vessels, vessel obstruction due to plaque, thrombus->emboli, weakening of vessel wall
32
what does narrow blood vessels cause
ischemia and turbulent flow
33
examples of narrow blood vessels
CAD, angina, PVD, heart failure
34
what does vessel obstruction due to plaque cause
causes ischemia to target tissue
35
examples of vessel obstruction due to plaque
MI, heart failure
36
what can thrombosis lead to
embolus
37
what does thrombosis cause
ischemia to target tissue
38
examples of thrombosis
DVT, pulmonary embolus, MI
39
what can weakening of vessel wall cause
aneurysm formation, hemorrhage or rupture, tompanade
40
CAD
coronary artery disease can be chronic or acute
41
chronic CAD
stable angina, stable plaque
42
acute CAD
unstable angina, unstable plaque can rupture and cause MI
43
plaque rupture steps
1. injury
2. vascular spasm
3. platelets activated
4. coagulation cascade
44
how are platelets activated
thromboxane A2, ADP, thrombin are released and signal platelets to activate
45
what happens when platelets are activated
platelet aggregation
46
what is the coagulation cascade
has 2 pathways that lead to making fibrin which leads to clots
47
how is the extrinsic pathway activated
when external damage causes endothelial cells to release tissue factors
48
how is the intrinsic pathway induced
when endothelial cells are exposed to collagen
49
how is thrombin made
active factor X + prothrombin (CF II)
50
what does thrombin do
converts fibrinogen to fibrin, activates CF XIII which creates stable fibrin, released by platelets to increase aggregation, can synthesize itself
51
what causes a STEMI
total blockage of coronary artery so large area of heart muscles don't receive blood
52
what happens during a STEMI
high ST segment so ventricles don't contact fully before relaxing
53
what is ischemia
reduction of blood getting to tissue = reduction of oxygen
54
what happens to cells during ischemia
become anaerobic
55
what do anaerobic cells produce and what does it do
lactic acid which decreases PH
56
signs and symptoms of ischemia
pain, SOB, hypoxemia, no contractility
57
onset of ischemia
fast onset, 1 minute
58
what happens to injured myocardial cells
leaks intrinsic enzymes and cause inflammation
59
what do myocardial cells leak
intrinsic enzymes like troponin and creatine kinase
60
what is found in blood during MI or ischemia
high troponin and creatine kinase
61
how to check for biomarkers
check levels of troponin and CK in plasma
62
what happens after 20-40 mins of ischemia
necrosis occurs which leads to scar tissue = heart failure
63
immediate ischemia treatments
vasodilate, oxygenate, remove obstruction, treat clotting
64
drug class used to vasodilate during ischemia
organic nitrates
65
examples of organic nitrates
nitroglycerin, isosorbide
66
what is nitroglycerin
exogenous nitric oxide
67
what does nitroglycerin do
causes vasodilation which decreases hearts oxygen demand
68
nitroglycerin doses
3 doses in 5 min intervals, if doesn't respond call 911
69
nitroglycerin routes of administration
SL, IV, spray
70
what kind of angina can nitroglycerin treat
stable angina
71
obstruction treatments
coronary angioplasty & CABG
72
what is a coronary angioplasty
when a narrowed coronary artery is opened using a balloon catheter
73
what is a CABG
when a vein graft from saphenous vein in leg is used and attached to the aorta and coronary artery to bypass the obstruction
74
what do antiplatelets do
prevent platelet aggregation and adhesion
75
how do antiplatelets work
work to prevent thromboxane A2, ADH, and glycoprotein IIb/IIIa receptor
76
meds that block thromboxane A2 release
ASA and aggrenox
77
asa as antiplatelet
cox1 inhibitor which prevent thrombin production which decreases aggregation
78
asa risks
NSAID so can cause ulcers
79
aggrenox fx
asa+dipyridamole decrease platelet aggregation
80
asa used for antiplatelet drug
baby asprin, low dose 81 mg
81
baby asa on children is used when
when they have kawasaki syndrome
82
meds that block ADH receptor
clopidogrel (plavix)
83
how does clopidogrel work
prevent ADH from binding to platelets which prevent aggregation
84
meds that block glycoprotein IIb/IIIa
abciximab, intrigrillin, aggrestat
85
how does abciximab work
inhibits the glycoprotein IIb/IIIa receptor which decrease fibrin = decreased platelet adhesion
86
glycoprotein IIb/IIIa receptor inhibitor ROA and uses
IV only, used only in hospital for pre/during obstruction treatment
87
function of anticoagulants
lengthen clotting time
88
anticoagulant target
coagulation cascade (clotting factors), thrombin formation, thrombin receptors, and CF formation
89
meds that inhibit thrombin synthesis
heparin, LMWH (enoxaprin, daltaprin)
90
how does heparin work
targets Xa and CF II which inhibits thrombin synthesis = no fibrin
91
how do LMWH work
targets Xa which inhibits thrombin synthesis
92
why are LMWH used
given when going home from hospital, short term use
93
meds that block thrombin receptors
dabigatran (pradaxa)
94
when is dabigatran used
for stroke prevention
95
meds that inhibit CF 2,7,9&10
warfarin (coumadin)
96
how does warfarin work
it inhibits activation of CF 2,7,9 and 10, inhibits vitamin k action
97
warfarin risks
high PPB and narrow TI
98
antidote for low dose warfarin
vitamin k since it activates CF
99
antidote for high dose warfarin
protamine sulfate
100
what to avoid when on warfarin
leafy greens, high vit K foods, other drug treatments
101
what is HIT
herparin induced thrombocytopenia
102
what causes HIT
immune system makes antibodies against heparin + CF 4, when the antibodies bind to the heparin complexes activating platelets
103
what can HIT lead to
clotting = DIC
104
how many ppl get HIT
50% of heparin users
105
how much HIT is life threatening
3% of ppl with HIT
106
how do you monitor heparin
monitor PT values
107
how do you monitor warfarin
monitor PTT values
108
how do you monitor LMWH
anti factor Xa
109
what is monitored for a bleeding risk
complete blood count
110
what are thrombolytics
break down clots
111
how do thrombolytics work
they activate plasminogen in blood into plasmin, which breaks down fibrin
112
thrombolytic meds
tissue plasminogen activators; alteplase, retelplase
113
tpa half life
13-16 mins
114
tpa roa
IV
115
what is used during an acute event
antiplatelets, thrombolytics
116
ppl with high clotting risk
ppl w dysryhthmia, complex surgery, severe MI
117
meds to give patients at risk for clotting
anticoagulants
118
routine prevention meds
antiplatlets
119
what is used to treat hypertension in patients with MI
beta blockers
