Ch 27 Flashcards
How can one prevent CAD
Control cholesterol Dietary measures Physical activity Medications Cessation of smoking Manage HTN Control diabetes
Coronary atherosclerosis
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.
Name the 6 cholesterol medications
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
What lab should be monitored when atorvastatin ( Lipitor) is administered
Liver enzymes
Atorvastatin ( Lipitor) is a HMG CoA reductase inhibitor and is hepatotoxic therefor liver enzymes should be monitored
What are medications for angina pectoris
Nitroglycerin Beta blockers Calcium channel blockers Anti platelet and anticoagulate medications Aspirin Clopidogrel and ticlopidine Heparin Glycoprotein IIB/IIIa agents
What is CRP
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
What are the four elements of fat metabolism
Total cholesterol LDL HDL triglycerides All are known to affect the developmEnt of heart disease
How is cholesterol processed
It is processed by the GI tract into lipo protein globules called chylomicrons. These are processed by the liver as lipoproteins
LDL levels
Less than 100
Less than 70 for very at risk patients
Total cholesterol levels
Less than 200
HDL levels
Greater than 40 for males
Greater than 50 for females
Triglyceride levels
Less than 150
What tests are clear predictors of coronary events
Total cholesterol
LDL
Triglycerides
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.
What are therapeutic effects of statins
Lowers; total cholesterol, LDL, Triglycerides
Increases; HDL
What is the therapeutic effects of nicotinic acids
Lowers; HDL, triglycerides, and total cholesterol, lipolysis in adipose tissue and lipoprotein synthesis in liver
Increases; HDL
What are the therapeutic effects of fibric acids ( Fibrates)
Increases; HDL
Decreases; triglycerides, synthesis of triglycerides and other lipids
What are uses of bile acid sequestrants
Lowers; LDL,
Slight HDL increase
Oxidizes cholesterol into bile acids which decreases fat absorption
What are the therapeutic effects of cholesterol absorption inhibitors
Lowers LDL
Inhibits absorption of cholesterol in small intestine
What are the therapeutic effects of omega3 acid ethyl esters
Lowers triglycerides
Inhibits triglyceride production in the liver
What do catecholamines do
They increase BP, HR and myocardial workload
What does nitrates do as far as treating angina
They are for short and long term reduction of myocardial oxygen consumption through selective vasodilation
What do beta blockers do for the relief of angina
Reduction of myocardial oxygen consumption by blocking beta adrenergic stimulation of the heart.
Calcium channel blockers are indicated for angina, how are they used
Negative Inotropic effects
Indicated in patients not responsive to beta blockers
Used in primary treatment for vasospasm
Name anti platelet meds
Aspirin Clopidogrel ( plavix) Prasugrel ( effient) Glycoprotein IIB/IIa agents; Abciximab ( ReoPro) Eptifibatide ( integrillin)
Name anticoagulant drugs
Heparin
Low molecular weight heparins;
Enoxaparin (lovenox)
Dalteparin ( fragmin)
What is used to diagnose a acute MI
Cardiac enzymes and biomarkers, which include troponin, creatinine kinase (CK) and myoglobin
Troponin
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.
CK-MB ( heart muscle)
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
CK- BB
Brain tissue
CK-MM
Skeletal muscle
S&S of diverticulosis
Constipation
Seepage of stool
Treatment of diverticulosis
Antibiotics or resection
Hydration
Diet changes
Diagnostics of diverticulosis
Abdominal x Ray
Barium enema
ESR, WBC, CRP levels will b elevated
Heme positive for occult blood
What are s&s of a peptic ulcer
Sharp pain knife like
Heart burn
Coffee ground emesis
Weakness fatigue
What are s&s of RA
Pain stiffness
What are risk factors for RA
Female
What are diagnostics of RA
X-ray
RA factor
NAA factor
ESR, CRP, ANTI CC, are all elevated
What are s&s of MS
Bowel, bladder and sexual dysfunction Fatigue, muscle weakness Ataxic, Diplopia Blurred vision Loss of ability to walk Constipation Incontinence Dysphagia
What are risk factors of MS
Genetic
Viruses
Age 30-40
Linked to Epstein Barr virus
What are diagnostics of MS
MRI
ELECTROPHORESIS OF SPINAL FLIUD
UNDERLYING BLADDER DYSFUNCTION DIAGNOSED BY URODYNAMIC STUDIES
NEUROPHYSIOLOGICAL STUDIES
