cardiac disorders pt. 2

Question 1

what are some immediate treatments for cardiac disorders?

Answer 1

-O2 therapy of hypoxemic
-aspirin 160-325 mg
-dual antiplatelet therapy
-nitro sublingual, spray, or IV
-morphine if pain not relived by nitro
-monitor ABCs, prepare for CPR/defibrillation

Question 2

cardiac output = ____ x _____

Answer 2

stroke volume x heart rate

Question 3

what is stroke volume determined by?

Answer 3

1) preload “pool”
2) afterload “pipes”
3) contractility “pump”

Question 4

which aspect of stroke volume is the “volume status”

Answer 4

preload

Question 5

which aspect of atroke volume is the resistance the heart pumps against?

Answer 5

afterload
After the heart = Afterload

Question 6

cardiac subjective pain assessment acronym

Answer 6

NOPQRST
N=normal
O= onset
P= precipitating/aggrevating
Q= quality
R= region/radiation
S= severity / other sx
T= timing
U= understanding/perception

Question 7

initial treatment measures for UA/NSTEMI/STEMI

Answer 7

-initial bedrest (dec. heart demand)
-positioning
-avoid valsalva maneuver (bearing down-vagus nerve)

Question 8

how does positioning help cardiac disorders

Answer 8

semi/high fowler’s decreases preload

Question 9

morphine effects on preload/afterload/myocardial O2 demand

Answer 9

prelaod and afterload reduction, decrease myocardial O2 demand and pain relief

Question 10

what do ACE-Is end in

Answer 10

“pril”

Question 11

which 2 classes of meds dec. afterload only

Answer 11

ACE-Is and ARBs

Question 12

what do ARBs end in

Answer 12

“sartan”

Question 13

which med mainly decreases prelaod but also afterload, increases myocardial O2 SUPPLY

Answer 13

nitroglyerin

Question 14

meds that decrease preload, afterload, or contractility ______ myocardial O2 demand

Answer 14

decrease

Question 15

which med decreases inotropic and chronotropic

Answer 15

beta blockers

Question 16

what do beta blockers end in

Answer 16

“lol”

Question 17

what class of meds decreases afterload, - ino, - chrono

Answer 17

clacium channel blocker
*not 1st line

Question 18

what do calcium channel blockers end in

Answer 18

“pine”

Question 19

which meds decrease preload

Answer 19

morphine
nitroglycerin
diuretics

Question 20

which meds decrease afterload

Answer 20

**ACE-I/ARB
nitro
morphine
calcium channel blockers
hydralazine
***nipride

Question 21

which meds decrease contractility (- ino)

Answer 21

**beta blockers
calcium channel blockers

Question 22

which meds decrease HR (- chrono)

Answer 22

**beta blockers
calcium channel blockers

Question 23

which med is contraindicated after sildenafil (viagara)?

Answer 23

nitro

Question 24

what is the benefit of administering metoprolol to a NSTEMI?

Answer 24

reduced myocardial workload

Question 25

what is the difference between anti-thrombotic therapy and fibrinolytic therapy?

Answer 25

anti-thrombotic prevents further clots and fibrinolytic lyse/destroy clots

Question 26

2 kinds of anti-thrombotics and examples of them

Answer 26

anti-platelet (aspirin) anticoagulant (heparin)

Question 27

what are the 2 anti-platelet agents used together?

Answer 27

aspirin and P2Y12 receptor inhibitor (clopidogrel & ticagrelor)

Question 28

examples of P2Y12 receptor inhibitors (anti-platelet)

Answer 28

clopidogrel ticagrelor

Question 29

examples of glycoprotein IIB/IIIa inhibitor (antiplatelet)

Answer 29

eptifibatide tirofiban

Question 30

which anticoagulat... -alters clotting cascade prevents conversion of fibrinogen to fibrin -potentiates antithrombin III which inactivates thrombin

Answer 30

heparin

Question 31

which anticoagulant also inhibits factor Xa

Answer 31

low-molecular weight heparin (enoxaparin/lovenox)

Question 32

which of the followjg is necessary to monitor APTT q6h? a) heparin sodium 1000 U/hr IV b) heparin sodium 5000 U SQ q8h c) lovenox 40 mg SQ q12h d) all

Answer 32

A (only continuous infusions)

Question 33

how does heparin affect PTT when therapeutic?

Answer 33

increases PTT (desired effect is 1-2x mornal rate) slows clotting

Question 34

what drug antagonizes heparin (antidote)

Answer 34

protamine sulfate

Question 35

complication associated w/ heparin and drugs to help complications (not bleeding)

Answer 35

heparin induced thrombocytopenia (HIT) bivalrudin or argatroban

Question 36

acronym for meds to help acute coronary syndromes

Answer 36

MONA BASH M= morphine O= oxygen N=nitrates A= aspirin B= beta-blocker A= ACE-I S= statins H= heparin

Question 37

example of medical reperfusion therapy

Answer 37

fibrinolytic therapy

Question 38

examples of interventional reperfusion

Answer 38

PCI CABG

Question 39

what is evidence of cardiac reperfusion

Answer 39

cessation of CP, elevated STs return to baseline, reperfusion dysrhythmias, early and marked peaking of troponin

Question 40

examples of reperfusion dysrhythmias

Answer 40

bradycardia accelerated idioventricular rhythm (AIVR) PVCs ventricular tachycardia

Question 41

when is fibrinolytic therapy used? (3)

Answer 41

-STEMI -when PCI (cath) can't be performed within 90 mins -several absolute and relative contraindication

Question 42

examples of fibrinolytic therapy (clot buster)

Answer 42

altepase (t-PA) tenecteplase (TNK) reteplase (r-PA) streptokinase (SK)

Question 43

complications post PCI (cath)

Answer 43

-coronary spasm -coronary artery dissection -bleeding/hematoma -compromised extremity blood flow -ventricular dysrhythmias -vasovagal response

Question 44

how long is bedrest post PCI

Answer 44

4-6h

Question 45

complications from AMI

Answer 45

-life-threatening ventricular dysrhytmias!!! -HF -pulmonary edema -cardiogenic shock

Question 46

how soon should stemi pts get a PCI

Answer 46

w/in 90 mins

Question 47

increases myocardial oxygen supply

Answer 47

oxygen

Question 48

removes clot that is causing ischemia/infarction

Answer 48

fibrinolytic agent

Question 49

reduces preload and afterlaod, dilates coronary arteries, increases myocarial oxygen supply and decreases myocardial oxygen demand

Answer 49

nitroglycerin

Question 50

reduces prelaod and afterlaod by venous and arterial vasodialtion decreasing myocardial oxygen demand and relieves pain

Answer 50

morphine

Question 51

reduces straining, which could rpecipitate vasovagal effect and cause dysrhythmias

Answer 51

stool softener

Question 52

reuces heart rate to reduce myocardial oxygen demand, infarct sixe, improves survival rates

Answer 52

beta blocker

Question 53

decreases afterlaod and myocardial oxygen demand

Answer 53

ACE-I