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Primary > Diagnosis and Management of Cardiovascular Disorders > Flashcards

Diagnosis and Management of Cardiovascular Disorders Flashcards

1
Q 
Blood Flow Through the Heart:
Superior Vena Cava ---->
Right Atrium ---->
Tricuscpid valve ---->
Right ventricle ---->
Pulmonic valve ---->
Pulmonic artery ---->
Lungs ------>
Pulmonary veins ---->
Left Atrium ---->
Mitral valve ----->
Left ventricle ----->
aortic valve ------>
aorta -------->
\_\_\_\_\_\_\_ ----->
A

body

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2
Q 
Blood Flow Through the Heart:
Superior Vena Cava ---->
Right Atrium ---->
Tricuscpid valve ---->
Right ventricle ---->
Pulmonic valve ---->
Pulmonic artery ---->
Lungs ------>
Pulmonary veins ---->
Left Atrium ---->
Mitral valve ----->
Left ventricle ----->
aortic valve ------>
\_\_\_\_\_\_ -------->
body ----->
A

aorta

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3
Q 
Blood Flow Through the Heart:
Superior Vena Cava ---->
Right Atrium ---->
Tricuscpid valve ---->
Right ventricle ---->
Pulmonic valve ---->
Pulmonic artery ---->
Lungs ------>
Pulmonary veins ---->
Left Atrium ---->
Mitral valve ----->
Left ventricle ----->
\_\_\_\_\_ \_\_\_\_\_ ------>
aorta -------->
body ----->
A

aortic valve

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4
Q 
Blood Flow Through the Heart:
Superior Vena Cava ---->
Right Atrium ---->
Tricuscpid valve ---->
Right ventricle ---->
Pulmonic valve ---->
Pulmonic artery ---->
Lungs ------>
Pulmonary veins ---->
Left Atrium ---->
Mitral valve ----->
\_\_\_\_\_ \_\_\_\_\_ ----->
aortic valve ------>
aorta -------->
body ----->
A

Left ventricle

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5
Q 
Blood Flow Through the Heart:
Superior Vena Cava ---->
Right Atrium ---->
Tricuscpid valve ---->
Right ventricle ---->
Pulmonic valve ---->
Pulmonic artery ---->
Lungs ------>
Pulmonary veins ---->
Left Atrium ---->
\_\_\_\_ \_\_\_\_ ----->
Left ventricle ----->
aortic valve ------>
aorta -------->
body ----->
A

Mitral valve

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6
Q 
Blood Flow Through the Heart:
Superior Vena Cava ---->
Right Atrium ---->
Tricuscpid valve ---->
Right ventricle ---->
Pulmonic valve ---->
Pulmonic artery ---->
Lungs ------>
Pulmonary veins ---->
\_\_\_\_ \_\_\_ ---->
Mitral valve ----->
Left ventricle ----->
aortic valve ------>
aorta -------->
body ----->
A

Left Atrium

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7
Q 
Blood Flow Through the Heart:
Superior Vena Cava ---->
Right Atrium ---->
Tricuscpid valve ---->
Right ventricle ---->
Pulmonic valve ---->
Pulmonic artery ---->
Lungs ------>
\_\_\_ \_\_\_\_ ---->
Left Atrium ---->
Mitral valve ----->
Left ventricle ----->
aortic valve ------>
aorta -------->
body ----->
A

Pulmonary veins

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8
Q 
Blood Flow Through the Heart:
Superior Vena Cava ---->
Right Atrium ---->
Tricuscpid valve ---->
Right ventricle ---->
Pulmonic valve ---->
Pulmonic artery ---->
\_\_\_\_\_ ------>
Pulmonary veins ---->
Left Atrium ---->
Mitral valve ----->
Left ventricle ----->
aortic valve ------>
aorta -------->
body ----->
A

Lungs

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9
Q 
Blood Flow Through the Heart:
Superior Vena Cava ---->
Right Atrium ---->
Tricuscpid valve ---->
Right ventricle ---->
Pulmonic valve ---->
\_\_\_\_\_ \_\_\_\_ ---->
Lungs ------>
Pulmonary veins ---->
Left Atrium ---->
Mitral valve ----->
Left ventricle ----->
aortic valve ------>
aorta -------->
body ----->
A

Pulmonic artery

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10
Q 
Blood Flow Through the Heart:
Superior Vena Cava ---->
Right Atrium ---->
Tricuscpid valve ---->
Right ventricle ---->
\_\_\_\_\_ \_\_\_\_ ---->
Pulmonic artery ---->
Lungs ------>
Pulmonary veins ---->
Left Atrium ---->
Mitral valve ----->
Left ventricle ----->
aortic valve ------>
aorta -------->
body ----->
A

Pulmonic valve

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11
Q 
Blood Flow Through the Heart:
Superior Vena Cava ---->
Right Atrium ---->
Tricuscpid valve ---->
\_\_\_ \_\_\_\_ ---->
Pulmonic valve ---->
Pulmonic artery ---->
Lungs ------>
Pulmonary veins ---->
Left Atrium ---->
Mitral valve ----->
Left ventricle ----->
aortic valve ------>
aorta -------->
body ----->
A

Right ventricle

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12
Q 
Blood Flow Through the Heart:
Superior Vena Cava ---->
Right Atrium ---->
\_\_\_\_\_ \_\_\_\_ ---->
Right ventricle ---->
Pulmonic valve ---->
Pulmonic artery ---->
Lungs ------>
Pulmonary veins ---->
Left Atrium ---->
Mitral valve ----->
Left ventricle ----->
aortic valve ------>
aorta -------->
body ----->
A

Tricuscpid valve

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13
Q 
Blood Flow Through the Heart:
Superior Vena Cava ---->
\_\_\_\_ \_\_\_\_ ---->
Tricuscpid valve ---->
Right ventricle ---->
Pulmonic valve ---->
Pulmonic artery ---->
Lungs ------>
Pulmonary veins ---->
Left Atrium ---->
Mitral valve ----->
Left ventricle ----->
aortic valve ------>
aorta -------->
body ----->
A

Right Atrium

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14
Q 
Blood Flow Through the Heart:
\_\_\_\_ \_\_\_\_\_ \_\_\_\_ ---->
Right Atrium ---->
Tricuscpid valve ---->
Right ventricle ---->
Pulmonic valve ---->
Pulmonic artery ---->
Lungs ------>
Pulmonary veins ---->
Left Atrium ---->
Mitral valve ----->
Left ventricle ----->
aortic valve ------>
aorta -------->
body ----->
A

Superior Vena Cava

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15
Q

Heart Sounds and Anatomical Location

_____
Mitral/tricuspid (AV) valves closure; aortic/pulmonic.(semilunar), valves open

A

S1

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16
Q

Heart Sounds and Anatomical Location

_____
Aortic/pulmonic (semilunar) valves closure; mitral/tricuspid (AV) valves open

A

S2

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17
Q

Heart Sounds and Anatomical Location

_______
The period between S1 and S2

A

Systole

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18
Q

Heart Sounds and Anatomical Location

______
The period between S2 and S1

A

Diastole

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19
Q

Heart Sounds and Anatomical Location

_____
“Ken-tuck’-y”; increased fluid states (e.g., CHF, pregnancy, etc.)

A

S3

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20
Q

Heart Sounds and Anatomical Location

______
“Ten-ne-ssee’”; stiff ventricular wall (e.g., MI, left ventricular hypertrophy, chronic hypertension etc.)

A

S4

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21
Q

Murmurs

_____: Loudest

A

VI/VI

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22
Q

Murmurs

_____: Very loud; heard with one comer of stethoscope off the chest wall

A

V/ VI

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23
Q

Murmurs

_____: Loud; associated with a thrill

A

IV/VI

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24
Q

Murmurs

_____: Moderately loud; easily heard

A

III/ VI

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25
Q

Murmurs

_____: Audible but faint

A

II/ VI

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26
Q

Murmurs

_____: Barely audible

A

I/VI

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27
Q

Valvular Disease: Major Problems

  1. _____ ____: Loud Sl murmur, low pitched, mid-diastolic; apical “crescendo” rumble
A

Mitral stenosis

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28
Q

Valvular Disease: Major Problems

2.____ _______: S3 with systolic murmur at 5th ICS MCL (apex); may radiate to base or left axilla; musical, blowing, or high pitched

A

Mitral regurgitation

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29
Q

Valvular Disease: Major Problems

  1. ______ ______: Systolic, “blowing”, rough harsh murmur at 2nd right ICS usually radiating to the neck
A

Aortic stenosis

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30
Q

Valvular Disease: Major Problems

  1. _____ _____: Diastolic, “blowing” murmur at 2nd left ICS. “Ms. Ard and Mr. Ass”
A

Aortic regurgitation

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31
Q

Mitral Stenosis and Aortic Regurgitation are in ______

A

Diastolic

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32
Q

Mitral Regurgitation and Aortic Stenosis are in _____

A

Systolic

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33
Q

Murmurs
Where?
a. ____ ICS = Apex = Mitral

A

5th

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34
Q

Murmurs
Where?
b.____ or ____ ICS = Base = Aortic

A

2nd or 3rd

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35
Q 
Signs/Symptoms (Acute): \_\_\_\_ \_\_\_\_
1. Dyspnea at rest
2. Coarse rams over all lung fields
3. Wheezing, frothy cough
4. Appears generally healthy except for the acute event
5. S3 gallop
6. The murmur of mitral regurgitation (systolic murmur 
     loudest at apex)
7. Pulmonary hypertension
A

Left failure

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36
Q

Signs/Symptoms (Chronic): ____ _____

  1. JVD
  2. Hepatomegaly, splenomegaly
  3. Dependent edema: As a result of increased capillary hydrostatic pressure
  4. Paroxysmal nocturnal dyspnea (PND)
  5. Appears chronically ill
  6. Diffuse chest wall heave
  7. Displaced PMI
  8. Abdominal fullness
  9. Fatigue on exertion
  10. S3 and/or S4
A

Right failure

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37
Q

Laboratory/Diagnostics: Heart Failure

  1. Hypoxemia and hypocapnia on ABG
  2. The basic metabolic profile usually normal unless the chronic failure is present
  3. Urinalysis
  4. Chest x-ray: Pulmonary edema, ____ B lines, effusions
  5. Echocardiogram will show contractile/relaxation, valve function, ejection fraction.
  6. ECG may show deviation or underlying problem: Acute myocardial infarction, dysrhythmia
  7. Pulmonary function tests for wheezing during exercise
A

Kerley

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38
Q

Management: Heart Failure

Non-Pharmacologic

  1. ______ restriction
  2. Rest/activity balance
  3. Weight reduction
  4. Others
A

Sodium

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39
Q

Management: Heart Failure

Pharmacologic

  1. ____ inhibitors
  2. Diuretics: Thiazides, loop, etc.
  3. Anticoagulation therapy for atrial fibrillation
A

ACE

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40
Q

Hypertension
A sustained elevation of systolic blood pressure (SBP)
> ____ mm Hg or diastolic blood pressure (DBP) > _____ mm Hg

A

SBP 140 or DBP 90

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41
Q

General Comments/ Hypertension
1. Two types
a. Primary/Essential: ___% of all cases; the onset usually
< 55 years of age

A

95

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42
Q

General Comments/ Hypertension

  1. Two types
    b. Secondary: ___% of all cases; secondary to other known causes such as estrogen use, renal disease, pregnancy, endocrine disorders, renal artery stenosis (RAS), etc.
A

5

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43
Q

General Comments/ Hypertension

  1. Exacerbating factors: _____, obesity, excessive alcohol intake, use of NSAIDs, and others
A

Smoking

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44
Q

Signs/Symptoms/ Hypertension

  1. Often none: “____ ____”
  2. Elevated BP
  3. With severe hypertension: Suboccipital pulsating headache, occurring early in the morning and resolving throughout the day
  4. Epistaxis
  5. Dizziness/lightheadedness
  6. S4 related to left ventricular hypertrophy
  7. Arteriovenous (AV) nicking
  8. Tearing chest pain may indicate aortic dissection
A

Silent killer

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45
Q

Laboratory/Diagnostic Findings/ Hypertension

  1. In uncomplicated hypertension, laboratory findings are usually ______.
  2. Other tests to rule out particular causes:
    a. Renovascular disease studies
    b. Chest x-ray (CXR) if cardiomegaly is suspected.
    c. Plasma aldosterone level to role out aldosteronism
    d. A.M./P.M.-cortisol levels to rule out Cushing’s Syndrome
  3. U/A, CBC, BMP, calcium, phosphorus, uric acid, cholesterol, Triglycerides
  4. Electrocardiography (ECG)
  5. PA and lateral CXR
A

normal

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46
Q

JNC 7 Guidelines:

Classifications: Normal
Systolic BP < ___
Diastolic BP < ___

A

120

80

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47
Q

JNC 7 Guidelines:

Prehypertension
Systolic BP ______
Diastolic BP ______

A

120 to 139 or

80 to 89

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48
Q

JNC 7 Guidelines:

Hypertension/ Stage 1
Systolic BP ______
Diastolic BP ______

A

140 to 159

90 to 99

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49
Q

JNC 7 Guidelines:

Hypertension/ Stage 2
Systolic BP > or equal to ___
Diastolic BP > or equal to ____

A

160

100

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50
Q

In contrast to JNC 7, _____ emphasizes treatment thresholds.

A

JNC 8

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51
Q

JNC 8 Recommendations (Grade ___ = expert opinion but insufficient evidence for the recommendation)

A

E

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52
Q

JNC 8 Recommendations (Grade ___= moderate recommendation)

A

B

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53
Q

JNC 8 Recommendations (Grade ___ = strong recolmnendation)

A

A

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54
Q

JNC 8 Recommendations (Grade ___ = weak recommendation)

A

C

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55
Q

According to the JNC 8 Recommendations
Recommendation 1
Population: Adults > 60 years of age
Goal BP: SBP < ____ mmHg or DBP < ____mmHg (Grade A)

A

150

90

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56
Q

According to the JNC 8 Recommendations
Recommendation 2
Population: Adults < 60 years of age
Goal BP: DBP < ___ mmHg (Grade A)

A

90

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57
Q

According to the JNC 8 Recommendations
Recommendation 3
Population: Adults < 60 years of age
Goal BP: SBP < ____mmHg (Grade E)

A

140

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58
Q

According to the JNC 8 Recommendations
Recommendation 4
Population: Adults > 18 with CKD
Goal BP: SBP < ___mmHg or DBP < ___ mmHg (Grade E)

A

140

90

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59
Q

According to the JNC 8 Recommendations
Recommendation 5
Population: Adults > 18 with DM
Goal BP: SBP < ___mmHg or DBP < ___ mmHg (Grade E)

A

140

90

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60
Q 
According to the JNC 8 Recommendations
Recommendation 6
Population: Non-African-American
Goal BP: \_\_\_\_ Type diuretic •
                CCB •
                ACEI •
                ARB •
A

Thiazide

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61
Q 
According to the JNC 8 Recommendations
Recommendation 7
Population: African-American
Goal BP: Thiazide Diuretics
               \_\_\_ \_\_\_\_ \_\_\_ (Grade B; grade C for 
                patients with DM)
A

Calcium Channel Blockers

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62
Q 
According to the JNC 8 Recommendations
Recommendation 8
Population: Adults > 18 Adults with CKD
Goal BP: \_\_\_\_
               ARB (Grade B)
               Regardless of race or other medical conditions
A

ACEI

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63
Q

According to the JNC 8 Recommendations
Treatment Goal Recommendation 9
The treatment goal for initial treatment is 1 month
• a. (1) Increase dose, then (2) add the second drug
• b. Continue to assess _____ until the goal is reached
c. Do not use an ACEI and ARB together
• d. Refer to hypertensive specialist if 3 or more drugs are
needed

A

monthly

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64
Q

Hypertension/ Management (Non-pharmacologic): Therapeutic Lifestyle Changes (TLCs)
1. Restrict dietary _____

A

sodium

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65
Q

Hypertension/ Management (Non-pharmacologic): Therapeutic Lifestyle Changes (TLCs)
2. Weight ____, if overweight

A

loss

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66
Q

Hypertension/ Management (Non-pharmacologic): Therapeutic Lifestyle Changes (TLCs)
3. ___ (Dietary Approaches to Stop Hypertension) diet (rich in fruits, vegetables, and low-fat dairy products, with reduced saturated mad total fat)

A

DASH

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67
Q

Hypertension/ Management (Non-pharmacologic): Therapeutic Lifestyle Changes (TLCs)
4. Exercise (aerobic exercise ____ min each day on most days of the week)

A

30-40

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68
Q

Hypertension/ Management (Non-pharmacologic): Therapeutic Lifestyle Changes (TLCs)
5. ___ management planning

A

Stress

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69
Q

Hypertension/ Management (Non-pharmacologic): Therapeutic Lifestyle Changes (TLCs)
6. Reduction or elimination of ______ consumption (fewer than two drinks daily for men, or one drink daily for women and lighter weight persons)

A

alcohol

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70
Q

Hypertension/ Management (Non-pharmacologic): Therapeutic Lifestyle Changes (TLCs)
7. _______ cessation

A

Smoking

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71
Q

Hypertension/ Management (Non-pharmacologic): Therapeutic Lifestyle Changes (TLCs)
8. Maintenance of adequate _____, calcium, and
magnesium intake

A

potassium

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72
Q

Hypertension/ Management (Pharmacologic)

  1. Based on the degree of blood pressure _____ and/or file presence of end-organ damage, cardiovascular diseases or other risk factors
A

elevation

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73
Q

Hypertension/ Management (Pharmacologic)

  1. The goal of therapy: to prescribe the ____ number of medications possible at the lowest dosage to attain acceptable blood pressure, thereby decreasing cardiovascular and renal morbidity and mortality
A

least

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74
Q

Common Agents Used in the Treatment of Hypertension:

1. ____ ____, the first-line drug of choice for hypertension

A

Thiazide diuretics

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75
Q

Common Agents Used in the Treatment of Hypertension:
1. Thiazide diuretics, the first-line drug of choice for hypertension
a. Examples: chlorothiazide (Diuril), __________
(Hygroton), hydrochlorothiazide, indapamide (Lozol),
metolazone (Zaroxolyn)

A

chlorthalidone

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76
Q

Common Agents Used in the Treatment of Hypertension:

  1. Thiazide diuretics, the first-line drug of choice for hypertension
    b. Increase excretion of _____ and water
A

sodium

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77
Q

Common Agents Used in the Treatment of Hypertension:

  1. Thiazide diuretics, the first-line drug of choice for hypertension
    c. ______ morbidity and mortality
A

Reduce

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78
Q

Common Agents Used in the Treatment of Hypertension:

  1. Thiazide diuretics, the first-line drug of choice for hypertension
    d. Screen for _____ allergy before administering
A

sulfa

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79
Q

Common Agents Used in the Treatment of Hypertension:
1. Thiazide diuretics, the first-line drug of choice for hypertension
e. May cause hypokalemia, _________,
hyperglycemia, hyponatremia, hypercalcemia, etc.

A

hypomagnesemia

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80
Q

Common Agents Used in the Treatment of Hypertension:
1. Thiazide diuretics, the first-line drug of choice for hypertension
f. Spironolactone (Aldactone) has a side effect of
________

A

gynecomastia

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81
Q

ACE inhibitors
a. Examples: ______ (Lotensin), captopril (Capoten),
enalapril (Vasotec), fosinopril (Monopril), lisinopril
(Zestril), moexipril (Univasc), perindopril (Aceon),
quinapril (Accupril), ramipril (Altace), trandolapril
(Mavik)

A

benazepril

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82
Q

ACE inhibitors
b. Cause vasodilation and block _____ and water
retention

A

sodium

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83
Q

ACE inhibitors

c. Do not initiate if potassium is greater than ___ mEq/L

A

5.5

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84
Q

ACE inhibitors

d. Contraindicated in ______

A

pregnancy

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85
Q

ACE inhibitors

e. Do not use in combination with an ___

A

ARB

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86
Q

ACE inhibitors
f. May cause cough, rash, ____ ______,
hyperkalemia, renal impairment, etc.

A

taste disturbances

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87
Q
  1. Angiotensin II-receptor blockers; reserved for patients _____ to ACE inhibitors
A

intolerant

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88
Q
  1. Angiotensin II-receptor blockers; reserved for patients intolerant to ACE inhibitors
    a. Examples: ________ (Atacand), eprosartan mesylate (Teveten), irbesartan (Avapro), losartan (Cozaar), olmesartan (Benicar), telmisartan (Micardis), valsartan (Diovan)
A

candesartan

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89
Q
  1. Angiotensin II-receptor blockers; reserved for patients intolerant to ACE inhibitors
    b. Cause vasodilation and block ____ and water
    retention
A

sodium

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90
Q
  1. Angiotensin II-receptor blockers; reserved for patients intolerant to ACE inhibitors
    c. Do not initiate if potassium is greater than ___ mEq/L
A

5.5

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91
Q
  1. Angiotensin II-receptor blockers; reserved for patients intolerant to ACE inhibitors
    d. Contraindicated in ______
A

pregnancy

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92
Q
  1. Angiotensin II-receptor blockers; reserved for patients intolerant to ACE inhibitors
    e. Do not use in combination with an ___ inhibitor
A

ACE

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93
Q

Angiotensin II- receptor blockers; reserved for patients intolerant to ACE inhibitors
f. May cause cough, ______, headache, taste disturbances, renal impairment, etc.

A

hyperkalemia

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94
Q

Calcium channel blocking agents
a. Examples: verapamil IR, verapamil (Calan SR), diltiazem IR, diltiazem (Dilacor XR), amlodipine (Norvasc), ______ (Plendil), isradipine (Dynacirc), nicardipine (Cardene SR), nifedipine (Adalat CC), nisoldipine (Sular)

A

felodipine

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95
Q

Calcium channel blocking agents

b. Monitor ___ ____, especially when administering verapamil and diltiazem

A

heart rate

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96
Q

Calcium channel blocking agents

c. May be used for angina, arrhythmias, and _______

A

migraines

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97
Q

Calcium channel blocking agents

d. May cause ______, flushing, bradycardia, etc.

A

headache

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98
Q

Beta-blocking agents
a. Examples: ______ (Sectral), atenolol (Tenormin), betaxolol (Ketone), bisoprolol (Zebeta), carvedilol (Coreg), labetalol (Normodyne) metoprolol (Lopressor), nadolol (Corgard), pindolol (Visken), propranolol
(Inderal), timolol (Blocadren)

A

acebutolol

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99
Q

Beta-blocking agents

b. Directly relax the _____

A

heart

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100
Q

Beta-blocking agents

c. May also be used for ____ and arrhythmias

A

angina

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101
Q

Beta-blocking agents

d. Monitor heart rate and avoid use in patients with ______/COPD

A

asthma

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102
Q

Beta-blocking agents

e. Not _____-line therapy

A

first

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103
Q

Beta-blocking agents

f. May cause ______, bradycardia, heart block, fatigue, insomnia, nausea, etc.

A

dizziness

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104
Q

Peripheral alpha-1 antagonists

a. Examples: _____ (Minipress), terazosin (Hytrin), doxazosin (Cardura)

A

prazosin

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105
Q

Peripheral alpha-1 antagonists

b. Cause what?

A

vasodilation

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106
Q

Peripheral alpha-1 antagonists

c. Take the first dose at _______

A

bedtime

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107
Q

Peripheral alpha-1 antagonists

d. Primarily used as an _____ therapy

A

adjunct

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108
Q

Peripheral alpha-1 antagonists

e. May be used for ___ _____ _____

A

benign prostatic hyperplasia

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109
Q

Peripheral alpha-1 antagonists

f. May cause first-dose syncope, _____ ____, orthostasis, dizziness, headache, nausea, etc.

A

dry mouth

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110
Q

Central alpha-2 agonists

a. Examples: ____ (Catapres), methyldopa (Aldomet)

A

clonidine

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111
Q

Central alpha-2 agonists
b. Prevent ________, cause vasodilation, and slow
the heart rate

A

vasoconstriction

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112
Q

Central alpha-2 agonists
c. Methyldopa is the drug of choice in ______,
clonidine is available as a transdermal patch

A

pregnancy

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113
Q

Central alpha-2 agonists
d. Do not ______ use abruptly, as it may cause
withdrawals and rebound hypertension.

A

discontinue

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114
Q

Central alpha-2 agonists

e. Primarily used as an ______ therapy

A

adjunct

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115
Q

Central alpha-2 agonists

f. May cause dry mouth, ______, depression, headache, bradycardia, etc.

A

sedation

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116
Q

Arterial vasodilators

a. Examples: _______ (Apresoline), minoxidil (Loniten)

A

hydralazine

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117
Q

Arterial vasodilators

b. Directly relax the vascular ____ muscle resulting in arterial vasodilation

A

smooth

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118
Q

Arterial vasodilators

c. Reduce frequency in _____ dysfunction.

A

renal

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119
Q

Arterial vasodilators

d. May cause reflex ________

A

tachycardia.

120
Q

Arterial vasodilators

e. Used primarily as an ______ therapy and is available intravenously.

A

adjunct

121
Q

Arterial vasodilators

f. May cause nausea, ______, dizziness, orthostatic hypotension, etc.

A

flushing

122
Q
  1. Direct renin inhibitors

a. Examples: _______ (Tekturna)

A

aliskiren

123
Q
  1. Direct renin inhibitors
    b. Inhibits _______, which decreases plasma renin activity (PRA) and inhibits the conversion of angiotensinogen I to angiotensin I
A

renin

124
Q
  1. Direct renin inhibitors

c. Does ______ offer an advantage over any other available regimens and is expensive.

A

not

125
Q
  1. Direct renin inhibitors

d. ________, avoid use in pregnancy.

A

Teratogenic

126
Q
  1. Direct renin inhibitors

e. May cause ______, dizziness, headache, hyperkalemia, etc.

A

diarrhea

127
Q
  1. Special considerations
    a. Neither age nor _______ usually affects agent
    responsiveness.
A

gender

128
Q
  1. Special considerations

b. ______-type diuretics are usually recommended for first-line treatment.

A

Thiazide

129
Q
  1. Special considerations
    c. Beta-blockers, ACE inhibitors, adrenergic receptor blockers, and calcium channel blockers are also useful alone or in _______ therapy.
A

combination

130
Q
  1. Special considerations
    * * When pharmacologic therapy is indicated, the goal is to use as few medications at the _______ doses to maintain blood pressure control. **
A

lowest

131
Q

Hypertensive Urgencies

1. Characterized by severe elevations in blood pressure of > ___/___ mmHg without progressive target organ dysfunction

A

180/110

132
Q

Hypertensive Urgencies

2. May or may not be associated with severe ______, shortness of breath, epistaxis, or severe anxiety

A

headache

133
Q

Hypertensive Urgencies
Management

  1. Oral therapies such as ______ (Catapres), captopril (Capoten), nifedipine (Procardia), loop diuretics, etc.
A

clonidine

134
Q

Hypertensive Urgencies
Management

  1. _____ therapy is rarely required
A

Parenteral

135
Q

Hypertensive Emergencies
Rare situations that require immediate (within ____ hour) blood pressure reduction to prevent or limit target organ damage

A

one

136
Q

Hypertensive Emergencies
Rare situations that require immediate (within one hour) blood pressure reduction to prevent or limit target organ damage
1. Situations associated with severe elevations in blood pressure of > ____/___ mmHg or higher

A

180/120

137
Q

Hypertensive Emergencies
Rare situations that require immediate (within one hour) blood pressure reduction to prevent or limit target organ damage
2. May occur at a lower blood pressure if complicated by evidence of impending or progressive target ____ dysfunction

A

organ

138
Q

Examples

  1. Malignant hypertension: Fundoscopic changes include flame-shaped retinal _______, soft exudates and papilledema (swelling of the optic disk with blurred margins)
  2. Hypertensive encephalopathy
  3. Intracranial hemorrhage
  4. Unstable angina
  5. Acute MI
  6. Acute LV failure with pulmonary edema
  7. Dissecting aortic aneurysm
  8. Eclampsia
A

hemorrhages

139
Q

Management: Hypertensive Emergencies

  1. Refer for:
    a. Require ______ agents, critical care beds, and invasive arterial pressure monitoring
A

intravenous

140
Q

Management: Hypertensive Emergencies

b. Blood pressure should be lowered to ____ mmHg systolic or to less than ____ mmHg diastolic (no more than 25% within minutes to 1-2 hr), and then gradually lowered over several days with oral therapy; common agents: Nicardipine (Cardene), Sodium nitroprusside (Nipride), or others

A

160-180

105

141
Q

Decreased blood flow through the vessel —> tissue ischemia

A

Angina

142
Q

Types of Angina:

1. _____ (classic or chronic): Exertional (most common)

A

Stable

143
Q

Types of Angina:

2. _______ (variant): Occurs at various times, including rest

A

Prinzmetal’s

144
Q

Types of Angina:

  1. ______ (pre-infarction, rest or crescendo, coronary syndromes)
  2. Microvascular (metabolic syndrome)
A

Unstable

145
Q

Types of Angina:

  1. __________ (metabolic syndrome)
A

Microvascular

146
Q

Signs/Symptoms: Angina

1. Characteristic chest ______ lasting several minutes

A

discomfort

147
Q

Signs/Symptoms: Angina

2. Exertional is usually precipitated by physical activity; subsides with ____

A

rest

148
Q

Signs/Symptoms: Angina

3. _____ shortens or prevents attacks

A

Nitroglycerin

149
Q

Physical Exam Findings: Angina

1. May see signs of _____ arterial disease

A

peripheral

150
Q

Physical Exam Findings: Angina

2. _____ sign = “clenched fist sign”

A

Levine’s

151
Q

Physical Exam Findings: Angina

3. Transient ____ not uncommon during angina

A

S4

152
Q

Laboratory/Diagnostic Findings: Angina

  1. ECG may be normal, with _______ of ST-segment, or T-wave peak or inversion during an attack
A

downsloping

153
Q

Laboratory/Diagnostic Findings: Angina

  1. Serum lipid levels should be evaluated
    a. Total cholesterol: Desirable = < ____ mg/dl
A

200

154
Q

Laboratory/Diagnostic Findings: Angina

  1. Serum lipid levels should be evaluated
    b. VLDLs (triglycerides): Normal = < ___ mg/dl
A

150

155
Q

Laboratory/Diagnostic Findings: Angina

  1. Serum lipid levels should be evaluated
    c. LDLs: Optimal = < ___ mg/dl
A

100

156
Q

Laboratory/Diagnostic Findings: Angina

  1. Historically, goals for patients with diabetes or documented coronary artery disease:
    a. LDL < ____
A

70

157
Q

Laboratory/Diagnostic Findings: Angina

  1. Historically, goals for patients with diabetes or documented coronary artery disease:
    b. HDL > ____
A

40

158
Q

Laboratory/Diagnostic Findings: Angina

  1. Historically, goals for patients with diabetes or documented coronary artery disease:
    c. TG < ____
A

150

159
Q

Laboratory/Diagnostic Findings: Angina

  1. Coronary ____ is the definitive diagnostic procedure but not indicated solely for diagnosis
A

angiography

160
Q

Management: Angina

  1. Reduction of risk factors when possible
  2. Manage diet: ______ saturated fats, then _______ unsaturated fats, and then consider plant sterols (e.g., nuts, vegetable oils, etc.)
A

decreased

161
Q

Management: Angina

  1. Low dose enteric-coated ____ (81 mg daily)
A

ASA

162
Q

Management: Angina

  1. Common pharmacotherapy for angina:
    a. Nitrates
    b. ___ ____
    c. Calcium channel blockers
A

Beta-blockers

163
Q

Management: Angina

  1. Optimizing lipid panel values:
    a. Pooled Cohort ______ to estimate 10-year atherosclerotic cardiovascular disease (ASCVD) risk, defined as file first occurrence of nonfatal and fatal MI and nonfatal and fatal stroke, to identify candidates for statin therapy; estimated risk of ASCVD is based on:
    1. Age
      • 2. Sex
      • 3. Race
      • 4. Total cholesterol
      • 5. HDL cholesterol
      • 6. Systolic blood pressure
      • 7. Diabetes status
      • 8. Smoking status
A

Equations

164
Q

Management: Angina

  1. Identify individuals who may benefit from statin therapy:
    (1) Individuals with clinical evidence of ______
A

ASCVD

165
Q

Management: Angina

  1. Identify individuals who may benefit from statin therapy:
    (2) Individuals with elevated LDL-C > ____ mg/dl
A

190

166
Q

Management: Angina

  1. Identify individuals who may benefit from statin therapy:
    (3) Diabetics 40-75 years of age with LDL-C between _____ mg/dl but without clinical evidence of ASCVD
A

70-189

167
Q

Management: Angina

  1. Identify individuals who may benefit from statin therapy:
    (4) Individuals without ASCVD or diabetes with LDL-C between 70-189 mg/dl but with an estimated 10-year risk ASCVD of ____% or higher
A

7.5

168
Q

Management: Angina

  1. Initiate TLC (everyone)
    a. Heart-healthy lifestyle habits are the foundation of ASCVD prevention. In individuals not receiving cholesterol-lowering drug therapy, recalculate an estimated 10-year ASCVD risk every ____ years for those aged 40-75 without clinical ASCVD or DM and with LDL-C 70-189 mg/dl.
A

4-6

169
Q

Management: Angina

  1. Initiate drug therapy (adults > ___years of age)
A

21

170
Q

Management: Angina

  1. Initiate drug therapy (adults > 21 years of age)
    a. High-intensity statin therapy: First-line in women and men < ____ years of age who have clinical ASCVD, timeless contraindicated (grapefruit should be avoided) •
A

75

171
Q

Management: Angina

  1. Initiate drug therapy (adults > 21 years of age)
    a. High-intensity statin therapy: First-line in women and men < 75 years of age who have clinical ASCVD, timeless contraindicated (grapefruit should be avoided) •
    1. _______-intensity statin therapy should be used
      when high-intensity statin therapy is
      contraindicated/statin-associated adverse effects are
      present.
A

Moderate

172
Q

Management: Angina

  1. Initiate drug therapy (adults > 21 years of age)
    a. High-intensity statin therapy: First-line in women and men < 75 years of age who have clinical ASCVD, timeless contraindicated (grapefruit should be avoided) •
    1. Patients with clinical ASCVD > 75 years of age:
      Evaluate the potential for ASCVD risk-reduction
      benefits and for adverse effects, drug-drug
      interactions, and to consider patient _____
      when initiating a moderate- or high-intensity statin
A

preferences

173
Q

Management: Angina

  1. Initiate drug therapy (adults > 21 years of age)
    a. High-intensity statin therapy: First-line in women and men < 75 years of age who have clinical ASCVD, timeless contraindicated (grapefruit should be avoided) •
    •
    1. ______ statements on whether statins increase the
      risk of hepatic damage
A

Varying

174
Q

Adults > 21 years of age with primary LDL-C > 190 mg/dl: Should be treated with statin ____-intensity statin therapy ( 10-year ASCVD risk estimation not required) unless contraindicated

A

high

175
Q

Individuals unable to tolerate high-intensity statin therapy, use the _______ tolerated statin.

A

maximum

176
Q

Reasonable to intensify statin therapy to achieve at least a ____% LDL-C reduction

A

50

177
Q

After the maximum intensity of statin therapy has been achieved, the addition of a ______ drug may be considered to further lower LDL-C Moderate-intensity statin therapy: Initiate or continue for adults 40-75 years of age with diabetes mellitus

A

non-statin

178
Q

_____-intensity statin therapy: Adults 40-75 years of age with diabetes with a > 7.5% estimated 10-year ASCVD risk unless contraindicated •

A

High

179
Q

Angina:
Adults > 21 years of age with primary LDL-C > ____ mg/dl: Should be treated with statin high-intensity statin therapy ( 10-year ASCVD risk estimation not required) unless contraindicated

A

190

180
Q

Angina:
Individuals unable to tolerate high-intensity statin therapy, use the ____ tolerated statin.
•

A

maximum

181
Q

Angina:

Reasonable to intensify statin therapy to achieve at least a ____% LDL-C reduction

A

50

182
Q

Angina:
After the maximum intensity of statin therapy has been achieved, the addition of a non-statin drug may be considered to further lower LDL-C Moderate-intensity statin therapy: Initiate or continue for adults ____ years of age with diabetes mellitus

A

40-75

183
Q

Angina:
High-intensity statin therapy: Adults 40-75 years of age with diabetes with a > ____% estimated 10-year ASCVD risk unless contraindicated •

A

7.5

184
Q

Angina:
Adults with diabetes < ___ or > 75 years of age: Evaluate the potential for ASCVD benefits and for adverse effects, for drug-drug interactions, and consider patient preferences when deciding therapy

A

40

185
Q

Angina:
The Pooled Cohort Equations should be used to estimate the 10-year ASCVD risk for individuals with LDL-C _____ mg/dl without clinical ASCVD to guide initiation of stain therapy for the primary prevention of ASCVD.

A

70-189

186
Q

Angina:
Adults aged 40-75 with LDL-C _____ mg/dl without clinical ASCVD or diabetes and an estimated 10-year ASCVD risk > 7.5%: Treat with moderate- to’ high-intensity statin therapy

A

70-189

187
Q

Angina:
Adults aged 40-75 with LDL-C 70-189 mg/dl, without clinical ASCVD or diabetes and an estimate 10-year ASCVD risk of _____%: Offer treatment with a moderate-intensity statin

A

5%-7.5

188
Q

Indications for statin therapy
_____-Intensity Statin Therapy
Daily dose lowers LDL-C on average, by greater than 50%

A

High

189
Q

Medication for High-Intensity Statin Therapy :

_____ 40-80 mg rosuvastatin 20-40 mg

A

atorvastatin

190
Q

______-Intensity Statin Therapy

Daily dose lowers LDL-C on average, by approximately 30 to less than 50%

A

Moderate

191
Q 
Medications for Moderate Inensity Statin Therapy:
atorvastatin 10-20 mg 
\_\_\_\_\_\_\_\_\_\_\_ 5-10 mg 
simvastatin 20--40 mg 
pravastatin 40-80 mg 
lovastafin 40 mg 
fluvastatin 80 mg 
pitavastafin 2-4 mg
A

rosuvastatin

192
Q

______-Intensity Statin Therapy

Daily dose lowers LDL-C on average, by less than 30%

A

Low

193
Q 
Low Intensity Statin Therapy:
simvastatin 10 mg 
pravastatin 10- 20 mg 
\_\_\_\_\_\_\_\_\_ 20 mg 
fluvastatin 20- 40 mg 
pitavastatin 1 mg
A

lovastatin

194
Q

Commonly used agents other than HMG-CoA reductase inhibitors (statins)
a. Bile acid sequestrants: Mostly decrease LDL; may increase triglycerides
1. __________ (Questran)
• 2. colesevelam (Welchol)
3. Colestipol (Colestid)

A

cholestyramine

195
Q

Commonly used agents other than HMG-CoA reductase inhibitors (statins)
b. Fibrates: decreased triglycerides, slightly decrease LDL and possibly increase HDL
• 1. _______ (Lopid)
• 2. fenofibrate (Tricor)
• 3. fenofibric Acid (Trilipix)

A

gemfibrozil

196
Q

Commonly used agents other than HMG-CoA reductase inhibitors (statins)

c. Cholesterol absorption inhibitor: Used in combination with a statin to decrease LDL •
1. _____ (Zetia)

A

ezetimibe

197
Q

Commonly used agents other than HMG-CoA reductase inhibitors (statins)
d. ______: decrease LDL and triglycerides and decreased HDL
• 1. immediate and extended-release preparations
• 2. High doses of niacin may cause “flushing”
sensation

A

Niacin

198
Q

Contributing to the leading cause of death in adults in the United States; 1.5 million annually result in myocardial necrosis; “clot on the plaque”

A

Myocardial Infarction/Acute Coronary Syndromes

199
Q

Signs/Symptoms

______ of patients give a history of alteration in typical anginal pain

A

One-third

200
Q

Signs/Symptoms

Most infarctions occur at ____: Pain similar to angina but more severe

A

rest

201
Q

Signs/Symptoms

_______ has little effect on Myocardial Infarction

A

Nitroglycerin

202
Q

Signs and Symptoms of Myocardial Infarction:

  1. _____ ____; weakness
  2. Impending doom
  3. Apprehension
  4. Light-headedness
  5. Syncope
  6. Dyspnea
  7. Cough
  8. Nausea and vomiting
A

Cold sweat

203
Q

Physical Exam Findings Myocardial Infarction:

  1. Dysrhythmia common
  2. S4 very common
  3. ________
  4. Pulmonary crackles
  5. Low-grade fever during the first 48 hrs.
  6. Tachycardia
A

Wheezing

204
Q

Laboratory/Diagnostics Myocardial Infarction:

1. ECG changes almost always; note: = ____% of patients have no initial ECG changes

A

30

205
Q

Laboratory/Diagnostics Myocardial Infarction:

  1. Peaked ___ waves, ST elevations, Q wave development (Q waves do not develop in 30 to 50% of MIs)
    a. I, aVL:
    b. II, III, aVF:
    c. V leads (precordial leads) or V3 and V4:
A

T

206
Q

Laboratory/Diagnostics Myocardial Infarction:
3. Cardiac enzyme elevations above normal within ____to six hours (Troponin T, Troponin I, CK-MB) and remain high for several days (three days to three weeks)

A

four

207
Q

Laboratory/Diagnostics Myocardial Infarction:

4. _______ for bed-side assessment of wall motion, EF, etc.

A

Echocardiography

208
Q

Laboratory/Diagnostics Myocardial Infarction:

5. Leukocytosis _____ to _____ uL on the second day

A

10,000 to 20,000

209
Q

Management Myocardial Infarction:

  1. Activate EMS
  2. ASA _____ mg tablet to chew
  3. NTG SL every five minutes x three
  4. Begin 02 therapy
  5. 12 lead ECG and cardiac monitor
  6. Hospital transport
A

325

210
Q

Test for Myocardial Infarction:
Normal
Therapeutic Values International Normalized Ratio (INR)
___ to ___ seconds

A

0.8 to 1.2

211
Q

Test for Myocardial Infarction:
Therapeutic Values:
MI: ___ to ___ × normal
Coumadin: ___ to ___ mg/dL

A

2.5 to 3.5

2 to 3

212
Q

Test for Myocardial Infarction:
Activated Coagulation Time (ACT)
___ to ____seconds

A

70 to 120

213
Q

Therapeutic Values for

____ to ____ or > 300 seconds post PTCA/stent

A

150 to 190

214
Q

Normal Activated Partial Thromboplastin Time

____ to ____ seconds

A

28 to 38

215
Q

Therapeutic Values:

____ to ____ × normal (APTT)

A

1.5 to 2.5

216
Q 
Prothrombin Time (PT) normal: 
\_\_\_\_ to \_\_\_\_seconds
A

11 to 16

217
Q

Partial Thromboplastin Time (PTT)

_______ seconds

A

60 to 90

218
Q

Therapeutic values for Partial Thromboplastin Time (PTT):

____ to ____ × normal

A

1.5 to 2.5

219
Q

Indications for Pharmacologic Revascularization for Myocardial Infarction:
1. Unrelieved chest pain (> ___ minutes and < six hours) WITH:

  1. ST-segment elevation > 0.1 mV in two or more contiguous leads
A

30

220
Q

Absolute Contraindications

1. Active _______ or risk there of, including abnormal coagulation values

A

bleeding

221
Q

________

Inflammation of the pericardium. A thorough history is essential in making an accurate diagnosis.

A

Pericarditis

222
Q

Etiology Pericarditis:

  1. Viruses - the most common cause
  2. Post myocardial infarction
  3. ___ ____
  4. Neoplastic, Tuberculosis, Septicemia
  5. Endocarditis
  6. Collagen diseases
  7. Drug/Trauma induced
  8. Viral infection
  9. Idiopathic (probably viral)
A

Renal failure

223
Q

Signs/Symptoms of Pericarditis:

  1. Very localized _______/precordial chest pain, pleuritic in nature
  2. The pain increased by deep inspiration, coughing, swallowing or recumbent
  3. Pain relieved by sitting forward
  4. Shortness of breath secondary to pain with inspiration
A

retrosternal/

224
Q

Physical Findings Pericarditis:

  1. Pericardial friction ____ characteristically present
  2. Pleural friction rub may also be present
  3. Fever may be present depending on the underlying cause
A

rub

225
Q

Lab/Diagnostics Pericarditis

1. ST-segment elevation in ____ leads

A

all

226
Q

Lab/Diagnostics Pericarditis

2. Return of ST-segment to normal in a few days followed by temporary ____ wave inversion

A

T

227
Q

Lab/Diagnostics Pericarditis:

3. _____ of the PR segment highly indicative of pericarditis

A

Depression

228
Q

Lab/Diagnostics Pericarditis:

4. ESR ______

A

elevation

229
Q

Lab/Diagnostics Pericarditis:

5. Blood _____ if bacterial cause suspected

A

cultures

230
Q

Lab/Diagnostics Pericarditis:

6. ____ to r/o infection or leukemia

A

CBC

231
Q

Lab/Diagnostics Pericarditis:

7. ___________ to confirm the presence of pericardial fluid or other abnormalities

A

Echocardiogram

232
Q

Lab/Diagnostics Pericarditis:

8. _______ BMP

A

Baseline

233
Q

Lab/Diagnostics Pericarditis:

8. _______ BMP

A

Baseline

234
Q

Management Pericarditis:

  1. NSAIDs are mainstay of treatment
  2. Ibuprofen (Advil) _______ mg every 6-8 hours
A

400-600

235
Q

Management Pericarditis:

3. _______ (Indocin) 25-50 mg every 8 hours for 2 weeks

A

Indomethacin

236
Q

Management Pericarditis:
4. _______ are indicated only when there is the total failure of high-dose NSAIDs over several weeks and with relapsing pericarditis. Can increase viral replication. When indicated, Dexamethasone 4 mg IV may relieve pain in a few hours. Prednisone 60 mg daily, then tapered

A

Corticosteroids

237
Q

Management Pericarditis:

5. _______ in cases of bacterial infection

A

Antibiotics

238
Q

Management Pericarditis:

  1. ________ 15-60 mg p.o. QID for pain
  2. Monitor for tamponade
A

Codeine

239
Q

A partial or complete occlusion of a vein by a thrombus with secondary inflammation to the wall of the vessel; may be superficial or deep

A

Venous Thrombosis

240
Q 
Venous Thrombosis
Causes/Incidence
1. Immobility
2. \_\_\_\_\_\_
3. Post-operative period
4. Prolonged bed rest
5. Use of oral contraceptives (particularly with smokers) 
6. Hypercoagulability
A

Female

241
Q

Signs and symptoms of _____ ______

1. Sudden onset of pain

A

Superficial Thrombosis

242
Q

Physical Exam findings of Superficial Thrombosis

  1. Localized heat and ______
  2. Low grade temperature
A

erythema

243
Q

Laboratory/ diagnostics of Superficial Thrombosis

1. _____

A

none

244
Q

Management of Superficial Thrombosis:

  1. Elevation of _______
  2. Warm compresses
  3. Non- steroidal agents
  4. D/C oral contraceptives
A

extremity

245
Q

Signs and symptoms of Deep Thrombosis:

  1. Sudden onset of ____
  2. Pain or tenderness especially while walking
  3. Pain may present as dull ache or tight feeling
A

pain

246
Q

Physical Exam Findings of _______

  1. Edema distal to the occlusion
  2. Low-grade temperature
  3. The skin may be cool to touch
A

Deep Thrombosis

247
Q

Laboratory/ diagnostics of Deep thrombosis

  1. Consider the need for deep thrombosis tests
  2. ________
  3. D dimer
  4. Venography
A

Ultrasounds

248
Q

Management of Deep Thrombosis:

1. Bed rest with the leg elevated until local tenderness subsides: ______ days

A

7 to 14

249
Q

Management of Deep Thrombosis:

2. Walking gradually ________

A

reintroduced

250
Q

Management of Deep Thrombosis:

3. Lovenox ____mg/kg every 12 h ( 1.5 mg/kg) or:

A

1

251
Q

Management of Deep Thrombosis:

4. Heparin infusion for _____ days

A

7 to 10

252
Q

Management of Deep Thrombosis:

5. Coumadin therapy for ___ weeks

A

12

253
Q

Management of Deep Thrombosis:

6. Consultation when ______ therapy instituted

A

anticoagulant

254
Q

Pathology of ___ ____ ____ arteriosclerotic narrowing fo the lumen of arteries resulting in decreased blood supply to the extremities

A

Peripheral vascular disease (PVD)

255
Q

Pathology of ___ ____ _____ impaired venous return due to either destruction of valves, canes due to deep thrombophlebitis, leg trauma, or sustained elevation of venous pressure (CHF)

A

Chronic Venous Insufficiency (CVI)

256
Q

Peripheral Vascular Disease cause/incidence:

1. Usually caused by _______

A

atherosclerosis

257
Q

Peripheral Vascular Disease cause/incidence:

2. Similar risk factors for _____

A

CAD

258
Q

Peripheral Vascular Disease cause/incidence:

3. Peak incidence: _____ to ___ years of age

A

40 to 70

259
Q

Peripheral Vascular Disease cause/incidence:

  1. Hyperlipidemia
  2. Smoking
  3. ____ mellitus
A

Diabetes

260
Q

Signs and symptoms of Peripheral Vascular Disease (PVD):

1) Usually first symptoms: C/O ____ pain (claudication)
2) Cold/ numbness to extremities
3) Progresses to pain at rest

A

calf

261
Q

Physical Findings of Peripheral Vascular Disease (PVD):

1) Shiny/ hairless skin
2) Dependent rubor
3) _____
4) Cyanosis
5) Ulcerations
6) Reduced pulses

A

Pallor

262
Q

Laboratory/ diagnostics fo Peripheral Vascular Disease (PVD):

1) Doppler U/S to evaluate the flow
2) Ankle- Brachial Index (ABI)
3)
4) Arteriography: Most definitive test

A

The X-ray may show calcification

263
Q

Management of Peripheral Vascular Disease:

1) Stop smoking and all tobacco use
2) Exercise: Walk 1 hour/day; stopping during pain and resuming when the pain subsides to develop collateral circulation
3) Pentoxifylline (Trental)
4) _______ (Pletal)
5) Weight reduction, as needed
6) Manage diabetes and hyperlipidemia
7) Angioplasty
8) Bypass surgery
9) Amputation

A

Cilostazol

264
Q

Impaired venous return due to either destruction of valves, changes due to deep thrombophlebitis, leg trauma, or sustained elevation of venous pressure (CHF)

A

Chronic Venous Insufficiency (CVI)

265
Q

Cause/ Incidence of Chronic venous Insufficiency

1) More common in _____ than _____
2) Maybe a genetic predisposition
3) History of leg trauma; may be associated with varicose veins

A

women than men

266
Q

Signs/ Symptoms of Chronic venous insufficiency:

1) ______ of the lower extremities relieved by elevation
2) Edema after prolonged standing
3) Night cramps of the lower extremities

A

Aching

267
Q

Physical Findings of Chronic venous insufficiency:

1) Trophic changes with ______ discoloration
2) Stasis leg ulcers
3) Edema of lower extremities
4) Dermatitis may be common
5) Cool to touch

A

brownish

268
Q

Laboratory/ Diagnostics of Chronic venous insufficiency:

1) _____ diagnostics of CVI
2) R/O edema due to heart failure and other causes

A

Nonspecifically

269
Q

Management of Chronic Venous Insufficiency:
1) Bed rest with legs elevated to diminish chronic edema
2) Use of heavy-duty elastic support stockings
3) Weight reduction in the obese
4) Treat dermatitis or ulcers as indicted
5) Acute weeping dermatitis
a) _____ compresses
b) 0.5% hydrocortisone cream after compresses
c) Systematic antibiotics only indicated if active
bacterial infection

A

Wet

270
Q

Cardiovascular: Gerontology Considerations

  1. Possible findings and/ or results
    a) Hypertension: Increased risk of CVA, MI, and renal failure
    b) _____murmurs common
    c) Decreased cardiac reserve (may lead to orthostatic hypotension or syncope)
    d) Overall, diminished peripheral pulses and cool extremities
    e) Dysrhythmias
A

Heart

271
Q

Side effects of Ginger:

a) Heartburn
b) _______
c) Flatus
d) Belching

A

Bloating

272
Q

Hazard/ Precautions/ Interactions of Ginger:

a) Increase the risk of _______
b) Should not be taken with ASA or warfarin
c) Others

A

bleeding

273
Q

Intended Use of _______

1) as an Adaptogen, uses to increase overall physical and mental well being
2) Lower cholesterol
3) Reduce fatigue
4) Enhance libido
5) Others

A

Ginseng

274
Q

Side effects of Ginseng:

1) ______
2) Nausea
3) Diarrhea
4) Headaches
5) Nervousness
6) Nose bleeds
7) Others

A

Insomnia

275
Q

Hazards/ Precautions/ Interactions with Ginseng:

1) Increased risk of bleeding
2) Should not be taken with ASA or warfarin
3) Blood pressure changes (high or low)
4) Mania in depressed patients take MAOIs
5) May inhibit the effects of ______
6) Others

A

opioids

276
Q

This herb is crushed flower buds or seedpods (reddish/purple liquid) used in tea, tablets, capsules

A

St. John’s Wort

277
Q

Intended Use of St. John’s Wort:

a) Depression
b) Anxiety
c) Sleep disorders
d) Improve _____ symptoms
e) Others

A

BPH

278
Q

Side effects of St. John’s Wort:

1) Increases sensitivity to sunlight
2) anxiety
3) Dry mouth
4) ________
5) Gastrointestinal symptoms
6) fatigue
7) headaches
8) sexual dysfunction
9) others

A

dizziness

279
Q

Hazards/ precautions/ interactions of St. John’s Wort:

1) increased risk of ____ _____
2) Should not be taken with ASA or Warfarin
3) Many drug interactions (e.g. in combination with SSRI, may contribute to serotine syndrome; may decrease the effectiveness of oral contraceptives, digoxin, alprazolam, amitriptyline, and others; may increase the effects of narcotics an others)
4) Reacts with light, perhaps leads to cataract formation

A

blood clotting

280
Q

This herb is a root or whole plant extract, capsule

A

Echinacea

281
Q

Echinacea is Intended Uses of this herb is to reduce symptoms of the common ______

A

cold

282
Q

Side effects of Echinacea include:

a) Allergic reactions
b) Nausea
c) ___ _____
d) dysuria
e) myalgias
f) others

A

abdominal pain

283
Q

Hazard/Precautions/Interactions of Echinacea:

a) ____________
b) hepatotoxicity
c) Nephrotoxicity
d) Potentially may cause increased sedation during anesthesia
e) others

A

anaphylaxis

284
Q

This herb is a leaf —-> extracts, capsules, tablets, teas and is associated with

1) memory and concentration enhancer
2) Improving symptoms of Alzheimer’s disease, intermittent claudication, and glaucoma

A

Gingko Biloba

285
Q

Side effects of Gingko Biloba:

a) Nausea
b) Vomiting
c) _______
d) headaches
e) dizziness
f) palpitations
g) restlessness

A

diarrhea

286
Q

Gingko Biloba Hazards and precautions are:

1) Increased risk of _______
2) Should not be taken with ASA or warfarin
3) May increase blood pressure

A

bleeding

287
Q

____ ___ is a herb common in plant root and stem —> capsule or liquid used for improving premenstrual and menopause discomfort

A

Black Cohosh

288
Q

Side effects of black cohosh include:

a) Nausea
b) vomiting
c) dizziness
d) ________
e) weight gain

A

mastalgia

289
Q

Hazards of black cohosh include:

1) When taking large amounts, may cause seizures, visual disturbances, bradycardia, and others
2) May increase the risk of______ (e.g. viginal)
3) Mimics estrogen effects; should not be taken by women taking hormone replacement

A

bleeding

290
Q

____ ___ is a herb plant root —> powder mixed cold water to drink

1) Improve relaxation without disrupting mental clarity
2) Others

A

Karva Karva

291
Q

Side effects of Karva Karva:

a) _____
b) Eye Irritation

A

Rash

292
Q

Hazards of Karva Karva:

a) Higher doses and long term use can lead to hypertension, _____ damage, visual impairment, and dry skin
b) Alcohol increases toxic effects
c) May worsen Parkinson’s symptoms
d) May impair reaction time when driving an automobile

A

liver

293
Q

This herb _____ is a bulb or root form

a) Improve indigestion respiratory complaints
b) Increase energy levels

A

Garlic

294
Q

Herb side effects of Garlic include:

a) bad _____
b) nausea
c) indigestion

A

breath

295
Q

Hazard effects of Garlic include:

a) Increase the risk of bleeding
b) Should not be taken with ______ or oral anticoagulants

A

ASA

Primary (44 decks)

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