cardiac disorders pt. 2 Flashcards
what are some immediate treatments for cardiac disorders?
-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
cardiac output = ____ x _____
stroke volume x heart rate
what is stroke volume determined by?
1) preload “pool”
2) afterload “pipes”
3) contractility “pump”
which aspect of stroke volume is the “volume status”
preload
which aspect of atroke volume is the resistance the heart pumps against?
afterload
After the heart = Afterload
cardiac subjective pain assessment acronym
NOPQRST
N=normal
O= onset
P= precipitating/aggrevating
Q= quality
R= region/radiation
S= severity / other sx
T= timing
U= understanding/perception
initial treatment measures for UA/NSTEMI/STEMI
-initial bedrest (dec. heart demand)
-positioning
-avoid valsalva maneuver (bearing down-vagus nerve)
how does positioning help cardiac disorders
semi/high fowler’s decreases preload
morphine effects on preload/afterload/myocardial O2 demand
prelaod and afterload reduction, decrease myocardial O2 demand and pain relief
what do ACE-Is end in
“pril”
which 2 classes of meds dec. afterload only
ACE-Is and ARBs
what do ARBs end in
“sartan”
which med mainly decreases prelaod but also afterload, increases myocardial O2 SUPPLY
nitroglyerin
meds that decrease preload, afterload, or contractility ______ myocardial O2 demand
decrease
which med decreases inotropic and chronotropic
beta blockers
what do beta blockers end in
“lol”
what class of meds decreases afterload, - ino, - chrono
clacium channel blocker
*not 1st line
what do calcium channel blockers end in
“pine”
which meds decrease preload
morphine
nitroglycerin
diuretics
which meds decrease afterload
**ACE-I/ARB
nitro
morphine
calcium channel blockers
hydralazine
***nipride
which meds decrease contractility (- ino)
**beta blockers
calcium channel blockers
which meds decrease HR (- chrono)
**beta blockers
calcium channel blockers
which med is contraindicated after sildenafil (viagara)?
nitro
what is the benefit of administering metoprolol to a NSTEMI?
reduced myocardial workload
what is the difference between anti-thrombotic therapy and fibrinolytic therapy?
anti-thrombotic prevents further clots and fibrinolytic lyse/destroy clots
2 kinds of anti-thrombotics and examples of them
anti-platelet (aspirin)
anticoagulant (heparin)
what are the 2 anti-platelet agents used together?
aspirin and P2Y12 receptor inhibitor (clopidogrel & ticagrelor)
examples of P2Y12 receptor inhibitors (anti-platelet)
clopidogrel
ticagrelor
examples of glycoprotein IIB/IIIa inhibitor (antiplatelet)
eptifibatide
tirofiban
which anticoagulat…
-alters clotting cascade
prevents conversion of fibrinogen to fibrin
-potentiates antithrombin III which inactivates thrombin
heparin
which anticoagulant also inhibits factor Xa
low-molecular weight heparin (enoxaparin/lovenox)
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
(only continuous infusions)
how does heparin affect PTT when therapeutic?
increases PTT (desired effect is 1-2x mornal rate)
slows clotting
what drug antagonizes heparin (antidote)
protamine sulfate
complication associated w/ heparin and drugs to help complications (not bleeding)
heparin induced thrombocytopenia (HIT)
bivalrudin or argatroban
acronym for meds to help acute coronary syndromes
MONA BASH
M= morphine
O= oxygen
N=nitrates
A= aspirin
B= beta-blocker
A= ACE-I
S= statins
H= heparin
example of medical reperfusion therapy
fibrinolytic therapy
examples of interventional reperfusion
PCI
CABG
what is evidence of cardiac reperfusion
cessation of CP, elevated STs return to baseline, reperfusion dysrhythmias, early and marked peaking of troponin
examples of reperfusion dysrhythmias
bradycardia
accelerated idioventricular rhythm (AIVR)
PVCs
ventricular tachycardia
when is fibrinolytic therapy used? (3)
-STEMI
-when PCI (cath) can’t be performed within 90 mins
-several absolute and relative contraindication
examples of fibrinolytic therapy (clot buster)
altepase (t-PA)
tenecteplase (TNK)
reteplase (r-PA)
streptokinase (SK)
complications post PCI (cath)
-coronary spasm
-coronary artery dissection
-bleeding/hematoma
-compromised extremity blood flow
-ventricular dysrhythmias
-vasovagal response
how long is bedrest post PCI
4-6h
complications from AMI
-life-threatening ventricular dysrhytmias!!!
-HF
-pulmonary edema
-cardiogenic shock
how soon should stemi pts get a PCI
w/in 90 mins
increases myocardial oxygen supply
oxygen
removes clot that is causing ischemia/infarction
fibrinolytic agent
reduces preload and afterlaod, dilates coronary arteries, increases myocarial oxygen supply and decreases myocardial oxygen demand
nitroglycerin
reduces prelaod and afterlaod by venous and arterial vasodialtion decreasing myocardial oxygen demand and relieves pain
morphine
reduces straining, which could rpecipitate vasovagal effect and cause dysrhythmias
stool softener
reuces heart rate to reduce myocardial oxygen demand, infarct sixe, improves survival rates
beta blocker
decreases afterlaod and myocardial oxygen demand
ACE-I
