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Med Surg > Ch 27 > Flashcards

Ch 27 Flashcards

0
Q

How can one prevent CAD

A 
Control cholesterol
Dietary measures
Physical activity
Medications
Cessation of smoking
Manage HTN
Control diabetes
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1
Q

Coronary atherosclerosis

A

Is the abnormal accumulation of lipid deposits and fibrous tissue within the arterial walls and lumen.
Blockages and narrowing of the coronary vessels reduce blood flow to the myocardium.

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2
Q

Name the 6 cholesterol medications

A 
3-hydroxy-3- methylglutaryl coenzyme A (HMG-CoA) or ( statins)
Nicotinic acids
Fibric acids or (Fibrates)
Bile acid sequestrants (or resins)
Cholesterol absorption inhibitors 
Omega-3 acid-ethyl esters
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3
Q

What lab should be monitored when atorvastatin ( Lipitor) is administered

A

Liver enzymes

Atorvastatin ( Lipitor) is a HMG CoA reductase inhibitor and is hepatotoxic therefor liver enzymes should be monitored

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4
Q

What are medications for angina pectoris

A 
Nitroglycerin 
Beta blockers
Calcium channel blockers
Anti platelet and anticoagulate medications
Aspirin
Clopidogrel and ticlopidine 
Heparin
Glycoprotein IIB/IIIa agents
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5
Q

What is CRP

A

CRP is known to be an inflammatory marker for cardiovascular risk, including acute coronary events and stroke
The liver produces CRP in response to a stimulus such as tissue injury, high levels of this protein is likely to occur in ppl with diabetes and who are likely to have an acute coronary event

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6
Q

What are the four elements of fat metabolism

A 
Total cholesterol
LDL
HDL 
triglycerides
All are known to affect the developmEnt of heart disease
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7
Q

How is cholesterol processed

A

It is processed by the GI tract into lipo protein globules called chylomicrons. These are processed by the liver as lipoproteins

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8
Q

LDL levels

A

Less than 100

Less than 70 for very at risk patients

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9
Q

Total cholesterol levels

A

Less than 200

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10
Q

HDL levels

A

Greater than 40 for males

Greater than 50 for females

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11
Q

Triglyceride levels

A

Less than 150

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12
Q

What tests are clear predictors of coronary events

A

Total cholesterol

LDL

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13
Q

Triglycerides

A

Are made up of fatty acids and is transported through the blood by a lipoprotein
Although a level beyond 200 may be genetic, it can also be caused from obesity, physical inactivity, excessive alcohol intake, high carbohydrate diets, diabetes, kidney disease and certain meds such as oral contraceptives and corticosteroids.

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14
Q

What are therapeutic effects of statins

A

Lowers; total cholesterol, LDL, Triglycerides

Increases; HDL

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15
Q

What is the therapeutic effects of nicotinic acids

A

Lowers; HDL, triglycerides, and total cholesterol, lipolysis in adipose tissue and lipoprotein synthesis in liver

Increases; HDL

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16
Q

What are the therapeutic effects of fibric acids ( Fibrates)

A

Increases; HDL

Decreases; triglycerides, synthesis of triglycerides and other lipids

17
Q

What are uses of bile acid sequestrants

A

Lowers; LDL,

Slight HDL increase
Oxidizes cholesterol into bile acids which decreases fat absorption

18
Q

What are the therapeutic effects of cholesterol absorption inhibitors

A

Lowers LDL

Inhibits absorption of cholesterol in small intestine

19
Q

What are the therapeutic effects of omega3 acid ethyl esters

A

Lowers triglycerides

Inhibits triglyceride production in the liver

20
Q

What do catecholamines do

A

They increase BP, HR and myocardial workload

21
Q

What does nitrates do as far as treating angina

A

They are for short and long term reduction of myocardial oxygen consumption through selective vasodilation

22
Q

What do beta blockers do for the relief of angina

A

Reduction of myocardial oxygen consumption by blocking beta adrenergic stimulation of the heart.

23
Q

Calcium channel blockers are indicated for angina, how are they used

A

Negative Inotropic effects
Indicated in patients not responsive to beta blockers
Used in primary treatment for vasospasm

24
Q

Name anti platelet meds

A 
Aspirin
Clopidogrel ( plavix)
Prasugrel ( effient)
Glycoprotein IIB/IIa agents;
Abciximab ( ReoPro)
Eptifibatide ( integrillin)
25
Q

Name anticoagulant drugs

A

Heparin
Low molecular weight heparins;
Enoxaparin (lovenox)
Dalteparin ( fragmin)

26
Q

What is used to diagnose a acute MI

A

Cardiac enzymes and biomarkers, which include troponin, creatinine kinase (CK) and myoglobin

27
Q

Troponin

A

A protein found in myocardial cells, regulates the myocardial contractile process
Troponin I&T are specific for cardiac muscle these are critical markers for myocardial injury.
A increase in the level of troponin can be detected within a few hours of a MI, it remains elevated for as long as 3 weeks therefore making it can be used to detect recent myocardial damage.

28
Q

CK-MB ( heart muscle)

A

Is the cardiac- specific isoenzyme it is found mainly in cardiac cells and therefore increases when There has been damage to these cells
Elevations of CK-MB is an indicator of an acute MI. The levels begin to peak within a few hours and peaks within 24 hours of an infarct

29
Q

CK- BB

A

Brain tissue

30
Q

CK-MM

A

Skeletal muscle

31
Q

S&S of diverticulosis

A

Constipation

Seepage of stool

32
Q

Treatment of diverticulosis

A

Antibiotics or resection
Hydration
Diet changes

33
Q

Diagnostics of diverticulosis

A

Abdominal x Ray
Barium enema
ESR, WBC, CRP levels will b elevated
Heme positive for occult blood

34
Q

What are s&s of a peptic ulcer

A

Sharp pain knife like
Heart burn
Coffee ground emesis
Weakness fatigue

35
Q

What are s&s of RA

A

Pain stiffness

36
Q

What are risk factors for RA

A

Female

37
Q

What are diagnostics of RA

A

X-ray
RA factor
NAA factor
ESR, CRP, ANTI CC, are all elevated

38
Q

What are s&s of MS

A 
Bowel, bladder and sexual dysfunction 
Fatigue, muscle weakness
Ataxic, Diplopia
Blurred vision
Loss of ability to walk
Constipation
Incontinence
Dysphagia
39
Q

What are risk factors of MS

A

Genetic
Viruses
Age 30-40
Linked to Epstein Barr virus

40
Q

What are diagnostics of MS

A

MRI
ELECTROPHORESIS OF SPINAL FLIUD
UNDERLYING BLADDER DYSFUNCTION DIAGNOSED BY URODYNAMIC STUDIES
NEUROPHYSIOLOGICAL STUDIES

Med Surg (19 decks)

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