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PathoPharm 2 > ch 33 coronary artery disease and acute coronary syndrome > Flashcards

ch 33 coronary artery disease and acute coronary syndrome Flashcards

1
Q

nonmodifiable risk factors for CAD (4)

A
  • increasing age
  • gender (most = middle aged men)
  • ethnicity (white)
  • genetic predisposition and family history
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2
Q

modifiable risk factors for CAD (9)

A
  • increased serum lipids (diet and exercise)
  • smoking
  • obesity
  • metabolic syndrome
  • HTN
  • physical immobility
  • diabetes
  • psychologic states
  • hemocysteine level
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3
Q

examples of beginning injuries that cause atherosclerosis (3)

A
  • HTN
  • T2 DM
  • smoking
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4
Q

recommended HDL levels for male and female

A

M >40

F>50

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5
Q

HDL levels that indicate low risk CAD

A

> 60

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6
Q

HDL levels that indicate high risk CAD

A

<40

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7
Q

recommended LDL levels

A

<100

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8
Q

LDL levels that indicate moderate risk CAD

A

130-159

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9
Q

LDL levels that indicate high risk CAD

A

> 160

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10
Q

first line meds for high cholesterol

A

antihyperlipidemics (statins)

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11
Q

purpose of statins (2)

A

lowers cholesterol

lowers risk MI and stroke

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12
Q

what should you monitor in pts on statins

A

liver enzymes (creatinine)

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13
Q

common side effects of statins

A

muscle soreness/aches

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14
Q

complication of statins

A

rhabdomylosis: breakdown of skeletal muscle, leads to renal failure

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15
Q

med: cholesterol absorption inhibitor
inhibits absorption cholesterol in GI
side effect: diarrhea

A

ezetimibe

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16
Q

side effect of niacin and how to prevent it

A

severe facial flushing after taking

-prevent: take 81 mg aspirin 30 mins before

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17
Q

med that reduces triglyceride levels (fibrates)

A

fenofibrate

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18
Q

med that inhibits absorption cholesterol in intestines (bile acid sequestrant). usually given to prevent diarrhea after cholecystectomy

A

cholestyramine

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19
Q

2 alternative therapies for treating high LDLs

A

high doses garlic

red yeast rice

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20
Q

what should you watch for with pt taking high doses garlic supplements

A

increased bleeding time

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21
Q

lack of bloodflow to area of heart, demand O2>supply

A

ischemia

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22
Q

what diseases are associated with silent ischemia (2)

A
  • HTN

- T2 DM

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23
Q

2 types angina

A
  • chronic stable

- unstable

24
Q

intermittent chest pain with exertion over period of time in predictable fashion, relieved with rest

  • more likely in men
  • at risk for MI
A

chronic stable angina

25
Q

new onset chest pain that occurs at rest or with increasing frequency/duration

A

unstable angina

26
Q

what med treats chest pain when it occurs in chronic stable angina

A

nitroglycerin (short acting nitrate)

27
Q

what med prevents chest pain with chronic stable angina

A

nitroglycerin ointment or patch

isordil (long acting nitrates)

28
Q

what meds can you give for chronic stable angina

A
  • nitroglycerin
  • nitroglycerin ointment/patch
  • b blocker (slows HR)
  • calcium channel blocker (slows HR)
  • ACE inhibitor (lowers bp)
29
Q

what should you educate pts about when taking nitroglycerin for chronic stable angina (6)

A
  • take with 1st signs angina
  • if 1st dose doesn’t help, call 911 before taking 2nd dose
  • keep med in vial bc sunlight breaks it down
  • replace q6months
  • put paste on upper chest
  • only wear patch during day
30
Q

type of angina not due to atherosclerosis

caused by coronary artery spasms causing decreased bloodflow, usually during sleep

A

prinzmetals angina

31
Q

treatment prinzmetals angina

A

calcium channel blockers

32
Q

diagnostic options for coronary artery disease (2)

A
  • ECG

- stress test

33
Q

what med should you hold before stress test for CAD

A

b blocker

34
Q

what meds can be given instead of running for stress test to diagnose CAD (2)

A

dobutamine

lexiscan

35
Q

2 ways to prevent MI with diagnosis of CAD after stress test

A
  • cardiac catheterization

- percutaneous coronary intervention (balloon or stent)

36
Q

preop nursing considerations for cardiac cath (4)

A
  • NPO 8 hrs before
  • hold ED meds 48 hrs before
  • clip hair at site
  • check allergies: shellfish (if DM hold metformin)
37
Q

postop nursing considerations for cardiac cath

A

AT HIGH RISK FOR MAJOR BLEED

  • sandbags, pressure dressing, or c-clamp on femoral site
  • assess site for bleeding q15 mins
  • assess VS q15 mins for 1st hour
38
Q

2 types acute coronary syndrome

A
  • ST-elevation MI (STEMI)

- non-ST-elevation MI (NSTEMI)

39
Q

what is acute coronary syndrome

A

MI

40
Q

difference between STEMI and NSTEMI

A

STEMI: 100% occlusion coronary artery
NSTEMI: significant blockage but <100%

41
Q

3 areas of damage after MI

A
  • area of infarction (irreversible)
  • area of injury
  • area of ischemia
42
Q

S+S unstable angina (ACS) (6)

A
  • new/change in/worsening of chest pain
  • chest pain at rest
  • SNS response: increased HR and bp
  • S3 and S4 heart sounds
  • N/V
  • fever, fatigue, sweating
43
Q

how does scar tissue affect heart after MI healing

A

dysrhythmias and decreased cardiac output

scar tissue doesn’t conduct impulses or contract the same

44
Q

complications of MI

A
  • dysrhythmias
  • HF
  • cardiogenic shock (severe hypotension)
  • papillary muscle dysfunction (heart valves don’t work)
  • ventricular aneurysm (bulge and rupture of ventricle)
  • acute pericarditis (dressler syndrome: 6 weeks after MI)
45
Q

diagnosis of unstable angina and MI (3)

A
  • ECG
  • cardiac markers (CK-MB)
  • if normal cardiac markers, exercise stress test
46
Q

what is included in CK-MB

A
  • creatine kinase (peaks late in MI)

- troponin T + I (peaks early in MI)

47
Q

emergency management unstable angina/MI

A 
(MONA)
Morphine
O2
Nitroglycerin
Aspirin (325 mg, CHEW)
48
Q

3 treatment options unstable angina/MI

A
  • fibrinolytic therapy
  • coronary artery bypass graft (CABG)
  • percutaneous coronary intervention (stent or balloon)
49
Q

what are pts high risk for after CABG (2)

A
  • dysrhythmias

- tamponade

50
Q

meds for acute ACS

A
  • antiplatelet (aspirin) or clopidogrel (plavix)
  • nitroglycerin
  • morphine
51
Q

meds for post MI

A
  • b blocker
  • ACE/ARB
  • antidysrhythmic drug
  • statin
  • stool softeners
52
Q

nutrition considerations for post MI pt (3)

A
  • low salt
  • low sat fat
  • low cholesterol
53
Q

what can aspirin toxicity cause (2)

A

tinnitus

reyes syndrome in children <12

54
Q

risk factors for sudden cardiac death (SCD) (7)

A
  • smoking
  • HTN
  • DM
  • family history
  • cardiomyopathy (in peds patients)
  • hypercholesteremia
  • coronary artery disease
55
Q

causes stable angina (8)

A
  • physical exertion
  • temperature extremes
  • strong emotions
  • consumption of heavy meals
  • smoking
  • sexual activity
  • stimulants
  • circadian rhythm patterns (morning)

PathoPharm 2 (33 decks)

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