-
in heart failure __ ___ can no longer meet ___ __
- cardiac output
- metabolic demands
-
major signs of heart failure include
- cardio,hepato and spleno "megaly"
- gallop rythym (s3)
- periph edema
- ascites
-
symptoms of right sided CHRONIC heart failure
- - anorexia and nausea
- -pain in UR quad
- -oliguria during day
- - polyuria at night
-
symptoms of left sided ACUTE heart failure
- dyspnea
- orthopnea
- paroxomyl dyspnea
- coughing and wheezing
-
drugs classifications used for heart failure
- -diuretics
- -cardiac glycosides
- - beta blockers and agonist
- - ACE inhibitors
- - angiotensin II receptor antag
- -phophodiaterase inhibit
- - vasodialators
-
beta blockers are all (-) or (+)
(-)
-
phosphodiesterase inhibitors are (-) or (+)
(+)
-
beta agonist are (-) or (+)
(+)
-
cardiac glycosides are (-) or (+)
- ino- (+)
- chrono(-)
- dromo(-)
-
before administering cardiac glycosides you must
take the patients pulse
-
when administering cardiac glycoside, if pulse is below __ or above __ you must ___
- 60
- 100
- hold meds and call doc
-
cardiac glycosides have a ___ therapeutic index
narrow
-
what does it mean if a pt has a narrow therapeutic index
it is easy for pt to become toxic
-
signs of digitalis toxicity
- anorexia or nausea
- brady
- tachy
- GI pain
- disrythmyia
- visual disturbance
-
define digibind
antidote for severe digitalis poisioning
-
define digitilization
process during which pt. gets a loading dose of digitalis to raise the blood level to the effective level
-
any disorder of the rate and rythym
arrhythmia or dysrythmia
-
disorders in cardiac electrophysiology result from
- automacity
- conductivity
- or both
-
define automacity
abnormality in spontaneous initiation of an impulse
-
anti-dysrhythmia are in the _____ classification system
Vaughan-Williams
-
anti-dysrhythmia
1) group 1
2) group 2
3)group 3
4) group 4
- 1) fast Na block
- 2) beta block
- 3) fast K block
- 4) slow Ca block
-
what else can be used to treat dysrythmia
cardiac glycoside
-
major side effect of anti-dysrhythmia meds
they can worsen or cause new dysrythmias
-
hypertention is defined as
>above 140/ > above 90
-
BP for
1) normal
2) prehypertensive
3) Hypertensive stage 1
4) hypertensive stage 2
- 1) < 120/80
- 2) 120-139/80-89
- 3) 140/159-90/99
- 4) > 160/ > 100
-
95% of hypertension is due to ___ and is termed_____
- etiology
- primary, essential and idiopathic
-
hypertension should first be treated with ___ and if no help then ____
-
hypertension drug classifications
- dieuretic
- A1 block
- CA A2 block
- B Block
- PA Block
- ACE inhibit
- Angio II Receptor antag
- Ca block
- ganglion block
- aldoster inhibit
-
major side effect of hyprtension drugs
hypotension
-
adverse effect of ACE inhibitors
non productive cough
-
define exertional angina
- (classic, stable or effort)
- chest pain from arteriosclerosis. caused from exertion or stress. 15 minutes
-
define unstable angina
- (crescendo, preinfarction)
- occurs more frequently and becomes more severe with time. can occur during sleep
-
define variant angina
- (prinzmetals, vasospastic)
- occurs only at rest and is assosciated with spasms of coronary arteries. occurs early morning
-
define thrombus
clot in the cardiovascular system
-
define embolus
detatched clot
-
define arteriosclerosis
hardening of the arteries
-
define artheriosclerosis
irregularly distributed lipid deposits in the intima of large and medium arteries. they provoke fibrosis and calcification
-
routes of admin for nitroglycerin
- subling
- tab XR
- oint
- transderm patch
- spray
- IV
-
shelf life for nitroglycerin
2 months
-
side effect of nitroglycerin
headache
-
protocol for nitroglycerin admin in event of angina
- 1) sit down
- 2) 1 tab subling
- 3)wait 5 min
- 4) if still pain, place another tab
- 5) wait 5 min
- 6) if still pain place another tab
- 7) if still pain call 9-1-1
-
why should you not take nitroglycerin with viagra
both meds cause vasodialation which drops bp
-
define arrhythmia/dysrythmia
any disorder of rate and/or rythym of heart beat
-
blood clots are formed from
fibrin and platelet aggregrates
-
final common pathway
- thromoplastin
- ↓
- prothrombin
- ↓
- thrombin
- ↓
- fibrinogen
- ↓
- fibrin
-
clotting proceedes in the presense of
calcium
-
____ prevent clots from forming
anticoagulants
-
heprin
1) onset
2) route
3) duration
4) antidote
- 1) immediate
- 2) sc/iv
- 3) short <4 hr
- 4) protamine sulfate
-
Coumarins
1) onset
2) route
3) duration
4) antidote
- 1) slow 24-48 hr
- 2) oral
- 3) long 2-5days
- 4) vit K
-
thrombolytic agents are contraindicated when
- PE recent surgery
- hemmoragic stroke
-
___ is used to prevent venous thrombi
___ is used to prevent arterial thrombi
- anti coagulant
- anti platelet
-
___ hasten clot formation to control rapid blood loss
antifibrinolytic(hemostatic, coagulant)
-
define anemia
the blood has an inability to adequate amounts oxygen
-
how are anemias classified
- RBC morphology
- amt of hemoglob in RBC
- etiology
-
iron deficiency anemia
meat, fish and soy
-
iron deficiency anemia side effects
nausea, gi, constipation, black tar stool, stained teeth
-
cyanocobalamin ( B12)
dietary defeciencys and lack of ability to synthesize intrinsic factor
-
cyanocobalamin ( B12) side effects
rare
-
folic acid deficency
green leafy veg and meat
-
folic acid deficency
rare
-
aplastic anemia
bone marrow
-
-
intrinsic factor is produced in
stomach
-
iron is essential for
o2 transport in RBC and for energy transfer in certain enzymes
-
which major electrolyte must be replaced when taking dieuretics
potassium
-
pt education when taking dieuretics
- weight qday
- keep weight log
- loss of K so supplement K
- dizzy and fainting
-
why are IV fluids administered
- correct decrese in body fluid volume
- increase plasma level
- increase electrolyte and gluecose
- admin drugs
- admin blood
- nutritional
- maintain venous access
-
-right side failure
-left side failure
-both
- -systemic
- -pulmonary
- -cause liver congestion and periph edema
-
right side failure symptoms
anorexia, nausea, pain in UR quad, oliguria during day, polyuria at night
-
left side failure symptoms
dyspnea, orthopnea, paroxysmal nocturnal dyspnea, cough and wheeze
-
cardiac glycosides
1) MOA
2) uses
- 1) inhibit active transport of Na and K into cardiac cell.(increase, forceful)
- 2) HF, supravent arryth, arterial fib,art flutter
-
phosphodiesterase inhibitors
1) MOA
2) uses
- 1) more calcium, vasodialation
- 2) short term manage of CHF
-
difference between primary and secondary hypertension
primary 95% is unknown cause, secondary 5% is known cause
-
what does MONA stand for
- morphine
- oxygen
- nitroglycerin
- asprin
-
in the event of an angina, ___ must always be administered before ___
nitroglycerin, morphine
-
MOA of loop dieuretics
loop of henle, clock reabsorption of Cl and secondarily Na+
-
MOA tthat enables most dieuretics to prevent the reabsorption of H2O and Na+
proximal tubule reduces H+ formation which blocks h2O and Na+
-
-
-
conditions treated with beta blockers
-
conditions treated with beta agonist
-
conditions treated with Ca2+ channel clockers
-
conditions treated with vasodialators
-
conditions treaded with cardiac glycosides
-
conditions treated with phosphodiesterase
-
conditions treated with ACE inhibitors
-
conditions treated with angio II antag
-
angiotensin II
- increase BP
- vasoconstrict
- SNS
- increase aldosterone and renal
- hypertension
- atherosclerosis
- repair myocardium after infarction
-
atrial flutter
abnormality in beating of heart
-
arterial fib
quivering or irregular heart beat(rythmia)
-
ino
chrono
dromo
- force of contraction
- heart rate
- speed of conduction
-
digoxin(Lanoxin)
- slows down heart
- strengthens heart muscle
- increase CO
-
explain the action of ADH
- hormone
- water balance at the collecting duct
- increase ADH, increase blood volume decrease urinary output
-
P wave represents
depolarization of atria
-
QRS wave represents
the depolarization of left and right ventricles
-
cause of ischemia of heart muscle
narrow arteries
-
cause of myocardial infarction(heart attack)
plaque buildup (atherosclerosis) ruptures
-
when should digoxin be held
rate is lower than 60 or higher than 100
-
cardiac action potential
- 1) depolar (perm to Na+)
- 2) repolarization
- 3) slight + b/c influx of Na+
- 4) slow flow in of Ca2+ and outflow of K+
- 5) rapid outflow of K+
- 6) resting period
- 7) Na+ out and K+ in, cell is polarized
-
electrical conduction through heart
- 1) SA node
- 2) intermodal pathway to two atria
- 3) atrial contraction
- 4) AV node electrical impulse delayed
- 5) bundle of His, conduction increases
- 6) right bundle branch
- 7) left bundle branch
- 8) posteriorinferior fascicle/anterosuperior fascicle of latter bundle branch
- 9) arrival of impulses at purkinje fibers
- 10) distribution to all parts of both ventricles
- 11) RA,RV
- 12) LA, LV
-
blood flow through heart
- unoxygenated
- in to IVC and SVC
- RA
- tricusp
- RV
- pulmonary valve
- pulmonary arter to lungs
- pulmonary vein from lungs
- LA
- mitral
- LV
- aortic valve
- aorta, oxygenated
-
the nephron
- h20 follows Na+
- H+ in, Na+ out
- Cl in, Na+ in
- G- plasma
- P- Na+ in
- LOH- Cl in
- D- Na+ in
- c- H+ out
-
-exertional angina
-unstable
-vaient
- -chest pain (classic)
- -frequent, OT, during rest (crescendo)
- - only at rest, early morning (prinzmetal)
-
___ was developed for pt who can not tolerate side effects of ACE inhibitors
Angiotensin II antagonist
-
-
-anticoagulant
-antiplatelet
- -venous thrombi
- -arterial thrombi
-
-
___ carries lipid compunds
lipoprotiens
-
HDL have high density of ___
LDL have high density of ___
which one is cardioprotective?
-
adverse effects of HMG-CoA
hepatotoxicity and rhamdomyolysis
-
which dieuetics do not inhibit reabsorption of Na+
osmotic and ADH
-
classification of diuretics
- carbonic
- osmotic
- loop
- thiazidide
-
main side effect of dieuretics
hypokalemia and hypotension
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