Obstruction to Circulation Flashcards
CAD
Coronary Artery disease
Arteriosclerosis is what?
calcification of the walls of the arteries. Walls become rough & vessels become narrow, decreasing blood volume, causing pain, ischemia & impaired tissue function
Medications for the treatment of CAD
Aspirin, beta blockers, Ace Inhibitors, Lipid management
What are Statins used for & their action?
Used for Lipid management to prevent 1st &2nd MI in pts with CAD, DM or hyperlipidemia. They increase HDL, decrease LDL, decrease TG, decrease total elevation in cholesterol
What are Bile Acid Sequestrants used for & their action?
Used for Lipid management. They decrease LDL Usually given when Statins are not sufficient to lower high cholesterol
What are Nicotinic acids used for & their action?
Used for Lipid management. They decrease VLDL
What are Fibrates used for & their action?
Used for Lipid management. They decrease HDL & increase TG
What are Cholesterol absorption inhibitors used for & their action?
Used for Lipid management. They decrease LDL & total
Side effects of Statins
GI, hepatotoxicity, osteoproosis, personality changes, muscle pain, increase risk of rhabdomyolysis
rhbdomyolysis
breakdown of muscles.
Bile Acid Sequesterants side effcts
GI, osteoporosis. They can actually increase Triglyceride levels
Nicotinic acid side effects
Flushing, rashes & itching which last about 30 mins. Take aspirin to take care of flushing or take at night
Fibrates side effects
GI, Hepatic, Cholelithiasis (formation of gall stones), muscle pain, rhabdomyolysis, SHORT TERM USE ONLY
Cholesterol absorption inhibitors example
Zetia
Psyllium fiber is found in what & what does it do?
Found in Metamucil, it helps reduce cholesterol
Antihypertensive medication
ACE inhibitors, Beta Blockers, Calcium Channel Blockers
Antiplatlet Medications
Aspirin, Clopidogrel (Plavix)
What kinds of things cause chest pain?
Rib & muscle inflammation, Pneumonia, Heart Attack, Angina, Galbladder inflammation, Gastroesophageal Reflux Disease
Unstable Angina, Angina + recurrent attacks at rest are both considered?
Acute Coronary Syndrome
Prodromal symptoms that appear a month before an episode of Acute Coronary Syndrome (ACS)
Fatigue, SOB, Sleep disturbances, Anxiety, Fleeting chest discomfort. Share these symptoms with people at risk for ACS
What can cause Angina?
Spasm, obstruction or both of the heart, Inflammation, infection of arteries, Injury
What is the most common cause of Angina?
Coronary Artery Disease
Progressive Angina leads to what?
heart attack because plague ruptures & clots attach which leads to hart attack.
Stable Angina is reversed by?
Diet and exercise
Why do you get pain with Angina?
because the heart is deprived of O2
What is the difference between unstable/stable angina?
Stable angina: person experiences pain while exercising, stress, heavy meal & pain lasts about 15 mins. Unstable Anginia: Pain can occur at rest, Nitro doesnt relieve pain, pain is more severe
Stable Angina Location, Duration, Radiation, & Character
Substernal, less than 15 secs, radiates to jaw, neck, arms & feels like pressure, squeezing, heaviness or burning
Stable Angina associated symptoms
SOB, dizziness, sweating, nausea, Rapid hr, fainting
How do you alleviate stable angina?
Rest, Nitroglycerian. If hospitalized after Nitro didn’t work you would get treated with Morphine & O2
What vital sign is important to check before giving Nitro & why
BP because Nitro lowers BP. Hold Nitro is BP is <90/60
Preload
stretching of the muscle fibers in the ventricles
Afterload
Amount of pressure the left ventricle must work to pump blood into circulation
How does Nitro work?
it relaxes the walls of arteries & veins allowing them to dilate & improve oxygen flow
How does Nitro effect preload & afterload?
it lowers it
Nitro oral capsule or tablet & patch are used for prevention or occurring angina?
Prevention
Sublingual or oral spray is used for prevention or occurring angina?
occurring
Where do you put a Nitro patch?
Above elbows& above the knees
Side effects of nitro & what can you do about the side effects
Dizzeness/light-headedness, flushed skin, headache. Take a Tylenol before they take Nitro to help with headache
Can Nitro tolerance develop? If so, what do you do about it?
Yes. Put patch on for 12 hours then take off for 12 hrs & repeat
Whats important to know about Nitro tablets?
they lose their effectiveness when exposed to light, air, heat.
Why are headaches a side of Nitro?
because Nitro causes vasodilation
What drugs shouldnt you take with Nitro & why?
Do not take Nitro with 1.)BP drugs (Beta blockers, Calcium channel blockers), 2.) Nitro causes a severe drop in BP when taken with Viagra, 3.)Aspirin increases Nitro effect, 4.)Alcohol can cause a swift decrease in blood pressure causing dizziness & fainting.
What do Beta Blockers do to the body?
decrease: HR, BP, force of contraction, O2 consumption, afterload
“BETA BLOCKER” side effects
Bradycardia, Exacerbates heart failure, Tired, Appetite loss ; Bad dreams, Low state-depression, Only occasionally able to preform, Contractility decreased, knowledge deficit, Exacerbates asthma, Really nauseated
Can you stop beta Blockers abruptly? when should you hold med & call Dr?
No; if HR <60
Atenolol (Tenormin), Metoprolol (Toprol, Lopressor), Nadolol (Corgard) are examples of?
Beta Blockers
What people should not take beta blockers?
people with asthma, PVD, Sinus bradycardia
Calcium Channel Blockers do what to the body?
decreases preload & afterload, O2 consumption, BP, electrical excitation & contractility
What do Calcium Channel Blockers do to coronary arteries & peripheral arteries?
dilates them
Adverse effects of CCB
Abrupt N/V, bradycardia, Constipation, Dizziness, EDEMA, Falling sperm count (doesnt stop them from being able to perform but it stops them from having kids), Gingival Overgrowth
Amlodipine (Norvasc), Dilitizem (Cardizem), Felopine (Plendil), Nifedipine (Procardia, Adalat) are examples of what medication?
Calcium Channel Blockers
What is a Atherectomy?
Procedure where plague is chipped away from artery from a rotating shaver that is inserted into artery
Which meds are used with chronic angina?
Beta blockers, CCB
Duration of a heart attack
longer than 15 mins
Heart attack character
Deep, dull, squeezing, crushing
Women can experience symptoms of a heart attack __ month before actually having a heart attack
1 or more months
Most common s/s of heart attack
unusual fatigue, sleep disturbance, shortness of breath
What do you do for the 1st 12-24hr with a patient that had an MI?
BR, no caffeine, O2, Stool softeners, avoid Valsalva maneuver (breathing out of nose) because it drops BP
What do you do between 24-48 hrs after a patient has had an MI?
gradual increase activity, no smoking, cardiac diet
How long before scar tissue starts to form after a heart attack?
10-14 days
When does collateral circulation start to form in heart after heart attack?
2-4 weeks, damaged area is still weak
When does scar tissue replace necrotic tissue after a heart attack?
6-8 weeks
Mevacor, Zocor, Pravachol, Lipitor, Lescol, Crestor are exmples of?
Statins
Nursing implications for Statins?
decreases the absorption of vit ADEK, increase bleeding time if on Coumadin, RUQ pain=discontinue, Report muscle aches
