EXAM 5 Flashcards
Purpose of glycoprotein IIb/IIIa inhibitor?
Antiplatelet agent.
What do nitrates and beta blockers do?
They are antieschemic agents.
What is the leading cause of death?
Heart disease.
- Arterial sclerotic heart disease
- Cardiovascular heart disease
- Ischemic heart disease
- Coronary heart disease
- CAD: Coronary Artery Disease
Regarding heart disease, what are the following risk factors?
Age
Gender
Ethnicity/Race
Family Hx/Genetics
Non-modifiable risk factors.
Anxiety, hostility/anger, and depression are all risks for developing and progressing which heart disease?
CAD
Depression in particular increases the risk for development and progression of CAD.
Regarding heart disease, what are the following risk factors?
Elevated serum lipids HTN Tobacco use Second-hand smoke Physical inactivity Obesity Diabetes Metabolic syndrome Psychological state Homocysteine levels Substance abuse Poverty Lack of social support
These are all modifiable risk factors for heart disease.
Prevention and early treatment is key.
Need to ID high risk people.
Lifestyle changes
Education and values need to line up in order to be effective.
Keep the goals realistic and attainable.
Physical fitness (also keep realistic)
What is the gold standard diagnostic tool for heart blockage?
Angiography: injecting a radio-opaque contrast agent into the blood vessel and imaging using X-ray based techniques to visualize % of block right away. Done in the cath lab.
What does Troponin decide?
Whether it’s a US/NSTEMI or a STEMI.
What condition shows an ST depression or no ECG change?
NSTEMI
Chest pain may resolve.
Partial occlusion of coronary artery.
How long can cardiac cells live for without O2?
About 20 minutes.
If patient can receive Tx within 20 minutes = greater prognosis.
What type of cardiac clinical manifestations are successfully treated with nitrates?
UA (unstable angina) and NSTEMI (non ST elevated MI)
Preserving the cardiac muscle, relieving the pain from the ischemia, and keeping their O2 saturation at 93%+ is the goal for ?
This is the goal for UA’ s, NSTEMI’s and STEMI’s.
What does MONA stand for?
Morphine
Oxygen
Nitroglycerin - sublingual
ASA (acetylsalicylic acid) - chewable
What do BNP labs look for?
HF
What is the CK-MB test for?
The CPK-MB test is a cardiac marker used to assist diagnoses of an acute myocardial infarction. It measures the blood level of CK-MB, the bound combination of two variants (isoenzymes CKM and CKB) of the enzyme phosphocreatine kinase.
What do troponin lab values indicate?
For patients who present with acute coronary syndromes, troponin T values greater than or equal to 0.01 ng/mL that are rising make the diagnosis of cardiac injury.
What medications are given to potential MI’s, sometimes even in the ambulance on the way?
Nitro and aspirin.
Nitro = relieves pain by dilating the arteries.
Aspirin = mild analgesic and starts the antiplatelet action to prevent making any clots worse.
Which cardiac stress test uses adenosine and is a test on one specific artery?
FFR - Fractional Flow Reserve
When given as a rapid IV bolus, adenosine slows cardiac conduction particularly affecting conduction through the AV node.
What do we call the cardiac test in the cath lab that enables you to look down an artery (like looking down a gunbarrel) for visual blockage or to see if the stint is open all of the way?
IVUS
What type of medication affects heart rate?
Chronotropic
Chrono = time "tropos" = a turn
Positive chronotropes increase heart rate; negative chronotropes decrease heart rate.
What type of medication affects the AV nodal conduction?
Dromotropic
Greek “dromos” = running, a course, a race…
A dromotropic agent is one which affects the conduction speed in the AV node, and subsequently the rate of electrical impulses in the heart. Agents that are dromotropic are often (but not always) inotropic and chronotropic.
What type of medication affects the myocardial contractility?
Inotropic agent
Negatively inotropic agents weaken the force of muscular contractions. Positively inotropic agents increase the strength of muscular contraction.
Which medication is used to treat atrial and ventricular dysrhythmias that cause tachycardia by blocking the sodium channel and preventing depolarization?
procainamide. class IA
Suppress the dysrhythmia by reducing automaticity and slowing impulse conduction across the myocardium delaying repolarization.
What are the adverse effects of procainamide?
- Blood disorders (may be fatal)
- Cardiotoxicity
- Hypotension
- May exacerbate lupus like symptoms
Which medication is used to slow conduction in the atria, ventricles, and His-Purkinje system by blocking the sodium channels?
Lidocaine (Xylocaine). Class 1B.
This reduces automaticity in the ventricles and His-Purkinje system.
Accelerates repolarization
IV, topical routes.
Adverse effects of lidocaine (CNS)?
High therapeutic doses = drowsiness, confusion, paresthesias.
Further toxicity: convulsions, respiratory arrest.
All of the class I’s are Sodium Calcium Blockers, what do they all have in common?
They are the largest group of antidysrhythmics.
Classified as IA, IB, and IC
Block the sodium channel - preventing depolarization from occurring.
Reduce automaticity and slow impulse conduction across the myocardium, delaying repolarization.
Heart rate of bradycardia:
What population is brady more common and why?
What is “Sick Sinus Syndrome”?
<60 bpm
Elderly bc they have loss of functional cells in the SA/AV nodes due to aging.
Sick Sinus Syndrome is when the SA node fails to generate or transmit a signal. HR can be down in the 40’s (bc AV node takes over the pace: 40-60 bpm). Tx: antiarrhythmics and/or pacemaker.
What two circumstances cause a dysrhythmia?
Alteration in GENERATION or CONDUCTION of an impulse.
What are the AV node block degrees and which ones require medication/pacemaker?
- First degree: slow impulse and the conduction is delayed.
- Second degree: SOME impulses are blocked from leaving the AV node.
- Third: TOTAL block of signals leaving the AV node.
Second and Third degrees require medication and/or a pacemaker.
This dysrhythmia is characterized by:
Rapid fire of the SA node
HR can be 160-200 bpm
Atrial tachycardia.
This dysrhythmia is characterized by:
Rapid irregular rhythm
Atria beating at 250 - 300 bpm
Ventricles beating 125 - 175 bpm
Atrial flutter
Has a “saw-tooth” pattern on the EKG strip.
This dysrhythmia is characterized by:
Chaotic firing… atria are quivering
The blood becomes stagnant in the heart and clots begin to form
Atrial fibrillation
The most COMMON dysrhythmia
Can lead to strokes bc of the clots forming.
This dysrhythmia is characterized by:
100 - 250 bpm
Needs to be treated immediately d/t risk of sudden death
Ventricular tachycardia
This dysrhythmia is characterized by:
Very chaotic and disorganized heart beat.
Cardiac arrest.
Ventricular fibrillation
According to the Vaughn Williams classification system, what class do Sodium Channel Blockers belong to?
Class I
Ex:
Class IA - Procainamide
Class IB - lidocaine (Xylocaine)
Class IC - don’t worry about yet.
According to the Vaughn Williams classification system, what class do Beta Blockers belong to?
Class II
Ex:
propranolol (Inderal)
According to the Vaughn Williams classification system, what class do Potassium Channel Blockers belong to?
Class III
Ex:
amiodarone (Cardarone)
According to the Vaughn Williams classification system, what class do Calcium Channel Blockers belong to?
Class IV
Ex:
verapamil (Calan)
dilitazem (Cardizem)
What two medications are classified as “other” according to the Vaughn Williams classification system of antidysrhythmics?
- adenosine
2. digoxin
If sodium is the first ion into the cell to depolarize then it is the first one to target if someone is having tachycardia… so, which class of antidysrhythmic medications target the sodium influx?
Class I: Sodium Channel Blockers
procainamide lidocaine (Xylocaine)
This medication is used to treat ATRIAL and VENTRICULAR dysrhythmias that cause tachycardia:
procainamide.
Used in CPR as last resort.
VERY toxic and NARROW therapeutic range
This medication is used to treat VENTRICULAR dysrhythmias by blocking Na channels, thereby reducing the conduction in the atria, ventricles and His Purkinje system in addition to accelerating repolarization:
lidocaine (Xylocaine)
Reduces the automaticity in the ventricles and His Purkinje system.
IV and
Topical routes
This anti-anginal is contraindicated
.
Which anti-anginals work by decreasing the workload of the heart?
Nitro
antenolol
verapamil
nifedipine
What are clopidogrel, abciximab, and aspirin?
Antiplatelets
What are altepase, and streptokinase?
Thrombolytics
What is aminocaproic acid?
Hemostatic
Used to clot blood
What are verapamil, nifedipine, atenolol, and nitroglycerin used to treat?
Angina. They are anti-anginals.
Nitro is an organic nitrate (also isosorbide dinitrate and isosorbide mononitrate)
verapamil is a CCB and is also used to tx dysrhythmias.
atenolol is a Beta-adrenergic antagonist (Beta Blocker).
nifedipine is a CCB
What type of drug is verapamil?
CCB
Used to treat both angina and dysrhythmias.
What type of drug is atenolol?
Beta-adrenergic antagonist (beta blocker)
What type of drug is nifedipine?
CCB
What type of drug is nitroglycerin?
Organic nitrate
What are atorvastatin, cholestyramine, Niacin B, fenofibrate, ezetimibe, and gemfibrozil used to treat?
Hyperlipidemia
atorvastatin is a statin
cholestyramine is a bile acid sequestrant
Niacin B is a complex vitamin
fenofibrate is a fibric acid
gemfibrozil is a fibric acid.
ezetimibe is the first medication in the novel class of selective cholesterol-absorption inhibitors to be released in the United States.
What are procainamide, lidocaine, amiodarone, verapamil, dilitazem, adenosine, and digoxin used to treat?
Dysrhythmias. They are anti-dysrhythmic medications.
procainamide is a Sodium Channel Blocker
lidocaine is a Sodium Channel Blocker
propanolol is a Beta Blocker
amiodarone is a Potassium Channel Blocker
verapamil is a Calcium Channel Blocker
dilitazem is a Calcium Channel Blocker
adenosine is a “miscellaneous class”
digoxin is also considered “miscellaneous class” of antidysrhythmics.
What class of drug is procainamide?
Sodium Channel Blocker
What class of drug is amiodarone?
Potassium Channel Blocker
What class of drug is dilitzaem?
CCB
What class of drug is digoxin (as far as anti-dysrhythmics go)?
“miscellaneous”
What class of drug is lidocaine?
Sodium Channel Blocker
What class of drug is verapamil?
CCB
What class of drug is adenosine?
“misc”
What are dabigatran, Heparin, and warfarin used to treat?
Prevention of coagulation.
Heparin is ok for pregnancy.
warfarin is the most popular oral anticoagulant.
dabigatran doesn’t require lab monitoring but is more expensive.
What is thrombocytopenia?
Low platelet count
Which anticoagulant drug can induce thrombocytopenia?
Heparin.
“HIT” = Heparin Induced Thrombocytopenia: an immune reaction to the heparin. Can occur in 30% of pts.
Tx: stop Heparin immediately.
What does fibrinolysis mean?
Breakdown of blood clots
