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N232 - Intro to Pharma > Module Four: CAD > Flashcards

Module Four: CAD Flashcards

1
Q

What is CAD?

A

Coronary Artery Disease

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2
Q

What is North America’s leading cause of death?

A

Coronary Artery Disease

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3
Q

What is ASHD?

A

Atherosclerotic Heart Disease

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4
Q

In what ways does ASHD affect the heart?

A
  1. Narrows the lumen of the vessel. Reducing blood flow to the area supplied by the artery. 2. Reduces elasticity, making it less resilient in the face of volume or pressure changes. Increasing the risk of vasospasm. 3. Increases risk of plaque rupture & subsequent clot formation with further occlusion & potential embolization. 4. Increases risk of vasospasm.
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5
Q

What are the modifiable Atherosclerosis risk-factors?

A

Smoking, Stress, Obesity, Sedentary Lifestyle, Alcohol. Medically Modifiable: HTN, Hyperlipidema, Diabetes Mellitus.

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6
Q

What are the Non-modifiable Atherosclerosis risk-factors?

A

Heredity, Age, Sex, Race.

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7
Q

What is a QRS complex?

A

The QRS complex is the depolaration of ventricular muscle cells

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8
Q

What are examples of increased workload on the heart in the face of a fixed supply of oxygen?

A
  1. Hypertension 2. Aortic Stenosis 3. Increased metabolic demand
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9
Q

What are examples and reasons for reduced blood supply to the heart?

A
  1. Artherosclerosis. 2. Coronary Artery Vasospasm 3. Thrombus/Embolus
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10
Q

What are some examples of reduced oxygen carrying capacity of the coronary arteries?

A
  1. Anemia. 2. Hemodilution 3. Acute Blood Loss
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11
Q

What are the two most important steps to take when dealing with a situation of too much oxygen demand and not enough supply?

A

Reduce the O2 demand, and increase the 02 supply.

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12
Q

What are effective ways to reduce the hearts oxygen demand?

A

Rest, Oxygen, Nitrates, Morphine. Beta Blockers. Ca Channel Blockers. ACE Inhibitors/ARB.

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13
Q

What are effective ways to increase the oxygen supply to the heart?

A

Aspirin 160 - 325 mg chewed. Fibrinolytics. Coronary Artery Bypass. Heparins, Antiplatelets, Statins.

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14
Q

What is the best way to manage ischemia?

A

MONA. Morphine, Oxygen, Nitrates, Activity/Aspirin. Not necessarily in this order.

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15
Q

What do Nitrates do?

A

Relax vascular smooth muscle in arteries (including coronary arteries) but particularly veins. Reduction of preload and consequently reducing cardiac workload.

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16
Q

What is the worst thing that can happen if someone takes Nitrates?

A

Vessels dilate too much and blood pools in periphery, reducing CO.

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17
Q

What is an example of Nitrates?

A

Nitroglycerine. Available as sublingual tabs, nasal spray, transdermal patches, and IV.

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18
Q

Check out this picture of the MOA of Angina drugs!

A
19
Q

What is the use of Morphine during a MI?

A

Morphine is an opiod narcotic analgesic. It reduces the SNS activity. Relaxation of vascular smooth muscle, particularly veins, reducing preload. Consequently, it reduces cardiac workload.

20
Q

What is the worst that can happen for someone taking Morphine for a MI?

A

The vessels could dilate too much and blood pools in the periphery, reducing the Cardiac Output. Respiratory depression can lead to arrest. Naloxone is the antidote for Morphine.

21
Q

What are Beta Blockers? What do they do?

A

Beta Blockers assist in the reduction of cardiac output (stoke volume) be blocking the beta receptors in the heart. The drugs typically end in the suffix -olol.

22
Q

What is the worst thing that can happen to someone on Beta Blockers?

A

Bradycardia, Inadequate Cardia Output, Bronchospasm.

23
Q

What are Calcium Channel Blockers? What do they Do?

A

Calcium channel blockers cause the relaxation of vessel walls through the blocking of calcium ion channels. The reduce the heart’s afterload and consequently the cardiac workload.

24
Q

What is the worst thing that can happen if someone take Calcium Channel Blockers?

A

Bradycardia (Heartblock) from too many calcium channels being blocked. Inadequate cardiac output. Heart failure.

25
Q

What is something a patient on Calcium Channel Blockers should not consume?

A

Grape fruit juice. It increases the effect of Calcium channel blockers.

26
Q

What are a few common Calcium Channel Blockers?

A

Diltiazem, Verapamil, Norvasc, Renidil.

27
Q

What do ACE Inhibitors do?

A

ACE Inhibitors block the conversion of angiotensin I to angiotension II. They reduce the afterload and consequently the cardiac workload.

28
Q

What is the worst thing that can happen from taking ACE Inhibitors?

A

ACE inhibitors can lead to inadequate cardiac output. They can also lead to a cough (angioedema) from action on vasodilator bradykinins.

29
Q

What is a common suffix for ACE Inhibitors? What are some examples?

A

-pril

30
Q

What does Asprin do?

A

Asprin is an anti-inflammatory, anti-platelet. It reduced mortality by up to 23%.

31
Q

What is the worse thing that can happen when taking aspirin?

A

You may have an allergic reaction.

32
Q

When would you want to receive a fibinolytic?

A

For STEMI MI, if it is within 12 hours of first symptom AND PCI is not available within 90 minutes of first medical contact.

33
Q

What is the percentage of reduced mortality if a fibrinolytic is delivered within 1st hour of onset?

A

47 - 75% reduction.

34
Q

What does a fibrinolytic do?

A

It dissolves all the bodies fresh fibrin clots. It is essential that the diagnosis has to be correct.

35
Q

What are percutaneous coronary interventions?

A

Stents.

36
Q

What is the purpose of Heparin?

A

Herparin lengthens clotting time, prevents thrombus formation/growth, and inhibits certain clotting factors. IV onset is immediate. SC may take up to 1 hour. Half life of Heparin is 1.5 hours.

37
Q

LMWH?

A

Low Molecular Weight Heparin Work similar to Heparin but less likely to cause thrombocytopenia. Duration is 2-4 times longer, and produces a more stable response than heparin. Less follow up lab work is needed.

38
Q

What do antiplatelets do?

A

Reduce platelet aggregation.

39
Q

During cardia maintenance, what types of lipids would you be testing for?

A

There are 3 types of lipids: Triglycerides, Phospholipids, and Steroids (Cholesterol). There are 2 types of Cholesterol: HDL (good, broken down in bile and excreted in feces), LDL (bad, contributes to plaque deposits and CAD.

40
Q

What are statins? What do they do?

A

Statins, or HMG Coenzyme A Reductase Inhibitors. Statins inhibit cholesterol production. They reduce LDL by 20-40% and raise HDL levels. They also lower triglycerides.

41
Q

What is the worst that can happen if someone takes Statins?

A

Liver dysfunction can occur. Liver function tests need to be done prior/3 months post. Muscle pain, tenderness, weakness. Monitor creatinine phosphokinase. Heartburn, Abdominal cramping and diarrhea - give CC in evening.

42
Q

What is a common example of a statin?

A

Atorvastatin (Lipitor).

43
Q

What are the common diagnositic tests to determine if your patient has ACS?

A

CK, CK-MB, Myoglobin (estimates damage from skeletal muscle injury or MI - not cariac specific), Troponin I and T (enzyme markers, detected 2-6 hrs after MR, peaks 15-24 hrs, returns to normal within 7 days).

N232 - Intro to Pharma (8 decks)

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