HLK Week 1 Flashcards
Both parasympathetic and sympathetic nervous systems affect heart activity. Where does parasympathetic action take place?
Sinoatrial (SA) node and in the right atrium
Where do chronotropic influences on the heart take place?
SA node
Where do dromotropic influences on the heart take place?
AV node and conduction fibers
Where do inotropic influences on the heart take place?
contractile fibers
Which type of muscarinic receptor is involved in heart activity?
M2
Describe the sources of epinephrine/norepinephrine:
Post-ganglionic sympathetic nerve fibers and the adrenal medulla.
What is the single biggest determinant of myocardial oxygen demand?
HR
Other determinants of myocardial oxygen demand:
- Myocardial contractility
- Ventricular wall stress
~ (LV pressure)(LV radius)/LV wall thickness
What are the three things B-blockers do that make them useful for treating angina?
- lower HR
- decrease BP
- decrease contractility
What 3 forms of disease does the term ACS refer to?
- Unstable angina
- Non ST Elevation Myocardial Infarction (NSTEMI)
- STEMI
What sort of patient would an ACE inhibitor be a good treatment for?
Patients with diabetes, kidney disease, proteinuria,
According to JNC 7, what is the target blood pressure treatment should aim for?
- 140/90, or
- 130/80 in pts with CKD or DM
According to JNC 8, what is the target blood pressure treatment should aim for?
- 150/90 in pts over 60
- 140/90 in all other pts 18 and older
What are the 4 basic categories of medicine used to treat HTN?
- Diuretics
- Calcium channel blocker
- ACE inhibitor
- Angiotensin II receptor blocker
According to JNC 8, what should initial treatment of HTN be for black populations?
Thiazide diuretic or CCB
According to JNC 8, what should initial treatment be in pts with CKD?
ACE inhibitor or ARB, regardless of race or DM status
According to JNC 8, when should you add a second drug to a pt’s HTN treatment?
If treatment goal isn’t achieved within a month of initiating treatment.
Common causes of 2-ary HTN:
- Hyperaldosteronism
- Renal disease/renal artery stenosis
- Coarctation of the aorta
- Pheochromocytoma
- Drug induced
- Thyroid/parathyroid disease
- Pregnancy
- Metabolic syndrome (Cushing’s syndrome)
“End organs” that are damages as a result of chronic HTN:
- Brain (stroke, TIA)
- Heart (LVH, MI, CHF, angina)
- Kidneys (CKD, proteinuria)
- Eyes (retinopathy)
- Peripheral artery disease (atherosclerosis)
Non-traditional risk factors for CAD:
- Lipoprotein a Lp(a)
- Homocysteine
- hs-CRP
- Coronary artery calcium score
- Intimal medial wall thickness (IMT)
Clinical signs (stigmata) of hyperlipidemia:
- Corneal arcus
- Xanthomas
- Xanthelasma
USPSTF recommendations for screening for lipid disorders:
- In men > 35, strongly recommended
- In men between 20 and 35, recommended if increased risk for CHD
- Not recommended in women at any age unless at risk for CHD
Side effects of thiazide diuretics:
- hypokalemia
- hyperuricemia
- hyperglycemia
Side effects of B-blockers:
- hypotension
- bradycardia
- fatigue
- insomnia
- hallucinations
- sexual side effects
- decreased HDL and increased TG
Side effects of ace inhibitors:
- dry cough
- altered taste
- rash
- hypotension
- hyperkalemia
Side effects with calcium channel blockers:
- dizziness
- HA
- fatigue
- gingival enlargement
- constipation
- flushing
Side effects of alpha blockers:
- reflex tachycardia
- postural hypotension
- water retention
Side effects of direct vasodilators:
- HA
- nausea
- tachycardia
- lupus-like syndrome
- arrhythmia
Side effects of centrally acting agonists:
- sedation
- dry mouth
- constipation
- salt/water retention
