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critical care > cardiac disorders pt. 2 > Flashcards

cardiac disorders pt. 2 Flashcards

1
Q

what are some immediate treatments for cardiac disorders?

A

-O2 therapy of hypoxemic
-aspirin 160-325 mg
-dual antiplatelet therapy
-nitro sublingual, spray, or IV
-morphine if pain not relived by nitro
-monitor ABCs, prepare for CPR/defibrillation

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2
Q

cardiac output = ____ x _____

A

stroke volume x heart rate

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3
Q

what is stroke volume determined by?

A

1) preload “pool”
2) afterload “pipes”
3) contractility “pump”

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4
Q

which aspect of stroke volume is the “volume status”

A

preload

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5
Q

which aspect of atroke volume is the resistance the heart pumps against?

A

afterload
After the heart = Afterload

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6
Q

cardiac subjective pain assessment acronym

A

NOPQRST
N=normal
O= onset
P= precipitating/aggrevating
Q= quality
R= region/radiation
S= severity / other sx
T= timing
U= understanding/perception

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7
Q

initial treatment measures for UA/NSTEMI/STEMI

A

-initial bedrest (dec. heart demand)
-positioning
-avoid valsalva maneuver (bearing down-vagus nerve)

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8
Q

how does positioning help cardiac disorders

A

semi/high fowler’s decreases preload

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9
Q

morphine effects on preload/afterload/myocardial O2 demand

A

prelaod and afterload reduction, decrease myocardial O2 demand and pain relief

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10
Q

what do ACE-Is end in

A

“pril”

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11
Q

which 2 classes of meds dec. afterload only

A

ACE-Is and ARBs

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12
Q

what do ARBs end in

A

“sartan”

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13
Q

which med mainly decreases prelaod but also afterload, increases myocardial O2 SUPPLY

A

nitroglyerin

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14
Q

meds that decrease preload, afterload, or contractility ______ myocardial O2 demand

A

decrease

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15
Q

which med decreases inotropic and chronotropic

A

beta blockers

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16
Q

what do beta blockers end in

A

“lol”

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17
Q

what class of meds decreases afterload, - ino, - chrono

A

clacium channel blocker
*not 1st line

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18
Q

what do calcium channel blockers end in

A

“pine”

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19
Q

which meds decrease preload

A

morphine
nitroglycerin
diuretics

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20
Q

which meds decrease afterload

A

**ACE-I/ARB
nitro
morphine
calcium channel blockers
hydralazine
***nipride

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21
Q

which meds decrease contractility (- ino)

A

**beta blockers
calcium channel blockers

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22
Q

which meds decrease HR (- chrono)

A

**beta blockers
calcium channel blockers

23
Q

which med is contraindicated after sildenafil (viagara)?

A

nitro

24
Q

what is the benefit of administering metoprolol to a NSTEMI?

A

reduced myocardial workload

25
Q

what is the difference between anti-thrombotic therapy and fibrinolytic therapy?

A

anti-thrombotic prevents further clots and fibrinolytic lyse/destroy clots

26
Q

2 kinds of anti-thrombotics and examples of them

A

anti-platelet (aspirin)
anticoagulant (heparin)

27
Q

what are the 2 anti-platelet agents used together?

A

aspirin and P2Y12 receptor inhibitor (clopidogrel & ticagrelor)

28
Q

examples of P2Y12 receptor inhibitors (anti-platelet)

A

clopidogrel
ticagrelor

29
Q

examples of glycoprotein IIB/IIIa inhibitor (antiplatelet)

A

eptifibatide
tirofiban

30
Q

which anticoagulat…
-alters clotting cascade
prevents conversion of fibrinogen to fibrin
-potentiates antithrombin III which inactivates thrombin

A

heparin

31
Q

which anticoagulant also inhibits factor Xa

A

low-molecular weight heparin (enoxaparin/lovenox)

32
Q

which of the followjg is necessary to monitor APTT q6h?
a) heparin sodium 1000 U/hr IV
b) heparin sodium 5000 U SQ q8h
c) lovenox 40 mg SQ q12h
d) all

A

A
(only continuous infusions)

33
Q

how does heparin affect PTT when therapeutic?

A

increases PTT (desired effect is 1-2x mornal rate)
slows clotting

34
Q

what drug antagonizes heparin (antidote)

A

protamine sulfate

35
Q

complication associated w/ heparin and drugs to help complications (not bleeding)

A

heparin induced thrombocytopenia (HIT)
bivalrudin or argatroban

36
Q

acronym for meds to help acute coronary syndromes

A

MONA BASH
M= morphine
O= oxygen
N=nitrates
A= aspirin

B= beta-blocker
A= ACE-I
S= statins
H= heparin

37
Q

example of medical reperfusion therapy

A

fibrinolytic therapy

38
Q

examples of interventional reperfusion

A

PCI
CABG

39
Q

what is evidence of cardiac reperfusion

A

cessation of CP, elevated STs return to baseline, reperfusion dysrhythmias, early and marked peaking of troponin

40
Q

examples of reperfusion dysrhythmias

A

bradycardia
accelerated idioventricular rhythm (AIVR)
PVCs
ventricular tachycardia

41
Q

when is fibrinolytic therapy used? (3)

A

-STEMI
-when PCI (cath) can’t be performed within 90 mins
-several absolute and relative contraindication

42
Q

examples of fibrinolytic therapy (clot buster)

A

altepase (t-PA)
tenecteplase (TNK)
reteplase (r-PA)
streptokinase (SK)

43
Q

complications post PCI (cath)

A

-coronary spasm
-coronary artery dissection
-bleeding/hematoma
-compromised extremity blood flow
-ventricular dysrhythmias
-vasovagal response

44
Q

how long is bedrest post PCI

A

4-6h

45
Q

complications from AMI

A

-life-threatening ventricular dysrhytmias!!!
-HF
-pulmonary edema
-cardiogenic shock

46
Q

how soon should stemi pts get a PCI

A

w/in 90 mins

47
Q

increases myocardial oxygen supply

A

oxygen

48
Q

removes clot that is causing ischemia/infarction

A

fibrinolytic agent

49
Q

reduces preload and afterlaod, dilates coronary arteries, increases myocarial oxygen supply and decreases myocardial oxygen demand

A

nitroglycerin

50
Q

reduces prelaod and afterlaod by venous and arterial vasodialtion decreasing myocardial oxygen demand and relieves pain

A

morphine

51
Q

reduces straining, which could rpecipitate vasovagal effect and cause dysrhythmias

A

stool softener

52
Q

reuces heart rate to reduce myocardial oxygen demand, infarct sixe, improves survival rates

A

beta blocker

53
Q

decreases afterlaod and myocardial oxygen demand

A

ACE-I

critical care (23 decks)

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