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Nursing 232 Post Midterm > Coronary Artery Disease > Flashcards

Coronary Artery Disease Flashcards

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1
Q

Athersclerotic Heart Disease causes 4 things to happen..

A
  1. Narrows Lumen of vessel
  2. Reduces Elasticity
  3. Increases risk of placque rupture & subsequent clot formation
  4. Increases risk of vasospasm
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2
Q

What are the Risk Factors for Athersclerosis?

  1. Unalterable (4)
  2. Medically Ulterable (3)
  3. Ulterable (5)
A
  1. Heredity, age, sex race
  2. Hypertension, hyperlipidemia, DM
  3. Smoking, alochol, diet, sedentary life, stress, obesity
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3
Q

The amount of damage on the heart in an MI depends on what?

A
  1. Degree / duration of obstruction
  2. Collateral circulation
  3. Time before treatment
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4
Q

How much does the blood flow to the coronary arteries need to be reduced before syptoms appear?

A

75%

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5
Q

02 Demand > Supply.

3 things that cause this?

A
  1. Increased workload of the heart
  2. Reduced blood supply to the heart
  3. Reduced oxygen carrying capacity of coronoary arteries
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6
Q

What would cause increased workload on the heart? (3)

A
  1. HTN
  2. Aortic stenosis (stiff valves)
  3. Increased metabolic demand (ex. going on a run)
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7
Q

What would cause reduced blood supply to the heart? (3)

A
  1. atherosclerosis
  2. coronary artery vasospasm
  3. thrmbus / embolus
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8
Q

What would cause reduced oxygen carrying capacity of coronary arteries? (3)

A
  1. anemia
  2. hemodilution
  3. acute blood lose
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9
Q

When 02 demand > 02 supply, how could you reduce the 02 demand?

A
  • rest
  • oxygen
  • nitrates (systemic vasodilation)
  • morphine (opioid analgesic to reduce pain AND relaxes vascular smooth muscle, particularily veins to reduce preload)
  • beta blockers (decreases heart contractility / CO)
  • Ca+ channel Blockers (affects smooth muscle causing vasodilation)
  • ACEI (inhibitits ANG1 to convert to ANG 2)
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10
Q

When 02 demand > 02 supply, how could you increase the 02 supply?

A
  • Aspirin (160 -325 mg chewed)
  • Fibrinolytics
  • PCI (percutaneous coronary interventions)
  • Coronary Artery Bypass
  • Heparins
  • Antiplatelets
  • HMG Coenzyme A Redcuctase Inhibitors
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11
Q

What is the acrnoynm for mangement of ischemia?

A

MONA

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12
Q

What does MONA stand for?

A 
M = Morphine
O = Oxygen
N = Nitrates
A = Aspirin
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13
Q

Is MONA done in the order of the acronym?

A

Not necessarily!

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14
Q

Nitrates:

  1. What does the drug do?
  2. What is the worst thing that could happen with the drug?
  3. Example:
A
  1. relaxes vascular smooth muscle in arteries (including arteries) AND partciularlry in veins, reducing preload… reducing cardiac workload
    • Vessels dialate too much, blood pools in periphery (reducing CO), fill the space with isotonic volume
    • Headache
  3. Nitroglycerine
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15
Q

What are the forms of Nitroglycerine?

A

SL, spray, transdermal patches, IV

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16
Q

Morphine:

  1. What does the drug do?
  2. What is the worst thing that could happen with the drug?
  3. Antidote?
A
    • Opioid analgesic (binds to opioid receptors altering te pain respsonse, be aware of LOC / RR)
    • Relaxes smooth muscle, particularily in the veins (reducuing preload, reducing cardiac workload)
    • Vessels dialate too much, pooling of blood in periphery
    • Respiratory depression (arrest!)
  3. naloxone
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17
Q

Beta Blockers:
1. What do they do?
2. What is the worst thing that could happen?
Examples:

A
  1. reduction in CO by blocking beta receptors (beta 1)
  2. bradycardia, inadequate CO, bronchospasm
  3. OLOLS! atenolol, metoprolol, propanolol
18
Q

Calcium Channel Blockers:

  1. What do they do?
  2. What is the worst thing that could happen?
  3. Examples:
A
  1. relaxation of vessel walls through blocking of calcium ion channels (reducing afterload & consequently cardiac workload)
  2. bradycardia, inadeqaute CO, heart failure
  3. Norsvac, Renidil, Diltiazem
19
Q

What type of juice can you not have when on a CA+ channel blocker?

A

grapefruit juice

20
Q

ACEI

  1. What do they do?
  2. What is the worst thing that could happen?
  3. Examples:
A
  1. Inhibition of the conversion of angiotensin 1 to angiotensin 11 (reduces after load and consequently cardiac workload)
  2. inadequate CO, cough aka angioedema (from action of vasodilator bradykinins)
  3. PRILS - Enapril, Captopril, Ramipril
21
Q

Aspirin

  1. What does this drug do?
  2. What is the worst that could happen?
  3. Examples
A
    • Anti ilfmm (NSAID), Anti platelet (can cause bleeding)
  2. Allergic reaction&raquo_space; antihistamine / epinephrine
  3. non- enteric coated ASA 160-325 mg chewed asap
22
Q

Fibrinolytics:

  1. For what type of MI?
  2. Within how many hours of first symptoms?
  3. Given if what is not available within first 90 minutes of first medical contact?
  4. What does the drug do?
A
  1. STEMI
  2. 12 hours
  3. PCI (Percutaenous Coronary Interventions)
  4. Disolves bodys fresh fibrin clots (ALL OF THEM!) must be careful because can cause to bleed out
23
Q

What is a PCI?

A

is a non-surgical procedure that uses a catheter (a thin flexible tube) to place a small structure called a stent to open up blood vessels in the heart that have been narrowed by plaque buildup, a condition known as atherosclerosis.

24
Q

What does Heparin do?

A

Lengthens clotting time, prevents thrombus formation / growth

25
Q

Heparin can be taken IV OR SC. What is the onest for IV and SC?

A 
IV = immediate
SC = up to 1 hour
26
Q

What are LMWH?

A

Heparin molecules that have been modified and shortened

27
Q

What is the inhibiton of LMWH specfic to?

A

Active factor x, less likely to cause thrombocytopenia

28
Q

Duration of action is 2 - 4 times longer than what?

A

Regular heparin

29
Q

Which produces a more stable response: LMWH or Heparin?

A

LMWH (hence less follow up lab tests are needed)

30
Q

Antiplatelets:

  1. What do the drugs do?
  2. Examples:
A
  1. Reduce platelet aggregation

2. Thienopyridines, Glycoprotein 11b / 111a inhibitors

31
Q

Maintenance - Statins aka….

A

HGA Coenzyme A Reductase Inhibitors

32
Q

HGA Coenzyme A Reductase Inhibitors:

  1. What do these drugs do?
  2. What is the worst that could happen?
  3. Example:
A
  1. Inhibit cholesterol production
    - 20 - 40% reduction in LDL, raise HDL levels and lower triglycerides
    2.
    - Liver dysfunction (must monitor LFT)
    Muscle Pain, tenderness and weakness, monitor CPK
    - Heartburn, abdominal cramping, diarrhea (give with meal in evening)
  2. Atrovastatin
33
Q

Testing for Atherosclerosis:

What are the Diagnostic Tests?

A
  1. CK
  2. CK-MB
  3. Myoglobin
  4. Troponin I /T
34
Q

What is myoglobin testing for?

A

Estimates damage from skeletal muscle injury or myocardial infarction (not cardiac specfic)

35
Q

What are Troponin I / T?

A

Specfic cardiac markers, enzyme detected 2-6 hrs, MI peaks 15-24 hours, returns to normal within 7 days

36
Q

What other testing can be done?

A
  1. Electrocardiogram
  2. Echocardiogram
  3. Stress testing
  4. Angiogram
37
Q

Stress testing, patients are being monitored for what 2 things during the test?

A
  1. ECG

2. BP

38
Q

ECG is measuring what?

A

Electrical Conductivity of the heart, not the mechanical function
- Can give info. on areas of the heart that are damaged

39
Q

What does an echocardiogram identify?

A
  1. Heart wall motion
  2. Identify valvular disease
  3. Evaluate heart under stress
  4. Identify & Quantity of pericardial fluid
40
Q

Coronary Angiogram allows for what?

A

X ray visulization of the coronary arteries following the injection of contrast medium. Looking for blockages!

Nursing 232 Post Midterm (10 decks)

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