Pharmexam2pt3.txt

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scawrse1
ID:
41903
Filename:
Pharmexam2pt3.txt
Updated:
2010-10-13 11:29:29
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Pharm exam ischemia acute coronary syndrome
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Pharm exam 2
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  1. What diseases are included in ischemic heart disease?
    chronic stable angina, acute coronary syndrom (which includes unstable angina, SNTEMI, and STEMI)
  2. Angina
    • characterized by chest pain
    • results from MI or imbalance of oxygen supply and demand
    • cell dealth occurs with MI
  3. Chronic stable angina
    reproducible pattern of pain following a given amount of exertion
  4. unstable angina
    • new onset of angina, worsening of angina, angina at rest
    • this is a medical emergency
  5. NSTEMI
    • results from plaque rupture leading to cell death
    • limited to subendocardial myocardium
    • less extensive than STEMI
  6. STEMI
    • results from plaque rupture that leads to cell death
    • extends the thickness of myocardial wall
    • Q waves commonly seen
  7. variant angina
    • caused by coronary artery vasospasm resulting in ischemia
    • uncommon
    • pain occurs at rest
  8. hormones indicative of MI
    troponin I and CPK-MB
  9. Law of Laplace
    • pressure equales tension in wall divided by radius of ventricle
    • therefore, a dilated heart needs more oxygen to do the same work
    • decreasing pressure decreases oxygen demand
  10. Most common cause of angina
    coronary atherosclerosis (fixed obstruction)
  11. Therapy for ischemic heart disease
    • increase supply of oxygen (improve pulmonary function, treat anemia, improve O2 extraction by not smoking, prevent platelet adhesion with aspirin)
    • decrease oxygen demand (reduce HR, wall tension, force of contraction)
    • morphine sulfate (to relieve pain and decrease preload)
  12. MONA
    • treatment for chest pain
    • M - morphine sulfate (given last)
    • O - oxygen (given first)
    • N - nitroglycerine (given second)
    • A - aspirin (given first)
  13. fibrinolytic therapy
    • alteplace, reteplace, streptokinase
    • given to STEMI pts only
  14. streptokinase
    fibinolytic
  15. antiplatelet therapy
    aspirin, thienopyridines (ticlid, plavix)
  16. aspirin
    • permanently inhibits COX1
    • reduces risk of MI
    • chew 325mg after chest pain
    • antiplatlet therapy following MI/chest pain
  17. ticlid
    • used as antiplatlet therapy in pts who cannot tolerate aspirin
    • requires 3 days to see max effect
  18. reopro, integrilin, aggrastat
    • glycoprotein receptor inhibitors
    • given in combo with ASA and heparin
    • bleeding is the main toxicity
  19. heparin
    • anticoagulant
    • aPTT, Hgb/Hct, platelets to monitor
  20. enoxaparin
    • low molecular weight heparin
    • decreases mortality, MI, and recurrent angina after acute coronary syndrome
    • bleeding is main toxicity
  21. fondaparinux
    • anticoagulant
    • first line therapy for pts with STEMI receiving thrombolytics
    • do not use with patients with renal probs
  22. nitrates
    nitroglycerine, isosorbide dinitrate, isorbide mononitrate
  23. nitroglycerine (and other nitrates)
    • causes venous and arterial dilation resulting in decrease preload and afterload (primarily venodilation)
    • oral admin for prophylaxis, sublingual for acute attacks or prophylaxis (5-10 min b/f activity); also given trnsmucosally, topically, IV
    • large first pass effect
    • toxicity: burning under tongue, syncope, HA, tachycardia
    • drug interaction: sildenafil citrate, cialis; causes decreased myocardial flow and ischemia
  24. beta blockers
    propanolol, atenolol, metoprolol
  25. propanolol, metoprolol
    • beta blockers
    • decrease O2 demand by decreasing HR, contractility, BP
    • decreases r/o arrhythmias and infaction size, imroves survival after MI
    • contraindication: cocain use (can use labetolol)
    • minimizes HR therefore helping a pt to avoid aerobic threshold
    • abrupt d/c may increase frequency, duration, severity of anginal attacks; taper over 2 weeks
    • Patient related variables: raynauds, variant angina, DM, unstable HF, asthma, hearblock, bradycardia
  26. calcium channel blockers
    verapamil, diltiazem, nifedipine
  27. verapamil, diltiazem, nifedipine
    • decrease O2 demand by causing arteriolar dilation and by increasing inotropic state (diltiazem, verapamil)
    • prevent and reverse coronary artery spasm, useful in variant angina
    • can cause reflex tachycardia (esp nifedipine)
    • toxicity: constipation, edema
    • patient related variables: preexisting heart block, systolic HF, concurent use of beta-blockers, hypovolemia
  28. nifedipine
    • calcium channel blocker
    • dyhodropyradine
    • increases vasodilation, renin activation, HR
  29. diltiazem, verapamil
    • calcium channel blockers
    • nondyhydropyradines
    • direct effects on heart
    • decrease HR, contractility
  30. meds used for secondary prevention of MI
    • ASA
    • clopidogrel
    • beta blockers
    • ACEI/ARBs
    • aldosterone antagonists
    • statins
  31. meds used for chronic stable angina
    • ASA
    • statins
    • ACEI/ARBs
    • nitrates
    • beta blockers
    • calcium channel blockers

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