Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
67 Cards in this Set
- Front
- Back
|
risk factors
|
smoking
high cholesterol DM age sex family hx genetics diet |
|
|
life style modifications
|
lose wt
limit EtOH intake increase exercise reduce sodium intake stop smoking reduce intake of dietary saturated fats & cholesterol maintain adequate intake of dietary potassium, calcium, magnesium |
|
|
congestive heart failure (CHF)
|
heart failure, cardiac failure, pump failure
heart muscle weakens & enlarges, losing ability to pump blood through heart Stages 1-4/A-D |
|
|
left-heart failure
|
LV unable to pump blood returned from lung & L aorta into peripheral circulation, leading to back up in lungs
symptoms - SOB, dyspnea |
|
|
right-heart failure
|
heart doesn't sufficiently pump blood returned from R atrium from systemic circulation, backing up of fluid in peripheral tissue
symptoms - pedal/periph edema |
|
|
myocardial hypertrophy
|
cardiomegaly - enlargement of heart)
|
|
|
CHF signs & symptoms
|
dyspnea on exertion (DOE), SOB
fatigue, weakness, pedal edema, pulmonary edema lab test: brain natriuretic peptide (BNP) ≤ 100 pg/mL |
|
|
treatment for CHF
|
vasodilators, diuretics, ace inhibitors, cardiac glycosides, beta blockers, calcium channel blockers, angiotension-receptor blockers (ARBs)
inotropics chronotropic dromotropic |
|
|
inotropics
|
affects increased force of contraction
|
|
|
chronotropic
|
interferes w/ rate of heart
|
|
|
dromotropic
|
pertains to conduction (of nerve fiber), both can be +/-
|
|
|
cardiac glycosides
|
digoxin (Lanoxin) - increase force of contraction, CO, & tissue perfusion, decrease heart rate, +inotropic
initial signs toxicity: n/v others - confusion, blurred vision, fatigue, drowsiness, a/v blocks, dysrhythmias check: therapeutic lvl, normal = 0.5-2 ng/mL antidote: digibind bind w/ digoxin to form complex molecules to be excreted in urine interactions: diuretics & cortisone leads to decreased potassium hold meds if apical rate < 60, heart blocks |
|
|
phosphodiesterase inhibitors
|
promotes positive inotropic response & vasodilation
inamrinone (Inocor) milrinone (Primacor) - give only for 48-72h via IV infusion in critical care setting; monitor EKG, BP |
|
|
atrial natriuretic peptide hormone
|
increases sodium loss
nesiritide (Natrecor) - causes vasodilation; monitor vital signs, electrolytes, wt, I&O, dizziness |
|
|
diuretics
|
decrease fluid volume by inhibiting Na & water reabsorption from kidney tubules
usually given w/ Lanoxin |
|
|
furosemide (Lasix)
|
loop diuretic
check electrolytes for decreased K, I&O |
|
|
spironolactone (Aldactone)
|
diuretic
potassium sparing: check electrolytes for increased K, monitor I&O, low BP, drowsiness, h/a |
|
|
BETA adrenergic blockers (CHF)
|
carvedilol (Coreg) for chronic CHF only
|
|
|
BiDil
|
combo of hydralazine for BP
& isosorbide dinitrate for chest pain works well for clients of color |
|
|
vasodilators
|
decrease venous blood return to heart, decrease cardiac filling, ventricular filling, & stretching (preload), O2 demand
|
|
|
angiotensin-converting enzyme (ACE)
|
ends in -pril
enalapril (Vasotec), captopril (Capoten), linsinopril (Zestril), Accupril check BP, cough, decreased K, n/v, h/a |
|
|
angiotensin II receptor blocker (ARB)
|
for clients who can't tolerate ACEs
ends in -artan valsartan (Diovan) candesartan (Atacand) lozartan (Cozaar) check dizziness, lytes, lithium toxicity, insomnia |
|
|
angina
|
chest pain as result of inadequate blood flow to myocardium
classic (stable) pain w/ stress unstable (pre-infarction) frequent over day/progression variant (prinzmetal, vasoplastic) occur at rest S/S: tight pressure in chest, radiating left arm, referred pain in neck, arm, choking feeling, SOB, indigestion |
|
|
anti-angina agents
|
nitrates, calcium channel blockers, ace inhibitors
|
|
|
nitrates
|
dilates veins, decreases preload (diastole), O2 demands, afterload (systole)
nitroglycerin, ointment, patch (remove old patch before applying new one), SL, po, IV drip isosorbide (Isordil) - long acting monitor BP before dose, h/a, dizziness, hypotension, n/v, syncope, confusion, dry mouth, pallor take 1/150 mg SL 5 min apart x 3 doses; no relief, seek med attention keep SL doses away from light in tight container |
|
|
calcium channel blockers (angina)
|
dilates arterioles which decrease afterload & decrease O2 demands
nifedepine/adalt (Procardia) - very potent po/SL diltiazem (Cardiazem) & verapamil (Calan) - po/IV SE: low BP & HR, dizziness, flushing, headaches check kidney function check LFTs for liver dmg |
|
|
BETA adrenergic blockers (angina)
|
decrease HR/myocardial contractility, decrease O2 demand reduce angina pain
ends in -lol propranolol (Inderal), nadolol (Corgard), atenolol (Tenormin), metoprolol (Lopressor) monitor BP, HR, heart block, h/a don't stop abruptly or give to clients w/ CHF, heart block client tolerate increased exercise w/ less O2 requirement |
|
|
cardiac arrhythmia
|
deviation from normal heart rate/pattern that's too slow, fast, or irregular
check decreased BP, HR, pr/qt intervals, dizziness causes: abnormal heart filling, MI, hypoxia, thyroid disease, lytes imbalance, hypercapnia (excessive CO2 in blood), stress |
|
|
anti-arrhythmic agents
class 1 A, B, C: |
slows conduction & prolongs repolarization
sodium channel blockers - xylocaine (Lidocaine), procainamide HCl (Pronestyl) |
|
|
anti-arrhythmic agents
class 2 |
reduce calcium re-entry & slows conduction
beta adrenergic blockers - propranolol, esmolol |
|
|
anti-arrhythmic agents
class 3 |
slows conduction through AV node
adenosine (Adenocard), amiodarone (Cardarone) monitor dizziness, asystole (cardiac standstill or arrest; absence of heartbeat), h/a, SOB, blurred vision, palpitations, decreased BP, n/v hold for heart blocks |
|
|
anti-arrhythmic agents
class 4 |
decreases myocardial contractility
calcium channel blockers - verapamil (Calan), diltiazem (Cardiazem) check decreased HR & BP, dizziness, seizures, PR & QT intervals hold for heart blocks |
|
|
hypertension
|
high blood pressure;
BP > systolic - 140 mm/hg, diastolic - 90 mm/hg |
|
|
cardiac output
|
volume of blood expelled from heart ea min
|
|
|
stroke volume
|
amt of blood ejected from left ventricle w/ ea heart beat
|
|
|
contractility
|
force of ventricular contraction
|
|
|
preload
|
blood flow force that stretches ventricles
|
|
|
afterload
|
the resistance to ventricular ejection of blood caused by opposing pressure in aorta
|
|
|
diastole
|
ventricles are relaxed
|
|
|
systole
|
ventricles are contracting
|
|
|
How do the kidneys regulate BP?
|
by the renin-angiotensin-aldosterone system;
renin + angiotensin → angiotensin 1 → to angiotensin 2, which leads to release of aldosterone by the liver → to sodium & water retention → elevated BP |
|
|
treatment for hypertension
|
lifestyle modifications
diuretics, beta blockers, adrenergic blocking agents, calcium channel blockers, ace inhibitors, direct vasodilating agents, combination therapy |
|
|
diuretics
|
decrease HTN & peripheral/pulmonary edema;
produce increased urine flow by inhibiting Na & water reabsorption form kidney tubules; promotes Na & water loss by blocking Na & chloride, increasing reabsorption; decreases fluid volume vascular area to control HTN thiazide & thiazide-like diuretics: acts on distal tubules to promote Na, Cl, H20 excretion - hydrochlorothiazide (HCTZ), Diuril check lytes, low K, magnesium, BP, n/v, h/a; will cause increased BP, cholesterol, digoxin lvl, calcium for all diuretics: monitor I&O, wt loss/gain, salt intake, HR, edema, drug effectiveness, lytes, n/v |
|
|
loop diuretics
|
acts on ascending Loop of Henle to inhibit Cl transport of Na into circulation to inhibit reabsorption of Na;
furosemide (Lasix): most potent & rapid acting; highly protein bound, short half-life, prolonged use → thiamine depletion, check hearing, decreased K, BS, wt, I&O SE: blurred vision, leg cramping, photosensitivity, dizziness, dehydration, take w/ food bumetanide (Bumex) |
|
|
osmotic diuretics
|
increases osmolarity & Na reabsorption in proximate tubule & Loop of Henle; decreased ICP (intracranial pressure), cerebral edema; mannitol causes rapid shift of fluid
|
|
|
potassium sparing diuretic
|
acts in collecting ducts & distal tubules to promote Na & H2O excretion, K retention;
leads to no K supplement needed; monitor BUN, creatinine, spirolactone (Aldactone) |
|
|
carbonic anhydrase inhibitors
|
block action of carbonic anhydrase enzyme, which leads to increased loss of Na, K, bicarbonate excretion;
treatment for HTN, IOP (intraocular pressure) glaucoma pts, diuresis (increased excretion of urine); acetazolamine (Diamox) monitor fluid/lyte imbalance, n/v, confusion, anorexia, orthostatic hypotension, hemolytic anemia, renal calculi contraindication: 1st trimester of pregnancy |
|
|
BETA adrenergic blockers (HTN)
|
decrease effects of SNS by blocking catechotamines, epinephrine/norepinephrine to decrease BP & HR;
use: stable angina, decreased cardiac output, decreased O2 demand; don't give w/ 1st degree blocks, lung distress; may not have increased HR during exercise; taper off to prevent rebound HTN & dysrhythmias; monitor HR, BP closely, depression, fatigue ends in -lol - propanolol (Inderal), antenolol (Tenormin), metoprolol (Lopressor), nadolol (Corgard) |
|
|
calcium channel blockers (HTN)
|
blocks Ca channel in heart muscles to promote vasodilation of coronary & peripheral arteries;
decrease O2 demand & myocardial contractility; grapefruit juice increases effect of CCBs; monitor decreased BP, HR, heart blocks, edema, dizziness, flushing, constipation, renal status, h/a; verapermil HCl (Calan, Isoptin), nifedipine (Procardia) - very potent, diltiazem (Cardiazem), nicardipine (Cardene), amlodipine (Norvasc) |
|
|
ACE for HTN
|
inhibits formation of angiotension II (vasoconstriction) & blocks release of aldosterone;
treat: HTN, CHF; don't stop abruptly, causes rebound HTN, check dry cough, swelling, decreased BP, increased K, h/a, dizziness, fatigue, increased BS, insomnia; Capoten, Vasotec, Altace, Accupril, Zestril |
|
|
angiotension receptor blocks (ARBs) for HTN
|
Cozaar, valsartan (Diovan), irbesartan (Avapro)
|
|
|
alpha adrenergic blocking agents
|
reduce peripheral vascular resistance & increase vasodilation to decrease BP;
frequently given w/ diuretic, slight effects on CO; don't give if impaired liver function, check LFTs, syncope; check dry mouth, dizziness, check low BP, h/a, palpitations; doxazosin mesylate (Cardura), prazosin HCl (Minipress), terozosin HCl (Hytrin) |
|
|
direct-acting alpha blockers
|
use for HTN crises & emergencies;
diazoxide (Hyperstat): 1-3 mg/kg, hydralazine (Apresoline): IV/po, short-acting, 10-40 mg, nitropusside (Nipride): 1-3 mcg/kg/min, IV w/ use of special tubing, labetalol (Normodyne): IV/po |
|
|
anti-coagulants
|
inhibit clot formation; prevent formation of new clots in veins of clients w/ venous & arterial disorders;
heparin: prolongs clotting time; prevents formation of clots; use: deep vein thrombosis (DVT), pulmonary emboli, MI, CVAs, post valve placement, atrial fibrillation, CABG; don't rub injection site or aspirate; check n/v, diarrhea, rash, fever, abdom cramps, bleeding, ecchymosis, tarry stools, hematuria, petechiae, hematemesis, VS, low platelet count |
|
|
heparin
|
monitor partial thromboplastin time (PTT) for effectiveness of treatment & appropriate therapy,
normal clotting - 25-30 sec; give sub-Q, IV push, or IV drip; overdose - give protamine sulfate |
|
|
low-molecular-weight heparin
|
has fewer bleeding complications than heparin;
ends in -parin enoxaparin (Lovenox), tinzaparin sodium (Innohep), dalteparin (Fragmin), danaparoid (Orgaran); check epistaxis, tarry stool, bld at IV site, ecchymosis |
|
|
warfarin (Coumadin) - anticoagulant
|
inhibits hepatic formation of vitamin K; give po;
monitor pt/INR prior to evaluate therapeutic effects; international normalized ratio (INR): normal 1.3-2, 2.5-3, up to 4.5 depending on situation; prothrombin time (PT): normal 10-13 sec; don't use straight razor, use electric one; avoid leafy green vegetables as much as possible; overdose - give vitamin K, 24-48h to be effective; check signs of bleeding, vital signs |
|
|
anti-platelets
|
prevent thrombosis formation in arteries by suppressing platelet aggregation; prophylactic use for MI, CVA;
Aspirin (ASA), clopidegrel (Plavix), ticlopidine (Ticlid); dipyridamole (Persantine) coronary vasodilator; check vitals, h/a, n/v, LFTs, bleeding, fatigue, GI upset |
|
|
glycoproteins
|
administered IV in ICU setting;
abciximab (Reopro), eptifibatide (Intergrilin), tirofiban (Aggrastat); check bleeding, HTN, can give w/ ASA & heparin, no IM injections |
|
|
thrombolytics
|
dissolve clot formation following MI/CVA;
retplase (Retavase), streptokinase (Streptase); plasminogen activate (TPA); very potent drug, monitor closely in ER/ICU; must obtain hx, onset of condition, length of time, hx of bleeding, BP, trauma, liver function, surgery; give 4-12h after MI & 3h after ischemia stroke; SE/adverse reactions: bleeding, intracerebral hemorrhage, dysrhythmias; check vitals, EKG, tracing, PT, PTT, WBC, neuro status |
|
|
hyperlipidemia
|
excess of lipids (esp. cholesterol) in blood;
lipoproteins: cholesterol, triglycerides, phospholipids; LDL: bad, < 100 = 50-60% cholesterol; HDL: good, 45-60% = more protein, less fat, removes cholesterol from blood to liver for removal; cholesterol: 150-200 normal; very low-density lipoprotein (VLDL): carries triglycerides through blood system; self-treat: diet, exercise, no smoking, limit EtOH use |
|
|
hyperlipidemics - cholesterol-lowering meds - fibric acid
|
use for type 4 cholesterol problem
fenofibrate (Tricor), gemfibrozie (Lopid): can cause cholelithiasis; check LFTs |
|
|
hyperlipidemics - nicotinic acid
|
niacin: will cause flushing of face/skin, elevate LFTs & BS; take ASA to reduce SE
ezetimibe (Zetia): works on small intestines cells to inhibit cholesterol (probably not nicotinic acid) |
|
|
cholesterol-lowering meds - statins
|
lower cholestrol, LDL, triglycerides, increase HDL
ends in -statin aotrvastatin calcium (Lipitor), lovastatin (Mevacor), simvasstatin (Zocar) check for increased LFTs, muscle weakness & pain, may cause rhabdomyolysis (muscle dmg), h/a, rash |
|
|
cholesterol-lowering meds - bile acid sequestrants
|
colestipol (Colestid), cholestyramine (Questran)
check GI upset, poor taste, constipation |
|
|
peripheral vasodilators
|
increases blood flow to extremities to treat peripheral vascular disorders of venous & arterial vessels cause by arteriosclerosis, hyperlipidemia;
S/S: numbness, coolness of extremities, intermittent claudication, pain, leg ulcer; clopidogrel (Plavix) for Peripheral Artery Disease (PAD); papaverine (Para-Time) for intermittent claudication; pentoxifylline (Trental): increases blood flow in Peripheral Vascular Disease (PVD); monitor - sedation, GI upset, skin flushing, low BP, h/a; take w/ food |
|
|
intermittent claudication
|
pain, tension, & weakness in legs on walking, which intensifies to produce lameness & is relieved by rest
|
