Term
|
Definition
| a clincial syndrome caused by insufficient O2 to the heart and is characterize by chest 'pain'. demand>supply |
|
|
Term
|
Definition
| Dull, heavy, squeezing substernal chest pain; GRIPPING, HEAVINESS, PRESSING, BORING, CHOKING, OR SQUEEZING |
|
|
Term
| where does angina radiate |
|
Definition
|
|
Term
| what usually causes angina pectoris |
|
Definition
| coronary atherosclerosis. demand>supply |
|
|
Term
| drugs for angina work in one of 2 ways |
|
Definition
Increase or improve myocardial oxygen supply
Or, decrease myocardial oxygen demand |
|
|
Term
|
Definition
CLASSICAL or STABLE angina
UNSTABLE angina
PRINZMETAL or VARIANT angina |
|
|
Term
| things that worsen angina |
|
Definition
ADVANCING AGE
HIGH SERUM CHOLESTEROL
HYPERTENSION
EKG abnormalities
CIGARETTE SMOKING
DIABETES MELLITUS |
|
|
Term
| how do cigarettes worsen angina? |
|
Definition
| increase heartrate, vasoconstrict |
|
|
Term
| treatment of choice for angina |
|
Definition
|
|
Term
| lifestyle modifications to treat angina |
|
Definition
Avoid precipitating factors such as HEAVY MEALS, EMOTIONAL UPSETS, AND EXPOSURE TO EXTREMES IN TEMPERATURES
Beverages containing caffeine, coffee, teas or colas |
|
|
Term
| life style modifications for angina cont. |
|
Definition
Strenuous exercise should be avoided
SMOKING should be stopped
Hypertension, obesity, hyperlipidemia, anemia, hyperthyroidism(causes arry), and arrhythmias should all be appropriately controlled |
|
|
Term
| 3 goals of treating angina |
|
Definition
1. The symptomatic relief of angina pain
2. The prevention of anginal attacks
3. Control of risk factors |
|
|
Term
| who has the worst prognosis |
|
Definition
| >60 women with unstable angina |
|
|
Term
| how do nitrates work at a gross level to treat angina? |
|
Definition
| decrease the amount of work your heart has to do by slowing it |
|
|
Term
| how do beta blockers work at a gross level to treat angina? |
|
Definition
|
|
Term
|
Definition
| relaxing smooth muscle (vascular, GI, Uterine, bronchial) causing vasodilation (venous circ.>arterial) |
|
|
Term
| what happens in the venous circ during vasodilation? |
|
Definition
| pooling of blood in the peripheral veins, decreased right heart return, decrease work |
|
|
Term
| what happens in the arterial circ. during vasodilation |
|
Definition
| reduced systemic vascular resistance and decreased pressure for the left ventricle to work against |
|
|
Term
| how do nitrates work on coronary vessels? |
|
Definition
|
|
Term
| how long do nitrates take to work? |
|
Definition
Usually relieves pain within 3 minutes in up to 75% of the population,
And within 4 to 15 minutes in a further 15%of the population
(so 90% in 15 minutes) |
|
|
Term
|
Definition
| destroys it. replace every three months. |
|
|
Term
|
Definition
| significant first pass effect. most destroyed by the Gi tract in 40 mins |
|
|
Term
|
Definition
| sublingual tabs,oral tabs, transdermal patch, ointment |
|
|
Term
|
Definition
|
|
Term
|
Definition
| nitroglycerin capsules (Nitrobid) Isosorbide mononitrate (ISMO) dinitrate, (ISORDIL)- last longer |
|
|
Term
| Transdermal Nitroglycerin |
|
Definition
Transderm-Nitro, nitrodur
-tolerance
-take patch off before defibrilation |
|
|
Term
| how to avoid tolerance to nitrates |
|
Definition
|
|
Term
|
Definition
| take one sublingually, if persists after 5 mins, take another. after 3, go to ER |
|
|
Term
| what is a very affective diet program for angina? |
|
Definition
| ornish- vegan like, with exercise |
|
|
Term
| side effects from nitrates |
|
Definition
***HEADACHES*** (49%)
dizziness
syncopal episodes
flushing
rash? |
|
|
Term
| how to treat angina step by step |
|
Definition
1. correct aggravating factors
2. Control comorbidities
3. prevent attacks with NTG |
|
|
Term
| three drug classes used for angina |
|
Definition
Nitrates
Beta Blockers
CCBs |
|
|
Term
|
Definition
| 1/4 deaths, women >60, men >40 |
|
|
Term
| lowering cholesterol's effect on coronary events |
|
Definition
| For every 1%reduction in cholesterol there is a 2% reduction in the frequency of heart attacks or other coronary events |
|
|
Term
|
Definition
| transport the majority of serum CHOL and supply most of the CHOL found in atherosclerotic plaques |
|
|
Term
|
Definition
| transport CHOL from body tissues to the liver, where it is eliminated or re-used (higher HDL hasnt been proven good yet) |
|
|
Term
| NCEP initial cholesterol screening recommendations |
|
Definition
Begin at age of 20
Repeated every 5 years
Screening should include serum cholesterol and HDL-cholesterol |
|
|
Term
| Further analysis of cholesterol should be done if |
|
Definition
1. CHOL is greater 240 mg/dl
2. HDL is less then 35 (40)
3. CHOL >200 mg/dl in a patient with 2 or more risk factors for CAD |
|
|
Term
| Personal Risk factors for CAD |
|
Definition
Men >45 yo
Women >55 yo
premature menopause w/o ER therapy
Cigarette smoking
Hypertension
Diabetes
HDL < 35 mg/dl |
|
|
Term
| Negative? Risk factors (good thing) |
|
Definition
HDL CHOL >60mh/dl
(counts as 2) |
|
|
Term
| Risk factors for CAD family history |
|
Definition
| Family history of MI or sudden death before 55 yo in a male 1st degree relative or Before age 65 in female 1st degree relative |
|
|
Term
|
Definition
<100 Optimal
100-129 Near Optimal
130-159 Borderline high
160-189 High
>190 Very High |
|
|
Term
| When do you do something about someones LDL? |
|
Definition
| When it is high or very high, >160 |
|
|
Term
| NCEP guidelines for total Cholesterol |
|
Definition
<200 Desirable
200-239 Borderline
>240 High risk |
|
|
Term
| total cholesterol: HDL ratio |
|
Definition
|
|
Term
|
Definition
<40 Low (undesirable)
>60 High (desirable) |
|
|
Term
| NCEP guidelines for Triglycerides |
|
Definition
<150 Normal
150-199 Borderline high
200-499 High
>500 Very High |
|
|
Term
|
Definition
Exercise
Cessation of smoking
Weight reduction |
|
|
Term
|
Definition
Decrease saturated fat intake
Maintain good body composition BMI<25
Increase dietary fiber
Increase aerobic exercise |
|
|
Term
| First line Lipid Lowering Drugs |
|
Definition
Bile Acid Sequestrants
Niacins
Statins
Fibric Acid Derivatives |
|
|
Term
| Bile Acid Sequestrant Examples |
|
Definition
Cholesytramine (Questran)
Colestipol
Colesevelam (Welchol) |
|
|
Term
| Bile Acid Sequestrants and GI |
|
Definition
| Not absorbed into GI so there are not a lot of GI side effects |
|
|
Term
| Bile Acid Sequestrants MOA complex terms |
|
Definition
Anion exchange agents which bind bile acids in the intestinal lumen
Liver converts hepatocellular cholesterol into bile acids
Upregulation of LDL receptor synthesis and the uptake of circulating LDL-C thus lowering levels |
|
|
Term
| Bile Acid Sequestrants MOA in simple terms |
|
Definition
| bile acids bind to sequestrants, you poop, your body secretes more that can bind. |
|
|
Term
| Bile Acid Sequestrants S/E |
|
Definition
| N, early satiety, bad taste (candy bar), Drug interaction (take two hours before or two hours after) |
|
|
Term
| Doses of bile acid sequestrants and affect on LDL |
|
Definition
5g decreases 15%
10g decreases 23%
15g decreases 27% |
|
|
Term
|
Definition
| Increases HDL. Also reduces the production of VLDL particles by the liver because LDL is a VLDL degradation product, reducing VLDL particles also lowers the LDL-cholesterol levels. |
|
|
Term
|
Definition
| ***LIVER TOXICITY***, flushing sensation, itching, HA, increased uric acid (gout), PUD, hyperglycemia, prostaglandin inhibitor |
|
|
Term
| How to decrease side effects of niacin |
|
Definition
| take an asprin 15-30 mins before taking |
|
|
Term
|
Definition
| start low, go slow up to 250 mg, then switch to sustained released (watch for liver toxicity) |
|
|
Term
| Niacin effect on HDL, LDL, triglicerides |
|
Definition
HDL increases Most effective for this
LDL decreases
TRGL decreases (therefore good for pts with high triglycerides)
therefore decrease in total cholesterol |
|
|
Term
|
Definition
| vit. B3. it is a water soluable B vitamin and may decrease the risk of MI but not as well as statins. |
|
|
Term
|
Definition
|
|
Term
|
Definition
Lovastatin (Mevacor)
Prevastatin (Pravachlor)
Simvistatin (Zocor)- more potent, more S/E |
|
|
Term
|
Definition
| more potent, more S/E. Myopathies because of decreased CoQ10 |
|
|
Term
|
Definition
| as you increase the dose, plateu |
|
|
Term
|
Definition
| Best agent for affect on HDL LDL and TRGLY |
|
|
Term
|
Definition
|
|
Term
| Mechanism of Action of the STATINS |
|
Definition
| Statins competitively inhibit the enzyme responsible for converting HMG CoA to mevalonate in an early step in the biosynthetic pathway of cholesterol |
|
|
Term
|
Definition
| most dramatic affect on lowering LDL (will get <100) and triglycerides and increases HDL |
|
|
Term
|
Definition
| well tolerated. some liver impairment (jaundice-get LFTs before starting) Myopathy due to decreased levels of CoQ10, can see increased myop. with other drugs. |
|
|
Term
|
Definition
| at bedtime or with last meal |
|
|
Term
|
Definition
| inhibits cholesterol synthesis on the body? |
|
|
Term
| Mechanism of Action of FIBRIC ACID DERIVATIVES |
|
Definition
Increases the activity of the enzyme, LIPOPROTEIN LIPASE, thus reducing TriG levels by increasing VLDL and IDL catabolism
Also reduce the secretion of VLDL from the liver, reduce the biosynthesis of Chol, and promote the secretion of Chol in the bile to a lesser extent |
|
|
Term
| Fibric Acid Derivatives and Statins |
|
Definition
| studies show no improvement as a combo |
|
|
Term
| S/E of Fibric Acid Derivatives |
|
Definition
| myopathies, cholesterol gall stones |
|
|
Term
| OTC products for decreasing cholesterol |
|
Definition
|
|
Term
|
Definition
| decreases Cholesterol, decreases BP, antiplatelet |
|
|
Term
|
Definition
| antiarrythmic, greases joints |
|
|
Term
| good combo of meds to decrease CHOL |
|
Definition
| Bile acid sequestrant with a Statin |
|
|
Term
|
Definition
| Ability of a group of cells to spontaneously polarize and cause as action potential |
|
|
Term
|
Definition
| Spread of an electrical impulse thru excitable tissue. |
|
|
Term
|
Definition
| Sudden surge of charged particles across a membrane which cancels out the resting membrane potential to produce an action potential |
|
|
Term
|
Definition
| The process by which the membrane returns to the resting potential |
|
|
Term
|
Definition
| The time of recovery needed for a cell that has just transmitted an impulse. During this time a normal stimulus will not bring about excitation of the cell. |
|
|
Term
|
Definition
|
|
Term
| What occurs during Phase 0 |
|
Definition
Rapid depolarization
Sudden depolarization after a threshold is reached |
|
|
Term
| What occurs during Phase 1 |
|
Definition
rapid repolarization may be produced by the cessation of sodium exchange
Early rapid repolarization |
|
|
Term
| What occurs during Phase 2 |
|
Definition
The plateau of the action potential
Plateau maintained mostly by calcium flow and chloride flow |
|
|
Term
| What occurs during Phase 3 |
|
Definition
Repolarization of the cell
Late rapid repolarization
Produced by potassium moving out of the cell
Late rapid repolarization |
|
|
Term
| What happens during phase 4 |
|
Definition
Spontaneous depolarization produced by a sodium leak
Slow depolarization
Automaticity occurs when the depolarization hits a threshold around -55mV |
|
|
Term
| Disturbances of Impulse Formation that cause arrhythmias |
|
Definition
1.Abnormal rate of SA node firing sinus bradycardia or tachycardia
2. Dominant discharge from ectopic pacemakers |
|
|
Term
| Disturbances of Impulse Conduction that cause arrhythmias |
|
Definition
1. Slowing or blocking of the normal cardiac impulse at various points in the conduction system (ischemia, impulse has to go around)
2. Reentry of the impulse into a responsive area of the myocardium as a result of unidirectional block |
|
|
Term
| Co factors that cause arrhythmias |
|
Definition
1. Electrolyte imbalances
2. Myocardial ischemia and scarring
3. Neurohormonal; Autonomic NS, Thyroid hormones
4. Toxins (caffeine) |
|
|
Term
| Arrythmias originating above the bundle of HIS |
|
Definition
| Supraventricular arrythmias |
|
|
Term
| types of supraventricular arrhythmias |
|
Definition
sinus brady
sinus tachy
PSVT
Atrial flutter
Atrial fibrillation
Wolff-Parkinson-White syndrome
Premature atrial contractions (PACs) |
|
|
Term
| arrhythmias originating below the bundle of HIS |
|
Definition
|
|
Term
| types of ventricular arrhythmias |
|
Definition
Premature ventricular contractions (PVCs)
Ventricular tachycardia
Ventricular fibrillation |
|
|
Term
| Conduction blocks listed separately based upon |
|
Definition
|
|
Term
| Supraventricular site of heart block e.g |
|
Definition
| 1st, 2nd, or 3rd degree AV block |
|
|
Term
| ventricular sites of heart block |
|
Definition
| right or left bundle branch block |
|
|
Term
| Anti-Arrhythmic Drug Classification system |
|
Definition
| Vaugh-Williams classification |
|
|
Term
| Class 1 Vaugh-Williams Drugs |
|
Definition
| sodium channel blockers further subdivided into class IA, IB, and IC. |
|
|
Term
| sodium channel blockers subclasses are differentiated by... |
|
Definition
| their effects on the sodium channel |
|
|
Term
|
Definition
| moderate blocking potency |
|
|
Term
| Class 1-A antiarrhythmic Examples |
|
Definition
Quinidine sulfate and gluconate salts
Procainamide (Pronestyl, Procan SR)
Disopyramide (Norpace, Norpace CR) |
|
|
Term
|
Definition
| lowest Na blocking potency |
|
|
Term
| Class 1-B antiarrhythmic examples |
|
Definition
Lidocaine (Xylocaine)
Mexiletine (Mexitil)
Tocainide (Tonocard) |
|
|
Term
|
Definition
highest Na blocking potency
not used for arrhythmias anymore |
|
|
Term
| Class 1-C antiarrhythmic Examples |
|
Definition
Flecainide (Tambocor)
Propafenone (Rythmol)
Moricizine (Ethmozine) |
|
|
Term
| Class 2 Vaugh-Williams Drugs and how do they work? |
|
Definition
| Beta blockers. depresses phase 4 depolarization. inhibit sympathetic NS stim. |
|
|
Term
| Class 2 antiarrhythmic drug examples |
|
Definition
Acebutalol (Sectral)
Esmolol (Brevibloc)
Propranolol (Inderal) |
|
|
Term
| Class 3 Vaugh-Williams Drugs and how do they work? |
|
Definition
| Potassium channel blockers. Produce a prolongation of phase 3 (repolarization) |
|
|
Term
| Class 3 antiarrhythmic drug Examples |
|
Definition
Amiodarone Cordarone)
Sotalol (Betapace)
Bretyllium (Bretylol)
Dofetilide (Tikosyn) |
|
|
Term
| Class 4 Vaugh-Williams Drugs and how do they work? |
|
Definition
| Calcium channel blockers. Depress phase 4 depolarization. Lengthen phases 1 and 2 |
|
|
Term
| Class 4 antiarrhythmic examples |
|
Definition
Verapamil (Isoptin, Calan)
Diltiazem(Cardizem) |
|
|
Term
| Examples of Unclassified agents |
|
Definition
Atropine
Adenosine (Adenocard)
Dronedarone (Multaq) |
|
|
Term
| common drugs that cause arrhythmias |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| anticholinergic promotes conduction through AV and increased HR |
|
|
Term
|
Definition
| IV, short acting. converts PSVT to NSR. |
|
|
Term
|
Definition
| naturally occuring nucleoside which is present at all the cells in the body. Slows conduction through AV and restores NSR |
|
|
Term
|
Definition
| derivative of amiodarone, for A fib |
|
|
Term
| contraindication for dronedarone |
|
Definition
| CHF esp on Dig= 2x higher death rate |
|
|
Term
|
Definition
| NVD stomach pain, heartburn, weakness, rash, itching, redness, SOB, chest tightness, swelling of legs, slowed HR, syncope |
|
|
Term
|
Definition
| dry mouth, thirst, blurred vision, constipation |
|
|
Term
| quinidine class, origin and uses |
|
Definition
| Class 1A. alkaloid from cinchoma bark. effective for atrial and V. arrhythmias. **treats malaria** |
|
|
Term
| quinidine's therapeutic index |
|
Definition
|
|
Term
| quinidine gluconate why? forms? |
|
Definition
less GI s/e
IV-painful
IV- less reliable
Oral- usually |
|
|
Term
|
Definition
|
|
Term
| quinidine cardiovascular s/e |
|
Definition
| 1st degree av block, V tach, V fib, asystole, pacemaker suppression, decrease BP and CO, *quinidine syncope* |
|
|
Term
|
Definition
| hypersensitivity rxn, cinchonism |
|
|
Term
|
Definition
| fever, maculopapular rash, thrombocytopenia |
|
|
Term
|
Definition
| have to drop the dose because it increases its concentration |
|
|
Term
|
Definition
| can cause increase in quinidine levels |
|
|
Term
|
Definition
QRS widening. if:
>25%- toxic effects
>50%- v fib |
|
|
Term
| procainamide class, half life |
|
Definition
class 1A
3 hours, but also available sustained release |
|
|
Term
|
Definition
| **arrhythmias, SLE** GI distress, hypotension, vent conduction disturbances |
|
|
Term
|
Definition
29% get it.
sx: arthralgias, myalgias, fever, pleuritis, pericarditis, butterfly rash
+ANA (80%) +LE prep |
|
|
Term
| disopyramide class, properties |
|
Definition
| Class 1A, anticholinergic |
|
|
Term
|
Definition
| dry mouth, urinary hesistancy, constipation, blurred vision. |
|
|
Term
| what patients do you want to avoid disopyramide in? |
|
Definition
elderly bc of anticholinergic
CHF bc inotropic and vasoconstriction |
|
|
Term
|
Definition
| class 1B, for vent arrhythmias |
|
|
Term
|
Definition
biphasic
1. kidney lung liver heart highly perfused
2. redistributed to muscle and adipose |
|
|
Term
|
Definition
CNS: drowsy, dizzy, tinitus, tremors, seizures
Cardiac |
|
|
Term
| what drugs are not good given orally due to first pass metabolism |
|
Definition
| Class 1B. Lidocaine, tocainide, mexiletine |
|
|
Term
|
Definition
| pulmonly fibrosis, agranulocytosis, leukopenia |
|
|
Term
| Class 2 drugs used for what? how are they given? |
|
Definition
| atrial or vent arrhythmias, given oral or IV |
|
|
Term
|
Definition
| hypotension, and LV failure |
|
|
Term
| what type of agent is better for COPD pts? |
|
Definition
|
|
Term
| Amiodarone class, form, and use |
|
Definition
| class 3, oral/IV. used for uncontrollable, life-threatening vent arrhyth, supravent arrhythmias (A fib), use for Code situations |
|
|
Term
| whats great about amiodarone |
|
Definition
| reduction in death rate of patients with complex vent arrhythmias after MI |
|
|
Term
|
Definition
corneal microdeposits (visual deficits)
photosensitivity
pulm toxicities
blue-gray pseudocyanosis
neuro symptoms
thyroid s/e
increased transaminases
coronary vasodilation |
|
|
Term
|
Definition
| long, therefore s/e for a long time. |
|
|
Term
|
Definition
class 3. (non selective BB and KCB)
for lifethreatening vent arrhyth
or supravent arrhyth
or complex arrhyth
(similar to amiodarone) |
|
|
Term
|
Definition
profile similar to BB: HA fatigue, depression.
*pro-arrythmic* in 4-5% |
|
|
Term
|
Definition
| Class 3, convert Aflutter/fib to NSR or maintain NSR in these patients |
|
|
Term
| whats special about dofetillide |
|
Definition
| have to apply for license through the company |
|
|
Term
|
Definition
Torsade de Pointes : vent arrhyth
HA, chest pain, dizzy
VD, seating, loss of appetite, increased thirst |
|
|
Term
|
Definition
| Class 3, last resort, vent arrhyth in ICU |
|
|
Term
| bretylium biphasic response |
|
Definition
1. increased BP and HR after initial infusion
2. decrease in BP and HR 30 min later |
|
|
Term
|
Definition
*dysphagia secondary to stroke*
obstruction (esophageal) |
|
|
Term
| enteral feeding timing mechanisms?? |
|
Definition
Bolus- over 4 hours via syringe
Intermittent- bag over ~hour
COntinuous- feeding pump, bedridden |
|
|
Term
|
Definition
|
|
Term
| enteral feeding s/e and prevention |
|
Definition
aspiration- HOB 30* bolus 90
D- not too fast or too concentrated
hyperglycemia
electrolyte imbalances
vitamin deficiencies |
|
|
Term
| osmotic enteral feeding examples |
|
Definition
| Isomil, Osmolite, Jevity (fibrous) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Pulmocare- fat calories better tolerated by COPD pts |
|
|
Term
| Kidney patient enteral feeding |
|
Definition
| Nephro- essential AA are better utilized |
|
|
Term
| Hepatic patients enteral feeding |
|
Definition
| HepaticAid- branched chain AA |
|
|
Term
| Peripheral IV nutrition how long? |
|
Definition
| no longer than 2 weeks, change site q2D |
|
|
Term
| Peripheral IV nutrition Osmolarity |
|
Definition
<1000, fat via Y-site decreased osmolarity 300mOsm
Protects veins |
|
|
Term
| peripheral IV nutrition contents? |
|
Definition
protein sparing (procalamine)
dextrose 10% |
|
|
Term
| central IV nutrition timing, and fat |
|
Definition
| long term, fat twice weekly to avoid deficiency |
|
|
Term
| central IV nutritional lines |
|
Definition
|
|
Term
|
Definition
Protein (AA solutions)
Carb (dextrose)
Far (Intralipid)
Electrolytes |
|
|
Term
|
Definition
| NaCl, KCl, K/NaPO4, K/Na acetate, mag sulfate |
|
|
Term
| whats in TPN thats converted to bicarb to Tx acidosis |
|
Definition
|
|
Term
|
Definition
Z, Cu, Chromium, Manganese, Selenium, molybdenium, cadium
Multivitamins, Fe, vit K, H2RA/PPI, heparin |
|
|
Term
what trace element is used for
1. hair loss
2. chielosis
3. cardiomypoathies |
|
Definition
|
|
Term
|
Definition
Marasmus v Kwashikor
Body weight v somatic proteins |
|
|
