Pharm Test 4 Part 2

Front 1

angina pectoris associated with

Back 1

transient myocardial ischemia, lack of oxygenated blood

Front 2

angina pectoris described as

Back 2

sudden substernal pain, radiate to L should arm and jaw, dull pressure

Front 3

angina pectoris occurs secondary to

Back 3

atherosclerosis of coronary arteries

Front 4

think of angina as

Back 4

symptom even though it is a disease

Front 5

angina pain is

Back 5

temporary and reversible

Front 6

angina is precursor to

Back 6

other cardiac episode

Front 7

accompanying symptoms of angina pectoris

Back 7

diaphoretic, SOB from anxiety, fear

Front 8

3 types of angina

Back 8

classic, variant, unstable

Front 9

classic angina triggered by

Back 9

inc. activity, emotional excitement, large meals, cold exposure

Front 10

angina from CAD has no compensatory effect meaning

Back 10

no way to reach the greater oxygen demand

Front 11

what helps classic angina

Back 11

nitrate

Front 12

classic angina underlying cause is usually

Back 12

CAD

Front 13

variant agina also referred to as

Back 13

prizmetals angina

Front 14

variant angina caused by

Back 14

coronary artery spasm

Front 15

variant angina pain occurs when

Back 15

at any time even during sleep

Front 16

tx for variant angina

Back 16

avoid spasm triggers

Front 17

spasm trigger for variant angina

Back 17

cold, stress, fluid overload, smoking

Front 18

variant angina drugs

Back 18

nitroglycerin and Ca channel blockers

Front 19

people with variant angina have hx of

Back 19

A-fib

Front 20

what falls between stable angina and MI

Back 20

unstable angina

Front 21

what angina is more likely to lead to MI and why

Back 21

unstable because CAD is more progressed

Front 22

ACS acronym and definition

Back 22

acute coronary syndrome

dont know if having MI but know something is wrong

Front 23

how to respond to ACS

Back 23

work pt up as if having MI until prove they are not

Front 24

tx goal for all angina types

Back 24

reduce frequency and intensity of angina attacks

Front 25

non drug tx for all angina types

Back 25

PTCA (andiogram), CABG (coronary artery bypass graph)

Front 26

tx drugs for all angina types

Back 26

nitrates, beta blockers, ca channel blockers, thrombolytics

Front 27

nitrates do what, best route

Back 27

vasodilate, SL

Front 28

beta blockers

Back 28

dec. workload of heart, help with blood supply and oxygen to heart

Front 29

what drugs only provide symptom relief

Back 29

nitrate, beta blockers, ca channel blockers

Front 30

what drug may treat cause

Back 30

thrombolytics (only if know for sure cause is clot)

Front 31

oldest and most frequently used antianginal drugs

Back 31

nitrates

Front 32

nitrate prototype

Back 32

nitroglycerin

Front 33

nitrate mech. of action

Back 33

relax smooth muscle of vessels

Front 34

is nitrate selective

Back 34

no

Front 35

another nitrate example

Back 35

Mg sulfate

Front 36

side effect from nitrate tx

Back 36

headache, orthostatic hypotension, reflex tachycardia

Front 37

nitrate tolerance

Back 37

develops rapidly - tachyphylaxis

Front 38

to prevent tachyphylaxis of nitrate tx

Back 38

NTG in lowest dose, longest acting, intermittently (8 hr break)

Front 39

what needs to be documented for anginal attack

Back 39

severity, incidence, circumstances

Front 40

check what each time before admin. of NTG and the intervals for admin.

Back 40

BP and HR, given 2 or 3 tabs q 5 minutes

Front 41

stability, storage, and discarding of SL nitrate

Back 41

chemically unstable, store in dark air tight container away from heat, discard after 6 months

Front 42

do what when admin. topical nitrate

Back 42

wear gloves

Front 43

transdermal nitrate looks like

Back 43

adhesive bandage

Front 44

transdermal nitrate given when and where

Back 44

q morning, rotate sides on non hairy area

Front 45

use what nitrate admin. when others fail

Back 45

IV

Front 46

IV nitrate found in

Back 46

glass bottle

Front 47

beta blockers relieve pain by

Back 47

dec. HR, dec. contractility, dec. oxygen demand

Front 48

Ca channel blockers relieve pain by

Back 48

dec. Ca influx which dec. contractility

Front 49

dec. contractility related with

Back 49

neg. inotropic

Front 50

dec. HR related with

Back 50

neg. chromotropic

Front 51

clinical symptoms of ACS

Back 51

unstable angina, NSTEMI, STEMI

Front 52

NSTEMI

Back 52

non-ST-elevated myocardial infarction

Front 53

ACS associated with

Back 53

rupture of atherosclerotic plaque and partial or complete thrombosis of artery

Front 54

ACS with stable CAD associated with

Back 54

ischemia, pathological Q wave, ST segment changes

Front 55

ischemia longer than _____ = irreveresable cell damage

Back 55

30-45 minutes

Front 56

85% of MI caused by

Back 56

coronary thrombosis

Front 57

large portion of atypical MI are

Back 57

silent

Front 58

long term angina precedes what % of MI

Back 58

20%

Front 59

typical MI symptoms

Back 59

chest pain, diaphoresis, perceived indigestion

Front 60

cellular ischemia is ST what

Back 60

ST depression

Front 61

best case scenario for MI

Back 61

ST depression (cellular ischemia)

Front 62

cellular injury is ST what

Back 62

ST elevation

Front 63

cellular injury from

Back 63

O2 deprevation

Front 64

survive cellular injury for how long

Back 64

20 minutes

Front 65

cellular death is what part of EKG

Back 65

Q wave

Front 66

cellular death is area of

Back 66

MI

Front 67

necrotic or infarcted area has permanent

Back 67

cesation of contractile function

Front 68

most MI affect what chamber

Back 68

L ventricle

Front 69

2 types of MI

Back 69

transmural, subendocardial

Front 70

most common type of MI

Back 70

transmural

Front 71

transmural includes and is

Back 71

all levels of ventricular wall and is more serious

Front 72

subendocardial inculdes and is

Back 72

only inner 1/3-1/2 of ventricular wall and is associated with less severe symptoms

Front 73

functional changes with MI

Back 73

dec. contractility, altered L ventricle compliance, dec. stroke volume, dec. EF, SA node malfunction

Front 74

what is the most common arrhythmia seen with MI

Back 74

A-Fib

Front 75

dx MI

Back 75

thorough family hx, 12-lead EKG, cardiac markers

Front 76

12-lead EKG localize what

Back 76

injured region of L ventricle

Front 77

12-lead EKG appearance

Back 77

ST elevation, Q wave, inverted T waves in 3 leads

Front 78

cardiac markers test what

Back 78

serum enzymes - CPK, troponin, LDH

Front 79

most common test enzymes for cardiac markers

Back 79

CPK and troponin

Front 80

how is it possible to draw serum enzymes

Back 80

when cardiac muscle cells die following MI they release their intracellular contents

Front 81

serum enzymes allows the dx of

Back 81

existence and extent of cell death

Front 82

elevated enzymes at different times tells

Back 82

timing of infarction

Front 83

enzymes that become elevated

Back 83

LDH, AST, WBC, CPK, troponin

Front 84

MI tx

Back 84

nitrate, beta blocker, Ca channel blockers, ACE inhibitors, thrombolytics, PTCA, CABG

Front 85

MI initial tx

Back 85

MONA - morphine, oxygen, nitrate, aspirin

Front 86

morphine does what

Back 86

dec. anxiety, vasodilate, dec. catecholamines

Front 87

oxygen does what and reason and dose

Back 87

inc. O2 supply to heart, standard tx for any chest pain, 4L/nasal canula (even COPD)

Front 88

nitrates do what

Back 88

coronary vasodilate, dec. preload, reduces workload and oxygen demand of heart

Front 89

nitrate route

Back 89

SL, spray, IV

Front 90

nitrate IV for what

Back 90

continued pain

Front 91

watch what with nitrate

Back 91

BP

Front 92

aspirin does what

Back 92

dec. mortality associated with MI, blocks platelet aggregation

Front 93

aspirin route admin.

Back 93

chew initially, additional tablet orally

Front 94

81 mg of aspirin means what

Back 94

dec. thrombosis formation for heart

Front 95

MI pharmacological tx

Back 95

ASA, nitrate, beta blocker, Ca channel blocker, ACE inhibitors, thrombolytics

Front 96

ACE inhibitors do what

Back 96

lower BP

Front 97

thrombolytics given if

Back 97

if hospital does not have cath lab

Front 98

MI surgical procedures

Back 98

PTCA, CABG

Front 99

HF manifests as

Back 99

pump failure that does not keep up with body

Front 100

HF is porblems with

Back 100

ejection fraction and cardiac output

Front 101

cormorbidities of HF

Back 101

diabetes, HTN, lung disorders, renal failure

Front 102

causes of HF

Back 102

inc. preload, inc. afterload, reduced contractility

Front 103

inc. preload from

Back 103

distention or overstretching of ventricles, renal failure, fluid overlaod

Front 104

inc. afterload from

Back 104

aortic stenosis, systemic HTN

Front 105

HF Dx methods based on

Back 105

symptoms

Front 106

HF Dx methods

Back 106

BNP, chest xray, hemodynamic monitoring

Front 107

HF tx

Back 107

reduce cardiac work, reduce preload, reduce afterload, enhance contractility, meds

Front 108

how to reduce preload

Back 108

diuretics, low Na diet

Front 109

how to reduce afterload

Back 109

vasodilate

Front 110

goal of enhancing contractility

Back 110

better perfusion

Front 111

stenosis

Back 111

narrowed valves

Front 112

regurgitation/insufficiency

Back 112

valve closure probs

Front 113

mitral valve prolapse

Back 113

floppy valve, leaflets don't close all the way

Front 114

stenosis, regurgitation, and prolapse seen in what valves

Back 114

mitral and aortic

Front 115

hear murmur from _____ when valve is open because of _____

Back 115

stenosis, narrow opening

Front 116

hear murmur from _____ when valve is closed because of _____

Back 116

regurgitation, blood leaking through

Front 117

ineffective endocarditis

Back 117

inflammation (and infection) of endocardium

Front 118

ways to get ineffective endocarditis

Back 118

inhaled > systemic > heart, central line (large vessel catheter)

Front 119

how to tx ineffective endocarditis

Back 119

4-6 weeks of IV therapy

Front 120

may need what after having ineffective endocarditis

Back 120

valve replacement

Front 121

if you have mitral valve issues what are you given when having oral surgery

Back 121

prophylactic

Front 122

pericarditis sometimes has what present

Back 122

fluid

Front 123

pericarditis fluid does what to heart

Back 123

strangle because it has nowhere to go

Front 124

pericarditis tx

Back 124

diuretics, tap fluid, NSAID

Front 125

cardiac tamponade is ____ (2 emotions)

Back 125

serious and scary

Front 126

cardiac tamponade manifests as

Back 126

fluid accumulation in pericardium, impair expansion and filling

Front 127

cardiac tamponade symptom

Back 127

engorged neck vessels

Front 128

acute arterial occlusion can result from

Back 128

thrombus, emboli, vessel compression, vasopressin, vessel changes

Front 129

acute arterial occlusion SnS

Back 129

acute pain, numbness, tingling, pallor, coldness

Front 130

acute arterial occlusion tx

Back 130

thrombolyitic or anticoagulant, avoid applying heat or cold

Front 131

atherosclerotic occlusive disease often affects

Back 131

superficial femoral or popliteal vessels

Front 132

atherosclerotic occluisve disease SnS

Back 132

intermittent claudication, thinning of skin and subQ tissue, popliteal pulse weak or absent, limb color blanches with elevation, loss of hair on limbs

Front 133

intermittent claudication

Back 133

pain when walking

Front 134

atherosclerotic occlusive disease alleviating and aggrevating

Back 134

better when dangle, worse when elevate

Front 135

atherosclerotic occlusive disease tx

Back 135

protect tissues, walking, fem-pop bypass, aspirin

Front 136

aneurysm is

Back 136

weakening of vessel wall, abnormal localized dilation of vessel

Front 137

aneurysm most common in

Back 137

aorta

Front 138

aneurysm SnS depends on and may be

Back 138

size and location - may be asymptomatic

Front 139

aneurysm SnS

Back 139

may be palpable, may hear murmur in abdomen, may cause pain in area

Front 140

aneurysm tx

Back 140

control HTN, possible surgery

Front 141

HTN further does what

Back 141

weakens vessel wall

Front 142

4 types of anuerysms

Back 142

berry, fusiform, saccular, aortic dissection

Front 143

berry aneurysm

Back 143

small spherical dilation of vessel at a bifurication

Front 144

berry aneurysm usually found in

Back 144

circel of willis

Front 145

fusiform aneurysm

Back 145

entire circumference of vessel, gradual and progressive dilation of vessel

Front 146

saccular aneurysm

Back 146

appears over part of circumference of vessel, appears sacklike

Front 147

aortic dissection aneurysm

Back 147

tear in initial layer of vessel, blood enters vessel wall

Front 148

which aneurysm is a false aneurysm

Back 148

aortic dissection

Front 149

venous thrombosis aka

Back 149

thrombophlebitis

Front 150

venous thrombosis may be in

Back 150

deep or superficial vein

Front 151

risk factors of venous thrombosis

Back 151

venous stasis, inc. blood coaguability, vascular trauma

Front 152

venous stasis from

Back 152

bedrest, immobility

Front 153

inc blood caoguability from

Back 153

contraceptives, trauma, pregnancy

Front 154

vascular trauma from

Back 154

surgery, fracture

Front 155

venous thrombosis tx

Back 155

anticoagulant therapy, heat, bedrest

Front 156

venous throbosis is risk for

Back 156

pulmonary embolus

Front 157

varicose veins

Back 157

dilated tortuous veins of lower extremeties

Front 158

varicose veins more common in

Back 158

>50 yrs, obese, more women than men

Front 159

varicose veins from

Back 159

prolonged standing, increased intra-abdominal pressure (pregnancy, lifting)

Front 160

what happens to the vessels of varicose veins

Back 160

vein valves become imcompetent from prolonged exposure to inc. pressure, valves don't closure, venous enlargement

Front 161

arterial insufficiency (pain, pulse, skin)

Back 161

pain - intermittent claudication, relieved by dependent positioning

pulse - diminished or absent

skin - dependent rubbor elevational, pallor, dry, shiny, cool, cold

Front 162

venous insufficiency (pain, pulse, skin)

Back 162

pain - aching, cramping, relieved by elevation

pulse - present

skin - thick and tough, brawny pigment, malleous