Diagnosis and Management of Cardiovascular Disorders Flashcards
(295 cards)
1
Q
Blood Flow Through the Heart: Superior Vena Cava ----> Right Atrium ----> Tricuscpid valve ----> Right ventricle ----> Pulmonic valve ----> Pulmonic artery ----> Lungs ------> Pulmonary veins ----> Left Atrium ----> Mitral valve -----> Left ventricle -----> aortic valve ------> aorta --------> \_\_\_\_\_\_\_ ----->
A
body
2
Q
Blood Flow Through the Heart: Superior Vena Cava ----> Right Atrium ----> Tricuscpid valve ----> Right ventricle ----> Pulmonic valve ----> Pulmonic artery ----> Lungs ------> Pulmonary veins ----> Left Atrium ----> Mitral valve -----> Left ventricle -----> aortic valve ------> \_\_\_\_\_\_ --------> body ----->
A
aorta
3
Q
Blood Flow Through the Heart: Superior Vena Cava ----> Right Atrium ----> Tricuscpid valve ----> Right ventricle ----> Pulmonic valve ----> Pulmonic artery ----> Lungs ------> Pulmonary veins ----> Left Atrium ----> Mitral valve -----> Left ventricle -----> \_\_\_\_\_ \_\_\_\_\_ ------> aorta --------> body ----->
A
aortic valve
4
Q
Blood Flow Through the Heart: Superior Vena Cava ----> Right Atrium ----> Tricuscpid valve ----> Right ventricle ----> Pulmonic valve ----> Pulmonic artery ----> Lungs ------> Pulmonary veins ----> Left Atrium ----> Mitral valve -----> \_\_\_\_\_ \_\_\_\_\_ -----> aortic valve ------> aorta --------> body ----->
A
Left ventricle
5
Q
Blood Flow Through the Heart: Superior Vena Cava ----> Right Atrium ----> Tricuscpid valve ----> Right ventricle ----> Pulmonic valve ----> Pulmonic artery ----> Lungs ------> Pulmonary veins ----> Left Atrium ----> \_\_\_\_ \_\_\_\_ -----> Left ventricle -----> aortic valve ------> aorta --------> body ----->
A
Mitral valve
6
Q
Blood Flow Through the Heart: Superior Vena Cava ----> Right Atrium ----> Tricuscpid valve ----> Right ventricle ----> Pulmonic valve ----> Pulmonic artery ----> Lungs ------> Pulmonary veins ----> \_\_\_\_ \_\_\_ ----> Mitral valve -----> Left ventricle -----> aortic valve ------> aorta --------> body ----->
A
Left Atrium
7
Q
Blood Flow Through the Heart: Superior Vena Cava ----> Right Atrium ----> Tricuscpid valve ----> Right ventricle ----> Pulmonic valve ----> Pulmonic artery ----> Lungs ------> \_\_\_ \_\_\_\_ ----> Left Atrium ----> Mitral valve -----> Left ventricle -----> aortic valve ------> aorta --------> body ----->
A
Pulmonary veins
8
Q
Blood Flow Through the Heart: Superior Vena Cava ----> Right Atrium ----> Tricuscpid valve ----> Right ventricle ----> Pulmonic valve ----> Pulmonic artery ----> \_\_\_\_\_ ------> Pulmonary veins ----> Left Atrium ----> Mitral valve -----> Left ventricle -----> aortic valve ------> aorta --------> body ----->
A
Lungs
9
Q
Blood Flow Through the Heart: Superior Vena Cava ----> Right Atrium ----> Tricuscpid valve ----> Right ventricle ----> Pulmonic valve ----> \_\_\_\_\_ \_\_\_\_ ----> Lungs ------> Pulmonary veins ----> Left Atrium ----> Mitral valve -----> Left ventricle -----> aortic valve ------> aorta --------> body ----->
A
Pulmonic artery
10
Q
Blood Flow Through the Heart: Superior Vena Cava ----> Right Atrium ----> Tricuscpid valve ----> Right ventricle ----> \_\_\_\_\_ \_\_\_\_ ----> Pulmonic artery ----> Lungs ------> Pulmonary veins ----> Left Atrium ----> Mitral valve -----> Left ventricle -----> aortic valve ------> aorta --------> body ----->
A
Pulmonic valve
11
Q
Blood Flow Through the Heart: Superior Vena Cava ----> Right Atrium ----> Tricuscpid valve ----> \_\_\_ \_\_\_\_ ----> Pulmonic valve ----> Pulmonic artery ----> Lungs ------> Pulmonary veins ----> Left Atrium ----> Mitral valve -----> Left ventricle -----> aortic valve ------> aorta --------> body ----->
A
Right ventricle
12
Q
Blood Flow Through the Heart: Superior Vena Cava ----> Right Atrium ----> \_\_\_\_\_ \_\_\_\_ ----> Right ventricle ----> Pulmonic valve ----> Pulmonic artery ----> Lungs ------> Pulmonary veins ----> Left Atrium ----> Mitral valve -----> Left ventricle -----> aortic valve ------> aorta --------> body ----->
A
Tricuscpid valve
13
Q
Blood Flow Through the Heart: Superior Vena Cava ----> \_\_\_\_ \_\_\_\_ ----> Tricuscpid valve ----> Right ventricle ----> Pulmonic valve ----> Pulmonic artery ----> Lungs ------> Pulmonary veins ----> Left Atrium ----> Mitral valve -----> Left ventricle -----> aortic valve ------> aorta --------> body ----->
A
Right Atrium
14
Q
Blood Flow Through the Heart: \_\_\_\_ \_\_\_\_\_ \_\_\_\_ ----> Right Atrium ----> Tricuscpid valve ----> Right ventricle ----> Pulmonic valve ----> Pulmonic artery ----> Lungs ------> Pulmonary veins ----> Left Atrium ----> Mitral valve -----> Left ventricle -----> aortic valve ------> aorta --------> body ----->
A
Superior Vena Cava
15
Q
Heart Sounds and Anatomical Location
_____
Mitral/tricuspid (AV) valves closure; aortic/pulmonic.(semilunar), valves open
A
S1
16
Q
Heart Sounds and Anatomical Location
_____
Aortic/pulmonic (semilunar) valves closure; mitral/tricuspid (AV) valves open
A
S2
17
Q
Heart Sounds and Anatomical Location
_______
The period between S1 and S2
A
Systole
18
Q
Heart Sounds and Anatomical Location
______
The period between S2 and S1
A
Diastole
19
Q
Heart Sounds and Anatomical Location
_____
“Ken-tuck’-y”; increased fluid states (e.g., CHF, pregnancy, etc.)
A
S3
20
Q
Heart Sounds and Anatomical Location
______
“Ten-ne-ssee’”; stiff ventricular wall (e.g., MI, left ventricular hypertrophy, chronic hypertension etc.)
A
S4
21
Q
Murmurs
_____: Loudest
A
VI/VI
22
Q
Murmurs
_____: Very loud; heard with one comer of stethoscope off the chest wall
A
V/ VI
23
Q
Murmurs
_____: Loud; associated with a thrill
A
IV/VI
24
Q
Murmurs
_____: Moderately loud; easily heard
A
III/ VI
25
Murmurs
_____: Audible but faint
II/ VI
26
Murmurs
_____: Barely audible
I/VI
27
Valvular Disease: Major Problems
1. _____ ____: Loud Sl murmur, low pitched, mid-diastolic; apical "crescendo" rumble
Mitral stenosis
28
Valvular Disease: Major Problems
2.____ _______: S3 with systolic murmur at 5th ICS MCL (apex); may radiate to base or left axilla; musical, blowing, or high pitched
Mitral regurgitation
29
Valvular Disease: Major Problems
3. ______ ______: Systolic, "blowing", rough harsh murmur at 2nd right ICS usually radiating to the neck
Aortic stenosis
30
Valvular Disease: Major Problems
4. _____ _____: Diastolic, "blowing" murmur at 2nd left ICS. "Ms. Ard and Mr. Ass"
Aortic regurgitation
31
Mitral Stenosis and Aortic Regurgitation are in ______
Diastolic
32
Mitral Regurgitation and Aortic Stenosis are in _____
Systolic
33
Murmurs
Where?
a. ____ ICS = Apex = Mitral
5th
34
Murmurs
Where?
b.____ or ____ ICS = Base = Aortic
2nd or 3rd
35
```
Signs/Symptoms (Acute): ____ ____
1. Dyspnea at rest
2. Coarse rams over all lung fields
3. Wheezing, frothy cough
4. Appears generally healthy except for the acute event
5. S3 gallop
6. The murmur of mitral regurgitation (systolic murmur
loudest at apex)
7. Pulmonary hypertension
```
Left failure
36
Signs/Symptoms (Chronic): ____ _____
1. JVD
2. Hepatomegaly, splenomegaly
3. Dependent edema: As a result of increased capillary hydrostatic pressure
4. Paroxysmal nocturnal dyspnea (PND)
5. Appears chronically ill
6. Diffuse chest wall heave
7. Displaced PMI
8. Abdominal fullness
9. Fatigue on exertion
10. S3 and/or S4
Right failure
37
Laboratory/Diagnostics: Heart Failure
1. Hypoxemia and hypocapnia on ABG
2. The basic metabolic profile usually normal unless the chronic failure is present
3. Urinalysis
4. Chest x-ray: Pulmonary edema, ____ B lines, effusions
5. Echocardiogram will show contractile/relaxation, valve function, ejection fraction.
6. ECG may show deviation or underlying problem: Acute myocardial infarction, dysrhythmia
7. Pulmonary function tests for wheezing during exercise
Kerley
38
Management: Heart Failure
Non-Pharmacologic
1. ______ restriction
2. Rest/activity balance
3. Weight reduction
4. Others
Sodium
39
Management: Heart Failure
Pharmacologic
1. ____ inhibitors
2. Diuretics: Thiazides, loop, etc.
3. Anticoagulation therapy for atrial fibrillation
ACE
40
Hypertension
A sustained elevation of systolic blood pressure (SBP)
> ____ mm Hg or diastolic blood pressure (DBP) > _____ mm Hg
SBP 140 or DBP 90
41
General Comments/ Hypertension
1. Two types
a. Primary/Essential: ___% of all cases; the onset usually
< 55 years of age
95
42
General Comments/ Hypertension
1. Two types
b. Secondary: ___% of all cases; secondary to other known causes such as estrogen use, renal disease, pregnancy, endocrine disorders, renal artery stenosis (RAS), etc.
5
43
General Comments/ Hypertension
2. Exacerbating factors: _____, obesity, excessive alcohol intake, use of NSAIDs, and others
Smoking
44
Signs/Symptoms/ Hypertension
1. Often none: "____ ____"
2. Elevated BP
3. With severe hypertension: Suboccipital pulsating headache, occurring early in the morning and resolving throughout the day
4. Epistaxis
5. Dizziness/lightheadedness
6. S4 related to left ventricular hypertrophy
7. Arteriovenous (AV) nicking
8. Tearing chest pain may indicate aortic dissection
Silent killer
45
Laboratory/Diagnostic Findings/ Hypertension
1. In uncomplicated hypertension, laboratory findings are usually ______.
2. Other tests to rule out particular causes:
a. Renovascular disease studies
b. Chest x-ray (CXR) if cardiomegaly is suspected.
c. Plasma aldosterone level to role out aldosteronism
d. A.M./P.M.-cortisol levels to rule out Cushing's Syndrome
3. U/A, CBC, BMP, calcium, phosphorus, uric acid, cholesterol, Triglycerides
4. Electrocardiography (ECG)
5. PA and lateral CXR
normal
46
JNC 7 Guidelines:
Classifications: Normal
Systolic BP < ___
Diastolic BP < ___
120
| 80
47
JNC 7 Guidelines:
Prehypertension
Systolic BP ______
Diastolic BP ______
120 to 139 or
| 80 to 89
48
JNC 7 Guidelines:
Hypertension/ Stage 1
Systolic BP ______
Diastolic BP ______
140 to 159
| 90 to 99
49
JNC 7 Guidelines:
Hypertension/ Stage 2
Systolic BP > or equal to ___
Diastolic BP > or equal to ____
160
| 100
50
In contrast to JNC 7, _____ emphasizes treatment thresholds.
JNC 8
51
JNC 8 Recommendations (Grade ___ = expert opinion but insufficient evidence for the recommendation)
E
52
JNC 8 Recommendations (Grade ___= moderate recommendation)
B
53
JNC 8 Recommendations (Grade ___ = strong recolmnendation)
A
54
JNC 8 Recommendations (Grade ___ = weak recommendation)
C
55
According to the JNC 8 Recommendations
Recommendation 1
Population: Adults > 60 years of age
Goal BP: SBP < ____ mmHg or DBP < ____mmHg (Grade A)
150
| 90
56
According to the JNC 8 Recommendations
Recommendation 2
Population: Adults < 60 years of age
Goal BP: DBP < ___ mmHg (Grade A)
90
57
According to the JNC 8 Recommendations
Recommendation 3
Population: Adults < 60 years of age
Goal BP: SBP < ____mmHg (Grade E)
140
58
According to the JNC 8 Recommendations
Recommendation 4
Population: Adults > 18 with CKD
Goal BP: SBP < ___mmHg or DBP < ___ mmHg (Grade E)
140
| 90
59
According to the JNC 8 Recommendations
Recommendation 5
Population: Adults > 18 with DM
Goal BP: SBP < ___mmHg or DBP < ___ mmHg (Grade E)
140
| 90
60
```
According to the JNC 8 Recommendations
Recommendation 6
Population: Non-African-American
Goal BP: ____ Type diuretic
CCB
ACEI
ARB
```
Thiazide
61
```
According to the JNC 8 Recommendations
Recommendation 7
Population: African-American
Goal BP: Thiazide Diuretics
___ ____ ___ (Grade B; grade C for
patients with DM)
```
Calcium Channel Blockers
62
```
According to the JNC 8 Recommendations
Recommendation 8
Population: Adults > 18 Adults with CKD
Goal BP: ____
ARB (Grade B)
Regardless of race or other medical conditions
```
ACEI
63
According to the JNC 8 Recommendations
Treatment Goal Recommendation 9
The treatment goal for initial treatment is 1 month
a. (1) Increase dose, then (2) add the second drug
b. Continue to assess _____ until the goal is reached
c. Do not use an ACEI and ARB together
d. Refer to hypertensive specialist if 3 or more drugs are
needed
monthly
64
Hypertension/ Management (Non-pharmacologic): Therapeutic Lifestyle Changes (TLCs)
1. Restrict dietary _____
sodium
65
Hypertension/ Management (Non-pharmacologic): Therapeutic Lifestyle Changes (TLCs)
2. Weight ____, if overweight
loss
66
Hypertension/ Management (Non-pharmacologic): Therapeutic Lifestyle Changes (TLCs)
3. ___ (Dietary Approaches to Stop Hypertension) diet (rich in fruits, vegetables, and low-fat dairy products, with reduced saturated mad total fat)
DASH
67
Hypertension/ Management (Non-pharmacologic): Therapeutic Lifestyle Changes (TLCs)
4. Exercise (aerobic exercise ____ min each day on most days of the week)
30-40
68
Hypertension/ Management (Non-pharmacologic): Therapeutic Lifestyle Changes (TLCs)
5. ___ management planning
Stress
69
Hypertension/ Management (Non-pharmacologic): Therapeutic Lifestyle Changes (TLCs)
6. Reduction or elimination of ______ consumption (fewer than two drinks daily for men, or one drink daily for women and lighter weight persons)
alcohol
70
Hypertension/ Management (Non-pharmacologic): Therapeutic Lifestyle Changes (TLCs)
7. _______ cessation
Smoking
71
Hypertension/ Management (Non-pharmacologic): Therapeutic Lifestyle Changes (TLCs)
8. Maintenance of adequate _____, calcium, and
magnesium intake
potassium
72
Hypertension/ Management (Pharmacologic)
1. Based on the degree of blood pressure _____ and/or file presence of end-organ damage, cardiovascular diseases or other risk factors
elevation
73
Hypertension/ Management (Pharmacologic)
2. The goal of therapy: to prescribe the ____ number of medications possible at the lowest dosage to attain acceptable blood pressure, thereby decreasing cardiovascular and renal morbidity and mortality
least
74
Common Agents Used in the Treatment of Hypertension:
| 1. ____ ____, the first-line drug of choice for hypertension
Thiazide diuretics
75
Common Agents Used in the Treatment of Hypertension:
1. Thiazide diuretics, the first-line drug of choice for hypertension
a. Examples: chlorothiazide (Diuril), __________
(Hygroton), hydrochlorothiazide, indapamide (Lozol),
metolazone (Zaroxolyn)
chlorthalidone
76
Common Agents Used in the Treatment of Hypertension:
1. Thiazide diuretics, the first-line drug of choice for hypertension
b. Increase excretion of _____ and water
sodium
77
Common Agents Used in the Treatment of Hypertension:
1. Thiazide diuretics, the first-line drug of choice for hypertension
c. ______ morbidity and mortality
Reduce
78
Common Agents Used in the Treatment of Hypertension:
1. Thiazide diuretics, the first-line drug of choice for hypertension
d. Screen for _____ allergy before administering
sulfa
79
Common Agents Used in the Treatment of Hypertension:
1. Thiazide diuretics, the first-line drug of choice for hypertension
e. May cause hypokalemia, _________,
hyperglycemia, hyponatremia, hypercalcemia, etc.
hypomagnesemia
80
Common Agents Used in the Treatment of Hypertension:
1. Thiazide diuretics, the first-line drug of choice for hypertension
f. Spironolactone (Aldactone) has a side effect of
________
gynecomastia
81
ACE inhibitors
a. Examples: ______ (Lotensin), captopril (Capoten),
enalapril (Vasotec), fosinopril (Monopril), lisinopril
(Zestril), moexipril (Univasc), perindopril (Aceon),
quinapril (Accupril), ramipril (Altace), trandolapril
(Mavik)
benazepril
82
ACE inhibitors
b. Cause vasodilation and block _____ and water
retention
sodium
83
ACE inhibitors
| c. Do not initiate if potassium is greater than ___ mEq/L
5.5
84
ACE inhibitors
| d. Contraindicated in ______
pregnancy
85
ACE inhibitors
| e. Do not use in combination with an ___
ARB
86
ACE inhibitors
f. May cause cough, rash, ____ ______,
hyperkalemia, renal impairment, etc.
taste disturbances
87
3. Angiotensin II-receptor blockers; reserved for patients _____ to ACE inhibitors
intolerant
88
3. Angiotensin II-receptor blockers; reserved for patients intolerant to ACE inhibitors
a. Examples: ________ (Atacand), eprosartan mesylate (Teveten), irbesartan (Avapro), losartan (Cozaar), olmesartan (Benicar), telmisartan (Micardis), valsartan (Diovan)
candesartan
89
3. Angiotensin II-receptor blockers; reserved for patients intolerant to ACE inhibitors
b. Cause vasodilation and block ____ and water
retention
sodium
90
3. Angiotensin II-receptor blockers; reserved for patients intolerant to ACE inhibitors
c. Do not initiate if potassium is greater than ___ mEq/L
5.5
91
3. Angiotensin II-receptor blockers; reserved for patients intolerant to ACE inhibitors
d. Contraindicated in ______
pregnancy
92
3. Angiotensin II-receptor blockers; reserved for patients intolerant to ACE inhibitors
e. Do not use in combination with an ___ inhibitor
ACE
93
Angiotensin II- receptor blockers; reserved for patients intolerant to ACE inhibitors
f. May cause cough, ______, headache, taste disturbances, renal impairment, etc.
hyperkalemia
94
Calcium channel blocking agents
a. Examples: verapamil IR, verapamil (Calan SR), diltiazem IR, diltiazem (Dilacor XR), amlodipine (Norvasc), ______ (Plendil), isradipine (Dynacirc), nicardipine (Cardene SR), nifedipine (Adalat CC), nisoldipine (Sular)
felodipine
95
Calcium channel blocking agents
| b. Monitor ___ ____, especially when administering verapamil and diltiazem
heart rate
96
Calcium channel blocking agents
| c. May be used for angina, arrhythmias, and _______
migraines
97
Calcium channel blocking agents
| d. May cause ______, flushing, bradycardia, etc.
headache
98
Beta-blocking agents
a. Examples: ______ (Sectral), atenolol (Tenormin), betaxolol (Ketone), bisoprolol (Zebeta), carvedilol (Coreg), labetalol (Normodyne) metoprolol (Lopressor), nadolol (Corgard), pindolol (Visken), propranolol
(Inderal), timolol (Blocadren)
acebutolol
99
Beta-blocking agents
| b. Directly relax the _____
heart
100
Beta-blocking agents
| c. May also be used for ____ and arrhythmias
angina
101
Beta-blocking agents
| d. Monitor heart rate and avoid use in patients with ______/COPD
asthma
102
Beta-blocking agents
| e. Not _____-line therapy
first
103
Beta-blocking agents
| f. May cause ______, bradycardia, heart block, fatigue, insomnia, nausea, etc.
dizziness
104
Peripheral alpha-1 antagonists
| a. Examples: _____ (Minipress), terazosin (Hytrin), doxazosin (Cardura)
prazosin
105
Peripheral alpha-1 antagonists
| b. Cause what?
vasodilation
106
Peripheral alpha-1 antagonists
| c. Take the first dose at _______
bedtime
107
Peripheral alpha-1 antagonists
| d. Primarily used as an _____ therapy
adjunct
108
Peripheral alpha-1 antagonists
| e. May be used for ___ _____ _____
benign prostatic hyperplasia
109
Peripheral alpha-1 antagonists
| f. May cause first-dose syncope, _____ ____, orthostasis, dizziness, headache, nausea, etc.
dry mouth
110
Central alpha-2 agonists
| a. Examples: ____ (Catapres), methyldopa (Aldomet)
clonidine
111
Central alpha-2 agonists
b. Prevent ________, cause vasodilation, and slow
the heart rate
vasoconstriction
112
Central alpha-2 agonists
c. Methyldopa is the drug of choice in ______,
clonidine is available as a transdermal patch
pregnancy
113
Central alpha-2 agonists
d. Do not ______ use abruptly, as it may cause
withdrawals and rebound hypertension.
discontinue
114
Central alpha-2 agonists
| e. Primarily used as an ______ therapy
adjunct
115
Central alpha-2 agonists
| f. May cause dry mouth, ______, depression, headache, bradycardia, etc.
sedation
116
Arterial vasodilators
| a. Examples: _______ (Apresoline), minoxidil (Loniten)
hydralazine
117
Arterial vasodilators
| b. Directly relax the vascular ____ muscle resulting in arterial vasodilation
smooth
118
Arterial vasodilators
| c. Reduce frequency in _____ dysfunction.
renal
119
Arterial vasodilators
| d. May cause reflex ________
tachycardia.
120
Arterial vasodilators
| e. Used primarily as an ______ therapy and is available intravenously.
adjunct
121
Arterial vasodilators
| f. May cause nausea, ______, dizziness, orthostatic hypotension, etc.
flushing
122
9. Direct renin inhibitors
| a. Examples: _______ (Tekturna)
aliskiren
123
9. Direct renin inhibitors
b. Inhibits _______, which decreases plasma renin activity (PRA) and inhibits the conversion of angiotensinogen I to angiotensin I
renin
124
9. Direct renin inhibitors
| c. Does ______ offer an advantage over any other available regimens and is expensive.
not
125
9. Direct renin inhibitors
| d. ________, avoid use in pregnancy.
Teratogenic
126
9. Direct renin inhibitors
| e. May cause ______, dizziness, headache, hyperkalemia, etc.
diarrhea
127
10. Special considerations
a. Neither age nor _______ usually affects agent
responsiveness.
gender
128
10. Special considerations
| b. ______-type diuretics are usually recommended for first-line treatment.
Thiazide
129
10. Special considerations
c. Beta-blockers, ACE inhibitors, adrenergic receptor blockers, and calcium channel blockers are also useful alone or in _______ therapy.
combination
130
10. Special considerations
* * When pharmacologic therapy is indicated, the goal is to use as few medications at the _______ doses to maintain blood pressure control. **
lowest
131
Hypertensive Urgencies
| 1. Characterized by severe elevations in blood pressure of > ___/___ mmHg without progressive target organ dysfunction
180/110
132
Hypertensive Urgencies
| 2. May or may not be associated with severe ______, shortness of breath, epistaxis, or severe anxiety
headache
133
Hypertensive Urgencies
Management
1. Oral therapies such as ______ (Catapres), captopril (Capoten), nifedipine (Procardia), loop diuretics, etc.
clonidine
134
Hypertensive Urgencies
Management
2. _____ therapy is rarely required
Parenteral
135
Hypertensive Emergencies
Rare situations that require immediate (within ____ hour) blood pressure reduction to prevent or limit target organ damage
one
136
Hypertensive Emergencies
Rare situations that require immediate (within one hour) blood pressure reduction to prevent or limit target organ damage
1. Situations associated with severe elevations in blood pressure of > ____/___ mmHg or higher
180/120
137
Hypertensive Emergencies
Rare situations that require immediate (within one hour) blood pressure reduction to prevent or limit target organ damage
2. May occur at a lower blood pressure if complicated by evidence of impending or progressive target ____ dysfunction
organ
138
Examples
1. Malignant hypertension: Fundoscopic changes include flame-shaped retinal _______, soft exudates and papilledema (swelling of the optic disk with blurred margins)
2. Hypertensive encephalopathy
3. Intracranial hemorrhage
4. Unstable angina
5. Acute MI
6. Acute LV failure with pulmonary edema
7. Dissecting aortic aneurysm
8. Eclampsia
hemorrhages
139
Management: Hypertensive Emergencies
1. Refer for:
a. Require ______ agents, critical care beds, and invasive arterial pressure monitoring
intravenous
140
Management: Hypertensive Emergencies
b. Blood pressure should be lowered to ____ mmHg systolic or to less than ____ mmHg diastolic (no more than 25% within minutes to 1-2 hr), and then gradually lowered over several days with oral therapy; common agents: Nicardipine (Cardene), Sodium nitroprusside (Nipride), or others
160-180
| 105
141
Decreased blood flow through the vessel ---> tissue ischemia
Angina
142
Types of Angina:
| 1. _____ (classic or chronic): Exertional (most common)
Stable
143
Types of Angina:
| 2. _______ (variant): Occurs at various times, including rest
Prinzmetal's
144
Types of Angina:
3. ______ (pre-infarction, rest or crescendo, coronary syndromes)
4. Microvascular (metabolic syndrome)
Unstable
145
Types of Angina:
4. __________ (metabolic syndrome)
Microvascular
146
Signs/Symptoms: Angina
| 1. Characteristic chest ______ lasting several minutes
discomfort
147
Signs/Symptoms: Angina
| 2. Exertional is usually precipitated by physical activity; subsides with ____
rest
148
Signs/Symptoms: Angina
| 3. _____ shortens or prevents attacks
Nitroglycerin
149
Physical Exam Findings: Angina
| 1. May see signs of _____ arterial disease
peripheral
150
Physical Exam Findings: Angina
| 2. _____ sign = "clenched fist sign"
Levine's
151
Physical Exam Findings: Angina
| 3. Transient ____ not uncommon during angina
S4
152
Laboratory/Diagnostic Findings: Angina
1. ECG may be normal, with _______ of ST-segment, or T-wave peak or inversion during an attack
downsloping
153
Laboratory/Diagnostic Findings: Angina
3. Serum lipid levels should be evaluated
a. Total cholesterol: Desirable = < ____ mg/dl
200
154
Laboratory/Diagnostic Findings: Angina
3. Serum lipid levels should be evaluated
b. VLDLs (triglycerides): Normal = < ___ mg/dl
150
155
Laboratory/Diagnostic Findings: Angina
3. Serum lipid levels should be evaluated
c. LDLs: Optimal = < ___ mg/dl
100
156
Laboratory/Diagnostic Findings: Angina
4. Historically, goals for patients with diabetes or documented coronary artery disease:
a. LDL < ____
70
157
Laboratory/Diagnostic Findings: Angina
4. Historically, goals for patients with diabetes or documented coronary artery disease:
b. HDL > ____
40
158
Laboratory/Diagnostic Findings: Angina
4. Historically, goals for patients with diabetes or documented coronary artery disease:
c. TG < ____
150
159
Laboratory/Diagnostic Findings: Angina
5. Coronary ____ is the definitive diagnostic procedure but not indicated solely for diagnosis
angiography
160
Management: Angina
1. Reduction of risk factors when possible
2. Manage diet: ______ saturated fats, then _______ unsaturated fats, and then consider plant sterols (e.g., nuts, vegetable oils, etc.)
decreased
161
Management: Angina
3. Low dose enteric-coated ____ (81 mg daily)
ASA
162
Management: Angina
4. Common pharmacotherapy for angina:
a. Nitrates
b. ___ ____
c. Calcium channel blockers
Beta-blockers
163
Management: Angina
5. Optimizing lipid panel values:
a. Pooled Cohort ______ to estimate 10-year atherosclerotic cardiovascular disease (ASCVD) risk, defined as file first occurrence of nonfatal and fatal MI and nonfatal and fatal stroke, to identify candidates for statin therapy; estimated risk of ASCVD is based on:
1. Age
2. Sex
3. Race
4. Total cholesterol
5. HDL cholesterol
6. Systolic blood pressure
7. Diabetes status
8. Smoking status
Equations
164
Management: Angina
6. Identify individuals who may benefit from statin therapy:
(1) Individuals with clinical evidence of ______
ASCVD
165
Management: Angina
6. Identify individuals who may benefit from statin therapy:
(2) Individuals with elevated LDL-C > ____ mg/dl
190
166
Management: Angina
6. Identify individuals who may benefit from statin therapy:
(3) Diabetics 40-75 years of age with LDL-C between _____ mg/dl but without clinical evidence of ASCVD
70-189
167
Management: Angina
6. Identify individuals who may benefit from statin therapy:
(4) Individuals without ASCVD or diabetes with LDL-C between 70-189 mg/dl but with an estimated 10-year risk ASCVD of ____% or higher
7.5
168
Management: Angina
7. Initiate TLC (everyone)
a. Heart-healthy lifestyle habits are the foundation of ASCVD prevention. In individuals not receiving cholesterol-lowering drug therapy, recalculate an estimated 10-year ASCVD risk every ____ years for those aged 40-75 without clinical ASCVD or DM and with LDL-C 70-189 mg/dl.
4-6
169
Management: Angina
8. Initiate drug therapy (adults > ___years of age)
21
170
Management: Angina
8. Initiate drug therapy (adults > 21 years of age)
a. High-intensity statin therapy: First-line in women and men < ____ years of age who have clinical ASCVD, timeless contraindicated (grapefruit should be avoided)
75
171
Management: Angina
8. Initiate drug therapy (adults > 21 years of age)
a. High-intensity statin therapy: First-line in women and men < 75 years of age who have clinical ASCVD, timeless contraindicated (grapefruit should be avoided)
1. _______-intensity statin therapy should be used
when high-intensity statin therapy is
contraindicated/statin-associated adverse effects are
present.
Moderate
172
Management: Angina
8. Initiate drug therapy (adults > 21 years of age)
a. High-intensity statin therapy: First-line in women and men < 75 years of age who have clinical ASCVD, timeless contraindicated (grapefruit should be avoided)
2. Patients with clinical ASCVD > 75 years of age:
Evaluate the potential for ASCVD risk-reduction
benefits and for adverse effects, drug-drug
interactions, and to consider patient _____
when initiating a moderate- or high-intensity statin
preferences
173
Management: Angina
8. Initiate drug therapy (adults > 21 years of age)
a. High-intensity statin therapy: First-line in women and men < 75 years of age who have clinical ASCVD, timeless contraindicated (grapefruit should be avoided)
3. ______ statements on whether statins increase the
risk of hepatic damage
Varying
174
Adults > 21 years of age with primary LDL-C > 190 mg/dl: Should be treated with statin ____-intensity statin therapy ( 10-year ASCVD risk estimation not required) unless contraindicated
high
175
Individuals unable to tolerate high-intensity statin therapy, use the _______ tolerated statin.
maximum
176
Reasonable to intensify statin therapy to achieve at least a ____% LDL-C reduction
50
177
After the maximum intensity of statin therapy has been achieved, the addition of a ______ drug may be considered to further lower LDL-C Moderate-intensity statin therapy: Initiate or continue for adults 40-75 years of age with diabetes mellitus
non-statin
178
_____-intensity statin therapy: Adults 40-75 years of age with diabetes with a > 7.5% estimated 10-year ASCVD risk unless contraindicated
High
179
Angina:
Adults > 21 years of age with primary LDL-C > ____ mg/dl: Should be treated with statin high-intensity statin therapy ( 10-year ASCVD risk estimation not required) unless contraindicated
190
180
Angina:
Individuals unable to tolerate high-intensity statin therapy, use the ____ tolerated statin.
maximum
181
Angina:
| Reasonable to intensify statin therapy to achieve at least a ____% LDL-C reduction
50
182
Angina:
After the maximum intensity of statin therapy has been achieved, the addition of a non-statin drug may be considered to further lower LDL-C Moderate-intensity statin therapy: Initiate or continue for adults ____ years of age with diabetes mellitus
40-75
183
Angina:
High-intensity statin therapy: Adults 40-75 years of age with diabetes with a > ____% estimated 10-year ASCVD risk unless contraindicated
7.5
184
Angina:
Adults with diabetes < ___ or > 75 years of age: Evaluate the potential for ASCVD benefits and for adverse effects, for drug-drug interactions, and consider patient preferences when deciding therapy
40
185
Angina:
The Pooled Cohort Equations should be used to estimate the 10-year ASCVD risk for individuals with LDL-C _____ mg/dl without clinical ASCVD to guide initiation of stain therapy for the primary prevention of ASCVD.
70-189
186
Angina:
Adults aged 40-75 with LDL-C _____ mg/dl without clinical ASCVD or diabetes and an estimated 10-year ASCVD risk > 7.5%: Treat with moderate- to' high-intensity statin therapy
70-189
187
Angina:
Adults aged 40-75 with LDL-C 70-189 mg/dl, without clinical ASCVD or diabetes and an estimate 10-year ASCVD risk of _____%: Offer treatment with a moderate-intensity statin
5%-7.5
188
Indications for statin therapy
_____-Intensity Statin Therapy
Daily dose lowers LDL-C on average, by greater than 50%
High
189
Medication for High-Intensity Statin Therapy :
| _____ 40-80 mg rosuvastatin 20-40 mg
atorvastatin
190
______-Intensity Statin Therapy
| Daily dose lowers LDL-C on average, by approximately 30 to less than 50%
Moderate
191
```
Medications for Moderate Inensity Statin Therapy:
atorvastatin 10-20 mg
___________ 5-10 mg
simvastatin 20--40 mg
pravastatin 40-80 mg
lovastafin 40 mg
fluvastatin 80 mg
pitavastafin 2-4 mg
```
rosuvastatin
192
______-Intensity Statin Therapy
| Daily dose lowers LDL-C on average, by less than 30%
Low
193
```
Low Intensity Statin Therapy:
simvastatin 10 mg
pravastatin 10- 20 mg
_________ 20 mg
fluvastatin 20- 40 mg
pitavastatin 1 mg
```
lovastatin
194
Commonly used agents other than HMG-CoA reductase inhibitors (statins)
a. Bile acid sequestrants: Mostly decrease LDL; may increase triglycerides
1. __________ (Questran)
2. colesevelam (Welchol)
3. Colestipol (Colestid)
cholestyramine
195
Commonly used agents other than HMG-CoA reductase inhibitors (statins)
b. Fibrates: decreased triglycerides, slightly decrease LDL and possibly increase HDL
1. _______ (Lopid)
2. fenofibrate (Tricor)
3. fenofibric Acid (Trilipix)
gemfibrozil
196
Commonly used agents other than HMG-CoA reductase inhibitors (statins)
c. Cholesterol absorption inhibitor: Used in combination with a statin to decrease LDL
1. _____ (Zetia)
ezetimibe
197
Commonly used agents other than HMG-CoA reductase inhibitors (statins)
d. ______: decrease LDL and triglycerides and decreased HDL
1. immediate and extended-release preparations
2. High doses of niacin may cause "flushing"
sensation
Niacin
198
Contributing to the leading cause of death in adults in the United States; 1.5 million annually result in myocardial necrosis; "clot on the plaque"
Myocardial Infarction/Acute Coronary Syndromes
199
Signs/Symptoms
| ______ of patients give a history of alteration in typical anginal pain
One-third
200
Signs/Symptoms
| Most infarctions occur at ____: Pain similar to angina but more severe
rest
201
Signs/Symptoms
| _______ has little effect on Myocardial Infarction
Nitroglycerin
202
Signs and Symptoms of Myocardial Infarction:
1. _____ ____; weakness
2. Impending doom
3. Apprehension
4. Light-headedness
5. Syncope
6. Dyspnea
7. Cough
8. Nausea and vomiting
Cold sweat
203
Physical Exam Findings Myocardial Infarction:
1. Dysrhythmia common
2. S4 very common
3. ________
4. Pulmonary crackles
5. Low-grade fever during the first 48 hrs.
6. Tachycardia
Wheezing
204
Laboratory/Diagnostics Myocardial Infarction:
| 1. ECG changes almost always; note: = ____% of patients have no initial ECG changes
30
205
Laboratory/Diagnostics Myocardial Infarction:
2. Peaked ___ waves, ST elevations, Q wave development (Q waves do not develop in 30 to 50% of MIs)
a. I, aVL:
b. II, III, aVF:
c. V leads (precordial leads) or V3 and V4:
T
206
Laboratory/Diagnostics Myocardial Infarction:
3. Cardiac enzyme elevations above normal within ____to six hours (Troponin T, Troponin I, CK-MB) and remain high for several days (three days to three weeks)
four
207
Laboratory/Diagnostics Myocardial Infarction:
| 4. _______ for bed-side assessment of wall motion, EF, etc.
Echocardiography
208
Laboratory/Diagnostics Myocardial Infarction:
| 5. Leukocytosis _____ to _____ uL on the second day
10,000 to 20,000
209
Management Myocardial Infarction:
1. Activate EMS
2. ASA _____ mg tablet to chew
3. NTG SL every five minutes x three
4. Begin 02 therapy
5. 12 lead ECG and cardiac monitor
6. Hospital transport
325
210
Test for Myocardial Infarction:
Normal
Therapeutic Values International Normalized Ratio (INR)
___ to ___ seconds
0.8 to 1.2
211
Test for Myocardial Infarction:
Therapeutic Values:
MI: ___ to ___ × normal
Coumadin: ___ to ___ mg/dL
2.5 to 3.5
| 2 to 3
212
Test for Myocardial Infarction:
Activated Coagulation Time (ACT)
___ to ____seconds
70 to 120
213
Therapeutic Values for
| ____ to ____ or > 300 seconds post PTCA/stent
150 to 190
214
Normal Activated Partial Thromboplastin Time
| ____ to ____ seconds
28 to 38
215
Therapeutic Values:
| ____ to ____ × normal (APTT)
1.5 to 2.5
216
```
Prothrombin Time (PT) normal:
____ to ____seconds
```
11 to 16
217
Partial Thromboplastin Time (PTT)
| _______ seconds
60 to 90
218
Therapeutic values for Partial Thromboplastin Time (PTT):
| ____ to ____ × normal
1.5 to 2.5
219
Indications for Pharmacologic Revascularization for Myocardial Infarction:
1. Unrelieved chest pain (> ___ minutes and < six hours) WITH:
2. ST-segment elevation > 0.1 mV in two or more contiguous leads
30
220
Absolute Contraindications
| 1. Active _______ or risk there of, including abnormal coagulation values
bleeding
221
________
| Inflammation of the pericardium. A thorough history is essential in making an accurate diagnosis.
Pericarditis
222
Etiology Pericarditis:
1. Viruses - the most common cause
2. Post myocardial infarction
3. ___ ____
4. Neoplastic, Tuberculosis, Septicemia
5. Endocarditis
6. Collagen diseases
7. Drug/Trauma induced
8. Viral infection
9. Idiopathic (probably viral)
Renal failure
223
Signs/Symptoms of Pericarditis:
1. Very localized _______/precordial chest pain, pleuritic in nature
2. The pain increased by deep inspiration, coughing, swallowing or recumbent
3. Pain relieved by sitting forward
4. Shortness of breath secondary to pain with inspiration
retrosternal/
224
Physical Findings Pericarditis:
1. Pericardial friction ____ characteristically present
2. Pleural friction rub may also be present
3. Fever may be present depending on the underlying cause
rub
225
Lab/Diagnostics Pericarditis
| 1. ST-segment elevation in ____ leads
all
226
Lab/Diagnostics Pericarditis
| 2. Return of ST-segment to normal in a few days followed by temporary ____ wave inversion
T
227
Lab/Diagnostics Pericarditis:
| 3. _____ of the PR segment highly indicative of pericarditis
Depression
228
Lab/Diagnostics Pericarditis:
| 4. ESR ______
elevation
229
Lab/Diagnostics Pericarditis:
| 5. Blood _____ if bacterial cause suspected
cultures
230
Lab/Diagnostics Pericarditis:
| 6. ____ to r/o infection or leukemia
CBC
231
Lab/Diagnostics Pericarditis:
| 7. ___________ to confirm the presence of pericardial fluid or other abnormalities
Echocardiogram
232
Lab/Diagnostics Pericarditis:
| 8. _______ BMP
Baseline
233
Lab/Diagnostics Pericarditis:
| 8. _______ BMP
Baseline
234
Management Pericarditis:
1. NSAIDs are mainstay of treatment
2. Ibuprofen (Advil) _______ mg every 6-8 hours
400-600
235
Management Pericarditis:
| 3. _______ (Indocin) 25-50 mg every 8 hours for 2 weeks
Indomethacin
236
Management Pericarditis:
4. _______ are indicated only when there is the total failure of high-dose NSAIDs over several weeks and with relapsing pericarditis. Can increase viral replication. When indicated, Dexamethasone 4 mg IV may relieve pain in a few hours. Prednisone 60 mg daily, then tapered
Corticosteroids
237
Management Pericarditis:
| 5. _______ in cases of bacterial infection
Antibiotics
238
Management Pericarditis:
6. ________ 15-60 mg p.o. QID for pain
7. Monitor for tamponade
Codeine
239
A partial or complete occlusion of a vein by a thrombus with secondary inflammation to the wall of the vessel; may be superficial or deep
Venous Thrombosis
240
```
Venous Thrombosis
Causes/Incidence
1. Immobility
2. ______
3. Post-operative period
4. Prolonged bed rest
5. Use of oral contraceptives (particularly with smokers)
6. Hypercoagulability
```
Female
241
Signs and symptoms of _____ ______
| 1. Sudden onset of pain
Superficial Thrombosis
242
Physical Exam findings of Superficial Thrombosis
1. Localized heat and ______
2. Low grade temperature
erythema
243
Laboratory/ diagnostics of Superficial Thrombosis
| 1. _____
none
244
Management of Superficial Thrombosis:
1. Elevation of _______
2. Warm compresses
3. Non- steroidal agents
4. D/C oral contraceptives
extremity
245
Signs and symptoms of Deep Thrombosis:
1. Sudden onset of ____
2. Pain or tenderness especially while walking
3. Pain may present as dull ache or tight feeling
pain
246
Physical Exam Findings of _______
1. Edema distal to the occlusion
2. Low-grade temperature
3. The skin may be cool to touch
Deep Thrombosis
247
Laboratory/ diagnostics of Deep thrombosis
1. Consider the need for deep thrombosis tests
2. ________
3. D dimer
4. Venography
Ultrasounds
248
Management of Deep Thrombosis:
| 1. Bed rest with the leg elevated until local tenderness subsides: ______ days
7 to 14
249
Management of Deep Thrombosis:
| 2. Walking gradually ________
reintroduced
250
Management of Deep Thrombosis:
| 3. Lovenox ____mg/kg every 12 h ( 1.5 mg/kg) or:
1
251
Management of Deep Thrombosis:
| 4. Heparin infusion for _____ days
7 to 10
252
Management of Deep Thrombosis:
| 5. Coumadin therapy for ___ weeks
12
253
Management of Deep Thrombosis:
| 6. Consultation when ______ therapy instituted
anticoagulant
254
Pathology of ___ ____ ____ arteriosclerotic narrowing fo the lumen of arteries resulting in decreased blood supply to the extremities
Peripheral vascular disease (PVD)
255
Pathology of ___ ____ _____ impaired venous return due to either destruction of valves, canes due to deep thrombophlebitis, leg trauma, or sustained elevation of venous pressure (CHF)
Chronic Venous Insufficiency (CVI)
256
Peripheral Vascular Disease cause/incidence:
| 1. Usually caused by _______
atherosclerosis
257
Peripheral Vascular Disease cause/incidence:
| 2. Similar risk factors for _____
CAD
258
Peripheral Vascular Disease cause/incidence:
| 3. Peak incidence: _____ to ___ years of age
40 to 70
259
Peripheral Vascular Disease cause/incidence:
4. Hyperlipidemia
5. Smoking
6. ____ mellitus
Diabetes
260
Signs and symptoms of Peripheral Vascular Disease (PVD):
1) Usually first symptoms: C/O ____ pain (claudication)
2) Cold/ numbness to extremities
3) Progresses to pain at rest
calf
261
Physical Findings of Peripheral Vascular Disease (PVD):
1) Shiny/ hairless skin
2) Dependent rubor
3) _____
4) Cyanosis
5) Ulcerations
6) Reduced pulses
Pallor
262
Laboratory/ diagnostics fo Peripheral Vascular Disease (PVD):
1) Doppler U/S to evaluate the flow
2) Ankle- Brachial Index (ABI)
3)
4) Arteriography: Most definitive test
The X-ray may show calcification
263
Management of Peripheral Vascular Disease:
1) Stop smoking and all tobacco use
2) Exercise: Walk 1 hour/day; stopping during pain and resuming when the pain subsides to develop collateral circulation
3) Pentoxifylline (Trental)
4) _______ (Pletal)
5) Weight reduction, as needed
6) Manage diabetes and hyperlipidemia
7) Angioplasty
8) Bypass surgery
9) Amputation
Cilostazol
264
Impaired venous return due to either destruction of valves, changes due to deep thrombophlebitis, leg trauma, or sustained elevation of venous pressure (CHF)
Chronic Venous Insufficiency (CVI)
265
Cause/ Incidence of Chronic venous Insufficiency
1) More common in _____ than _____
2) Maybe a genetic predisposition
3) History of leg trauma; may be associated with varicose veins
women than men
266
Signs/ Symptoms of Chronic venous insufficiency:
1) ______ of the lower extremities relieved by elevation
2) Edema after prolonged standing
3) Night cramps of the lower extremities
Aching
267
Physical Findings of Chronic venous insufficiency:
1) Trophic changes with ______ discoloration
2) Stasis leg ulcers
3) Edema of lower extremities
4) Dermatitis may be common
5) Cool to touch
brownish
268
Laboratory/ Diagnostics of Chronic venous insufficiency:
1) _____ diagnostics of CVI
2) R/O edema due to heart failure and other causes
Nonspecifically
269
Management of Chronic Venous Insufficiency:
1) Bed rest with legs elevated to diminish chronic edema
2) Use of heavy-duty elastic support stockings
3) Weight reduction in the obese
4) Treat dermatitis or ulcers as indicted
5) Acute weeping dermatitis
a) _____ compresses
b) 0.5% hydrocortisone cream after compresses
c) Systematic antibiotics only indicated if active
bacterial infection
Wet
270
Cardiovascular: Gerontology Considerations
2. Possible findings and/ or results
a) Hypertension: Increased risk of CVA, MI, and renal failure
b) _____murmurs common
c) Decreased cardiac reserve (may lead to orthostatic hypotension or syncope)
d) Overall, diminished peripheral pulses and cool extremities
e) Dysrhythmias
Heart
271
Side effects of Ginger:
a) Heartburn
b) _______
c) Flatus
d) Belching
Bloating
272
Hazard/ Precautions/ Interactions of Ginger:
a) Increase the risk of _______
b) Should not be taken with ASA or warfarin
c) Others
bleeding
273
Intended Use of _______
1) as an Adaptogen, uses to increase overall physical and mental well being
2) Lower cholesterol
3) Reduce fatigue
4) Enhance libido
5) Others
Ginseng
274
Side effects of Ginseng:
1) ______
2) Nausea
3) Diarrhea
4) Headaches
5) Nervousness
6) Nose bleeds
7) Others
Insomnia
275
Hazards/ Precautions/ Interactions with Ginseng:
1) Increased risk of bleeding
2) Should not be taken with ASA or warfarin
3) Blood pressure changes (high or low)
4) Mania in depressed patients take MAOIs
5) May inhibit the effects of ______
6) Others
opioids
276
This herb is crushed flower buds or seedpods (reddish/purple liquid) used in tea, tablets, capsules
St. John's Wort
277
Intended Use of St. John's Wort:
a) Depression
b) Anxiety
c) Sleep disorders
d) Improve _____ symptoms
e) Others
BPH
278
Side effects of St. John's Wort:
1) Increases sensitivity to sunlight
2) anxiety
3) Dry mouth
4) ________
5) Gastrointestinal symptoms
6) fatigue
7) headaches
8) sexual dysfunction
9) others
dizziness
279
Hazards/ precautions/ interactions of St. John's Wort:
1) increased risk of ____ _____
2) Should not be taken with ASA or Warfarin
3) Many drug interactions (e.g. in combination with SSRI, may contribute to serotine syndrome; may decrease the effectiveness of oral contraceptives, digoxin, alprazolam, amitriptyline, and others; may increase the effects of narcotics an others)
4) Reacts with light, perhaps leads to cataract formation
blood clotting
280
This herb is a root or whole plant extract, capsule
Echinacea
281
Echinacea is Intended Uses of this herb is to reduce symptoms of the common ______
cold
282
Side effects of Echinacea include:
a) Allergic reactions
b) Nausea
c) ___ _____
d) dysuria
e) myalgias
f) others
abdominal pain
283
Hazard/Precautions/Interactions of Echinacea:
a) ____________
b) hepatotoxicity
c) Nephrotoxicity
d) Potentially may cause increased sedation during anesthesia
e) others
anaphylaxis
284
This herb is a leaf ----> extracts, capsules, tablets, teas and is associated with
1) memory and concentration enhancer
2) Improving symptoms of Alzheimer's disease, intermittent claudication, and glaucoma
Gingko Biloba
285
Side effects of Gingko Biloba:
a) Nausea
b) Vomiting
c) _______
d) headaches
e) dizziness
f) palpitations
g) restlessness
diarrhea
286
Gingko Biloba Hazards and precautions are:
1) Increased risk of _______
2) Should not be taken with ASA or warfarin
3) May increase blood pressure
bleeding
287
____ ___ is a herb common in plant root and stem ---> capsule or liquid used for improving premenstrual and menopause discomfort
Black Cohosh
288
Side effects of black cohosh include:
a) Nausea
b) vomiting
c) dizziness
d) ________
e) weight gain
mastalgia
289
Hazards of black cohosh include:
1) When taking large amounts, may cause seizures, visual disturbances, bradycardia, and others
2) May increase the risk of______ (e.g. viginal)
3) Mimics estrogen effects; should not be taken by women taking hormone replacement
bleeding
290
____ ___ is a herb plant root ---> powder mixed cold water to drink
1) Improve relaxation without disrupting mental clarity
2) Others
Karva Karva
291
Side effects of Karva Karva:
a) _____
b) Eye Irritation
Rash
292
Hazards of Karva Karva:
a) Higher doses and long term use can lead to hypertension, _____ damage, visual impairment, and dry skin
b) Alcohol increases toxic effects
c) May worsen Parkinson's symptoms
d) May impair reaction time when driving an automobile
liver
293
This herb _____ is a bulb or root form
a) Improve indigestion respiratory complaints
b) Increase energy levels
Garlic
294
Herb side effects of Garlic include:
a) bad _____
b) nausea
c) indigestion
breath
295
Hazard effects of Garlic include:
a) Increase the risk of bleeding
b) Should not be taken with ______ or oral anticoagulants
ASA
