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Cardiopulm Test 1 > Lecture 3 > Flashcards

Lecture 3 Flashcards

1
Q

Anticoagulants inhibit what hormone

A

thrombin

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2
Q

Stage A Heart disease

A

No structural heart disease, just a medical condition like hypertension

treatment: encourage lifestyle change, potentially ACE inhibitors

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3
Q

Stage B heart disease

A

Structural heart disease no symptoms

-Consider ACE inhibitor, ARB, or B Blockers

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4
Q

Stage C heart disease

A

Symptomatic structural heart disease

Treatment: diuretics, ACE inhibitor, b blocker, ARB, Digitalis, Aldosterone agonist, nitrate

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5
Q

Stage D heart disease

A

Severely symptomatic (end stage)

Treatment: critical care

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6
Q

In order to control hypertension you must (reduce OR increase) the renin-angiotensin-aldosterone system in order to:

Promote: ______ and reduce _______

A

Reduce

Promote: Vasodilation and reduce fluid volume

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7
Q

-lol suffix

A

Beta Blocker

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8
Q

How do beta blockers work?

A

Reduces B-receptor binding sites of epinephrine and norepinephrine

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9
Q

Selective vs non-selective beta blocker

A

Selective:

B1- Causes decrease HR and myocardial contractility

OR

B2- Causes bronchoconstriction, vasoconstriction

Non-selective:

BOTH

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10
Q

Nonselective betablockers are not indicated for individuals with….

A

PVD or COPD

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11
Q

Beta blocker effect on patient exercise tolerance:

A

Earlier fatigue and less exercise tolerance

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12
Q

Beta blockers are clinically indicated for….

A

Hypertension
Ischemic heart disease
Heart failure
Arrhymthia.

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13
Q

How can beta blockers effect patients with diabetes

A

May mask hypoglycemia by dulling response

Note: also patients on beta blockers are at increased risk of heat injury

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14
Q

Calcium channel blockers are clinically indicated for

A

Ischemic heart disease

Arrhythmia

BP control

Reduction of re-infarction in patients with non-Q wave infarcts

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15
Q

Calcium channel blocker side effects:

A

Very few except for negative inotropic effects

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16
Q

-pine suffix

A

Calcium channel blockers

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17
Q

Patients on calcium channel blockers may need to use RPE for exertion rating during exercise because….

A

HR response to exercise may be blunted

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18
Q

How do calcium channel blockers work?

A
  1. Decrease arterial blood pressure by: smooth muscle relaxation, vasodilation
  2. Reduces O2 demand by: Reducing intracellular CA++, Slow HR, Reduce strength of contraction

“Reduce afterload”

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19
Q

Nitrates are clinically indicated for……

A

Hypertension
Ischemic heart disease
Angina
Heart failure

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20
Q

How do nitrates work?

A

——»> Reduce blood to heart by dilating veins (reduce preload)
Cause heart to contract with less force

——-»» Both of these combined: Lower blood pressure —»»

Less resistance the heart has to push against (less afterload).

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21
Q

Nitrate is primarily used to treat _____

A

Angina, because they fix the oxygen supply and demand issue at the myocardium!

Note: most are delivered Parenteral route, some oral.
relief in chest pain its expected in 5 minutes. If chest pain doesn’t subside patient can take it 2 more times (15 mins) if chest pain continues go to ER.

Parenteral route has quicker onset

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22
Q

Angina is caused by

A

Imbalance of myocardial oxygen supply and demand

Lack of oxygen stimulates pain receptors within heart

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23
Q

Nitrates tend to have ____ in the name of the drug

A

“Nitr”

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24
Q

If nitrates are taken before exercise..

A

It is important to measure vitals before and after drugs are taken

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25
Q

Nitrate side effects:

A

Hypotension
Dizziness
Reflex Tachycardia
Flushing of skin/ vomiting

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26
Q

An ECG shift downward of ____ is indicative of ischemia

A

.5mm downward

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27
Q

Angina symptoms can be anywhere above the ________

A

Umbilicus

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28
Q

Stable vs Unstable angina

A

Stable: pain free at rest, worse with activity,

Unstable: Unpredicable, accelerating in frequency and intensity, duration over 15 mins

Note: unstable is a signal of progression of disease

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29
Q

Prinzmetal (variant) angina

A

Occurs exclusively at rest (often in morning)

ST segment elevation on ECG

Thought to be the result of cardiac vasospasm

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30
Q

If a patient needs to limit cardiac vasospasm, what should they take?

A

Calcium channel blockers

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31
Q

If a patient needs to cause vasodilation to increase blood flow to myocardium, what is a good class for medicine to take?

A

Nitrates, ARB, ACE

32
Q

If a patient needs to decrease the workload of the heart and decrease heart rate, what is the best kind of medicine to take?

A

Beta blockers

33
Q

How do thrombolytic agents work?

A

Facilitate the conversion of plasminogen to plasmin

34
Q

Thrombolytic agents should be administered within ________ of evidence of thrombus formation

A

30 minutes

Note: Overall goal is to keep ischemic time to under 120 minutes

35
Q

What are common side effects of thrombolytic agents?

A

Excessive bleeding
Hemorrhagic CVA possible

Note: watch out for these patients they cannot do high intensity exercise while on the medication

36
Q

How do anti-platelet medications work?

A

Decrease platelet adherence to site of injury

Note: can be a primary or secondary method of preventing thrombus

37
Q

Diuretics are used clinically for what conditions

A

Hypertension

Heart failure

38
Q

How do duiretics work to help the heart?

A

More urination -> less blood volume -> less preload

Improved electrolyte balance

39
Q

-ide suffix

A

Diuretics

40
Q

diuretics can potentially caused hypo________

A

Hypokalemia

41
Q

The most potent diuretics are what?

A

Loop diuretic

Act in the loop of henle

42
Q

How do sodium-glucose transport inhibitors help cardiac issues?

A

Lowers blood sugar for Type 2 diabetes

Reduce cardiac deaths

Slows progression of kidney disease

Reduces systolic BP 3-5mmHG

Promotes weight loss (4-6lbs)

43
Q

-ozin suffix

A

Sodium-Glucose transport inhibitors

44
Q

Potential side effects of sodium/glucose transport inhibitors include:

____Gylcemia

____tension

UTIs

Diabetic Ketoacidosis

A

Hypoglycemia

Hypotension

UTIs

Diabetic ketoacidosis

45
Q

ACE inhibitors block the conversion of Angiotensin 1 to Angiotensin 2

Angiotensin 2 causes:

Systemic vaso_______

Renal water and sodium _______

Aldosterone _______

A

Systemic vasoconstriction

Renal water and sodium constriction

Aldosterone stimulation

46
Q

-ril suffix

A

ACE inhibitors

47
Q

-sartan suffix

A

ARB

Angiotensin receptor blocker

48
Q

Patients who are intolerant to ACE inhibitors can use….

A

ARBs

49
Q

How do ARBs work? (Angiotensin receptor blockers)

A

Limits effects of angiotensin 2 (vasoconstriction) at arterial beds

50
Q

What is Entresto

A

Neprolysin Inhibitor AND Angiotensin receptor blocker

51
Q

How do neprolysin inhibitors work?

A

Reduces abnormal
remodeling of vessels

Promote diuresis + Vasodilation

Na excretion / K retention

52
Q

Side effects of ACE inhibitors and ARBs

A

Hypotension

Light headedness

Dizziness

Angioedema (life threatening)

Hyperkalemia

Persistent dry cough

53
Q

Digitalis and Digoxin are what kind of drugs?

A

Cardiac Glyocosides

Increase intracellular Ca+

Increase contraction strength

Decrease HR and conduction time

54
Q

Out of Digitalis and Digoxin, which one is less toxic with a shorter half life

A

Digoxin

55
Q

What kind of side effects do patients experience with cardiac glyocosides?

A

-GI sickness

-Neurological symptoms

56
Q

Digoxin controls ___________ due to lengthening the PR interval

A

A-FIB

note: patient may have abnormal pulse on this medication

SO the pulse needs to be taken for the FULL MINUTE

57
Q

Cardiac glycosides should not be used in patients with….

A

2nd and 3rd degree heart blocks

(because it slows conduction time even more!)

57
Q

What should you ask a patient on digoxin who is not feeling well?

A

Did you just start the medication?

did you increase the dose?

Report findings to physician!

58
Q

What are Sympathomimetics used for?

A

Acute heart failure to improve CO

they mimic the sympathetic nerve system stimulation to increase contraction strength

59
Q

How long should a patient use Sympathomimetics

A

SHORT PERIOD

minimize the possibility of sympathetic receptor desensitization

60
Q

What medication is used when heart failure is present with systemic hypotension

A

Dopamine (Inotropin)

61
Q

What medication is used short term for patients awaiting heart transplant?

A

Phosphodiesterase Inhibitors

last line of defense medication when cardiac glyocosides and Sympathomimetics failed

62
Q

What do Phosphodiesterase Inhibitors do?

A

Increase intracellular Ca+

positive ionotropic

63
Q

What are 3 medications that vasodilate?

A

Ca+ Channel Blockers
ACE inhibitors
Nitrates

64
Q

how do Venodilators affect cardiac preload?

A

reduce

65
Q

α Adrenergic Antagonists are used for…

A

hypertension and not heart failure

66
Q

side effects of α Adrenergic Antagonists

A

increase in blood volume

reflex tachycardia

67
Q

What medication dilates both veins and arteries?

A

Nipride

68
Q

How does Nipride help patients?

A

Effective in treatment of severe heart failure

Increased venous capacitance reduces preload

Decreased arterial resistance reduces afterload

Result is reduced myocardial oxygen demand

69
Q

How does morphine affect the veins and arteries??

A

Veno-dilation and mild arterial dialation

-also reduces anxiety which reduces heart effort for severe heart failure

70
Q

What kind of side effects can Vasodilators have?

A

Compensatory sympathetic activation:
Tachycardia
Vasoconstriction
Increase aldosterone
Elevated plasma renin

—-> these side effects lead to patient taking more meds to control side effects

71
Q

What are class 1 antiarrythmics

A

(Xylocaine)
Clinically indicated for:
Ventricular and supraventricular tachycardia
Atrial fib

72
Q

Beta blockers are considered a ___________ anti-arrythmic

A

Class 2

Clinically indicated for:
Ventricular and supraventricular arrhythmia post MI and exercise

73
Q

Calcium channel blockers are considered ______________ anti-arrythmics

A

Class 4

74
Q
A

Cardiopulm Test 1 (11 decks)

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