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This nonspecific lab marker is for inflammation and is increased in many CAD patients.
C-reactive Protein (CRP)
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What is Hyperhomo - cysteinemia?
- Sulfur containing amino acid
- Increased levels of this increase clotting, promoting plaque buildup and damages blood vessel lining
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What can chronic elevation of CRP associated with?
- Assoaciated with unstable plaques and oxidation of LDL cholesterol.
- CRP is increased in patients with CAD
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List lipid-lowering therapy if diet and exercise is ineffective
- Statins: HMG-CoA reductase inhibitors
- - decreases LDL, increase HDL
- - Atorvastatin (10-80mg) HS
- Niacin (Nicotinic Acid):
- - Lowers LDL and triglyceride
- - Increase HDL
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What are the therapeutic effects and adverse effects of Statins and Niacins?
- Statins:
- - TE: Decrease LDL, increase LDL
- - SE: myopathy and liver dmg
- Niacins:
- - TE: Lowers LDL and triglyceride, increase HDL
- - SE: Flushing, pruritus, GI, orthostatic hypotension
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Which of these drugs can cause orthostatic hypotension?
C.
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Do you want to give Gemfibrozil (Fibric Acid Derivative) with or without meals?
What is its indication?
- AC: 600 mg
- d/t GI side effects
- *it is a lipid lowering agent
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This type of drug converts cholesterol to bile acids.
What is its consideration?
Cholestyramine or Cholestipol: Binds with other drugs
-
This drug decreases absorption of dietary and biliary cholesterol:
A.
-
List top three things you want patient to lower or stop to reduce risk of CAD?
- 1. Treat HTN
- 2. lower lipids
- 3. Stop smoking
-
For physical activity teaching, you want the patient to:
B.
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Fill in: Angina is a __a__ ischemia. It occurs when arteries are __b__ % or more blocked, and hypoxia occurs within __c__ seconds of occlusion.
It is viable for __d__ minutes.
- a. reversible
- b. 75%
- c. 10 seconds
- d. 20 minutes
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What is this term: Intermittent chest pain that occurs over a long period with the same pattern of onset, duration, and intensity of symptoms.
Chronic Stable Angina
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Fill in: Chronic stable anginas have a __a__ to __a__ minute durations. They will have __b__ and/or __c__ on their rhythm strips.
- a. 5 to 10 minute
- b. ST segment depression
- c. T-wave inversion
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Define Silent Ischemia
What is it associated by?
How is it confirmed?
- Definition: ischemia that occurs int he absence of any subjective symptoms
- Associated: with diabetic neuropathy
- Confirmed: by ECG changes
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This type of angina occurs only at night but not necessarily during sleep:
A.
-
This type of angina has chest pain that occurs only while lying down. It is relieved by standing or sitting:
A.
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This type of angina occurs usually at rest in response to spasm of major coronary artery. It may with or without CAD:
B.
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This type of angina has chest pain occuring in the absence of significant coronary atherosclerosis or coronary spasm:
A.
-
This type of angina is seen in patients with a hx of migraine HA and raynaud's phenomenon:
A.
-
List short-acting drug for chronic stable angina, forms and delivery, and implementation
- Nitrates: dilates peripheral and coronary blood vessels
- - can give sublingually or by spray
- Implementation: Give first dose, if no relief in 5 minutes, call EMS.
- - if some relief, repeat q5mins for a maximum of 3 doses.
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List main side effects of long-acting nitrates for Chronic Stable angina.
Headache and orthostatic hypotension
-
List diagnostic studies with chronic stable angina
- CXR
- Lab: troponin, serum lipids, lytes
- 12-Lead or Holter monitor
- Calcium score screening heart scan
- Echocardiogram
- Exercise stress test
- Nuclear imaging
-
List the two things that can result from acute coronary syndrome
- Partial occlusion of coronary artery: UA or NSTEMI (non-ST segment elevation MI)
- Total occlusion: STEMI (ST-segment elevation MI)
-
List characteristics of an unstable angina
- New in onset
- Occurs at rest
- Worsening pattern and increase in frequency
- It is unpredictable and a medical emergency
-
List 4 initial drug therapy for ACS Ischemia
- 1. Anti-platelet agents (ASA 81mg, and Plavix 75mg)
- 2. Nitrates: SL tab or spray, IV drip, or ointment 2%
- 3. Beta blockers: Metropolol
- 4. Ca Channel blockers: Diltiazem
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