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69 Cards in this Set
- Front
- Back
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why is factor 12 important?
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start of intrinsic cascade
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Why is 10A important
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conversion of prothromin to thrombin
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low molecular wt heparin only inactivates which factor
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10A
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reversal for low molecular heparin
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protamine sulfate
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intrinsic hep blocks which factors
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12a, 9a, 11a
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extrinsic hep block which factor?
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10a, thrombin
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What are secretions of pancreas?
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amylase and lipase
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how is coumadin reversed
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aqua-methyton (phytonadoine)
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portal hypertension leads to splenomegaly which leads to?
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leukopenia, thrombocytopenia, anemia-->BLEEDING
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how does aspirin work?
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inhibits cyclooxygenase--makes plts less sticky
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What are teaching points about warfarin?
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monitor with INR, risk for bleeding
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When converting from heparin to coumadin only tx what do you need to do
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continue heparin for 4 days
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HIT
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heparin intolerance
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Von willibrans disorder
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NO VONwillibrans to activate factor 8. Factor 8 necessary for plt adhesion
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hemophilia a
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deficient in factor 8 or factor 8 not working correctly
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Normal blood pressure range
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< 120 and <80
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prehypertensive range
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120-139 or 80-89
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stg 1 hypertension range
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140-159 or 90-99
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stg 2 hypertension range
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>/= 160 or >/= 100
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how long should you fast before getting a lipid panel?
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12 hours
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how should you take other meds with bile acid binding drugs (resins)?
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take other med 1 hr before or 4 hrs after resin (bile acid binding drug).
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What is HMG COA?
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Statin
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how do statins work?
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Works directly in the liver to decrease LDL synthesis,therefore decreasing
LDL; may also increase HDL, but has no significant impact on triglycerides |
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What are AEs of statins?
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AE: hepatotoxicity, myopathy (rhabdomyolysis)
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What are HDL primarily composed of?
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high density lipids are primarily made of protein
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What are the different classes of lipid lowering drugs?
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bile acid (resins), fibric acid, nicotinic acid, hmg coA , statin combo
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What are the three types of angina?
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-Stable
-variant -unstable |
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What is variant angina?
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pain in the chest due to hypercontractility of vascular smooth muscle. Usually occurs with rest.
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How do you treat stable angina?
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stop activity, smoking cessation, stress reduction, nitrates (short acting and long acting), beta blockers, CCB
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What are the three types of angina?
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-Stable
-variant -unstable |
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What is variant angina?
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pain in the chest due to hypercontractility of vascular smooth muscle. Usually occurs with rest.
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How do you treat stable angina?
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stop activity, smoking cessation, stress reduction, nitrates (short acting and long acting)
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What is angina?
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ischemic (lack of oxygen). sudden pain underneath the sternum, often radiating
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How do you give nitro tabs?
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up to 3 tabs under tongue (sublingual) 5 minutes apart
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with fibric acid derivatives (gemfibrozly) which drug should you be careful with?
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coumadin and Zosin (increase risk for bleeding and myopathy)
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What is the difference between angina and MI?
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both involves ischemia, but MI has necrosis. Troponins will be elevated if MI.
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how many seconds until ischemia?
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10
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What are treatments for MI?
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MONA, thrombolytics, ASA, statins, BB, CCB, ACEs
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How do you treat variant angina?
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nitro, CCB (NOT BETA blockers)
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What are high density lipids primarily composed of?
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proteins
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What goes into acute mgmt for MI?
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control pain
limit damage to myocardium prevent of treat complications |
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How do you control the pain in MI?
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MONA--Oxygen
• Morphine –decrease pain + vasodilation = decrease oxygen demand • Beta blockers –decrease HR = decrease oxygen demand • Nitrates –vasodilation = decrease preload = decrease oxygen demand and increase oxygen supply |
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What kind of treatment for MI do you give to help with reperfusion therapy?
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–Thrombolytic drugs (clot busters)
–Antiplatelet therapy (ASA) –angioplasty (PCTA) –stent placement –bypass surgery (CABG) |
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How do you treat MI complications (i.e. cardiogenic shock)?
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Cardiogenic shock
–inotropic agents • Dopamine/Dobutamine increase CO –vasodilators • NTG, Nitroprusside increase tissue perfusion & decrease workload |
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What is heart failure?
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Ventricular dilation which causes Increased SNS response.
Definition: "A complex clinical syndrome in which the heart is incapable of maintaining a cardiac output adequate to accommodate metabolic requirements and the venous return." |
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How is CHF caused?
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loss of functional myocardial cells (MI, hypertension, infections, etc)
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How do you manage CHF(tx)?
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Diuretics
ACE inhibitors Beta-blockers (Carvediol & Metropolol) Digoxin Aldosterone antagonists Inotropes & IV Vasodilator ARBs |
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What are issues with ACE inhibitors when using them to tx CHF?
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Monitor :
Potassium, BUN/Cr BP Cough Pregnancy (fetal injury) Angioedema |
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Which dz might you have to worry about in a pt on a heparin drip?
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HIT & TTP
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chronic pancreatitis leads to what other chronic disease?
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diabetes
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be sure to monitor ________in pancreatic ca patients when giving them opiods so that they do not become toxic.
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albumin
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NY heart class I?
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no symp
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ny heart class II?
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slight limit
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ny heart class III?
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marked limit
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NY heart class IV?
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present even at rest
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What is an electrolyte issue with ACE?
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too much potassium
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Preload:
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end-diastolic pressure
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Afterload:
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peripheral vascular resistance
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verapamil and cardizem (Diltiazam) work on ...
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heart and arts
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What does verapamil do to peripheral arterioles?
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Blocks peripheral aterioles
= vasodilation = decreased BP |
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What does verapamil do to coronary arteries?
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Blocks coronary arteries
= vasodilation = increase perfusion and O2supply |
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Digoxin and Cardizem together, you are at risk for?
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extreme bradycardia and decreased conduction and contractility
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What does verapamil do to the SA node?
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Blocks SA node = decreases HR
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What does verapamil do to the AV node?
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Blocks at AV node = decreased conduction
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What does verapamil do to the myocardium?
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Blocks myocardium = decreased contractile force
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BB:
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cardioprotective; decrease HR and contractility, decrease the work of the heart and decreases oxygen demand. Use for MI management, for reflexive tachycardia caused by Nitrates or CCB. Use for stable angina.
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CCB
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CCB: Majorly decrease contractility and interfere with AV node conduction which decreases HR. Used for vasospasm, HTN. NEVER use with heart failure.
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ACE
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ACE: Stop Angiotensin 2 from being formed. This lack of Angio 2 will not stimulate aldosterone to increase and cause the body to hold onto water and sodium. Instead; the body will experience some vasodilation and diurese the water and sodium out and keep potassium in. Used for heart failure, MI management, and HTN.
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Nitrates
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Nitrates: Cause direct and rapid vasodilation. Can also cause a fluid rush into the vessels. In those cases; give a diuretic. If body responds to sudden BP drop by having reflexive tachycardia; give BB to stop that. Use for HTN, chest pain, ischemia (temporary O2 decrease to tissues) and for MI (which has infarction or permanent oxygen decrease to tissues)
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