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Tests various > 🏩- Cardiac Test > Flashcards

🏩- Cardiac Test Flashcards

1
Q

Preload

A

Is the amount of blood in the ventricles at the end of diastole

“Stretching of the 💕 muscle”

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2
Q

Frank starlings law

A

The more blood that fills the ventricle, the more blood will be pumped

^ volume = ^ stretch = ^ contraction

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3
Q

Afterload

A

Resistance to flow the ventricle must overcome to open the semilunar valves and eject its contents

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4
Q

Myocardial contractility

A

The force of the mechanical contraction

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5
Q

Renin Angiotensin Aldosterone System

A

The release of Aldosterone promotes Na and water re absorption in the kidneys, which increases circulating fluid volume

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6
Q

Aldosterone

A

Is made by the adrenal gland when K+ are increased

Aldosterone causes Na+ to be reabsorbed by the DCT and collecting duct and K+ to be secreted by the DCT and collecting duct.

^aldosterone = ^BP

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7
Q

ADH

A

Antidiuretic hormone

“Makes you urinate less”

ADH increases water reabsorption in the DCT by stimulating cells to insert aquaporins into the apical epithelial cell memebrane

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8
Q

Brain natriuretic peptide

A

Released from heart tissue when fluid volumes are high

BNP is made in the heart and shows how well the heart is working

Too much= bad

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9
Q

What are the 2 left coronary artery branches

A

Left anterior descending branch

Circumflex branch

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10
Q

Right coronary artery

A

Branches to right marginal branch and posterior interventricular branch

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11
Q

Left anterior descending branch supplies ?

A

Supplies both ventricles , anterior interventricular septum , anterior wall of the heart

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12
Q

Circumflex branch supplies ?

A

Left atrium and the posterior wall of the left ventricle

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13
Q

Right marginal branch supplies ?

A

Lateral aspect of right atrium and ventricle

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14
Q

Posterior interventricular branch supplies ?

A

Posterior aspect of both ventricles and interventricular septum

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15
Q

Anasarca

A

Generalized edema - due to prolonged congestion of the liver

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16
Q

Rubor

A

Dusky pink appearance on the extremity indicates arterial insufficiency

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17
Q

S1

A
  • Closure of mitral and tricuspid valves
  • Softer and longer
  • lower left sternal border
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18
Q

S2

A
  • closing of aortic and pulmonic valves
  • shorter than s1
  • higher pitched
  • base of heart
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19
Q

Gallops

A

Late diastolic sound

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20
Q

Baroreceptors

A

Located in the carotid sinus, aorta

“Pressure receptor” /stretch

^Bp= stretching receptors= decrease heart rate

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21
Q

Prehypertension range

A

Systolic : 120-139

Diastolic : 80-89

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22
Q

Stage I HTN range

A

Systolic : 140-159

Diastolic : 90-99

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23
Q

Stage II HTN range

A

Systolic : greater than 140

Diastolic : greater than 100

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24
Q

Patients with diabetes should have a BP less than what

A

130/90

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25
Q

Hypotension

A

BP less than 90/60

Maybe inadequate for providing sufficient nutrition to the body’s cells

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26
Q

Normal range for MAP

A

70-100 mmHg

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27
Q

Ape to Man ❤️ sounds

A

Aortic: R 2nd intercostal
Pulmonic: L 2nd intercostal
Erbs point: L 3rd intercostal
Tricuspid: lower L eternal border; 4th intercostal
Mitral: L 5th intercostal; midclavicular line

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28
Q

S3 heart sound associated with

A

❤️ failure or too much fluid

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29
Q

Primary (essential) hypertension

A

Most common

Results in damage to vital organs

Has no identifiable medical cause; multifactorial polygenic condition

Causes medial hyperplasia (thickening) or arterioles

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30
Q

Common risk factors for the development of essential hypertension

A

Obesity
Smoking
Stress
Family history

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31
Q

Secondary hypertension

A

Is characterized by elevations in blood pressure due to a specific cause

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32
Q

Common causes of secondary hypertension

A 
Renal disease 
Primary aldosteronism 
Pheochromocytoma
Cushing's syndrome 
Medications
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33
Q

Pheochromocytoma

A

Hormone-secreting tumor that can occur in the adrenal glands

{common cause of secondary hypertension}

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34
Q

Malignant hypertension

A

> 200/150

Rapidly increases, morning headaches, blurred vision, dyspnea, uremia

Untreated leads to renal failure, left ventricular failure, stroke

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35
Q

What is the best indicator of fluid balance

A

Weight

2.2 lb= 1 kg= 1L of fluid

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36
Q

What are the 5 regulators of blood pressure

A 
RAAS
Baroreceptors 
ADH 
ANP 
BNP
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37
Q

Salt substitutes are high in what ?

A

Potassium

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38
Q

Metoprolol

A

Cardioselective beta blocker

Interferes with RAAS to lower BP; lower HR through sympathetic response

*Monitor closely for:
Bradycardia, hypotension, orthostatic hypotension, heart block, cough, rebound hypertension

CAN CAUSE HYPOGLYCEMIA

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39
Q

Examples of beta blockers

A

Nonselective or cardioselective

Propranolol , carvedilol , carteolol or atenolol , bisoprolol , metoprolol

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40
Q

Examples of alpha 2 agonist

A

Centrally acting

Clonidine, methyldopa, guanfacine

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41
Q

Examples of alpha 1 blockers

A

Doxazosin , prazosin , terazosin

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42
Q

Prazosin

Alpha 1 blocker

A

Promotes vasodilation through sympathetic response

Lower vldl and ldl ; raises hdl

OFTEN PRESCRIBED TO TREAT BENIGN PROSTATIC HYPERTROPHY (bph)

*Monitor for:
Hypotension , orthostatic hypotension, rebound hypertension , reflex tachycardia , fluid retention

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43
Q

Clonidine

A

Side effects include sedation, dry mouth and nasal mucosa, bradycardia (due to increased vagal stimulation of the SA node as well as sympathetic withdrawal) orthostatic hypotension and impotence

Constipation, nausea and gastric upset are also associated

Fluid retention and edema

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44
Q

What are the 5 types of diuretics

A
  1. Osmotic (mannitol to decrease ICP)
  2. Carbonic anhydrase inhibitors (diamox)
  3. Loop diuretics (furosemide)
  4. Thiazides (hydrochlorothiazide)
  5. Potassium- sparing (spironolactone)
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45
Q

Furosemide

Loop diuretic

A

Very potent- water, Na, K, Ca, Mg

Highly protein bound

*monitor closely for:
Hypokalemia, electrolyte imbalance, hypotension, digitalis toxicity, HYPERglycemia, renal function, dehydration, intake and output and falls

*education:
Importance of K supplement, fluid restriction, daily weight, monitor BS levels

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46
Q

Hydrochlorothiazide

Thiazide diuretic

A

Ca is retained

DECREASE K INCREASE CA

Don’t give in those with renal dysfunction

*monitor closely for:
Hypotension, hypercalcemia, hypokalemia, electrolyte imbalance, digitalis toxicity, lithium toxicity, HYPERGYLCEMIa, renal function

-check BUN and creatinine levels before use

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47
Q

Spironolactone

Potassium sparing diuretic

A

Potassium is retained

Least effective at removing excess fluid

SHOULD NOT be given with acei’s or arbs

*monitor closely for:
Hyperkalemia , electrolyte imbalance, renal function, hypotension

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48
Q

Lisinopril

Ace inhibitors

A

Interferes with RAAS to lower BP

DO NOT take with K+ sparing diuretic

CRITICAL TO LOOK FOR ANGIOEDEMA

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49
Q

What are some side effects of ace inhibitors

A 
Cough 
Potassium EXCESS 
Taste changes 
Orthostatic hypotension 
Lower gfr (kidney function)
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50
Q

Losartan

A

Angiotensin II receptor blocker (arb)

More costly than acei’s , used as second choice

*Monitor for:
Hypotension , rebound hypertension , reflex tachycardia , hyperkalemia

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51
Q

Normal range of troponin

A

Less than 0.03 ng/ml (undetectable)

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52
Q

Normal range of CK-MB

A

O-3% ng/ml

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53
Q

Normal range of total cholesterol

A

Less than 200 mg/dl

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54
Q

Normal range of tryglycerides

A

Less than 150 mg/dl

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55
Q

Normal range of HDL

A

Greater than 50 mg/dl

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56
Q

Normal range of LDL

A

Less than 100 mg/dl

*less than 70 for those with heart disease

Less than 130 for individuals who are at low risk for coronary artery disease

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57
Q

What levels are checked to confirm ❤️ attack

A

Troponin and CK-MB

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58
Q

HDL

A

Good cholesterol

Legend can be increased with exercise (higher the better)

Removes cholesterol from blood and takes it to the liver

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59
Q

LDL

A

Bad cholesterol

Picks up cholesterol from the blood and takes it to the cells

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60
Q

Triglycerides

A

Levels are increased from eating simple sugars or drinking alcohol. Associated with heart and blood vessel disease

**wait 2 months after ❤️ attack, surgery, infection, injury or pregnancy to check levels

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61
Q

Electrocardiograph

A

ECG

assess the electrical conduction system of the heart

Graphic recording of electrical activity in heart

12 leads- 12 angles

Can identify dysrhythmias, new or old heart muscle damage, electrolyte abnormalities and/or cardiac hypertrophy

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62
Q

Echocardiogram

A

Used ultrasound to provide information on the size and pumping function of the heart, blood volume status and valve function and integrity

Provides pictures of the hearts valves and chambers

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63
Q

Trans esophageal echocardiogram

A

TEE

Places ultrasound transducer in the throat to provide information posterior from the ❤️

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64
Q

Nuclear stress test

A

If patient can’t walk on treadmill isotopes are injected to visualize areas of poor perfusion in the heart

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65
Q

Ejection fraction

A

A measurement of the amount of blood pumped out of the left ventricle with each heartbeat

70-90 ml ejected per ventricle per stroke

50ml of blood remains in each ventricle at the end of systole

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66
Q

Normal range of ejection fraction

A

55-70 percent

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67
Q

Hemodynamic monitoring

A

Invasive system provides quantitative information about vascular capacity, blood volume, pump effectiveness, tissue perfusion

Aka swangans carheter

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68
Q

Supraventricular arrhythmias

A

Arrhythmias that begin in the atria

“Supra” means above

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69
Q

Name 9 causes of arrhythmias

A
  • Coronary artery disease
  • High BP
  • Changes in the heart muscle (cardiomyopathy)
  • valve disorders
  • electrolyte imbalances in the blood, Na or K
  • Injury from a ❤️ attack
  • the healing process after heart surgery
  • caffeine, smoking, stress
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70
Q

P wave

A

Atrial depolarization and contraction

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71
Q

QRS wave

A

Ventricle contraction / depolarization

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72
Q

T wave

A

Ventricle repolarization and filling

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73
Q

How long is each small box on an ekg

A

0.04 seconds

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74
Q

How long is each large box on an ekg

A

0.2 seconds

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75
Q

5 big blocks is how long ? 30 big blocks is how long ? On an ekg

A

5- 1 second

30- 6 seconds

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76
Q

How long is a normal PR interval

A

0.12-0.2 seconds

3-5 small boxes

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77
Q

How long is a normal QRS complex

A

0.04-0.1 seconds

1-2 1/2 small boxes

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78
Q

What does the PR interval measure

A

The measure of time it takes an electrical impulse to depolarize the atria and travel to the ventricles

Time from SA mode to bundle

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79
Q

What are the SIX steps to read an ekg

A

1 determine the ❤️ rate (count # of spikes in 6 sec block and X by 10)

2 determine the heart rhythm (regular or irregular)

3 analyze the P waves (present or uniform)

4 measure the PR interval (length)

5 measure the QRS duration (length)

6 interpret the rhythm (what is it)

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80
Q

Atrial fibrillation

A

Many impulses begin and spread through the atria

Results in disorganized , rapid and irregular rhythms

NO P WAVES ON EKG

Irregularly irregular

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81
Q

Premature ventricular contraction

A

Are wide and atypical (or bizarre looking) QRS complexes that fire earlier than expected from within the ventricles

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82
Q

Ventricular tachycardia

A

Defined as 3 or more PVC’s in a row.

First thing to do is check for a pulse

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83
Q

What to do if in VT WITH a pulse

A

Medication .. give lidocaine

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84
Q

Pulseless VT

A

Describes a patient who is in cardiac arrest

Do cpr and SHOCK them

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85
Q

Ventricular fibrillation

A

Life threatening dysrhythmia that needs to be treated immediately

Occurs when ventricle has multiple chaotic impulses rapidly firing

NO P or ORS WAVES PRESENT - rhythm on ekg is shaky or quivering

Use: chest compressions, SHOCK, medication

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86
Q

Ventricular asystole

A

No measurable electrical activity originating from the heart

FLAT LINE

DONT SHOCK

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87
Q

Ventricular asystole

A

No measurable electrical activity originating from the heart

FLAT LINE

DONT SHOCK

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88
Q

Ventricular fibrillation

A

Life threatening dysrhythmia that needs to be treated immediately

Occurs when ventricle has multiple chaotic impulses rapidly firing

NO P or ORS WAVES PRESENT - rhythm on ekg is shaky or quivering

Use: chest compressions, SHOCK, medication

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89
Q

Pulseless VT

A

Describes a patient who is in cardiac arrest

Do cpr and SHOCK them

90
Q

What to do if in VT WITH a pulse

A

Medication .. give lidocaine

91
Q

Ventricular tachycardia

A

Defined as 3 or more PVC’s in a row.

First thing to do is check for a pulse

92
Q

Premature ventricular contraction

A

Are wide and atypical (or bizarre looking) QRS complexes that fire earlier than expected from within the ventricles

93
Q

Atrial fibrillation

A

Many impulses begin and spread through the atria

Results in disorganized , rapid and irregular rhythms

NO P WAVES ON EKG

Irregularly irregular

94
Q

What are the SIX steps to read an ekg

A

1 determine the ❤️ rate (count # of spikes in 6 sec block and X by 10)

2 determine the heart rhythm (regular or irregular)

3 analyze the P waves (present or uniform)

4 measure the PR interval (length)

5 measure the QRS duration (length)

6 interpret the rhythm (what is it)

95
Q

What does the PR interval measure

A

The measure of time it takes an electrical impulse to depolarize the atria and travel to the ventricles

Time from SA mode to bundle

96
Q

How long is a normal QRS complex

A

0.04-0.1 seconds

1-2 1/2 small boxes

97
Q

How long is a normal PR interval

A

0.12-0.2 seconds

3-5 small boxes

98
Q

5 big blocks is how long ? 30 big blocks is how long ? On an ekg

A

5- 1 second

30- 6 seconds

99
Q

How long is each large box on an ekg

A

0.2 seconds

100
Q

How long is each small box on an ekg

A

0.04 seconds

101
Q

T wave

A

Ventricle repolarization and filling

102
Q

QRS wave

A

Ventricle contraction / depolarization

103
Q

P wave

A

Atrial depolarization and contraction

104
Q

Name 9 causes of arrhythmias

A
  • Coronary artery disease
  • High BP
  • Changes in the heart muscle (cardiomyopathy)
  • valve disorders
  • electrolyte imbalances in the blood, Na or K
  • Injury from a ❤️ attack
  • the healing process after heart surgery
  • caffeine, smoking, stress
105
Q

Supraventricular arrhythmias

A

Arrhythmias that begin in the atria

“Supra” means above

106
Q

Hemodynamic monitoring

A

Invasive system provides quantitative information about vascular capacity, blood volume, pump effectiveness, tissue perfusion

Aka swangans carheter

107
Q

Normal range of ejection fraction

A

55-70 percent

108
Q

Ejection fraction

A

A measurement of the amount of blood pumped out of the left ventricle with each heartbeat

70-90 ml ejected per ventricle per stroke

50ml of blood remains in each ventricle at the end of systole

109
Q

Nuclear stress test

A

If patient can’t walk on treadmill isotopes are injected to visualize areas of poor perfusion in the heart

110
Q

Trans esophageal echocardiogram

A

TEE

Places ultrasound transducer in the throat to provide information posterior from the ❤️

111
Q

Echocardiogram

A

Used ultrasound to provide information on the size and pumping function of the heart, blood volume status and valve function and integrity

Provides pictures of the hearts valves and chambers

112
Q

Electrocardiograph

A

ECG

assess the electrical conduction system of the heart

Graphic recording of electrical activity in heart

12 leads- 12 angles

Can identify dysrhythmias, new or old heart muscle damage, electrolyte abnormalities and/or cardiac hypertrophy

113
Q

Triglycerides

A

Levels are increased from eating simple sugars or drinking alcohol. Associated with heart and blood vessel disease

**wait 2 months after ❤️ attack, surgery, infection, injury or pregnancy to check levels

114
Q

LDL

A

Bad cholesterol

Picks up cholesterol from the blood and takes it to the cells

115
Q

HDL

A

Good cholesterol

Legend can be increased with exercise (higher the better)

Removes cholesterol from blood and takes it to the liver - where it is used to make bile and then excreted in feces

116
Q

What levels are checked to confirm ❤️ attack

A

Troponin and CK-MB

117
Q

Normal range of LDL

A

Less than 100 mg/dl

*less than 70 for those with heart disease

Less than 130 for individuals who are at low risk for coronary artery disease

118
Q

Normal range of HDL

A

Greater than 50 mg/dl

119
Q

Normal range of tryglycerides

A

Less than 150 mg/dl

120
Q

Normal range of total cholesterol

A

Less than 200 mg/dl

121
Q

Normal range of CK-MB

A

O-3% ng/ml

122
Q

Normal range of troponin

A

Less than 0.03 ng/ml (undetectable)

123
Q

Losartan

A

Angiotensin II receptor blocker (arb)

More costly than acei’s , used as second choice

*Monitor for:
Hypotension , rebound hypertension , reflex tachycardia , hyperkalemia

124
Q

What are some side effects of ace inhibitors

A 
Cough 
Potassium EXCESS 
Taste changes 
Orthostatic hypotension 
Lower gfr (kidney function)
125
Q

Lisinopril

Ace inhibitors

A

Interferes with RAAS to lower BP

DO NOT take with K+ sparing diuretic

CRITICAL TO LOOK FOR ANGIOEDEMA

126
Q

Spironolactone

Potassium sparing diuretic

A

Potassium is retained

Least effective at removing excess fluid

SHOULD NOT be given with acei’s or arbs

*monitor closely for:
Hyperkalemia , electrolyte imbalance, renal function, hypotension

127
Q

Hydrochlorothiazide

Thiazide diuretic

A

Ca is retained

DECREASE K INCREASE CA

Don’t give in those with renal dysfunction

*monitor closely for:
Hypotension, hypercalcemia, hypokalemia, electrolyte imbalance, digitalis toxicity, lithium toxicity, HYPERGYLCEMIa, renal function

-check BUN and creatinine levels before use

128
Q

Furosemide

Loop diuretic

A

Very potent- water, Na, K, Ca, Mg

Highly protein bound

*monitor closely for:
Hypokalemia, electrolyte imbalance, hypotension, digitalis toxicity, HYPERglycemia, renal function, dehydration, intake and output and falls

*education:
Importance of K supplement, fluid restriction, daily weight, monitor BS levels

129
Q

What are the 5 types of diuretics

A
  1. Osmotic (mannitol to decrease ICP)
  2. Carbonic anhydrase inhibitors (diamox)
  3. Loop diuretics (furosemide)
  4. Thiazides (hydrochlorothiazide)
  5. Potassium- sparing (spironolactone)
130
Q

Clonidine

A

Side effects include sedation, dry mouth and nasal mucosa, bradycardia (due to increased vagal stimulation of the SA node as well as sympathetic withdrawal) orthostatic hypotension and impotence

Constipation, nausea and gastric upset are also associated

Fluid retention and edema

131
Q

Prazosin

Alpha 1 blocker

A

Promotes vasodilation through sympathetic response

Lower vldl and ldl ; raises hdl

OFTEN PRESCRIBED TO TREAT BENIGN PROSTATIC HYPERTROPHY (bph)

*Monitor for:
Hypotension , orthostatic hypotension, rebound hypertension , reflex tachycardia , fluid retention

132
Q

Examples of alpha 1 blockers

A

Doxazosin , prazosin , terazosin

133
Q

Examples of alpha 2 agonist

A

Centrally acting

Clonidine, methyldopa, guanfacine

134
Q

Examples of beta blockers

A

Nonselective or cardioselective

Propranolol , carvedilol , carteolol or atenolol , bisoprolol , metoprolol

135
Q

Metoprolol

A

Cardioselective beta blocker

Interferes with RAAS to lower BP; lower HR through sympathetic response

*Monitor closely for:
Bradycardia, hypotension, orthostatic hypotension, heart block, cough, rebound hypertension

CAN CAUSE HYPOGLYCEMIA

136
Q

Salt substitutes are high in what ?

A

Potassium

137
Q

What are the 5 regulators of blood pressure

A 
RAAS
Baroreceptors 
ADH 
ANP 
BNP
138
Q

What is the best indicator of fluid balance

A

Weight

2.2 lb= 1 kg= 1L of fluid

139
Q

Malignant hypertension

A

> 200/150

Rapidly increases, morning headaches, blurred vision, dyspnea, uremia

Untreated leads to renal failure, left ventricular failure, stroke

140
Q

Pheochromocytoma

A

Hormone-secreting tumor that can occur in the adrenal glands

{common cause of secondary hypertension}

141
Q

Common causes of secondary hypertension

A 
Renal disease 
Primary aldosteronism 
Pheochromocytoma
Cushing's syndrome 
Medications
142
Q

Secondary hypertension

A

Is characterized by elevations in blood pressure due to a specific cause

143
Q

Common risk factors for the development of essential hypertension

A

Obesity
Smoking
Stress
Family history

144
Q

Primary (essential) hypertension

A

Most common

Results in damage to vital organs

Has no identifiable medical cause; multifactorial polygenic condition

Causes medial hyperplasia (thickening) or arterioles

145
Q

S3 heart sound associated with

A

❤️ failure or too much fluid

146
Q

Ape to Man ❤️ sounds

A

Aortic: R 2nd intercostal
Pulmonic: L 2nd intercostal
Erbs point: L 3rd intercostal
Tricuspid: lower L eternal border; 4th intercostal
Mitral: L 5th intercostal; midclavicular line

147
Q

Causes of ventricular asystole

A

Common primary cause in the presence of CAD , AMI

Electrolyte disturbances, drug effect, acidosis, hypoxia

148
Q

How to treat ventricular asystole

A

DONT SHOCK

transcutaneous (external) pacing - initiate early

Epinephrine - increases diastolic BP and blood flow to the brain

Atropine - suppresses excessive vagal (parasympathetic) tone

149
Q

Coronary artery disease

A

Arteries that are clogged and hardened by cholesterol and fatty buildup restrict blood flow to the heart muscle

150
Q

What are the symptoms of a heart attack in women

A
  • pain or discomfort in the chest, left arm or back
  • unusually rapid heartbeat
  • shortness of breath
  • nausea or fatigue
151
Q

Cardiovascular disease and menopause

A

Early menopause (before age 50) or surgical menopause , the risk of cardiovascular disease is also higher , especially when combined with other risk factors

After menopause, cardiovascular disease becomes more of a risk for women because of the reduced level of estrogen in the body

152
Q

Reduced levels of estrogen related to cardiovascular disease can cause what

A
  • changes in the walls of blood vessels that may cause plaque and blood clots to form
  • increase in LDL decrease in HDL
153
Q

Arteriosclerosis

A

Thickening or hardening of arterial wall often associated with aging

154
Q

Atherosclerosis

A

Type of arteriosclerosis involving formation of plaque within arterial wall

155
Q

How are lipids transported through the blood

A

Packaged as lipoproteins

156
Q

Normal range of platelets

A

150,000 - 400,000

157
Q

Normal range of fibrinogen levels

A

200-400

158
Q

Normal prothrombin time

A

12-13 seconds

159
Q

Normal partial thromboplastin time PTT

A

25-35 seconds

160
Q

Normal international normalized ratio INR

A

0.8 - 1.2

161
Q

Normal range of BNP

A

Less than 100

162
Q

Nursing interventions for cholesterol

A
  • evaluate total serum cholesterol levels and lifestyle changes
  • nutrition therapy (low fat: no fried,fast, whole milk, red meats)
  • drug therapy
  • smoking cessation
  • exercise
163
Q

List the 5 classes of antihyperlipidemics

A

1 bile-acid sequestrants
Cholestyramine (questran)

2 fibrates
Gemfibrozil (lopid)

3 nicotinic acid
Niacin (niaspan)

4 cholesterol absorption inhibitor
Ezetimibe (zetia)

5 HMG-CoA reductase inhibitor
Atorvastin (Lipitor)

164
Q

HMG- CoA reductase inhibitors (statins)

A

Used in reducing blood lipid levels

*patient education:
TAKE AT BEDTIME, report any muscle weakness or aching immediately, diet and medication compliance

*monitor closely for:
Liver enzyme levels, creatinine kinase levels, rhabdomyolosis

165
Q

What are some side/adverse effects of HMG-CoA reductase inhibitors (statins)

A
  • may cause gastrointestinal upset
  • may cause liver damage
  • rhabdomyolosis
  • may rise the risk of diabetes in women
166
Q

Fenofibrate

A

Lopid

Decreases triglycerides more than increasing HDL , take before meals , gi side effects

Type: fibrate , antihyperlipidemic

167
Q

Ezetimibe

A

Zetia

Blocks cholesterol absorption, take with meals , very well tolerated usually in combination therapy

Type: cholesterol absorption inhibitor, antihyperlipidemic

168
Q

Cholestyramine

A

Questran

Bind bike acids in the small intestine, preventing their return to the liver , bound cholesterol is excreted in the stool

Take before meals, may cause constipation

Interact with most drugs including anticoagulants, digoxin, hormones, antibiotics

Type: bile-acid sequestrants, antihyperlipidemics

169
Q

Niacin

A

Niaspan

Mechanism of action unknown, take with food

Many side effects including significant vasodilation, flushing and gi distress

Type: nicotinic acid, antihyperlipidemic

170
Q

Claudication manifestations

A

(Pain on walking)

  • foot, calf, thigh or buttock pain
  • pain worse with exertion
  • pain relived with several minutes rest
  • pain relieved in dependent position
171
Q

Objective assessment of the vascular system

A
  • decreased skin temperature
  • shiny skin
  • hairless
  • dystrophic toenails
  • distal extremity color change with position
  • skin pallor with elevation
  • skin rubor when leg dependent
  • bilateral leg diminished pulses
  • slow wound healing
  • impotence
172
Q

Dystrophic toenails

A

Thick, yellow , brittle

173
Q

Vascular ultrasound

A

Noninvasive ultrasound method (also called duplex study) used to examine the blood circulation in the arms and legs

174
Q

What does noninvasive mean

A

The procedure doesn’t require the use of needles, dye, radiation or anesthesia

175
Q

Arteriogram and pre/post care

A

Visualizing vasculature to assess for structures, bleeding, and other abnormalities

NPO
Dye
Assess for shellfish/iodine allergy

176
Q

Peripheral arterial disease

A

Alters natural flow of blood through arteries and veins of peripheral circulation

Deprives lower extremities of O2 and nutrients

Legs more frequently than arms

177
Q

Peripheral vascular disease

A

Aka arteriosclerosis obliterans

Manifests as insufficient tissue perfusion caused by existing atherosclerosis

178
Q

Advanced pvd/pad may manifest as

A

Mottling in a “fishnet pattern” , pulselessness, numbness or cyanosis

Paralysis and cold extremity

Gangrene

*poorly healing injuries or ulcers in the extremities help provide evidence of preexisting pvd

179
Q

SIX P’s of acute arterial occlusion/insufficiency

A

PAIN of loss of sensory nerves 2nd to ischemia

PULSELESSNESS

POIKILOTHERMIA (coldness)

PALLOR caused by empty superficial veins and no cap refill

PARESTHESIA and loss of position sense

PARALYSIS

180
Q

What are the 2 most common locations of peripheral arterial diseases

A

Aortoiliac bifurcation

Femoral bifurcation

181
Q

Manifestation of pain in PAD vs PVD

A

PAD- intermittent claudication, rest pain may be present, worsens with elevation

PVD- achy, heaviness, exercise and elevation decrease pain

182
Q

Manifestation of skin color/temp in PAD vs PVD

A

PAD- absence of hair, thin, shiny skin, thick toenails, pale with dependent rubor and cool

PVD- brown discoloration, dependent cyanosis, may be warmer

183
Q

Manifestation of sensation in PAD vs PVD

A

PAD- decreased

PVD- pruritis may be present

184
Q

Manifestation of pulses in PAD vs PVD

A

PAD- decreased to absent

PVD- present , may be difficult to palpate related to edema

185
Q

Manifestation of edema in PAD vs PVD

A

PAD- may be present, but usually absent

PVD- present, worse at the end of the day

186
Q

Manifestation of muscle mass in PAD vs PVD

A

PAD- reduced in chronic disease

PVD- unaffected

187
Q

Manifestation of ulcers in PAD vs PVD

A

PAD- small painful ulcers in pressure points

PVD- broad shallow slightly painful ulcers of the ankle and lower leg

188
Q

Management of PAD

A
  • Smoking cessation
  • Skin care
  • Exercise
  • Diet change
  • Promote arterial flow (reverse trendelenburg, fleece boots, elevated heels)
  • medications (trental, cilostazol, asa, clopidogrel, L-arginine)
189
Q

Doppler ultrasound

A

Evaluation of audible arterial signals measurement of limb pressures

190
Q

Ankle-brachial index

A

Used to diagnose PAD. Compares blood pressure in your ankle to blood pressure in your arm

191
Q

Normal range of ABI

A

1.0 or greater

(With a range of 0.90 to 1.30)

Less than 0.9 in either leg is diagnostic of PAD

192
Q

Four stages of chronic PAD

A

Stage I- asymptomatic

Stage II- claudication

Stage III- rest pain

Stage IV- necrosis/gangrene

193
Q

Inflow vascular disease Manifests as

A

Discomfort in lower back, buttocks, thighs

194
Q

Outflow vascular disease manifests as

A

Burning or cramping in valves, ankles, feet, toes

195
Q

How to asses for PAD in dark skinned patients

A

Skin and nail beds for dull, lifeless color

Soles of feet and toenails

196
Q

Percutaneous trandluminal angioplasty

A

Minimally invasive method of improving arterial blood flow.

A cannula is inserted into or above an occluded or stenosed artery , the occluded artery is then dilated with a ballon catheter

197
Q

Atherectomy

A

Used to improve blood flow to the ischemic limbs of people with PAD.

for very hard, calcified stenotic lesions that aren’t amenable to balloon angioplasty

Goal is removal of the plaque by breaking it into micro fragments

198
Q

Varicose veins

A

Distended, protruding veins that appear darkened and tortuous

Collaborative care: 
Elastic stockings
Elevation of extremities 
Sclerotherapy 
Surgical removal of veins 
Radio frequency energy to heat veins
199
Q

Phlebitis

Management/complications

A

Inflammation of superficial veins

Management- warm, moist, soaks; elastic stockings

Complications- tissue necrosis, infection, pulmonary embolism , pain

200
Q

Virchows triad

A

Venous thrombosis occurs via 3 mechanisms:

Decreased flow rate of the blood, damage to the blood vessel wall and an increased tendency of the blood to clot

201
Q

Signs of pulmonary embolism

A

Shortness of breath
Chest pain
Petechiae
Decreases O2 sat

202
Q

Assessment of VTE

A
  • calf or groin tenderness or pain
  • sudden onset of unilateral swelling of leg
  • localized edema
  • venous flow studies
  • d dimer (indicative of clots)
203
Q

Normal range of d dimer

A

Less than .5

A global market of coagulation activation and measuring fibrin degradation products produced from fibrinolysis (clot breakdown)

204
Q

Nonsurgical management of VTE

A

Rest, preventative measures

Drug therapy: 
Unfractionated heparin
Low-molecular weight heparin
Warfarin
Thrombolytics
205
Q

Anticoagulants

A

Prevent clot formation in veins through inhibition of fibrin

206
Q

Antiplatelets (antithrombotics)

A

Prevent clot formation in arteries through inhibition of platelet activity

207
Q

Thrombolytics

A

Dissolve boosts that have already formed

208
Q

Heparin

A

Anticoagulant

Monitored via PTT

do NOT give with antiplatelet therapy, IM injections

*monitor closely for:
Thrombocytopenia HIT, bleeding, hypotension

209
Q

What is the antidote for heparin overdose

A

Protamine sulfate

210
Q

Enoxaparin

A

Low-molecular weight heparin

Given SQ

Patients may give their own injections

*monitor closely for:
Bleeding hypotension

Antidote is protamine sulfate

211
Q

Coumadin

A

Anticoagulant

Given PO

*monitor closely for
Bleeding, hypotension, tarry stools, drug interaction

Antidote: vitamin K

212
Q

Normal INR levels

A

Normal: less than 1.4

Therapeutic Coumadin range: 2.0-3.0

Higher risk therapeutic Coumadin range: 2.5-4.0

213
Q

Antiplatelets

A

Oral ex: aspirin, clopidogrel, prasugrel, dipyridamole with ASA

IV ex: reopro, aggrastat, integrelin

Oral dosing used for prophylaxis, IV dosing used for ACS

oral dosing must be stopped 7 days before surgery

Do NOT give with NSAIDS

214
Q

Thrombolytics

A

Promote rapid destruction of thrombus

Must be given within narrow time frame/Given IV

Ex: streptokinase , urokinase, tPA

*monitor for
Baseline blood counts, bleeding, tachycardia , increased pulse/decreases pressure

“Usually end in -ase”

215
Q

Abdominal aortic aneurysm

A

Outpouching or dilation of the arterial wall of the latter portion of the descending segment of the aorta

  • seen in men most often 40-70
  • asymptomatic usually
  • back pain and abdominal pain will follow with growth of mass
216
Q

What are signs of an abdominal aortic aneurysm

A 
Swelling
Bleeding out 
Diminished pulses 
Flush/warm upper 
Pale lower 
BACK PAIN/PRESSURE
217
Q

What is something to do when an abdominal aortic aneurysm is suspected

A

Check BP in right vs left arm

218
Q

Saccular aneurysm

A

Projects from only one side of the vessel

219
Q

Fusiform aneurysm

A

An entire arterial segment becomes dilated

220
Q

Tricuspid valve location vs Bicuspid (mitral) valve location

A

Triscuspid - R side

Bicuspid - L side

Tests various (20 decks)

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