Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pharm 1 > drug therapy for coronary heart disease > Flashcards

drug therapy for coronary heart disease Flashcards

(61 cards)

Start Studying
1
Q

chronic coronary artery disease (CAD) reults from…

A

damage to the intima (inner layer) of cornoary arteries = build up of lipids and fiber in lumens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is CAD

A

narroing or blockage of the coronary arteries, usually caused by atherosclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is atherosclerosis

A

-sometimes called hardening or clogging of the arteries
-is a buildup of cholesterol and fatty deposits (called plaques) on the inner walls of the arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

describe how CAD works

A

plaque = decrease diameter of artery = macrophage increase to degrade plaque = plaque rupture = endothelium injury = platelet aggregation = thrombus = release chemical mediators thromboxane, serotonin, plt growth factor = vasoconstriction = further narrow coronary arteries = less o2 to tissue and worsen myocardial ischemia (reduced blood flow)

manifests as chest pain = BAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are some risk factors for developing CAD

A

-SMOKING
-hyperlipidemia
-hypertension
-obesity
-diabetes mellitus or prediabetes
-physical conditioning
-age
-ethnicity
-hisotry of preeclampsia in pregnancy
-genetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

risk factors for CAD

describe hyperlipidemia

A

-abnormal cholesterol levels
-high total cholesterol and low density lipoprotein cholesterol and low high-density lipoprotein cholesterol
-<40mg/dl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

risk factors for CAD

describe obesity

A

->20% over ideal body weight
-abdominal obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

risk factors for CAD

describe physical conditioning

A

<30mins of moderate intensity aerobic exercise less than 3 times weekly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

risk factors for CAD

describe age

A

men > 45 years
women > 55 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

risk factors for CAD

describe genetics

A

-heart disease in father or brother <55 years
-heart disease in mother or sister <65 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

describe the clinical manifestation of CAD

A

-stable angina (i.e. classic, typical, exertional angina)
-variant angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

describe stable angina

A

-clinical expression of myocardial
-results when myocardial O2 demand is greater than the O2 supply to the heart muscle
-often results from exercise, physical exertion, elemental exposer to cold, emotions/stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the signs and symptoms of stable angina

A

-substernal CP
-“squeezing”
-may radiate to jaw, neck, shoulders, arm (brief 5 minutes - O2 restoration helps)
-can have SOB, diaphoresis, N/V
-can be mistaken for arthritis pain/GI disturbances
-gender differences exist in symptom quality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the goal of treatment for stable angina

A

-relieve signs and symptoms
-then increase tolerance and quality of life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is the treatment for stable angina

A

-thrombolytics and interventional therapies
-calcium channel blockers, beta blockers, and nitrates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

describe variant angina

A

-occurs at rest/minimal exertion (bedtime presentation)
-same time of day
-cyclic, 3-6 months
-subsides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

describe acute coronary syndrome (ACS)

A

-unstable angina (crescendo, rest or preinfarction angina)
-acute pain occurs at rest and lasts longer than 20 minutes
-can occur hours or days prior to acute myocardial infarction
-action = imperative
-time = tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are the two types of MIs

A

-NSTEMI
-STEMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are some signs of myocardial infarction

A

subjective:
-sudden onset CP
-left arm pain (may or may not radiate)

objective:
-SOB
-diaphoresis, pale, cool skin
-ekg
-labs (creatine kinase and cardiac troponin 1 +troponin T)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

describe NSTEMI

A

non ST elevate myocardial infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

describe STEMI

A

greater then 20 minute persistent ST elevation on EKG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what labs are used to determine MI

A

-creatinine kinase
-cardiac troponin 1 and troponin T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

describe cardiac kinase

A

-cardiac isoenzyme
-eleavated value indicates damage to skeletal, visceral, or cardiac muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

describe cardiac troponin 1 and troponin T

A

biomarker of myocyte injury r/t MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what are some nonpharmacologic management of CAD
-risk factor modification -patient education -revascularization, interventional procedures
26
describe risk factor modification with CAD
lifestyle changes, medications -obesity, stop smoking -elevated triglycerides, cholesterol -elevated BP, fasting glucose
27
describe revascularization, interventional procedures r/t CAD
-cardiac catheterization -coronary artery bypass graft -intracoronary stent
28
describe antianginal agents and give examples of types
-can be used alone or in combination with other heart meds or lifestyle changes -nitrates, beta adrenergic blockers, calcium channel blockers
29
what is the goal of antianginal agents
-improve O2 delivery or decrease consumption -dilate blood vessels -decrease cardiac workload
30
what are nitrates and give examples
-potent vasodilators -examples include **nitroglycerin,** isosorbide dinitrate, and isosorbide mononitrate
31
whare are some therapeutic actions and indications of nitrates
-telax and dilate veins, arteries, and capillaries; increase bloodflow; lower systolic pressure -relief of and prevention of angina pain -decrease preload and afterload (allows more O2 to get to tissue)
32
what are some adeverse effects of nitrates
-severe headache -dizziness -bradycardia -syncope -**hypotension/orthostatic hypotension** -**can see reflex tachycardia in response to hypotension (heart thinks it needs to speed up)**
33
what are the adverse effects of nitrates related to
-the hemodynamic changes are responsible for preload and afterload reducation and vasodilation
34
how are nitrates administered
-may be SL (most common: 3 doses q 5min / while administering 3rd dose call 911 if at home) -translingual spray -transdermal patch -topical ointment -PO -IV
35
why is SL administration of nitrates preferred in emergency situations
avoids the first pass effect
36
describe the absorbtion and half life of nitrates
-rapidly absorbed -half life is 1-4 mins
37
where are nitrates metabolized and excreted
-metabolized in liver -excreted in urine
38
what are some nursing implications r/t nitrates
-check vitals, especially BP prior to and after administration -pay attention to pts presentation and watch for signs of MI -teach about orthostatic hypotension and remind pt to keep nitrates with them
39
what are some examples of beta adrenergic blockers
-aten**olol** -metropr**olol** -bisopr**olol** ## Footnote these are all examples of cardo selective beta adrenergic blockers
40
describe cardio selective beta adrenergic blockers
-20x more potent at blockig beta 1 receptors in the heart than they are at blocking beta 2 receptors -less likely to cause bronchoconstriction compare to nonselctive beta adrenergic blockers
41
describe the therapeutic actions and indications of beta adrenergic blockers
-decrease cardiac workload by slowing HR, decrease BP, and reduce contractility -> **increase O2 to heart** -cornerstone daily tx for pts with angina -tw of angina, HTN, prevention and tx post MI
42
when should you take caution when giving beta adrenergic blockers
-2nd/3rd degree heart block -cardiogenic shock -severe bradycardia -hypotension -heart failure
43
what is the black box warning for beta adrenergic blockers
remember DO NOT abruptly withdrawal medication, expecially in pts with CAD; slowly taper off med
44
describe how beta adrenergic blockers interact with renal function
-well tolerated in patients with renal impairment -may slow renal function decline
45
gave an example of a calium channel blocker
nifedipine
46
describe the theraputic actions and indications of calcium channel blockers
-inhibit the reflux of calcium entering through slow channels, producing vasodilation of the peripheral blood vessels and coronary arteries -**does not affect heart rate**
47
describe the pharmacokinetics of calcium channel blockers
-first pass metabolism in liver -fecal and urinary excretion
48
what are some adverse effects of calcium channel blockers and what may help reduce them
-hypotension -flushing -headache -dizziness -lower limb edema -reflex tachycardia -**these appear to be dose related and the medication dose can be adjusted to help limit these effects**
49
what are the adverse effects of calium channel blockers related to
-vasodilation -dosage
50
describe the nursing implications related to calcium channel blockers
-chack vitals, especially BP prior to and after administration -grapefruit juice will increase effects of med -do not use with adrenergic stimulants (cocaine/ampethamines) -will increase digoxin levels
51
name some adjunctive antianginal drugs
-ranolazine -dyslipidemic drugs -antihypertensive drugs -morphine -antiplatelets
52
describe ranolazine
-antiischemic metabolic modulator -first line treatment for chronic angina
53
what are some examples of dyslipidemic drugs
-atorvastatin -cholesyramine -niacin
54
what are dyslipidemic drugs used for
management of pts with major risk factors for atherosclerosis and vascular disorders (CAD, stroke, peripheral arterial insufficiency) when lifestyle changes alone do not reduce blood lipids
55
describe antihypertensive treatment as an adjunctive antianginal drug
-decrease peripheral vasular resistance can treat angina -example: angiontensin converting enzyme (ACE) inhibitor
56
describe morphine as an adjunctive antianginal drug
-opiod analgesic -tx for pain and anxiety which decreases preload -primary reliever of pain in post MI patients with unacceptable levels of pain
57
what are some examples of antiplatelets given for antianginal effects
-aspirin (STANDARD) -adenosine diphosphate (ADP) receptor antagonists -glycoprotein (GP) IIb/IIa receptor antagonists
58
describe aspirin as an antiplatelet
antiplatelet effect which at a lower dose effectovely suppress pletelet aggregation w/o affecting important endothelial function
59
what is the goal of therapy with antianginal drugs
-relieve acute anginal pain -reduce number and severity of acute anginal attacks -improve exercise tolerance and life quality -delay progression of CAD -prevent MI and sudden cardiac death
60
describe tolerance of long acting nitrates
-develops with high dose, uninterrupted therapy -decreases adverse effects and efficacy
61
describe preventing tolerance stretegies for nitrates
-administer lowest effectove dose -avoid long acting formas of nitrates -only use long acting forms during waking hours

Pharm 1 (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions