Test 8: Cardio

Question 1

Vasculature - Stable Angina

Answer 1

Stable fixed atherosclerotic plaque

Question 2

Vasculature - Acute coronary syndrome

Answer 2

Unstable plaque –> unstable angina
Non-ST segmented elevation MI–> Thrombus
ST-segmented elevation MI –> complete thrombus

Question 3

Digoxin

Answer 3

Class: Inotropes
Purpose/Action: slow tachy rates (atrial), increase myocardial contraction.
Dosing: 1st round with MD, very narrow therap. range
Cont: ventricular arryth, constrictive pericarditis, subaortic stenosis
Nursing Imp: Monitor vitals, ECG, w/hold HR < 60, make sure to use the same brand each time to avoid toxicity Antidote is Digibind!!

Question 4

Amiodarone

Answer 4

Class: Antiarrythmia
Purpose/Action: ventricular arrhyth.
Side Effects: optic issues, hypothyroidism, neuro effects.
Cont: cardiogenic shock, bradycardia
Nurs. Impl: assess vitals closely, MD standby

Question 5

Nitroglycerin

Answer 5

Class: antianginals
Purpose/Action: manage angina, increases c.o., reduces BP.
Side Effects: tachycardia, blurred vision, syncope, hypotension
Contra: severe anemia, pericardial tamponade, constrictive pericarditis

Question 6

Atenolol

Answer 6

Class: beta-adrenergic blocker
Purpose/Action: HTN, angina, prevent MI
Side Effects: fatigue, weakness, e.d.,cv issues, CNS problems, respiratory issues.

Question 7

Doxazosin

Answer 7

Class: Antihypertensive / Alpha 1 adrenergic blocker
Purpose/Action: dilates arteries and veins by blocking A1 adrenergic receptors. It is used to lower blood pressure.
Side Effects: dizziness, head ache, orthostatic hypertension w/ 1st dose, GI issues, derm
Cont: hypersensitivity. Use caution in liver dysfunction, PT undergoing cataract surgery.
Nursing consid: Administer daily dose at bedtime. May be given concurrently with diuretic or other anti HTN meds.

Question 8

Labetalol

Answer 8

Class: Alpha and beta Adrenergic Blocking Agents
Purpose/Action: HTN. Blocks B1, B2 and some A1 receptors.
Side Effects: CV issues, fatigue, weakness, back pain, respiratory issues.
Cont: uncompensated HF, pulmonary edema, cardiogenic shock, bradycardia or heart block.
Nursing Consid: Assess vitals, for PO give with meals to enhance absorption

Question 9

Hydrochlorothiazide

Answer 9

Class: diuretic, thiazide diuretics
Purpose/Action: promotes fluid excretion. Treats edema due to HF, renal dysfunction, cirrhosis, glucocorticoid & estrogen therapy.
Side effects: hypokalemia, rash, GI, hypotension, dizziness, glaucoma, dehydration, Hypercalcemia
Nursing Consid: administer in the morning, may give with food or milk to minimize GI issues.

Question 10

Furosemide (Lasix)

Answer 10

Class: Loop diuretics
Purpose/Action: promotes fid excretion. Treats HTN, edema due to HF, hepatic impairment, renal disease
Side Effects: headache, hearing loss, hypotension, GI, GU, blood changes
Nursing consid: give in am and if BID give last dose no later than 5pm. May take with food/milk.

Question 11

Spironolactone

Answer 11

Class: potassium sparing diuretics
Purpose/Action: causes fluid loss while saving potassium & hydrogen ions. Used to manage hyperaldosteronism, essential HTN. Treatment of hypokalemia. Treat edema.
Side effects: gender issues, GI irritation, fluid & electrolyte imbalance.
Nursing consid: give in morning. Take with food.

Question 12

Verapamil

Answer 12

Class: Calcium channel blocker
Purpose/Action: decreases SA & AV conduction and prolongs AV node refractory period. It treats HTN, angina pectoris, printzmetal angina, abnormal rates/rhythms.
Side effects: many CV & CNS issues. GI problems, derm
Contra: systolic BP < 90, AV block, HF, severe ventricular dysfunction, cardiogenic shock
Nursing consid: give w/ food or milk, assess/monitor vitals, monitor serum potassium periodically

Question 13

Nifedipine

Answer 13

Class: Calcium channel blocker
Purpose/Action: systemic vasodilation, coronary vasodilation. Used to treat HTN, angina pectoris and vasospastic angina.
Side Effects: head ache, peripheral edema, flushing, GI issues, CNS Issues.
Contra: coadmin. w/ grapefruit juice and many drug-drug interactions
Nursing consid: give w/ or w/out food, monitor vitals, check LFT’s with prolonged therapy

Question 14

Enalopril

Answer 14

Class: ACE Inhibitors
Purpose/Action: lowers BP, decreases development of HF, increases survival of and decreases symptoms of symptomatic HF.
Side Effects: cough, hypotension, proteinuria, angioedema
Contra: hx of angioedema, PREGNANCY!!
Nursing consid: monitor vitals, monitor labs, make sure PT has adequate fluid level before therapy

Question 15

Losartan

Answer 15

Class: Angiotensin II Receptor Blocker (ARB)
Purpose/Action: blocks angiotensin II at various receptor sites. Used to treat HTN, diabetic neuropathy, prevent stroke w/ HTN & LV hypertrophy.
Side Effects: diarrhea, angioedema, CNS, weight gain, hypoglycemia
Contra: Bilateral renal artery stenosis, PREGNANCY!
Nursing consid: monitor liver & kidney function, monitor for compliance, monitor vitals.

Question 16

Heart Failure

Answer 16

• the heart fails to effectively pump
• can be right sided or left sided
• the weakened heart cannot pump blood properly leading to congestion in body tissues and/or lungs
• **with heart failure think backwards (flow) **

Question 17

Systolic heart failure

Answer 17

• reduced L ventricular contraction

- ejection fraction is less than 40%

Question 18

Diastolic heart failure

Answer 18

• impaired L diastolic ventricular relaxation
• ineffective filling leading to pulmonary congestion and low C.O.
• Ejection fraction may be normal or increased
• Occurs in association with L ventricular hypertrophy or ischemic HD

Question 19

Heart failure right side

Answer 19

• structures involved: sup/inf vena cava, R atrium, tricuspid valve, R ventricle, pulmonary valve, pulmonary artery
• s/s pitting edema, JVD, swollen belly, hepatic enlargement/edema

Question 20

Heart failure left side

Answer 20

• structures involved: pulmonary veins, L atrium, mitral valve, L ventricle, aortic valve, aorta
• S/S: fatigue, dizziness, change in level of consciousness possible.

Question 21

Heart Failure - Treatment

Answer 21

Non-pharm: limit salt intake, limit alcohol intake, don’t smoke, avoid obesity, mild exercise
Pharm: ACE inhibitors, ARB’s and beta blockers; diuretics as adjunctive therapy

Question 22

HTN

Answer 22

defined as a BP > 140/90
Normal = 140/90 monotherapy
Stage 2 = > 160/100 two drug combination
Hypertensive crisis = over 210/120

Question 23

Essential HTN

Answer 23

• unknown cause
• 90% of those with HTN
• Contributing factors: family hx, hyperlipidemia, African American, diabetes, obesity, again, stress, smoking, alcohol

Question 24

Secondary HTN

Answer 24

-related to renal and/or endocrine disorders.

Question 25

Preload

Answer 25

• Volume work of the heart.

- The work or load imposed on the heart before the contraction begins.

Question 26

Afterload

Answer 26

The pressure the heart must generate to move blood into the aorta - after the contraction has started.

Question 27

Contractility

Answer 27

The force with which left ventricular ejection occurs.

Question 28

Angina

Answer 28

Pain or pressure in the chest caused by inadequate blood flow and oxygenation to heart muscle. It is usually produced by atherosclerosis of the coronary arteries and in Western cultures is one of the most common emergent complaints bringing adult patients to medical attention.

Question 29

MI (myocardial infarction)

Answer 29

• The loss of living heart muscle as a result of coronary artery occlusion.
• MI or its related syndromes (acute coronary syndrome or unstable angina) usually occurs when an atheromatous plaque in a coronary artery ruptures, and the resulting clot obstructs the injured blood vessel. Perfusion of the muscular tissue that lies downstream from the blocked artery is lost. If blood flow is not restored within a few hours, the heart muscle dies.

Question 30

Heart Failure (Tabers’s definition)

Answer 30

• Inability of the heart to circulate blood effectively enough to meet the body’s metabolic needs.
• Heart failure may affect the left ventricle, right ventricle, or both. It may result from impaired ejection of blood from the heart during systole or from impaired relaxation of the heart during diastole.

Question 31

ARB

Answer 31

• Angiotensin II Receptor Blocker
• Angiotensin II = Physiologically active form of angiotensin; a powerful vasopressor and stimulator of aldosterone production and secretion.

Question 32

ACE Inhibitors

Answer 32

A class of drugs that block the effects of angiotensin-converting enzyme, preventing the formation of angiotensin II and therefore preventing a rise in blood pressure. Drugs from this class are used to treat hypertension, heart failure, myocardial infarction, and in diabetics, kidney failure.

Question 33

CCB

Answer 33

• Calcium channel blockers
• A group of drugs that slow the influx of calcium ions into smooth muscle cells, resulting in decreased arterial resistance and oxygen demand.
• These drugs are used to treat angina, hypertension, vascular spasm, intracranial bleeding, congestive heart failure, and supraventricular tachycardia. Because hypotension occurs as both an intended and occasionally an unwelcome effect, blood pressure must be monitored especially closely during the initial treatment period.

Question 34

Digitalis toxicity

Answer 34

Acute or chronic toxicity due to the cumulative effect of digitalis. Its most common adverse effects include anorexia, nausea, vomiting, atrial tachycardia and other dysrhythmias, atrioventricular heart blocks, confusion, dizziness, or neurological depression. Digitalis toxicity is a potentially life-threatening, and frequently a drug-related, complication.

Question 35

Inotropes / Cardiac Glycosides

Answer 35

Digoxin!! Slow the rate of the heart & increase contractility.