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86 Cards in this Set
- Front
- Back
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What is the spark plug of the heart that generates electrical impulses?
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SA node
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Cardiac electrical mechanisms occur as a result of changes in what specific ions found inside and outside of cell
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sodium, potassium, and calcium
(Na and Ca outside; K inside) |
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what is a type of blood vessel disorder that is included in the general category of artherosclerosis?
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coronary artery disease
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what begins as soft deposits of fat that harden with age and is referred to as hardening of the arteries?
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artherosclerosis- can occur in any artery in the body
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what are artheromas?
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fatty deposits with a preference for the coronary arteries
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what are arteriosclerotic heart disease, cardiovascular heart disease, coronary heart disease, and artherosclerosis?
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all terms to describe the same disease process of artherosclerosis
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what is the major cause of death in the US?
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cardiovascular disease
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what are the leading cause of all cardiovascular disease deaths?
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heart attacks
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what is the major cause of CAD?
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artherosclerosis
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artherosclerosis is characterized by a focal deposit of cholesterol and lipid where?
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primarily within the intimal wall of the artery
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what is altered as a result of inflammation and injury in artherosclerosis?
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endothelial lining
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in artherosclerosis, continued inflammation of the endothelial lining can result in what three things?
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plaque instability, ulceration, and rupture
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what is the final stage in the progression of artherosclerosis?
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complicated lesion: continued inflammation can result in plaque instability, ulceration, and rupture; platelets accumulate and thrombus forms; increased narrowing or total occlusion of lumen
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what are the five nonmodifiable risk factors for CAD?
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age, gender, ethnicity, family history, genetic predisposition
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what are the 9 modifiable risk factors for CAD?
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elevated serum lipids, hypertension, tobacco use, physical inactivity, obesity, diabetes, metabolic syndrome, homocysteine level, psychologic states
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what are the two ways that drugs used in cardiac disease work?
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reducing oxygen consumption by myocardial tissue and increasing blood flow to myocardial tissue
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How are these two things (reducing O2 consumption of heart and increasing blood flow to heart tissue) accomplished?
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decreasing preload and decreasing afterload
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what is the primary cause of primary stable angina?
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artherosclerosis
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what three things can trigger primary stable angina?
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exercise, stress, and drugs that stimulate the sympathetic nervous system
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what type of angina subsides after rest or anti-anginal drugs?
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primary stable angina
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when will unstable angina normally occur?
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early stages of CAD (pre-infarction angina)
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what type of angina increases in intensity and frequency and will eventually occur while at rest?
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unstable angina
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what type of angina occurs from spasms in cardiac smooth muscle and is not precipitated by any specific cause?
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vasospastic angina
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what type of angina will typically occur at the same time of day?
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vasospastic angina
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what are the three types of anti-anginal drugs?
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nitrates, beta blockers, calcium channel blockers
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what are the four goals of anti-anginal drugs?
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minimize frequency of attacks; decrease duration and intensity of pain; improve functional ability; prevent or delay MI
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what is the MOA for nitrates?
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dilate vessels esp. coronary vessels
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what does venous dilation decrease? preload or afterload?
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preload, which decreases myocardial workload and decreases O2 demand
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what types of angina are nitrates used with?
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stable, unstable, and vasospastic
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what type is used for prevention of angina? long or short acting nitrate?
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long acting nitrate
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what are sublingual and IV nitrates used for?
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acute unstable attacks
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what are three things contraindicated for nitrates?
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severe anemia, hypotension, and severe head injury
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what should nitrates never be used in conjunction with?
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erectile dysfunction drugs (Viagra, Cialis)
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what are three SE of nitrates?
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headache (most common adverse effect), hypotension, reflex tachycardia (if vasodilation occurs too rapidly)
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what are four nitrates that are taken PO?
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isosorbide dinitrate (Isordil); isosorbide mononitrate (Imdur); nitroglycerine (Nitrobid, Nitrostat) (also sublingual, IV, topical, inhaler, patch)
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What is isosorbide dinitrate?
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a nitrate; Isordil; causes venous dilation which decreases preload, myocardial workload, and oxygen demand; used with angina; available in rapid-acting sublingual, immediate release tabs, and long acting oral doses
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what is isosorbide mononitrate?
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a nitrate; Imdur; venous dilation decreases preload, myocardial workload, and O2 demand; used with angina; more stable and steady therapeutic response; most commonly used in sustained release form
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which nitrate would be used for prevention of angina?
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long acting nitrate like isosorbide dinitrate (Isordil) in long-acting oral dosage form
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what is the prototypical nitrate?
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nitroglycerin
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what is the most important drug used in the symptomatic treatment of ischemic heart conditions such as angina?
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nitroglycerin
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what is the problem when giving nitroglycerin orally?
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very large first-pass effect; for this reason nitroglycerin in administered by many other routes to bypass the first-pass effect
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what are nitrobid and nitrostat?
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nitrates; names for nitroglycerin; venous dilation decreases preload which decreases myocardial workload and O2 demand; used for angina
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what is used for acute unstable angina attacks?
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sublingual and IV nitrates such as nitroglycerin or Isordil sublingual tab
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why must nitroglycerin tabs be stored in their original dark container?
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because air and moisture inactivates them
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what BP and pulse numbers are required for administration of nitrates?
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90 systolic and pulse rate of 60
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what five things should the nurse note about the anginal pain?
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onset, scale, location, character, precipitating factors
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what becomes present with long term nitrate use?
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tolerance to nitrates
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what can be used for nitrate SE of headache?
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acetaminophen
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you should apply nitroglycerin ointment to what type of skin?
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hairless, then cover with plastic covering
always clean paste from old site |
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what should you always wear when administering nitroglycerin ointment?
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gloves
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do you have to rotate sites with nitroglycerin application?
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Yes!
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what can the patient do in order to prevent tolerance with nitrates?
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remove transdermal patch at bedtime
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IV nitroglycerine is not compatible with many drugs. T or F
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True
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how often should nitrate meds be replaced?
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every six months
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what should you do before taking a sublingual tab?
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lie down; take one tab under tongue q 5 minutes X 3
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blocking of beta1 receptors leads to what three things?
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decrease in HR, cardiac output, and cardiac contractility
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what do beta blockers do for the heart?
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decrease O2 demands of myocardium
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what are four beta blockers used for treatment of angina?
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MEtoprolol, NADolol, Atenolol and PROpanolol
Me nads are pro angina. |
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what anti-anginal type of drug has improved survival in MI patients?
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beta blockers
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what anti-anginal drugs suppress renin, a potent vasoconstrictor and decrease the heart rate?
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beta blockers
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what type of angina are beta blockers most effective for?
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exertional angina (caused by exercise); remember that ADL is exercise for some people and can be a major stressor
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what is the problem with beta blockers and hypoglycemia?
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they may mask signs of hypoglycemia induced tachycardia
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what four cardiovascular diseases do beta blockers treat?
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angina, MI, dysrhythmias, and hypertension
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what are potential problem with beta blockers and asthma?
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blocking of beta2 receptors may result in bronchoconstriction; use with caution unless cardiac specific (atenelol, metoprolol are cardiac selective)
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which of the antianginal beta blockers are cardio selective?
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atenelol (Tenormin), metoprolol (Lopressor)
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which of the antianginal beta blockers are non selective?
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nadolol and propranolol
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why are beta blockers contraindicated in peripheral vascular disease?
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beta blockers can further compromise cerebral or peripheral blood flow
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what are nine adverse effects of atenolol and metoprolol (cardio selective beta blockers)?
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bradycardia, hypotension, HF, fatigue, mental depression, unusual dreams, impotence, hyperglycemia, or hypoglycemia
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what should you assess for with patient on beta blockers for angina?
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edema; weight gain of 2 lbs in 24 hrs or 5 lbs in one week should be reported immediately
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what will abrupt withdraw of beta blockers for angina cause?
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rebound angina and tachcardia
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what are the safety concerns for beta blockers used for angina?
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dizziness, hypotension
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when should you hold beta blockers?
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pulse less than 60 or systolic less than 90
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what do calcium channel blockers do?
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promote relaxation of smooth muscle which surrounds coronary vessels allowing them to dilate
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what does dilation of smooth muscle which surrounds coronary vessels (action of CCB) do (4 things)?
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increases blood flow to the heart, decreases vascular resistance, reducing the workload of the heart and the O2 demands of the heart, and decreases cardiac automaticity (decreases HR)
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what are four CCB?
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verapamil (Calan), nifedipine (Procardia XL, Adalat), diltiazem (Cardizem, Tiazac), amlodipine (Norvasc)
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what three things are CCB considered first-line drugs for?
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HTN, angina, and supraventricular tachycardias (atrial fibrillation and flutter)
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what is a very popular CCB, indicated for angina and HTN, and is available only for oral use?
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Norvasc (amlodipine)
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what is verapimil (Calan)?
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CCB; used for treatment of angina
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what is nifedipine (Procardia XL, Adalat)?
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CCB used for treatment of angina
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what is diltiazem (Cardizem, Tiazac)?
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CCB used for treatment of angina
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what two things do you monitor for with CCB?
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edema and weight gain
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what digestion problem can CCB cause?
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constipation; provide fiber and fluids to prevent
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what is an issue with CCB?
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safety
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what juice can reduce the metabolism of CCBs, especially nifedipine?
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grapefruit juice
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CCBs are not as effective as the beta blockers in treating what type of angina?
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exercise induced angina (
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what is one of the few CCB that is available in parenteral form?
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diltiazem
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