Module 7: Cardiovascular (Hypertension and Diuretics) Flashcards
(154 cards)
1
Q
What is the order of blood flow in the heart?
A
- Vena cava (in to heart)
- Right atrium
— tricuspid valve — - Right ventricle
— pulmonary valve — - Pulmonary artery
- Lungs
- Pulmonary veins
- Left atrium
— mitral valve— - Left ventricle
— aortic valve — - Aorta (to arteries - out to body)
2
Q
What is hyperlipidemia?
A
Increased levels of fats (lipids) in the blood
3
Q
What is angina?
A
Chest pain due to decreased blood fow to heart
4
Q
What is acute coronary syndrome?
A
Sudden reduced blood flow to heart causing myocardial infarction (heart attack)
5
Q
What is hypertension?
A
High BP
6
Q
What is heart failure?
A
Weakened heart muscle (or atrophy) doesn’t pump blood as it should.
7
Q
What is arhythmias?
A
Probelm with rate or rhythm of heart beat
8
Q
What is Acute Ischemic Stroke?
A
Sudden loss of blood to brain, resulting in loss of neurological function.
9
Q
What is the function of the right coronary artery?
A
Supplies blood to R atrium, R ventricle, bottom portion of L ventricle and septum
10
Q
What is the function of the left coronary artery?
A
Spilts in Circumflex artery and Left anterior descending artery - supplies blood to L atrium and L ventricle
11
Q
What is the function of coronary veins?
A
Take oxygen-poor (deoxygenated) blood that has been used by the muscles back to the heart and right atrium
12
Q
What is the leading cause of death in Canada and what % of it accounts for mortality?
A
Cardiovascular disease - accounts for 40% of total mortality
13
Q
What is high levels of cholesterol correlated with?
A
Coronary Artery Disease (CAD)
14
Q
What does moderate CAD manifest itself as?
A
Angina (chest pain)
15
Q
What does severe CAD manifest itself as?
A
Myocardial infarction (MI, Heart attack)
16
Q
What does an acuumulation of cholesterol in the vessels lead to? (medical term)
A
Artherosclerosis
17
Q
Explain how atherosclerosis evolve within the vessel?
A
Fatty streaks -> Fibrous stage -> Lesions (involving calcification, ulceration, hemorrhage and eventually thrombosis and occlusion of a vessel)
18
Q
Is atherotherombosis clinically present?
A
No it is clinically silent
19
Q
What does complicated lesion/rupture in atherothrombosis lead to?
A
- unstable angina
- MI (myocardial infarction)
- Ischemic stroke
- acute limb ischemia
- cardiovascular death
20
Q
What does fibrous plaque in vessels lead to?
A
- stable angina
- intermittent claudication (muscle pain on mild exertion)
21
Q
List the risks of Atherosclerotic CAD?
A
- dyslipidemis (high LDL and low HDL)
- hypertension
- DM
- smoking
- family hx of CAD
- obesity, lack of exercise
- male sex and advanced age
- others (homocysteinemia, C reactive protein (CRP), Lipoprotein a (Lpa), infection (?Chlamydia pneumonie)
22
Q
What is LDL (low density protein) known to be?
What does it do?
A
“Bad” cholesterol
It causes formation of thick and hard plaques along blood vessel walls which clog arteries, completely or partially, resulting in less flexible blood vessels.
23
Q
What is HDL (high densty protein) known to be? What does it do?
A
“Good cholesterol”
It scavenges LDL and helps recycle them in the liver, thus reducing the level of cholesterl in blood.
24
Q
What are some important functions of HDL in our body?
A
- builds/maintains cell membranes
- manufactures bile
- necessary for fat and vitamin absorption
- insulates nerve fibers
- aids in adrenal gland hormone production
- aids in sex hormone productions
25
What risks does LDL pose on our body? (outcomes of high LDL)
- clog arteries
- lead to CAD (coronary artery disease)
- lead to heart attack
- lead to stroke
- ultimately lead to death
26
What total components make up cholesterol? (3)
| What should they be on blood test?
Total cholesterol (below 5.2) = LDL (below 2.6), HDL (above 1.5), and triglycerides (bwloe 1.7)
27
List the drug classes used for Dyslipidemia?
| "He fell behind Nancy & Edward"
- HMG -CoA Reductase Inhibitors (Statins)
- Fibrates
- Bile Acid Asequestrants (Resin)
- Nicotinic Acid (Niacin, Vit 3)
- Ezetmibe
28
How do HMG-CoA Reductase Inhibitors (Statins) work on Dyslipidemia?
They reduce HMG-CoA enzyme which is the final enzyme needed in creation of cholesterol
29
What are the main therapeutic uses of Statins?
- Hyperlipidiamia
- Primary (before 1st heart attack)
- Secondary ( to prevent 2nd heart attack)
30
What are the side effects of Statins?
Myopathy (elevated CPK levels in body indicating injury)
| Liver dysfunction
31
Describe myopathy
myopathy is a disease of the muscle in which the muscle fibers do not function properly. This results in muscular weakness.
32
What is CPK?
creatinine phosphokinase (enzyme in body that is important for muscle function and is indicative of muscle disease)
33
Are there an any drug interactions with Statins and what do they do?
Fibrates - increases chances of myopathy (pain or breakdown of muscles)
34
What is Hypercholesterolemia?
Hypercholesterolemia, also called high cholesterol, is the presence of high levels of cholesterol in the blood.
35
What is steatorrhea?
the excretion of abnormal quantities of fat with the feces owing to reduced absorption of fat by the intestine
36
What drug class do Gemfbrozil and Fenofibrate belong to?
Fibrates for Hyperlipidimia
37
How do fibrates work?
reduces VLDL (carry triglycerides to blood) production in liver and speed up removal of triglycerides from blood
38
What is the clinical use for fibrates?
For pts with hypertriglyceridemia
39
What are the side effects of fibrates?
gallstones, liver dysfunction
40
Are there any drug interactions with fibrates?
Statins (myopathy)
41
Should fibrates with taken empty stomach?
NO with food.
42
What drug class do Prevalite and questran (cholestyramine) belong do?
Bile Acid Sequestrants
43
What is the clinical use of Bile Acid Sequestrants?
Hypercholesterolemia
44
How do Bile Acid Sequestrants work?
convert cholesterol to bile acids in liver
45
What are the side effects of Bile Acid Sequestrants?
Bad taste, GI upset (including steatorrhea), cause deficiency of lipid-soluble vitamins (A, D, E K), gall stones, increased VLDL and increased triglycerides
46
When are Bile Acid Sequestrants contraindicated?
With pts with hypertriglyceridemia (b/c side effect Bile Acid Sequestrants = raise triglycerides)
47
How does Nicotinic Acid work?
Helps increase HDL and decrease LDL from bloostream
48
What is the therapeutic use of Nicotinic Acid?
Hypertriglycerdemia
49
What drugs are taken for Hyperglycerdemia(2) ?
Nicotinic Acid and Fibrates
50
What does low doses of Nicotonic Acid vs. high doses do?
Low - increase HDL
| High - decrease LDL
51
What are the adverse effects of Nicotinic Acid?
Frankie turned red and itchy, but could not itch her itch in public and could not drink with her friends either to avoid the itch.
Flushing
Rash
pruritis (anus itch)
hepatotoxity (liver damage due to drugs)
52
Are there any drug interactions with Nicotinic acid?
Statins (risk of liver damage)
| Fibrate (risk of gallstones)
53
How does Ezetimibe work and how?
Lower LDL and it does so by blocking absorption of cholesterol in the small intestine
54
What is the therapeutic use of Ezetimibe?
For those with elevated LDL (used alone or with Statins)
55
What are the side effects of Ezetimibe?
Nausea, bloating
56
Are there any drug interactions for Ezetimibe?
None (mentioned by Bassam)
57
What are the main drugs used for Acute Coronary Syndrome?
- thrombolytics
- anti-thrombotic agents
- anti-coagulant agents (warfarin, heparin, low molecular weight heparin)
- beta blockers
- calcium channel blockers
- statins
- ace inhibitors
58
What drug class do warfarin, heparin and low molecular weight heparin fall under?
Anti-coagulant
59
How do thrombolytics work/
They help open up clogged arteries
60
What drug category do TPA, RPA, and TNK fall under?
Thrombolytics
61
Out of the 3 thrombolytics, which is the only 1 used for strokes?
TPA (Alteplase)
62
What are the therapeutic uses of thrombolytics?
heart attack, stroke (TPA only)
63
What are the side effects of thrombolytics?
bleeding, reperfusions dysrhythmias, hypotension
64
What is reperfusion arrhythmias?
arrhythmias occurring as the result of increased myocardial perfusion are called reperfusion arrhythmias - blood entering back to organ
65
What does are the 3 different thrombolytics given at?
TPA: loading then infusion
RPA: 2 bolus doses 30 mins apart
TNK: 1 bolus dose
66
What drug category do ASA, Clopidogrel, Ticlopidine, IIb-IIa Antagonists fall under?
Anti-thrombotix agents
67
What kind of antaagonists are Eptifibitide, Tirofiban, and Abciximab?
llb-llla Antagonists (Anti-thrombotic agents)
68
How do Anti-thrombotic agents work?
They decrease the function of platelets
69
What are the therapeutic uses of Anti-thrombotic agents?
```
Prevent heart attack
Prevent stroke (ASA, Clopidogrel, Ticlopidine)
```
70
What are the side effects of Anti-thrombotic agents?
Bleeding, nausea, thrombocytopenia (decreased platelet count)
71
What dosing are Anti-thrombotic agents used at?
Oral: ASA, Clopidogrel, Ticlopidine
Parentral: lllb-llla antagonist agents (loading dose then infusion)
72
What is pulmonary embolism?
is a blockage in one of the pulmonary arteries in your lungs
73
What drug category do warfarin, heparin, and low molecular heparin fall under?
Anti-coagulant agents
74
How do Anti-coagulant agents work?
Inhibit clotting factors
75
What are the therapeutic uses of Anti-coagulant agents?
- clotting disorders
- prevent/tx heart attack
- tx pulmonary embolism (blockage of pulmonary artery to lung)
- prevent/tx DVT
- prevent stroke
- atrial fibrilation (hearts 2 upper chambers beat chaotically)
76
What are the side effects of warfarin?
bleeding, purple toes
77
With what are the effects of warfarin reversed?
Vitamin K
78
How long does it take warfarin to "kick in" and what is used alongside until warfarin kicks in?
5 days to kick in
| Heparin/LMWH used until warfarin kicks in
79
Is warfarin contraindicated for anyone?
Preg women
80
How should the therapeutic effects of warfarin be monitored?
Blood test (INR)
81
Explain the different administration routes for warfarin, heparin, ad LMWH?
warfarin - oral
heparin - IV or subcutaneous
LMWH - subcutaneous
82
Explain the difference in monitoring between warfarin, heparin, ad LMWH?
warfarin - bloodtest (INR)
heparin - aPPT (not same as INR)
LMWH - no monitoring
83
What are the side effects of Heparin and LMWH?
Bleeding, Heparin Induced thrombocytopenia (HIT - decreased platelet count)
84
Whata drug class do Dabigatran and Rivaroxaban fall under?
Anti-coagulant agents
85
Why is Dabigatran and Rivaroxaban used as an alternative to warfarin?
When it is hard to stablize pts to warfarin or when pt is porly compliant to monitoring (INR)
86
What are the side effects of Dabigatran and Rivaroxaban?
bleeding, GI upset
87
How is Dabigatran and Rivaroxaban administered?
Orally
88
At what BP is a person considered to be hypertensive?
140/90 mm or higher
89
Risk factors for hypertension? (that you have control over)
-smoking
-physical inactivity
-obesity (esp around waist)
-high fat diet
-excess salt intake
excessive alcohol consumption
90
Risk factors for hypertension? (that you don't have control over)
- family hx
- old age
- ethnicity
91
At what BP is a person considered to be hypotensive?
80/60 mmHg
92
What are the medications used for initial therapy for hypertension?
- Diuretics
- ACEI
- ARB
- Long acting CCB
- Beat blockers (not for pts over 65)
And (covered in hypertension module):
- Alpha1 antagonists
- Alpha 2 antagonists
- Direct acting visodilators
93
What should be consdered if initial therapy isn't adhering to pts hypertension?
Dual therapy (2 drugs togethers) or triple/quadruple
94
What are the 3 kinds of diuretics?
Thiazides, Loop, Potassium Sparing
95
What is the function of Thiazides (diuretics)?
- cause diuresis (decrease plasma volume_
- reduce peripheral vascular resistance
- works in distal part of the kidney
96
What is the function of Loop (diuretics)?
- cause more diuresis than thiazides
- not for chronic management of hypertension
- works in the "loop of Henle" in kidney
97
What is the function of Potassium Sparring (duretics)?
- weak diuresis
| - usually combined with a thiazide to preent potassium loss
98
How do diuretics work to treat hypertension
Diuretics help rid your body of sodium and water. Most work by making your kidneys release more sodium into the urine. The sodium then takes water with it from your blood decreasing the amount of fluid flowing through your blood vessels hence lowering blood pressure.
99
What are the therapeutic uses of diuretics?
Hypertension
| Heart Failure
100
What are the adverse effects of Diuretics?
- hypotension
- electrolyte abnormalities
- gynecomastis
- NSAID reduce effectiveness of diuretics
101
Why is monitoring important with use of diuretics and what should be monitored?
- Electrolytes can range abnormally
- kidney function
- BP (hypotension can occur)
102
How do the Angiotensin-converting enzyme (ACE) inhibitors to treat hypertension and Angiotension Receptor Bockers (ARBs)?
help relax your veins and arteries to lower your blood pressure. ACE inhibitors prevent an enzyme in your body from producing angiotensin II, a substance that narrows your blood vessels.
103
What are the therapeutic uses of Angiotensin-converting enzyme (ACE) and Angiotension Receptor Bockers (ARBs)?
Hypertension
Heart failure
Heart attack
DM Nephropathy (diabetic kidney disease)
104
What are the adverse effects of Angiotensin-converting enzyme (ACE) and Angiotension Receptor Bockers (ARBs)?
Hypotension
Abnormal electrolytes
Couch (ACEI only)
Angioedema (swelling of the lower layer of skin and tissue just under the skin or mucous membranes)
105
What is the prefix for Angiotensin-converting enzyme (ACEI) drugs?
end in "pril"
106
What is the prefix for Angiotension Receptor Bockers (ARBs) drugs?
end in "sartan"
107
What is prostatic hypertrophy?
A benign (not cancer) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine.
108
What do Alpha1 Antagonists do to treat hypertention?
they prevent the stimulation of alpha1 receptors (vasocontrictors)
109
Along with hypertension, what else do Alpha1 antagonists do in men with prostatic hypertrophy?
relax smooth muscle in the prostate and bladder neck, thus decreasing blockage of urine flow
110
What are the therapeutic uses of Alpha1 Antagonists?
Hypertension
| Prostatic Hypertrophy
111
What are the adverse effects of Alpha1 Antagonists?
Hypotension
dizzy
fluid retention
nasal congestion
112
How do Alpha2 Agonists work to treat hypertension?
They act within the brain to suppress sympathetic (norepinephrine) outflow to heart and blood vessel, which results in vasodilaton and reduced cardiac output
113
What are the therapeutic uses of Alpha2 agonists?
Hypertension
| Pre-eclampsia (+proteinuria - protein in urine above 20 weeks gestation)
114
What are the side effects of Alpha2 Agonists?
Hypotension
Fluid retention
Dry mouth
Sedation
115
What kind of Alpha2 agonist is used for Pre-sclampsia pts?
Methlydopa
116
What happens if you abruptly stop this Alpha2 agonist, Clonidine?
rebound hypertension therefore DO NOT
117
What drug class do Clonidine and Methydopa belong to?
Alpha2 Agonists
118
What drug class do minoxidil and hydralazine belong to?
Direct Acting Vasodilators
119
How do direct acting vasodilators work to treat hypertension?
cause vasodilaton in arterioles
120
Do direct acting vasodilators act on arteries and veins?
Only on arterioles
Limited effect on veins, therefore minimal orthostatic hypotension (postural hypotension)
121
What are the therapeutic uses of direct acting vasodilators?
hypertension
baldness
pre-eclampsia
122
What kind of direct acting vasodilator is used for pre-eclampsia?
hydralazine
123
What are the side effects of direct acting vasodilators?
hypotension,
fluid retention
Hydralazine can cause systemic lupus erthromatosis
Minocidil can cause hypertrichosis (excessive hair growth)
124
Along with diuretics, ACEIS, ARBs, alpha1 antagonist, alpha2 agonists, and direct acting vasodilators, what other drugs are also used to treat hypertension ?(2)
betablockers
calcium channel blockers
125
What cells regulate the rhythm of the herat and where are they located?
pacemakers cells
located within sinoatrial (SA) node which is within the wall of the rght atrium
126
What is an arrhythmia?
irregular heartbeat (either too fast, too slow, or mismath between frequency of atrial and ventricular beats)
127
How are cardiac arrhythmias classified?
- heart rate
- heart rhythm
- site of origin
- complexes on ECG
128
What is the most frequennt cause of arrhythmias?
| Why?
Coronary artery disease
Cause it results in myocardial ischemia (decreased blood flow to heart) and infarction (muscle damage)
129
Due to what cellular level reasions are there change sin the rhythm of a heart?
- changes in pacemaker cells
- abnormal generation of impulse at sites other than the SA node
- ectopic foci (abnormal pacemaker sites within heart)
130
What is the difference betwen tachyarrhythmias and bradyarrhythmias?
Tachy = Supraventricular or ventricular
| Brady =Atrioventicular (block) or sinus node dysfunction
131
What are the 3 main ions in charge of heart rhythm?
NA+, Ca2+, K+
132
How do Anti-Arrhythmic Drugs work?
They act primarily by altering ion fluxes within the tissue of the myocardium
133
How are antiarrhythmic drugs classified?
On their ability to directly or indirectly block flux of one of these ione (NA+, CA2+, K+)
134
What medications are used for Arrhythmias?
Class 1A (Procainamide), Class 1B (Lidocaine), Class 1C (Propafenone), Class III (Amiodarone)
135
What 2 medications are used for both atrial and ventricular arhythmias?
Class 1A (Procainamide) and C III (Amiodarone)
136
What impact does Class 1A (Procainamide) have on ions?
Moderate block of NA+
137
What impact does Class 1B (Lidocaine) have on ions?
Mild block of Na+
138
What impact does Class 1C (propafenone) have on ions?
Marked block of Na+
139
What impact does Class III (amiodarone) have on ions?
Block of K+
140
List the different administration routes for the 4 classes of anti-arrhythmic drugs?
```
Class 1A (procainamide) - oral and parenteral
Class 1B (Lidocaine) - parenteral
Class 1C (propafenone) - Oral and IV (loading dose)
Class III (amiodarone) - oral and parenteral (loading dose for converson out of atrial fibrillation)
```
141
What are the side effects of Class 1A (procainamide)?
- hypotention (dizzy)
- rash (drug induced systemic lupus erthromatosis)
- bradycardia
vision disturbances
142
What are the side effects of Class 1B (Lidocaine)?
Hypotention (dizzy)
| Bradycardia
143
What are the side effects of Class 1C (propafenone)?
Hypotention (dizzy)
bradycardia
SOB (asthma pts)
144
What are the side effects of Class III (Amiodarone)?
- Hypotention (dizzy)
- hypo + hyperthyroidism
- BLUE SKIN
- liver toxicity
bradycardia
nausea
pumonary fibrosis (lung disease - tissue damaged and scarred - leads to SOB)
145
What nursing implications need to be taken for all 4 classes of Anti-Arrhythmic drugs?
Monitor for tolerability, HR and response (ECG)
146
Which class of anti-arrhythmic drug is safe to use for pts with CHF (congestive heart failure)?
Class III (Amiodarone)
147
With which class of anti-arrhythmic drug should caution be taken for CHF and asthma pts?
Class 1C (propafenone)
148
What 2 additional tests need to be done for pts using Class III (Amiodarone) anti-arrhythmic drug?
Thyroid function tests (b/c side effect = hypo/hyperthyroidism)
Chest x-ray (b/cside effects = pulmonary fibrosis)
149
Which anti-arrhythmic drug class has a side effect of blue skin?
Class III (Amiodarones)
150
What are the 2 main types of strokes?
- Thrombotic (bloost blot blocks blood flow to brain)
| - Embolic (plaque or clot breaks away and flows to brain where blocks arteries)
151
What are the goals of stroke therapy (meds)?
- minimize brain damage
- prevent complication
- reduce risk of recurrence
- restore function of the individual
152
Explain the difference between the hemorrhagics - intracerebral and subarachnoid
- Intracerebral - bleed within brain tissue and ventricles
| - subarachnoid - bleed between brain and surround membranes (life-threatening)
153
What are the symptoms of Acute Ishemic Stroke?
Sudden:
- weakness (numbness in face, arm, legs etc)
- trouble speaking
- vision problems
- headaches
- dizziness (loss of balance)
154
Explain briefly the treatment/assessment of a stroke?
1. identify signs of a possible stroke
2. critical EMS assessment (ABCs -airway, breathing, circulation).
3. Immediate general assessment and stabalization
4. Immediate neurologic assessment by stroke team
5. Does CT scan show any hemorrhage?
Yes - consult neurosurgeon No - consider fibrinolytic therapy
6. If pt remains a candiate for fibrinolytic therapy then review risk/benefits with pt and family and give tPA (no anticoagulants or antiplatelet tx for 24 hrs)
7. If pt does not remain a candidate for fibrinolytic therapy then administer aspirin. (admit to stroke unit, monitor BP, monitor neurologic status, monitor blod glucose, initiate supportive therapy.
