Intermediate Med Surg Cad/mi

Front 1

Modifiable Risk factors (associated with CAD)

Back 1

Cholesterol abnormalities
smoking
HTN
Diabetes
Obesity
physical inactivity

Front 2

Non-Modifiable Risk factors (associated with CAD)

Back 2

fam hx
Age
gender(men earlier)
Race (african americans have a higher incidence)

Front 3

What is the most beneficial risk factor to modify in regards to CAD?

Back 3

Reducing cholesterol to decrease risk of CAD

Front 4

What is the goal range for Total cholesterol?

Back 4

Less than 200

Front 5

What is the goal range for HDL?

Back 5

Greater than 40

Front 6

What is the goal range for LDL?

Back 6

Less than 100

Front 7

If the patient already has CAD what is the goal range for LDL?

Back 7

Less than 70

Front 8

Dietary measures to reduce cholesterol

Back 8

Weight loss
Increased fiber
antioxidants

Front 9

What two types of diets are good to reduce cholesterol?

Back 9

Mediterranean diet (olive oils,fish, nuts) is the best, also

DASH diet (grains, fruit, veg, poultry, fish, nonfat dairy, nuts, seeds)

Front 10

4 subclasses of Antihyperlipidemics?

Back 10

Statins
Fibric acid derivatives
Nicotinic acid
Bile acid sequestrants

Front 11

Prototype statin?

Back 11

lovastatin

All statins end in "statin"

Front 12

Example of Fibric acid derivatives?

Back 12

fenobribrate, gemfibrozil

Front 13

Example of Nicotinic acid?

Back 13

niacin

Front 14

Example of Bile acid sequestrants?

Back 14

cholestyramine

Front 15

What is the only Antihyperlipidemic subclass that will decrease overall mortality rate?

Back 15

The Statins

Front 16

What do that statins do to lipid levels?

Back 16

Lowers LDL, triglycerides, & Total cholesterol; raises HDL

Front 17

How do statins work?

Back 17

They inhibit synthesis of cholesterol

Front 18

Statins cause an increase adverse effect of what?

Back 18

muscle weakness and "rabdomylosis"- break down of muscle fibers, myalgia

Front 19

Why do statins need to be taken with a meal?

Back 19

They are highly protein bound so if not taken with a meal they can quickly reach toxic levels

Front 20

What food can't statins be taken with and why?

Back 20

Do not take with grapefruit! It inhibits the P450 system which slows metabolism of the meds and make more available to the body, which can increase risk of toxicity

Front 21

Are statins a prn drug or a lifelong drug, and why?

Back 21

Lifelong commitment, if they are stopped abruptly a 3 fold rebound effect will happen and most likely cause an MI

Front 22

Is diet still important even though pt is taking a statin?

Back 22

Yes, it is not a substitute for diet change!

Front 23

Fibrates (fibric acid) work to..

Back 23

Decreased triglyceride production in liver
and
Increases HDL

Front 24

Fibrates (fibric acid) have to be used in conjunction with

Back 24

diet and exercise

Front 25

What to monitor when pt is on Fibrates (fibric acid) therapy?

Back 25

Monitor trigylceride & cholesterol levels

Front 26

Adverse effects of Fibrates (fibric acid)

Back 26

G: abd pain, diarrhea

Front 27

When to take Fibrates (fibric acid)

Back 27

Take 30 min. ac meals

Front 28

Nicotinic acid- niacin- is most effective at...

Back 28

increasing HDL

Front 29

Nicotinic acid- niacin- also decreases...

Back 29

LDL & Tri

Front 30

Niacin Adverse Effects:

Back 30

GI upset,
flushing of face & neck,
pruritus,
hyperglycemia

Front 31

Take niacin with or without meals?

Back 31

with meals

Front 32

How do Bile Sequestrants work?

Back 32

Binds with bile acids in the GI tract forming an insoluble complexincreased clearance of cholesterol

Front 33

Bile Sequestrants ultimately decrease...

Back 33

LDL

Front 34

Adverse effects of Bile Sequestrants (cholestyramine)

Back 34

Abd discomfort, CONSTIPATION, nausea

Front 35

When to give Bile Sequestrants (cholestyramine)

Back 35

Give AC meals; give other meds 1hr before or 4-6hrs after this med

Front 36

How to admin Bile Sequestrants (cholestyramine)

Back 36

Mix (dry powder) with water or noncarbonated drinks

Mix for patients! They have been known to just put the dry powder in their mouths.

Front 37

Why should Bile Sequestrants be used with extreme caution in children?

Back 37

Intestinal obstruction!!

Front 38

What labs can be affected by Bile Sequestrants?

Back 38

They may cause a prolonged Prothrombin time

Front 39

Cad leads to ____ which leads to ______ which leads to ____

Back 39

Ischemia ……Necrosis……MI

Front 40

Does CAD happen quickly?

Back 40

No, it is a Progressive disease, will get worse, must be watched

Front 41

With CAD, Arteries supplying heart become _________ by plague from _________ -heart is O2 starved

Back 41

blocked

cholesterol

Front 42

What is the outcome of blocked arteries from CAD?

Back 42

Outcome depends on how long blood flow is limited

Front 43

With a short duration of limited blood flow, the muscle becomes

Back 43

ischemic

Front 44

Is there any long term damage if the heart muscle becomes ischemic?

Back 44

Not if the blood flow is restored

Front 45

Chronic stable angina

Back 45

Predictable w/ moderate to prolonged exertion and relieved by rest and nitroglycerin. It results only in slight limitation of activity.

Front 46

Chronic stable angina Occurs w/ mod-prolonged _________

Back 46

exhertion

Front 47

Chronic stable angina Results in slight limitation of ______

Back 47

activity

Front 48

Chronic stable angina duration:

Back 48

usually 15 minutes or less

Front 49

Chronic stable angina is resolved with?

Back 49

rest and nitroglycerin

Front 50

Unstable angina is...

Back 50

anytime angina is not relieved by rest or nitroglycerin

Front 51

Which angina is due to demand ischemia?

Back 51

chronic stable angina

Front 52

Which angina is due to supply ischemia? (low supply)

Back 52

Unstable angina

Front 53

With unstable angina there is a severe drop in

Back 53

blood flow

Front 54

Which angina is a medical emergency?

Back 54

unstable angina, and it needs immediate attention

Front 55

Acute Coronary syndrome (ACS) includes...

Back 55

Unstable angina and

MI (STEMI and non-STEMI)

Front 56

STEMI

Back 56

ST elevated myocardial infarction

Front 57

Non-ST elevation MI

Back 57

MI with no ST elevation

Front 58

Unstable angina is an increase in ___ deficiency with increase in ________

Back 58

O2

blockage

Front 59

Unstable angina Occurs at rest or w/ minimal _____

Back 59

exhertion

Front 60

Unstable angina Duration:

Back 60

Lasting greater than 15 minutes

Front 61

Unstable angina Associated symptoms:

Back 61

SOB, diaphoresis, sweaty, pale, SCARED, "Overwhelming sense of impending doom"

Front 62

How can MIs be different for women or diabetics?

Back 62

They can show little or no symptoms, chest pain may be mild or absent, may feel pain somewhere else like jaw

Front 63

Myocardial Infarction

Back 63

Vessel blocked & blood flow is abruptly interrupted --> lack of O2--> infarction

Front 64

Infarction= ?

Back 64

irreversible tissue death

Front 65

How long does it take for permanent damage during a myocardial infarction?

Back 65

6 hours and after

Front 66

Need to treat MI pts within _____ hrs

Back 66

4-6 hrs

Front 67

After 6 hours of MI, myocardium will become permanently damaged and is replaced with?

Back 67

Scar tissue

Front 68

When myocardium is replaced with scar tissue after an MI, this Permanently changes size & shape of left ventricle, this is called

Back 68

Ventricular remodeling

Front 69

Does the scar tissue contract or conduct electrical activity after ventricular remodeling?

Back 69

No.

Front 70

Ventricular remodeling decreases ____ and increases chances for _______ for cases of Heart Failure

Back 70

function

mortality

Front 71

After 6 hours of MI, the heart turns ___ and ______

Back 71

blue and enlarged

Front 72

After 48 hours of MI, the heart tissue turns

Back 72

Grey

Front 73

Most MIs are a result of?

Back 73

atherosclerosis of a coronary artery, rupture of plaque, thrombosis, and occlusion of flow

Front 74

How do we build up Collateral circulation?

Back 74

Through exercise

Front 75

How can collateral circulation be a problem with children with cardiac problems?

Back 75

It can be the cause of death, kids are too young to have built up their collateral circulation yet

Front 76

The extent of the MI injury can really depend on ____ _____

Back 76

Collateral circulation