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HSC116 > Module 6: Cardiovascular (Angina and HF) > Flashcards

Module 6: Cardiovascular (Angina and HF) Flashcards

1
Q

Side effects of nitrates?

A

Headache
Hypotension
Reflex tachycardia

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2
Q

How can headache (adverse effect) from Nitrate be treated?

A

Analgesics - acetaminophen

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3
Q

Does the headache from nitrates remain forever?

A

No, it diminishes over time.

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4
Q

What are the therapeutic uses of nitrates?

A
  • to relieve an attack (when attack begins)
  • to prevent an attack (before attack is expected)
  • to decrease the number of attacks (used regularly on a long term basis)
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5
Q

In what forms can nitrates be administered?

A 
Sublingual/oral
Spray
Patch
Paste 
IV
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6
Q

What drug do nitrates interact with?

A

Sildenifil (viagra)

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7
Q

How does sildenifil (viagra) interact with nitrates? Side effects?

A

Inhibits cyclic GMP.

Intensifies nitrates = severe vasodilation = life threatening hypotension

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8
Q

What do nursing have to watch for in patients using nitrates?

A

Blood pressure

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9
Q

Types of beta blockers and their functions?

A

B1 - HEART = decreases heart rate and contractility

B2 - LUNGS = bronchoconstriction

(Some drugs are more selective for B1, therefore reduced risk of bronchoconstriction)

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10
Q

What are the various uses of beta blockers?

DAMP H3

A 
Dysthymias
Angina
Myocardial infarction
Pre/eclampsia
Hypertension 
Heart failure 
Hyperthyroidism
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11
Q

What are the adverse effects of beta blockers?

everything slow (HR, BP, BR =?)

A

Bradycardia
Hypotension
Bronchoconstriction
Fatigue

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12
Q

How are beta blockers administered?

A

IV (faster onset)

ORAL

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13
Q

Prefix for beta blockers?

A

lol

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14
Q

What do non-selective beta blockers do?

A

Block both B1 and B2 receptors

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15
Q

What do selective beta blockers do? And what are they also referred as?

A

Block only B1 receptors and known as cardio-selective

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16
Q

What do calcium channels do?

A

Regulate function of the myocardium, the sinoatrial node(SA), and the atrioventricular node (AV)

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17
Q

What is the function of CCBs?

A

Block calcium channels - prevents calcium ions from entering cells.

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18
Q

What desired effects do CCBs produce? How does channel blocking help in patients experiencing an angina?

A

Decrease BP
Decrease HR
Decrease electrical conduction
Decrease force of contraction

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19
Q

What is dysrhythmia?

A

Disturbance in the rate of cardiac muscle contractions or any variations from the normal rhythm or rate of heart beat.

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20
Q

What is preeclampsia?

A

High BP in pregnancy

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21
Q

What are the therapeutic uses of CCBs(calcium channel blockers)?

AMHD

A

Angina
Myocardial infarction
Hypertension
Dysrhythmias

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22
Q

What are the side effects of CCBs?

A 
Hypotension 
Bradycardia 
Dizziness 
Flushing
Contraindicated in pts with heart failure
Monitor BP, HR (<50 bpm), ECG, response
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23
Q

Various administration routes for CCBs?

A

IV and Oral

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24
Q

What is the prefix for CCBs? Are there any exceptions?

A

“ine”

Except for diltiazem, verapamil

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25
Q

What does the “push compartment” layer on CCBs tablets do?

A

Allows sustained release

Has a nonabsorable shell that slowly releases drug for body to absorb

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26
Q

What is heart failure?

A

Weakened heart muscle = unable to pump blood adequately throughout the body.

27
Q

Does heart failure happen suddenly?

A

No -over time!

Underlying conditions weak the organ

28
Q

In what percentages does heart failure affect the population?

A

Affects 1% of ppl aged 50 and over.

Affects 5% of ppl aged 75 and over.

29
Q

What’s the mortality rate of those with heart failure?

A

10% of pts with heart failure die within a year.

50% die within 5 years of diagnosis

30
Q

What is systolic heart failure?

A

Weak heart muscle = less blood pumped out of ventricles

31
Q

What is diastolic heart failure?

A

Stiff heart muscle won’t relax normally = less blood fills in ventricles

32
Q

Causes of heart failure?

A 
Myocardial infarction 
Coronary artery disease
Valve disease
Idiopathic cardiomyopathy 
Viral and bacterial cardiomyopathy
Myocarditis
Pericarditis
Arrhythmias
Chronic hypertension 
Throid disease
Pregnancy
Septic shock
33
Q

What is idiopathic cardiomyopathy?

A

Unknown cause behind weakened heart muscle that makes it harder for your heart to pump blood to rest of body

34
Q

What is myocarditis?

A

Inflammation of the heart muscle. Affects heart’s electrical system = reduces heart’s ability to pump and causes rapid or abnormal heart rhythms.

35
Q

What is pericarditis?

A

Inflammation of the lining outside the heart.

36
Q

What is a septic shock?

A

Life threatening- when BP drops dangerously low after an infection.

37
Q

How is heart failure clinically evaluated?

A 
Symptoms
Functional limitations
Cardiovascular disease/risk factors
Comorbid conditions
Volume status
38
Q

What are the initial investigations for suspected heart failure?

A 
Blood work
Labs
Chest radiograph
Electrocardiogran
BNP (blood test -measures levels of protein called brain natriuretic peptide that is made by heart and blood vessels - higher than normal if you have heart failure)
39
Q

How is ventricular function assessed?

A

echocardiogram

Radionucleotide ventriculography

40
Q

How is suspected heart failure diagnosed?

A

Step 1: clinical evaluation
Step 2: clinical investigations
Step 3: assessment of ventricular function

41
Q

What is ejection fraction?

A

It is the percentage of blood pumped out of the left ventricle with each contraction (out of the total percentage of blood in ventricle).

42
Q

How do you calculate ejection fraction?

A

% of blood pumped out / total blood in ventricle

43
Q

What is normal ejection fraction?

A

60%

44
Q

What are abnormal % of ejection fraction?

A 
40-45% = mild dysfunction 
30-40% = moderate 
10-25% = severe
45
Q

How do you measure ejection fraction?

A

Echocardiogram

46
Q

Explain the basic treatment progression for heart failure?

A

Ace -> beta blockers -> spironolactone -> seek specialist (move if up still symptomatic)

47
Q

If ACE inhibitors are not tolerated as treatment for heart failure what alternative should be considered?

A

Angiotention II receptor antagonist

48
Q

What should be used during tx for heart failure to aid with congestive symptoms/fluid retention?

A

Diuretics

49
Q

What purpose do diuretics serve during tx of heart failure?

A

Help control congestive symptoms and fluid retention

50
Q

What medication should be used if pt is symptomatic despite titrating from ACE (including use of angiotention II antagonist) to beta blockers, with the use of diuretics?

A

Digoxin

51
Q

When is digoxin used?

A

When ACE (including angiotensin II), beta blockers, and diuretics fail to provide therapeutic relief from symptoms.

52
Q

What is atrial fibrillation? (Aka AFib or AF)

A

Most common type of heart arrhythmia(irregular heartbeat).

Occurs when 2 upper chambers of heart experience chaotic electrical signals.

53
Q

What medication is the first line of defense during atrial fibrillation?

A

Digoxin

54
Q

What is a common symptoms of ACE inhibitors during heart failure tx? What can be done?

A

Severe cough.

Switch to angiotention II receptor antagonist

55
Q

Where does Digoxin come from?

A

Fox glove plant

56
Q

What are the therapeutic uses of Digoxin?

A

Congestive heart failure

Dysrhythmias

57
Q

How does Digoxin work?

A

Increases the pumping force of heart (positive inotrope)
Binda to sodium pump(Na-K-ATPase)
Slows conduction through heart

58
Q

Side effects of Digoxin?

A

Bradycardia
Nausea
Vision disturbances

59
Q

What 2 types of heart failure meds are to be careful with? Why?

A

Aminodarane and Verapamil

Significantly increase digoxin blood levels

60
Q

How to insure digoxin blood levels are not high?

A

Serum blood concentration.

Check HR prior to administration

61
Q

What are precautions that need to be taken with Digoxin?

A

Check serum blood concentration for significantly high levels in blood.

Check HR before administration

62
Q

What does the increased force of contraction by the heart due to Digoxin do?

A

Improves circulation which leads to reduced sympathetic activity, which then reduced peripheral resistance with reduction in heart rate.

63
Q

What does Digoxin do within the heart (AV node)?

A

Slows down conduction velocity through the AV node, which sccounts for its use in atrial fibrillation.

HSC116 (5 decks)

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