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MIDTERMS COVERAGE > CAD > Flashcards

CAD Flashcards

1
Q

Is the narrowing or blockage of the coronary artery, usually caused by atherosclerosis

A

Coronary Artery Disease (CAD)

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2
Q

Risk factors of CAD in Nonmodifiable Risk Factors

A

-Family history of CAD
-Age (> 45 years for men; 55 years for women)
-Gender: Men develop CAD at an earlier age
-Race: African American

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3
Q

Risk factors of CAD in Modifiable Risk Factors

A

-Hyperlipidemia
-Cigarette smoking, tobacco use
-Hypertension
-Diabetes
-Metabolic Syndrome
-Obesity
-Physical inactivity

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4
Q

Is an abnormal accumulation of lipid and fibrous tissue in the lining of arterial blood vessel walls

A

Coronary atherosclerosis

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5
Q

Involves a repetitious inflammatory response to injury of the artery wall and subsequent alteration in the structural and biochemical properties of the arterial walls

A

Coronary Atherosclerosis

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6
Q

Medical Management of Coronary Atherosclerosis

A

Goal: Prevent, modify, or slow progression of the disease

-Health Promotion
-Diet Therapy
-Physical Acitvity
-Drug Therapy

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7
Q

All adults 20 years and older should have a fasting lipid profile performed once every 5 years, and more often if the profile is abnormal

A

Fasting Lipid Profile

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8
Q

Preparation for Fasting Lipid Profile

A

NPO for 10-12 hours

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9
Q

Low-Density Lipoprotein (LDL)

A

<100 mg/dl (<70 mg/dl for very high risk)

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10
Q

Total Cholesterol

A

<200 mg/dl

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11
Q

High-Density Lipoprotein

A

> 40 mg/dl for males, >50 mg mg/dl for females

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12
Q

Triglyceride

A

<150 mg/dl

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13
Q

Diet Therapy

A

Therapeutic Lifestyle Changes (TLC) Diet

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14
Q

TLC Diet Characteristics

A

-Decreased consumption of saturated fat and cholesterol
-Increase in complex carbohydrates and fiber

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15
Q

Reduces risk of CAD when eaten regularly

A

Omega- 3 fatty acids

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16
Q

Without CAD:

A

Fatty fish (i.e., salmon, tuna) 2x a week as these contain eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)

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17
Q

With CAD:

A

EPA and DHA supplements together with diet

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18
Q

Intensity aerobic activity for at least 150 minutes per week

A

Moderate

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19
Q

Intensity aerobic activity at least 75 minutes per week

A

Vigorous

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20
Q

If weather is hot and humid:

A

-Exercise during the early morning, or indoors
-Wear loose-fitting clothing

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21
Q

If weather is cold:

A

-Layer clothing
-Wear a hat

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22
Q

Drug Therapy for Coronary Atherosclerosis

HMG-CoA Reductase Inhibitors Drugs

A

-Atorvastatin (Lipitor)
-Simvastatin (Zocor)

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23
Q

Therapeutic Effects of HMG-CoA Reductase Inhibitors

A

Decrease total cholesterol, decrease LDL, increase HDL, decrease TG

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24
Q

Drug Therapy for Coronary Atherosclerosis

Fibric Acids Drugs

A

Fenofibrate (Tricor)

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25
Q

Therapeutic effects of Fibric Acids Drugs

A

Increase HDL, decrease TG

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26
Q

Drug Therapy for Coronary Atherosclerosis

Bile Acid Sequestrants Drugs

A

Cholestyramine (Questran)

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27
Q

This drug is used as an adjunct therapy if statins alone are not effective in controlling lipid levels

A

Bile Acid Sequestrants

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28
Q

Therapeutic effects of Bile Acid Sequestrants Drugs

A

Decrease LDL, slight increase in HDL, oxidizes cholesterol into bile acids

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29
Q

A clinical syndrome usually characterized by episodes or paroxysms of pain or pressure in the anterior chest

A

Angina Pectoris

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30
Q

Etiology of Angina Pectoris

A

Coronary Atherosclerosis

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31
Q

Types of Angina

A

-Stable Angina
-Unstable Angina
-Intractable Angina
-Prinzmetal’s Angina

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32
Q

Characteristics of Stable Angina

A

PORN

-Predictable and consistent pain
-Occurs on exertion
-Rest
-NTG

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33
Q

Characteristics of Unstable Angina

A

-Symptoms increase in frequency and severity
-May not be relieved by rest and/or NTG
-Unstable: Up

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34
Q

Characteristics of Intractable Angina

A

-Severe, incapacitating pain
-Intractable: Incapacitating

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35
Q

Characteristics of Prinzmetal’s Angina

A

-Pain at rest
-Reversible ST-segment elevation
-Prinzmetal’s: Pain at Rest

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36
Q

Clinical Manifestations of Angina Pectoris

A

-Deep behind sternum (retrosternal area)
-Radiates to the neck, jaw, shoulder, and inner aspects of upper left arm
-Accompanied by apprehension and a feeling of impending death
-Feeling of weakness or numbness in the arms, wrists, and hands
-SOB
-Pallor
-Diaphoresis
-Dizziness
-N/V

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37
Q

Diagnostics of Angina Pectoris

A

-12-Lead ECG
-Treadmill Stress Test
-Dobutamine Stress Test

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38
Q

Reveals an inverted T-wave

A

12-Lead ECG

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39
Q

Medical Management of Angina Pectoris

A

Goal: increase oxygen supply while decreasing oxygen demand

-Oxygen therapy
-Drug Therapy

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40
Q

-Initiated at onset of chest pain
-Attempts to increase the amount of oxygen delivered to the myocardium and to decrease pain

A

Oxygen Therapy

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41
Q

Drug therapy for Angina Pectoris is

A

Nitroglycerin (NTG)

42
Q

A potent vasodilator and a treatment of choice

A

Nitroglycerin

43
Q

Placed under tongue or in the cheek and ideally alleviates pain within 3 minutes

A

Sublingual NTG

44
Q

May be given to hospitalized patients with recurring s/sx of ischemia or after a revascularization procedure

A

Continuous/Intermittent IV infusion of NTG

45
Q

Major S/E of Nitroglycerin (NTG)

A

Headache

46
Q

Nursing Responsibility of Nitroglycerin

A

Educate on proper administration of “as needed” doses of NTG

47
Q

T/F NTG is dispensed in a dark glass bottle to prevent being inactivated by sunlight

A

True

48
Q

Metoprolol is a

A

Beta-Blockers

49
Q

Decreased myocardial oxygen consumption by blocking beta-adrenergic sympathetic

A

Metoprolol (Neobloc)

50
Q

Metoprolol result

A

Reduced HR, slowed conduction of impulses, decreased BP, and reduced myocardial contractility

51
Q

S/E of metoprolol

A

Depressed mood, fatigue, decreased libido, dizziness

52
Q

Decreases sinoatrial node automaticity and Atrioventricular node conduction resulting in a slower heart rate (negative chronotropic) and decreased strength of myocardial contractility (negative inotropic)

A

Calcium-channel blockers

53
Q

S/E of calcium-channel blockers

A

Hypotension, AV block, bradycardia, and constipation

54
Q

Prevents platelet aggregation and reduces incidence of MI and death in patients with CAD

A

Aspirin

55
Q

Initial dose of Aspirin

A

162-mg to 325-mg dose

56
Q

Maintenance dose of Aspirin

A

81 to 325 mg

57
Q

Side Effects of Aspirin

A

GI upset

58
Q

May take a few days to achieve antiplatelet effects

A

Clopidogrel

59
Q

Side Effects of Clopidogrel

A

GI bleeding and bleeding from other sites

60
Q

Prevents formation of new blood clots and reduces risk of MI in unstable angina

A

Unfractionated Heparin IV

61
Q

Therapeutic level of heparin

A

aPTT is 2 to 2.5 times normal

62
Q

Enoxaparin SQ

A

is a subcutaneous injection of low-molecular-weight heparin

63
Q

Treatment for unstable angina or Non-ST-elevation MI

A

Enoxaparin SQ

64
Q

Provides effective and stable anticoagulation, potentially reducing the risk of rebound ischemic events, and eliminating the need to monitor aPTT.

A

Enoxaparin SQ

65
Q

Unfractionated Heparin and LMWH side effects

A

Risk for bleeding

66
Q

When using an unfractionated heparin and LMWH you need to watch out for internal and external bleeding such as:

A

-Hypotension
-Tachycardia
-Decreased serum hemoglobin and hematocrit

67
Q

Bleeding Precautions are

A

-Applying pressure to the site of any needle puncture
-Avoiding IM injections
-Avoiding tissue injury and bruising from trauma or use of constrictive devices

68
Q

Is an emergent situation characterized by an acute onset of myocardial ischemia that results in myocardial death if definitive interventions do not occur promptly.

A

Acute Coronary Syndrome (ACS)

69
Q

Presenting Symptom of Acute Coronary Syndrome

A

CHEST PAIN

70
Q

Clinical Manifestations of Acute Coronary Syndrome (ACS)

A

-Chest Pain
-Acute, substernal chest pain radiating to the left arm, jaw.
-crushing, vice-like
- “Stepped on by an elephant”

-Diaphoresis
-SOB
-Anxiety
-Tachycardia
-Tachypnea
-Cool, pale, moist skin

71
Q

Clench fist held over the anterior chest

A

Levine Sign

72
Q

Diagnostic of ACS

A

-12-Lead ECG

73
Q

Should be obtained within 10 minutes from the time the patient reports pain or arrives in the ER

A

12-Lead ECG

74
Q

Ischemia alters and delays myocardial repolarization

A

T wave inversion

75
Q

Injured myocardial cells depolarize normally but repolarize more rapidly than normal cells, causing the ST segment to rise at least 1 mm above the isoelectric line

A

ST segment elevation

76
Q

-Develops within 1 to 3 days because of the absence of depolarization current conducted from necrotic tissue.
- ≥ 0.04 second and 25% of R wave depth

A

Abnormal Q wave

77
Q

Diagnostic of Acute Coronary Syndrome

A
  • Troponin
    -Creatine kinase- MB (CK-MB)
    -Myoglobin
78
Q

A protein found in myocardial cells which regulates the myocardial contractile process

A

Troponin

79
Q

Cardiac specific

A

Troponin I and T

80
Q

An enzyme found in cardiac cells

A

Creatine kinase-MB (CK-MB)

81
Q

Indicator of acute MI and begins to rise in 4-14 hours and return to normal after 36 to 48 hours

A

Creatine kinase- MB (CK-MB)

82
Q

A heme protein that helps transport oxygen

A

Myoglobin

83
Q

Found in cardiac and skeletal muscle

A

Myoglobin

84
Q

Rises in 1 to 3 hours and normalized within 24 hours

A

Myoglobin

85
Q

Troponin elevation is

A

4-12 hours

86
Q

CK-MB Elevation is

A

4-14 hours

87
Q

Myoglobin elevation is

A

1-3 hours

88
Q

Normal Level of Troponin

A

0.4 - 2 ng/ml

89
Q

Normal Level of CK-MB is

A

0-6 mg/ml

90
Q

Normal Level of Myoglobin is

A

17.4-105.7 ng/ml

91
Q

Opioid Agonist

A

Morphine Sulfate

92
Q

Morphine Sulfate in Indications of MI:

A

-Reduce pain and anxiety
-Reduces preload and afterload thereby decreasing the workload of the heart

93
Q

Side Effects of Morphine Sulfate

A

-Hypotension
-Respiratory depression

94
Q

Volume of blood in ventricles at end of diastole (end diastolic pressure)

A

Preload

95
Q

Resistance left ventricle must overcome to circulate blood

A

Afterload

96
Q

Preload increase in

A

-Hypervolemia
-Regurgitation of cardiac valves
-Heart Failure

97
Q

To prevent further clot formation

A

Unfractionated heparin or LMWH+ platelet

98
Q

Used to open occluded coronary artery and promote reperfusion to the area that has been deprived of oxygen and must be performed in less than 60 minutes from time of admission.

A

Percutaneous Coronary Intervention

99
Q

Initiated when primary PCI is not available or the transport time to a PCI-capable hospital is too long.

A

Thrombolytic Therapy

100
Q

Must be given within 30 minutes of presentation to the hospital

A

Thrombolytic Therapy

101
Q

Drugs used during Thrombolytic Therapy

A

-Alteplase (Activase)
-Reteplase (Retavase)
-Tenecteplase (TNKase)

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