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Patho/Pharm 2 Test 1 > CAD > Flashcards

CAD Flashcards

1
Q

CAD

A
  • asymptomatic possible
  • chronic stable angina
  • unstable angina and MI more serious = ACS
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2
Q

Atherosclerosis

A
  • soft deposits of fat (atheromas) that harden with age

- leads to collateral circulation

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3
Q

CAD Modifiable Risk factors

A
  • elevated serum lipids
  • HTN
  • tobacco use
  • physical inactivity
  • diabetes and obesity
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4
Q

HDL Level

A
  • Recommended = Male > 40mg/dl & Female > 50 mg/dl
  • ≥ 60 mg/dl – low risk for CAD
  • < 40 mg/dl – high risk for CAD
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5
Q

LDL Level

A
  • Recommended = < 100 mg/dl

- > 160 = High risk for CAD

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6
Q

Familial Hyperlipidemia

A
  • autosomal dominant disorder
  • leads to increased levels of LDL
  • heterozygous less severe homozygous
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7
Q

Health-Promoting Behavior

A

-FITT: 30 min > 5 days/wk

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8
Q

Antihyperlipidemics

A
  • Statins
  • lower cholesterol & LDL, increases HDL
  • contra: pregnancy & hep
  • SE: myopathy-rhab & hepatotoxicity
  • precautions: liver disease & excessive alcohol use
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9
Q

Statins Nursing Implications

A
  • instruct client to report unexplained muscle pain/tenderness
  • monitor liver function
  • admin in evening
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10
Q

Simvastatin

A

Increased risk for rhabdomyolysis when also used with gemfibrozil (Lopid) or niacin.

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11
Q

Cholesterol Absorption Inhibitors

A
  • Ezetimibe (Zetia)
  • Common addition to statin
  • Contra: hypersensitivity, severe hepatic disease
  • tabs 10 mg
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12
Q

Niacin

A
  • decreases cholesterol & LDL
  • flushing (face & neck) may occur in 20 min and last for 30-60 min
  • can premed with aspirin or NSAID 30 min before
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13
Q

Fibrates

A
  • reduce triglyceride & VLDLs
  • tricor & lopid
  • may increase risk of bleeding with wartfarin
  • may increase effects of antihyperglycemic drugs
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14
Q

How do … Bile Acid Sequestrants work?

A

Bind with acids in intestine
Binding results in removal of LDL and cholesterol
Example: Cholestyramine (Questran)

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15
Q

Bile Acid Sequestrants Nursing Implications

A

GI upset
Interfere with absorption of other drugs
Give other drugs an hour to absorb before giving
Give questran 4 hours to absorb before giving other drugs

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16
Q

What complementary & alternative therapies are used to lower lipid levels?

A

Garlic (not very effective but enhances warfarin)
Omega-3 fatty acids (fish and flaxseed oil)
Fiber (pectin, oat bran, psyllium, fruits, beans)
Phytosterols (nuts, seeds, soybeans, veg oils)
Soy
Milk Thistle, Hawthorn, Coenzyme Q10,

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17
Q

Silent Ischemia

A
  • asymptomatic
  • associated with DM, diabetic neuro, HTN
  • ECG changes
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18
Q

Chronic Stable angina

A

Chest pain that appears intermittently over a period of time in a predictable fashion

  • O2 demand > supply
  • pain lasts 3-5 min
  • ST depression and/or T inversion
19
Q

Unstable Angina

A

New onset, occurs at rest or occurs with increasing frequency or duration.

20
Q

Chronic Stable Angina Meds

A
  • short acting nitrates:

- long acting: NTG & Isosorbide

21
Q

Nitrates & Angina

A

. Dilates venous and arterial vessels – which decreases preload and afterload.
Dilates coronary artery vessels
Lowers B/P

22
Q

NTG

A

Call 911 !!!! After 1st dose before taking 2nd dose

If significantly improved - Repeat in 5 minutes X 2 more doses (3 total max

23
Q

Proper use of NTG

A

Carry at all times
Keep in original container
Replace every 6 months
Should cause fizzing or tingling under tongue
Side Effects: headache, dizziness, flushing, hypotension (monitor for orthostatic hypotension)

24
Q

Prinzmetal Angina

A
  • at rest
  • with history of migrains & raynaud’s
  • ST elevated
  • T: calcium blocker or mod exercise
25
Q

CAD Diagnostics

A
  • homocysteine: high = risk for thrombi
  • EKG
  • stress test: exercise, meds (dobu or lexi), stress EKG
  • cardiac catheter
26
Q

Cardiac Catherization Post

A
  • bedrest for 4-6 hrs
  • keep insertion site straight
  • pressure dressing
  • 5-10lb sand bags
  • assessments q 15 min x 4 then hourly
27
Q

Acute coronary syndrome

A
  • deterioration of once stable plaque -> thrombus
  • partial occlusion: UA & NSTEMI
  • total: STEMI (ST elevated)
  • AKA heart attack or MI
28
Q

MI Healing Process

A
  • 24 hrs: WBCs infiltrate
  • 10-14 days: scar tissue weak
  • 6 wks: necrotic tissue replaces
  • ventricular remodeling
29
Q

Complications of MI

A
  • dysrhythmias
  • HF
  • cardiogenic shock
  • papillary muscle dysfunction
  • ventricular aneurysm
  • acute pericarditis
  • dessler syndrome
30
Q

Heart Murmurs Causes

A 
Stenosis of valve
Partial obstruction
Aortic regurgitation
Mitral regurgitation
Septal defect
31
Q

Serum Cardiac Markers

A
  • > 4%-6% creatinine kinase

- > 2.3 troponin

32
Q

Treatment of MI

A

Morphine
Oxygen (1st)
Nitroglycerine
ASA or Plavix

33
Q

ACS Care

A
  • emergent PCI
  • fibrinolytic therapy
  • CA bypass graft
  • CABG: first 24-36 hrs
34
Q

Thrombolytics

A
  • for MI
  • SE: streptokinase
  • admin within 4-6 hrs
  • monitor I&O and Hct
  • maintain bed rest
35
Q

thrombolytics contraindications

A

•Cerebrovascular disease and pregnancy
•Active bleeding, aortic dissection, pericarditis
•History of intracranial hemorrhage
•Recent major surgery
•History of gastrointestinal (GI) bleeding
`

36
Q

CABG

A

Assessing the patient for bleeding (e.g., chest tube drainage, incision sites)
Monitoring fluid status
Replacing electrolytes PRN
Restoring temperature (e.g., warming blankets)

37
Q

ACS Acute

A

Antiplatelet
IV nitroglycerin
Morphine sulfate

38
Q

ACS Post Acute

A 
β-adrenergic blockers
Angiotensin-converting enzyme inhibitors
Antidysrhythmia drugs
Cholesterol-lowering drugs
Stool softeners
39
Q

ACS Nutritional Therapy

A

Low-salt
Low-saturated fat
Low-cholesterol

40
Q

Antiplatelt therapy

A
  • low dose ASA (81 mg)
  • Plavix
  • 1st line for angina
  • give with heparin or asprin
41
Q

Improve Perfusion

A
  • PCI

- cardiac monitoring

42
Q

Sudden cardiac death (SCD)

A

Unexpected death from cardiac causes
Rapid CPR, defibrillation with AED, and early advanced cardiac life support increase survival rates
Death usually within 1 hour of onset of acute symptoms
Most caused by ventricular dysrhythmias

43
Q

SCD risk factors

A

Left ventricular dysfunction (EF 30%)

Ventricular dysrhythmias after MI

Patho/Pharm 2 Test 1 (12 decks)

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