UNIT 4 Cardiovascular System

Question 1

Arrhythmia: Causes

Answer 1

CHF, CAD, MI, drug therapy

Question 2

Arrhythmia: Symptoms

Answer 2

mild palpitations, cardiac arrest, asymptomatic, fatigue

Question 3

Arrhythmia: Types

Answer 3

bradycardia, tachycardia, atrial flutter, atrial fibrillation, ventricular fibrillation, premature atrial contraction, premature ventricular contraction

Question 4

Antiarrhythmics: Goal

Answer 4

return to a normal sinus rhythm;
does not cure the underlying cause;
affects the membrane and movement ions to improve cardiac function

Question 5

Cardiac Arrest

Answer 5

heart stops beating suddenly

Question 6

Antiarrhythmics: Classes

Answer 6

Class I: blocks Na+ channels;
Class II: beta blockers
Class III: blocks K+ channels
Class IV: CCBs
Miscellaneous Antiarrhythmic

Question 7

Antiarrhythmics: Class I

Answer 7

MOA: block Na+ channels, decrease influx of Na+ during repolarization, decrease rate, decrease conduction, prolong refractory period

USES: ventricular and supraventricular arrhythmias

DRUGS: quinidine (Quinaglute)
procainamide (Pronestyl)
lidocaine (Xylocaine)

PATIENT TEACHING/SIDE EFFECTS: N, D, tremors, restlessness, anorexia

Question 8

Antiarrhythmics: Class II

Answer 8

Beta-Blockers

MOA: bind to beta-1 receptors, slow down HR, slow down velocity of conduction

USES: increased sympathetic nervous system activity; ventricular and supraventricular tachyarrhythmias

DRUGS: propranolol (Inderal) - non-selective beta blocker

PATIENT TEACHING/SIDE EFFECTS: drowsiness, GI upset, CNS depression, mental depression, monitor serum lipid levels, monitor glucose levels in diabetics, bradycardia, do not use with asthma patients - bronchoconstriction

Question 9

Antiarrhythmics: Class III

Answer 9

K+ channel blockers

MOA: blocks K+ channels, delays repolarization, prolongs refractory period

USES: ventricular tachycardia, ventricular fibrillation

DRUGS: bretylium (Bretylol)
amiodarone (Cordarone) - potent, while others are not effective, contains iodine, may interfere with thyroid fxn

PATIENT TEACHING/SIDE EFFECTS: may affect thyroid fxn - contains iodine, hypotension, dizziness, GI upset, tremors, skin discoloration

Question 10

Antiarrhythmics: Class IV

Answer 10

CCBs

MOA: blocks entry of Ca2+ into cells; decreases HR and velocity of conduction, decreases FOC (watch our for CHF patients)

USES: tachyarrhythmias (SVT)

DRUGS: verapamil (Calan)
diltiazem (Cardizem)

PATIENT TEACHING/SIDE EFFECTS: hypotension, dizziness, xerostomia, facial flushing, HA, constipation

Question 11

Miscellaneous Antiarrhythmic

Answer 11

MOA: decreases activity Ca2+ in SA and AV nodes, decreases conduction and rate

DRUGS: adenosine (Adenocard) - emergent or acute situations

USES: SVT

PATIENT TEACHING/SIDE EFFECTS: respiratory difficulty/bronchospasm, hypotension

Question 12

Anemia

Answer 12

insufficient RBCs or Hbg
insufficient levels of O2

Question 13

Anemia: Symptoms

Answer 13

weakness, fatigue, increased HR, SOB, pallor, irritability

Question 14

Anemia: Causes

Answer 14

genetic, blood loss, bone marrow suppression, destruction of RBCs, lack of vitamins and minerals, drugs

Question 15

Anemia: Types

Answer 15

Iron Deficiency Anemia, Vitamin B12 Anemia/Pernicious Anemia, Folic Acid Deficiency Anemia

Question 16

Iron Deficiency Anemia (Fe+)

Answer 16

lack of iron causing decreased Hgb

DIET: fish, meat, soy, beans, green veggies
-give supplement (Vitamin C to increase intestinal absorption)

DRUGS: ferrous sulfate
ferrous gluconate
ferrous fumarate

PATIENT TEACHING/SIDE EFFECTS: N, constipation, darkened stools, gastric irritation, discoloration of teeth (use a straw or mix with juice)

Question 17

Vitamin B12 Deficiency Anemia/Pernicious Anemia

Answer 17

DIET: meats, eggs, milk, seafood

not enough in diet (not common); stomach lacks an intrinsic factor for absorption of the vitamin (B12)
may lead to production of megablastic RBCs (too large and have a short lifespan)

Vitamin B12 USES: DNA synthesis, cell division, RBC production, myelin sheath protection

DRUGS: cyanocabalamin (Vitamin B12)

PATIENT TEACHING/SIDE EFFECTS: invasive, injections are for lifetime, monitor injection site for reactions

Question 18

Folic Acid Deficiency Anemia

Answer 18

USES OF FOLIC ACID: cell growth, cell reproduction, protein synthesis

DIET: leafy greens, fortified cereals, citrus fruits

-may lead to megablastic anemia (RBCs are too large and have a short lifespan)

DRUGS: folic acid

Question 19

Erythropoietin (EPO)

Answer 19

protein produced by the kidneys that is responsible RBC production

MOA: increases number of RBCs, increases H&H

DRUG: epoietin alpha (Epogen, Procrit)

PATIENT TEACHING/SIDE EFFECTS: N, D, HA, joint pain

Question 20

Thromboembolism

Answer 20

moving clot becomes lodged

Question 21

Coagulation

Answer 21

1) Thromboplastin is an enzyme that secreted by platelets (clotting factors); it is a tissue extract (substance released from injured cells)
2) Prothrombin is converted into thrombin with the use of thromboplastin
3) Thrombin converts fibrinogen into fibrin (a mesh responsible for forming a clot; it folds platelets together; is the main component of a clot)
Ca2+ and K+ are required for formation and functioning of clotting factors
4) Plasminogen is converted into plasmin by tissue plasminogen activator (tPA);
plasmin - an enzyme that makes fibrin a more soluble product
5) balance between clot formation and clot breakdown occurs due to homeostasis

Question 22

Anticoagulants

Answer 22

used against clot formation when the clotting mechanism becomes too active

USES: Deep Vein Thrombosis, Thrombophlebitis, Pulmonary Embolism, Stroke, MI, atrial fibrillation

Question 23

Anticoagulants: Types

Answer 23

1) High Molecular Weight
2) Low Molecular Weight
3) Oral Vitamin K Antagonist

Question 24

Anticoagulants: High Molecular Weight

Answer 24

MOA: interferes with platelet aggregation; binds to platelets and thromboplastin, preventing thrombin formation
given IV and SubQ
do not administer IM (hematoma) or orally (too acidic for stomach)
do not cross placenta
antidote: protamine sulfate

DRUGS: heparin

PATIENT TEACHING/SIDE EFFECTS: risk for hemorrhage, alopecia, thrombocytopenia, osteoporosis, fever, petechiae, do not massage the injection site, rotate the injection, do not administer where there is bruising from previous injection, epistaxis, easy bruising

Question 25

Anticoagulants: Low Molecular Weight

Answer 25

MOA: binds to factor X

DRUGS: enoxaparin (Lovenox)
given subQ
does not cross placenta
antidote: protamine sulfate

PATIENT TEACHING/SIDE EFFECTS: risk for hemorrhage, petechiae, do not massage the injection site, rotate the injection, do not administer where there is bruising from previous injections, easy bruising

Question 26

Anticoagulants: Vitamin K Antagonist

Answer 26

MOA: prevents formation of platelets and prothrombin;
slow onset, long duration of action (oral)
benefits: oral administration, inexpensive
antidote: Vitamin K

DRUG: warfarin (Coumadin)

PATIENT TEACHING/SIDE EFFECTS: easy bruising, bleeding of the gums, N, V, HA, hematuria, fatigue, cannot administer during pregnancy, epistaxis