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828 Dosage Forms > Cardiovascular System > Flashcards

Cardiovascular System Flashcards

1
Q

Cardiovascular Disease Epidemiology

A

Leading cause of death for both men and women

  • 630,000 deaths/year (1 in every 4 deaths)
  • Coronary heart disease (aka coronary artery disease (CAD), ischemic heart disease (IHD)): 366,000 deaths/year
  • 1 heart attack in the US every 40 seconds

Risk factors: high blood pressure, high LDL cholesterol, smoking

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2
Q

Atherosclerotic Cardiovascular Disease (ASCVD)

A

Terminology: coronary heart disease (CHD), coronary artery disease (CAD), ischemic heart disease (IHD) - All the acronyms that represent the same thing

Imbalance of myocardial oxygen supply and demand (atherosclerosis of coronary arteries)

-the building up of plaque to clog an artery

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3
Q

ASCVD (Known for exam*****)

A
  • Acute coronary syndromes (ACS)
  • History of MI
  • Stable or unstable angina
  • Coronary ot other arterial revascularization
  • Stroke/TIA
  • Peripheral artery disease (atherosclerotic origin)
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4
Q

ASCVD Causative Risk Factors (High correlation between the condition and ASCVD)

A
  • cigarette smoking
  • hypertension
  • low high-density lipoprotein cholesterol (<40mg/dl)
  • high total and low-density lipoprotein cholesterol
  • type 1 and type 2 diabetes mellitus
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5
Q

ASCVD Predisposing Risk Factors

A
  • obesity/overweight
  • physical activity
  • family history of premature coronary heart disease (in male, first degree relative <55 years; in females, first-degree relative <65 years)
  • age (men>=45 years; women >=55 years
  • insulin resistance
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6
Q

Angina

A

-intermittent chest pain caused by temporary oxygen insufficiency and myocardial ischemia

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7
Q

Angina (Stable)

A
  • caused with plaque
  • occurs with increased workload, exercise, or stress
  • Oxygen supply can’t be increased to compensate for increase demand
  • Typically described as diffuse, heavy pressure, or deep squeezing
  • May or may not radiate down arm or to jaw
  • Usually relieved with rest or nitroglycerin
  • β-blockers, calcium channel blockers, and aspirin
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8
Q

Angina (Unstable)

A
  • caused with plaque
  • may occur with exertion, or at rest
  • Typically more intense and can last longer than stable
  • At higher risk of MI
  • May or may not be relieved by rest
  • Can use same medications to treat
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9
Q

Angina (Variant)

A
  • Occurs at rest; typically to younger patients
  • Caused by coronary vasospasm
  • Patient usually younger
  • Can use same medications to treat
  • Ex: Leg spasm
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10
Q

Myocardial Infarction (MI)

A

-Commonly called a ‘heart attack’

  • Myocardial cell death and necrosis due to local, severe, or prolonged ischemia
  • **Caused by coronary artery occlusion
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11
Q

Myocardial Infarction Signs

A
  • rapid, weak heart rate
  • ECG changes (ie Q waves, ST segment elevation, T-wave inversion)
  • rise in troponin
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12
Q

Myocardial Infarction Symptoms

A
  • Moderate to severe angina not relieved by rest or nitroglycerin (may last several hours; radiate to arm(s), next, jaw, shoulder, or back)
  • shortness of breath
  • nausea, vomiting, or both
  • sweating
  • light-headedness or dizziness
  • fainting
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13
Q

Heart Failure

A

-Inability to pump sufficient blood to meet the metabolic needs of the body

-Systolic dysfunction
Reduced LV ejection fraction (LVEF) < 40%

-Diastolic dysfunction
Normal LVEF (55-70%)
Stiff LV wall, unable to relax  during diastole (volume of what it pumps out is less)
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14
Q

Heart Failure (HF) - Compensatory Responses - Cardiac Dilation

A
  • Residual blood accumulated in the ventricle

- Causes stretching of myocardial fibers and dilation of ventricle

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15
Q

Heart Failure (HF) - Compensatory Responses - Cardiac Hypertrophy

A
  • An adaptation to the increase diastolic volume

- Causes increased ventricular muscle mass and wall thickness

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16
Q

Heart Failure (HF) - Compensatory Responses - Activation of sympathetic nervous system

A
  • Release of norepinephrine and other catecholamines in response to reduced CV output and tissue perfusion
  • Causes increased HR and contractility to maintain normal CV output
17
Q

Heart Failure (HF) - Compensatory Responses - Stimulation of renin- angiotensin-aldosterone system (RAAS)

A

-Due to reduced renal perfusion through sympathetic nervous system activation
-Causes aldosterone release  sodium and water retention  increased
venous pooling of blood due to failing ventricle

18
Q

Heart Failure (HF) Signs***

A
  • Tachycardia
  • S3 gallop
  • LV hypertrophy
  • Rales or crackles
  • EF <40%
  • Weight gain
  • Increase blood urea nitrogen (BUN)
  • jugular venous distension
  • hepatomegaly
  • hepatojugular reflex
19
Q

Heart Failure (HF) Symptoms

A
  • shortness of breath
  • dyspnea on exertion
  • orthopnea
  • paroxysmal nocturnal dyspnea
  • peripheral edema
  • cough
  • weakness
  • fatigue
20
Q

Hypertension (HTN)

A

-Elevated SBP > 140 mmHg, DBP > 90 mmHg, or both
90% of patients have idiopathic HTN (idipathic = we don’t know why you have hypertension)

-Secondary causes (10%): renal disease, adrenal disorders (primary aldosteronism, Cushing’s Syndrome, or pheochromocytoma), or pregnancy

21
Q

Lipid Disorders

A

Terminology: Hyperlipidemia (HLD), Dyslipidemia, hypercholesterolemia, “high cholesterol”

22
Q

Triglycerides (TG)

A
  • Consist of FFA and glycerol, used for stored energy
  • Levels above 500 can increase risk of pancreatitis
  • Dependent on dietary fat
23
Q

Lipoproteins

A
  • LDL is the “bad cholesterol”  lodges in arterial walls and stimulates atherosclerotic plaque development
  • HDL is the “good cholesterol”  removes cholesterol from arterial wall, takes to liver for disposal
  • Lipoprotein (a)  similar to LDL, genetically determined, higher tendency to form clots
24
Q

Apolipoproteins

A
  • Play major role in binding, solubilizing, and transport of lipids
  • Include Apo B and A1 (as examples)
25
Q

Goals of Treatment - Lipid Disorders

A
  • LDL: <100 - optimal; >= 190 - very high
  • TC: <200 - optimal; >= 240 - very high
  • HDL: <40 - low; >= - 60 high
  • TG: <150 - optimal; >= 500 - very high

828 Dosage Forms (8 decks)

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