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137 Cards in this Set

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Positive chronotropic effect
An ⇧ in the HR
Positive dromotropic effect
An increase in the conduction of cardiac electrical impulses through the AV node. Leads to a systolic heart beat.
Positive inotropic effect
An increase in the force of contraction of the heart muscle.
Adrenergics
stimulate the sympathetic nervous system.
Examples of catecholamines
1. norepinephrine
2. epinephrine
3. dopamine
Name some Beta Blockers
-most drugs end in "olol"
Atenolol
metoprolol
carvedolol
labetolol
propranolol
Beta Blockers will ....
- slow HR
- mask hypoglycemia
- cause fatigue
Central acting Alpha blockers effects
vasodilate by decreaseing SNS response
Cardioselective beta blockers
acebutolol(Sectral)
atenonolol(Tenormin)
Metoprolol(Lopressor and Toprol XL)
esmolol (Bevibloc)
betaxolol(kerlone)
Name some alpha blockers
Clonidine(Catapres)
Guanabenze(Wytensin)
Guanafacine(Tenex)
Methyldopa(Aldomet)
Beta Blockers effect
-decrease HR
-decrease contractility
Why would you NOT give a beta blocker to an asthmatic?
in the lungs - beta blockers causes vasoconstriction
Why would you give a beta blocker to a hypertensive individual?
Beta blockers
-decrease HR
-vasodilate the arteries causing decrease in after load
What is >= 160/ >= 100?
Stage II Hypertension
What is <120/<80?
Normal Blood Pressure
What is considered prehypertension?
Systolic/Diastolic
120-139 / 80-89
Stage I Hypertension is ?
140-159 / 90-99
A Dx of Hypertension will be given after?
2 or more visits to the doctor with a BP of >140/90
Hypertension can damage....
The Heart ....Coronary Artery Disease, Left Ventricular Hypertrophy, Heart Failure
and
the Brain ....stroke
Medications used to treat Hypertension
-Diuretics decrease Na, excrete water
-Adrenergic Inhibitors
alpha blockers - vasodilate
Beta blockers - decrease HR
-ACE inhibitors - block ACE cycle
-Calcium channel blockers - vasodilate
-Vasodilators - decrease SVR
Name some side effects of ACE inhibitors?
hypotension, dizziness, fatigue, cough, abdominal pain, diarrhea, N/V, erectile dysfunction, impaired renal function, rashes, dyspepsia, ANGIOEDEMA
Medications that slow the HR include?
Calcium channel blockers, beta blockers, digoxin and adenosine
Calcium channel blockers....
-decrease automaticty and rate of impulse initiation
-slows the speed of conduction across the AV junction
What is the most common cause of death in pts whose HTN is under control?
Coronary artery disease
What is Atrial fibrillation?
-cardiac dysrhythmia involving atrial contractions that are ro rapid that they prevent full repolarization
-do not allo the ventricals to fill with blood.
-prevents normal tissue perfusion
A pt with Heart Failure can present with ....
- SOB
- pitting edema
- enlarged tender liver
- engorged neck veins
- pulmonary rales
An inability of the heart to maintain circulation of blood is .....
Heart Failure
What are adverse effects of Digoxin?
bradycardia, tachycardia, headache, fatigue, malaise, confusion, convulsions,
colored vision, anorexia, nausea, vomiting, diarrhea
Refractory period is ....
a time when the cardiac cells are readjusting its sodium and potassium levels and can not be depolarized again.
The portion of blood that is ejected during each ventricular contraction compared with the total ventricular filling volume. .....
Ejection fraction

normal fraction is 65%
Therapeutic effects of ACE inhibitors include:
- ⇩ BP
- ⇧survival & reduction of symptoms in pts w/ HF
- ⇩ devl of HF
Captopril(capoten)
Enalapril(vasotec)
lisinopril(prinivil, Zestril)
are examples of what classification of drugs
ACE inhibitors
Atenolol(Tenormin)
Carvedilol(Coreg)
Meteprolol(Lopressor, Toprol)
Labetolol(Normayne, Trandate)
Propranolol(Inderal)
Are examples of what classification of drugs?
Beta Blockers
Phase 0 of the cardiac cylcle correspond to when ...
the LT and RT ventricles contract
The coronary arteries fill with blood during ....
diastole
Chest pain resulting due to insufficient oxygen supply and nutrients to the heart
Angina pectoris
What causes the pain associated with Angina pectoris?
Lactic acid from the hearts attempt to get the oxygen needed from anaerobic means. lactic acid is a metabolic byproduct of anaerobic metabolism.
The 3 main antianginal Drugs are?
Nitrites
Beta Blockers
Calcium Channel blockers
What is the goal of antianginal drug therapy?
⇧blood flow to ischemic myocardium
⇓ oxygen demand
What are signs and symptoms of Angina?
Chest pain
Nitroglycerin, a type of antianginal drug has side effects that include?
Headache, tachycardia, postural hypotension
Beta blockers can be considered both...
antianginals
&
antihypertensives
What drug should be given to a pt that has just had a myocardial Infarction?
Beta Blocker
- block the harmful effects of the circulating catecholamines
What happens during an angina attack?
During Stress or exercise, HR is ⇧causing the heart to spend less time in diastole and more time in systole. This causes the heart arteries to receive less blood causing chest pain.
Nifedipine (Adalat, Procardia)
Verapamil (Calan)
Diltiazem (Cardizem)

are what classification?
Calcium channel blockers
When would a calcium channel blocker be prescribed?
1st line drugs for Tx of angina, HTN, supraventricular tachycardia.
What are side effects of Calcium channel blockers...
Hypotension, tachycardia, constipation, nausea, edema, wheezing, bradycardia, rash, flushing, dermatitis
How do calcium channel blockers work?
CCB cause smooth muscle to relax causing the arteries of the heart to vasodilate resulting in more blood being delivered to the heart.
Calcium channel blockers...
cause vasodilation in the arteries of the heart as well as the rest of the body
⇓ afterload ⇓work load of the heart
therfore...
⇓oxygen demand
Nitroglycerin is given...
to prevent the occurrence of angina.
IV Nitroglycerin is light sensitive T or F?
True
When assessing a pt with angina who is to start B-blocker therapy, the nurse is aware that the presence of which condition may be a problem if these drugs are used?
Asthma
What classification of drugs work by blocking the body's production of a chemical called angiotensin II.
ACE inhibitors (angiotensin-converting enzyme inhibitors)

This chemical causes blood vessels to narrow -- so, blocking its production allows blood vessels to become wider.
Blood Pressure =
Cardiac Output x Systemic Vascular Resistance

CO = amount of blood ejected from LT ventrical
SVR = the force the LT ventricle has to push against to eject the blood.
Adrenergic - blockers include
Doxazosine (Carural)
Prazoozin (Minipress)
Terazosin (Hytrin)
Aldosterone is a hormone that ....
causes the tubules of the kidneys to retain sodium and water.
Beta Blockers block this hormone to reduces both angio-tensin II mediated vasocontriction and aldosterone-mediated volume expansion
Renin
drugs with the ending -pril are classified as
ACE inhibitors

ex:
Captopril
Enalapril
Lisinopril
ACE inhibitors are 1st line drugs for what disorders
heart failure & HTN
Ace inhibitors Captopril and Lasinopril are the ONLY drugs that are not prodrugs and can be given to what type of patient?
to patients that have liver dysfunction
- prodrugs must be biotransformed in the liver to become effective
Ace inhibitor Enapril ....
comes in both PO and IV forms
Angiotensin II is a potent vasocontrictor and also...
releases aldosterone which stimulates sodium and water resorption which can raise BP.
ACE inhibitors decrease work load of the heart by...
lowering blood volume and return to the heart and decreasing preload (left ventricular end-diastolic volume) AND
decreasing systemic vascular resistance(SVR) or afterload.
Why can ACE inhibitors cause hyperkalemia?
ACE inhibitors tend to promote resorption of potassium by the kidneys
Name some adverse effects of ACE inhibitors....
dry, nonproductive cough, hypotension, loss of taste,hyperkalemia, rash, anemia, neutropenia, thrombocytosis, agranulocytosis, may cause acute renal failure
potassium sparing diuretics and potassium supplements can cause what when given with ACE inhibitors.
HYPERKALEMIA
ACE inhibitors are similar to ARBs(angiotensinIIreceptor blockers in that they...
prevent vasocontriction and the release of aldosterone
drugs ending in -sartan are classified as ....
ARBs
angiotensin II receptor blockers
What kind of drugs may be given if a person has Raynaud's disease or Migraine headaches?
Calcium Channel blockers because they relax smooth muscle by blocking binding of calcium to its receptors.
If a person is hypertensive what type of diuretic may be given most commonly?
Thiazide diuretic
What should a patient be taught when they are on a diuretic?
The patient should be taught to take weights, BP, to take medication as prescribed.
If a pt is on a diuretic they will be precribed this supplement....
potassium

diuretics will cause hypokalemia unless it is a pottasium sparing diuretic such as spironolactone(aldactone)
Sodium nitroprusside(Nipride)
Hydralazine(Apresoline)
Nitroglycerin(Tridil)
are all examples of what kind of drug?
Vasodilators
A hypertensive patient with an airway problem will be given these beta blockers because they are cardioselective....
metoprolol(Lopressor, Toprol XL)
atenolol(Tenormin)
the inability of the heart to pump sufficiently because of an alteration in the ability of the heart to fill....
Diastolic Heart Failure
what happens during diastole?
the inability of the heart to pump sufficiently because of an alteration in the ability of the heart to contract....
Systolic Heart Failure
what is supposed to happen during systole?
The inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients....
Heart Failure
What is Left-sided heart failure?
inability of the left ventricle to fill or pump sufficient blood to meet the needs of the tissues for oxygen and nutrients
what is right-sided heart failure?
inability of right ventricle to fill or pump sufficient blood to the pulmonary circulation
A drug is administered to a series of congestive heart failure pts and it is found to produce a fall in the plasma concentration of angiotensin I and II and aldosterone. What is likely the identity of the drug?
a) Captopril
b)Digozin
c)Losartan
d)Nifedipine
e) Propranolol
E. Propranolol

inhibits the release of renin which is needed for the others to be released thus decreasing them.
Heart failure manifests as these 2 symptoms. ....
A patient may present with pulmonary and peripheral edema
A pt suspected of HF will have ______ to help diagnose HF.
chest x-ray, ECG, Labs [serum electrolytes, BUN, creatine, thyroid-stimulating hormone, CBC, B-type natriuetic peptide(BNP) and urinalysis]
Digoxin(Lanoxin)
increases the force of myocardial contraction and slows conduction through the AV note. Improves contractility, increasing LT ventricular output
Digoxin therapeutic levels are ....
0.5-2.0ng/mL
If a pt has acute decompensated heart failure, what drug will they be given?
Nesiritide (Natrecor)

a B-type natriuretic peptide
An abnormal condition in which the damaged heart can no longer maintain sufficient cardiac output with normal compensatory mechanisms. This condition is typified by a relatively sudden and drastic worsening of heart failure
decompensated heart
The B-type natriuretic peptide cause
a rapid improvement in the symptoms of HF.
mitral valve prolapse .
- stretching of the valve leaflet into the atria during systole
- extra heart sound heard upon ausculation (mitral click)
- most people may not have symptoms
- those that do may feel fatigue, SOB, lightheadedness, dizziness, syncope, palpitaions, chest pain, and anxiety.
mitral regurgitation
blood from LT ventricle will backflow into the LT atria during systole
causes
- leaflets shorten or tear
- chordae tendineae shorten, tear or elongate
Hydochlorathiazide is used to treat hypertension. You can expect the antihypertensive
effect of this drug to be due to?
diuresis and vasodilation
Mr. Jones’ has a long standing diagnosis of hypertension. Today his blood
pressure is 172/104. This is considered to be:
Stage II hypertension
Many of the calcium channel blockers end....
- dipine
Nitroglycerin is used for the treatment of angina. A specific concern related to the
long term use of this drug is:
tolerance developing requiring larger doses
All of the following categories are useful in the treatment of hypertension except:
a. Venous and arterial dilators
b. Angiotensin Converting Enzyme Inhibitors (ACE-I) and Angiotensin II Receptor Blockers.
c. Beta Blockers and diuretics
d. Aldosterone and Ephedrine
d. Aldosterone and Ephedrine

Aldosterone and ephedrine will increase the blood pressure. Remember that
spironalactone works by inhibiting Aldosterone. All other categories of drugs will
decrease blood pressure
When triglycerides are greatly elevated, what aspect of the lipid profile will not be
accurate?
a. LDL Cholesterol
b. HDL Cholesterol
c. Both HDL and LDL Cholesterol
d. Only Total Cholesterol
a. LDL Cholesterol

LDL is calculated while triglycerides, HDL and total cholesterol are actually measured.
Great error in estimating LDL can occur with elevated (greater than 350) triglycerides.
11. Mrs. Thomas is a 55 year old woman with dilated cardiomyopthy and a left
ventricular ejection fraction of .25. She has a third heart sound on auscultation
and a systolic murmur heard best in the 5th intercostals space in the anterior
auxiliary line. You suspect that she also has:
a. Diastolic Heart failure
b. Aortic insufficiency
c. Mitral regurgitation
d. Mitral stenosis
c. Mitral regurgitation
A patient comes to the emergency department after a syncopal episode while at
work. On examination a III/VI systolic murmur is noted at the 2nd right
intercostals space. The most likely reason for the syncope is:
a. angina
b. transient pulmonary hypertension
c. mitral insufficiency
d. aortic stenosis
d. aortic stenosis
Mr. Walker tells you that he is having cramping pain in the calf of his right leg
when he walks. When he rests it is relieved. What is the most likely cause for this
type of pain?
a. Peripheral edema
b. Deep vein thrombosus
c. Pulmonary embolus
d. Claudication from Peripheral arterial disease.
d. Claudication from Peripheral arterial disease.

Claudication pain occurs with exercise and is relieved by rest. The pain of DVT occurs at
rest and exercise. Edema may result in mild discomfort but it would also be constant. PE
will cause chest pain, dyspnea, and hypoxemia.
Chest pain that occurs seven days after an acute myocardial infarction that is
associated with auscultation of an intermittent rub in the mitral area and an ECG
with ST elevation in most leads is probably:
a. extension of the area of infarction
b. infective endocarditis
c atrial fibrillation
d. pericarditis.
d. pericarditis.

Pericarditis is an inflammation that often follows a myocardial infarction. The
inflammation often results in: positional chest pain that may be relieved by sitting up and
leaning forward, auscultation of a friction rub that may be intermittent or positional, and
global ECG changes of elevated ST segments or T wave changes. It may also be
accompanied by other signs of inflammation such as fever.
Digoxin is one of the oldest drugs used in the treatment of heart failure. Which of
the following is (are) signs of digoxin toxicity?
a. arrhythmias including heart block
b. nausea and vomiting
c. visual disturbances including seeing yellow halos or spots
d. all of the above
d. all of the above

Digoxin has all of these potential adverse reactions. Others include confusion,
hallucinations, and thrombocytopenia. Digoxin has a narrow therapeutic window and the
elderly are particularly prone to the development of toxicity. Renal dosing should be used
with low creatinine clearance. When digoxin is administered there is often a classic
slurring of the ST segment in all or most leads of the ECG. This change is not indicative
of toxicity. Toxicity can be treated with digoxin immune Fab (Digibind)
Mr. Jeremy has chronic atrial fibrillation and is taking warfarin (Coumadin).
What is the reason he is on this drug?
a. To prevent deep vein thrombosis
b. To prevent blood clots from building up on his own native aortic valve.
c. To prevent blood clots from developing in the atrium due to stasis of blood in
a noncontractile chamber.
d. To reduce the adhesiveness of platelets and prevent a myocardial infarction.
c. To prevent blood clots from developing in the atrium due to stasis of blood in
a noncontractile chamber.
Which of the following drugs would be contraindicated for someone with a
potassium level of 5.1?
a. Spironalactone
b. Hydocholorathiazide
c. Furosemide (lasix)
d. Warfarin (Coumadin)
a. Spironalactone

Spironalactone is a potassium sparing diuretic. Serum potassium will likely rise in
someone started on this drug. If the person already has a high potassium level this drug
may cause dangerous elevations in potassium.
The most life threatening adverse effect of taking a HMG coenzyme A Reductase
Inhibitor (Statins) is:
a. angioedema
b. renal failure
c. myalgia
d. rhabdomylysis
d. rhabdomylysis

Angioedema is associated with the use of an ACE-I. Statins are metabolized in the liver
and more likely to be associated with liver damage. Myalgia is associated with statin
use, but only becomes a problem is there is massive breakdown of muscle tissue
associated with rhabdomylysis. If this occurs, renal failure ensues.
Which noninvasive diagnostic test will provide clinically useful information
regarding the structure and movement of heart valves and the left ventricle.
a. Echocardiogram
b. Left heart catheterization
c. Thallium Study
d. CT with Calcium Score
a. Echocardiogram
What does the nurse expect to find when examining a patient with a 5-year history of poorly
controlled HTN?
A. Right atrial dilation
B. Right ventricular hypertrophy
C. Left atrial dilation
D. Left ventricular hypertrophy
D. Left ventricular hypertrophy
Modifiable risk factors for HTN and cardiovascular disease include:
A. Age and gender
B. Positive family history and tobacco use
C. Obesity and sedentary lifestyle
D. Consumption of high carbohydrate diet
C. Obesity and sedentary lifestyle
Which is considered a CHD equivalent?
A. Hypertension
B. Alzheimer’s dementia
C. Diabetes mellitus
D. Gastroesophageal reflux disease (GERD)
C. Diabetes mellitus
Individuals with cardiac or vascular disease are asked about allergy to iodine or shellfish
because:
A. fish is used to lower cholesterol level during acute illness.
B. there is a high incidence of thyroid dysfunction among individuals with cardiac and
vascular disease.
C. the contrast dye that is used in common diagnostic studies of the cardiac and vascular
system contains iodine.
D. individuals who are allergic to iodine are likely to be allergic to cardiac anti-dysrhythmic
drugs.
C. the contrast dye that is used in common diagnostic studies of the cardiac and vascular
system contains iodine.
Which heart sound is suggestive of mitral regurgitation?
A. A diastolic murmur
B. A systolic murmur
C. An extra heart sound heard early in diastole
D. An extra heart sound heard early in systole
B. A systolic murmur
The primary method of action of angiotensin-converting-enzyme (ACE) inhibitors results in:
A. heart rate reduction.
B. reduced risk of thromboembolic events.
C. reduction of neurohormonal stimulation.
D. prevention of lethal arrhythmias.
A. heart rate reduction.
ACE inhibitors like captopril (Capoten) is used to treat kidney problems in people
who take insulin to control diabetes.
Captopril and lisinopril are also given to some patients after a heart attack ....
Heart attacks damage and weaken the heart muscle, and the damage continues even after a person recovers from the attack. This medicine helps slow down further damage to the heart.
The primary method of action of angiotensin-converting-enzyme (ACE) inhibitors results in:
A. heart rate reduction.
B. reduced risk of thromboembolic events.
C. reduction of neurohormonal stimulation.
D. prevention of lethal arrhythmias.
A. heart rate reduction.
A patient with peripheral vascular disease and hypertension is advised by his physician to
lose weight, stop smoking, and begin a progressive walking program. The nurse knows that the
patient is more likely to comply with this advice if he:
A. makes an explicit commitment to change.
B. attends a smoke cessation class.
C. has an external locus of control.
D. requests a referral to the dietician.
A. makes an explicit commitment to change.
What is the first step in the management of dyslipidemia?
A. Assessment of atherosclerosis risk profile
B. Teaching about therapeutic lifestyle changes
C. Treatment with plant stanols/sterols
D. Pharmacotherapy
B. Teaching about therapeutic lifestyle changes
Antihypertensive response of which drug is due to calcium channel blockade?
A. Methyl dopa (Aldomet)
B. Amlodipine (Norvasc)
C. Chlorothiazide (Diuril)
D. Enalapril (Vasotec)
B. Amlodipine (Norvasc)
The rationale for administering propranolol (Inderal) along with nitroprusside when treating
hypertension is to:
A. augment the hypotensive action by blockade of beta-adrenergic receptors in cutaneous
vessels.
B. increase renin release.
C. prevent the development of orthostatic hypotension by increasing cardiac output.
D. prevent reflex cardiac stimulation in response to vasodilation.
A. augment the hypotensive action by blockade of beta-adrenergic receptors in cutaneous
vessels.
What is the most common cause of right sided heart failure?
Left Sided Heart Failure
What is the result of hypertension on heart sounds?
Hypertension increases the intensity of the second heart sound
List 4 side effects of ACE inhibitors?
* Hyperkalemia
* Acute renal failure
* Chronic cough
* Angioedema
Which drugs inhibits the angiotensin converting enzyme, reducing the levels of angiotensin, and preventing the inactivation of bradykinin, a potent vasodilator?
ACE inhibitors
Describe a first degree heart block?
AV conduction time is delayed, but all impulses are conducted to the ventricle.
Describe some of the potential differences in the findings of left and right sided heart failure?
* Right sided heart failure is associated with JVD, peripheral cyanosis, ascites, hepatic congestiion, and hepatojugular refux. Left sided heart failure is associated with paradoxic splitting of S2 and S3, tachypnea, rales, and murmurs of MR, AS, AR
What three parameters should be followed in patients taking ACE-inhibitors?
* Potassium
* Renal function
* Blood pressure
What are the symptoms of right heart failure?
Right heart failure is characterized by peripheral edema and nocturia
What is the most common symptom of congestive heart failure?
Dyspnea
Which heart sound is caused by aortic closure followed by pulmonic closure?
The second heart sound
Which drug would not be given as a 1st line drug for a pt with aortic regurgitation except?
a. meteprolol
b.captopril
c.nifedipine
d.lisinopril
a. metaprolol

Calcium channel blockers and ACE inhibitors are given as 1st line drugs because of their vasodilating effect.
Lovastatin
prevastatin
atorvastatin
are examples of what classifications of drugs
Antilipemic drugs which help lower lipid levels.
An obstruction to this artery in the heart is called the "widow maker".
Left main, Left anterior descending
Right coronary artery supplies blood to ..
The SA node, AV node
RT atrium and ventricle
Inferior-posterior wall left ventricle
The coronary veins empty into the ...
RT atrium
Troponin test is considered to be the most accurate for
a.stress
b.atherosclerosis
c.heart attack
d. angina
c.heart attack
MONA stands for .....
Morphine
Oxygen
Nitroglycerin
Aspirin
The goals of angina meds are ..
to Increase blood supply to the heart and decrease demands of the heart
digoxin is used for the treatment of ...
heart failure and atrial fibrilation and flutter

Lilly pg 322
The first sign that a DVT has occured is usually
a. pain in the calf that occurs with exercise
b. generalized edema of the involved extremity
c. parastesia and coolness of the leg
d. pallor and cyanosis of the involved extremity
b. generalized edema of the involved extremity