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21 Cards in this Set
- Front
- Back
- 3rd side (hint)
Angina Pectoris:
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Lack of oxygen to the heart cells causing discomfort. It is a symptom of CAD, AKA ischemic heart disease.
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Atherosclerosis or spasm of the arteries = reduced blood flow through coronary arteries.
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Chronic stable angina:
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Impulsed by physical exertion or stress, lasts a few minutes, relieved by nitroglycerin SL.
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Unstable angina:
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Unpredictable; changes in:
1) ease of onset 2) frequency 3) duration 4) intensity |
Caused by a combo of atherosclerotic narrowing, vasospasm, & thrombus formation.
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Variant angina:
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Occurs at rest, specified by ECG changes, cause by vasospasm of a coronary artery reducing blood flow.
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Testing for a type of angina pectoris is diagnosed by?
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Combo of:
1) Hx 2) ECG changes during attack 3) Exercise tolerance w/ or without thallium-201 (radioisotope) scintigraphy (2D). |
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What are the actions of Nitrates?
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Oldest effective therapy; coronary vasodilators that do not increase total coronary blood flow. Relieve angina by:
1)Inducing relaxation of peripheral vascular smooth muscle = dilatation of arteries & veins. This reduces venous blood return (preload) to the heart = decreased oxygen demand. 2)Increase myocardial oxygen supply by dilating large coronary arteries & redistributing blood flow = enhanced oxygen supply to ischemic areas. |
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What are the actions of beta-adrenergic blockers?
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Reduce myocardial oxygen demand by blocking the beta adrenergic receptors in the heart, preventing stimulation from NE & E that would normally cause an increased HR.
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Also reduce BP
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What are the actions of calcium channel blockers?
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Inhibit the movement of Ca ions across a cell membrane. Tx of angina:
1)Decreases workload = less O2 demand. 2)Increase myocardial blood supply by coronary artery dilation. 3)Inhibiting smooth muscle contraction. 4)Dilate blood vessels = decreased resistance to blood flow. |
AKA calcium ion antagonists, slow channel blockers, & calcium influx inhibitors.
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Dilation of peripheral vessels reduces?
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The workload of the heart.
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Coronary artery dilation?
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Improves coronary blood flow.
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What are the actions of angiotensin-converting enzyme (ACE) inhibitors?
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They prevent thrombus formation by inhibiting angiotensin-converting enzymes, that cause the endothelial walls of coronary arteries to dilate & minimize platelet aggregation.
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Major breakthrough in the tx of CAD! See pages 374-376.
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What is the rationale for using HMG-CoA reductase inhibitors (statins) to treat angina attacks?
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Because atherosclerosis causes narrowing/closure of the coronary arteries, which induces angina & MIs.
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What is the nursing assessment required to evaluate an anginal attack?
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1)PQRSTU; What activities precipitate an attack? Relieved by rest? After eating? Fatigue, SOB, related w/indigestion/nausea?
2)Medication Hx 3)Mental status 4)Cardiovascular: palpitations, HR, BP, CAD Hx, check peripheral perfusion, smoke? 5)Nutrional Hx: special diet, high cholesterol, eating cause fatigue/SOB? Edema in ankles? |
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What are the actions of the Fatty Oxidase Enzyme Inhibitor ranolazine (Ranexa)?
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It is an enzyme modulator that shifts the metabolism within myocardial cells to reduce the oxygen required to generate energy for muscle contractions. Demand for O2 reduced = O2 imbalance/demand diminished = reduced myocardial ischemia/sx.
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How would the nurse educate a pt about anginal therapy?
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1)Teach S&S of hypotension that may occur with nitrates.
2)Dizziness/faintness can be relieved by increasing muscular activity (flexing/relaxing muscles in legs). 3)Resting for 10 to 15 minutes after med is taken to manage hypotension. 4)Lightheadedness or fainting can occur when taking nitroglycerin; teach safety measures of orthostatic hypotension. 5)Headaches after nitro, should subside within 20-30 minutes. |
See page 411 for additional info.
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What lab value should be considered in a premedication assessment for calcium ion antagonist drugs?
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Lab values for hepatoxicity.
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How many hours do the transmucosal tablets release nitroglycerin?
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3 to 5
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Following administration of a nitrate the patient may experience?
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hypotension
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remember dilation!
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How long should a patient wait after removing an old Nitro-Dur patch before applying a new one?
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12 to 24 hours
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The most effective agents for relieving ischemia & angina are:
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Beta blockers, calcium antagonists, & nitrates.
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Ca ion antagonists:
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Dilate coronary arteries and peripheral blood vessels, thereby increasing myocardial blood flow & decreasing workload.
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