Term
| In the clotting process, what happens when an injury occurs? |
|
Definition
1. Cells lining the damaged blood vessel release chemicals that begin the clotting process.
2. The vessel immediately spasms or constricts to limit blood flow to the injured area.
3. Small blood componets, called platelets, become sticky, adhere to the injured area, and aggregate, or clump, to the injured area to plug the damaged vessel. |
|
|
Term
| What is the difference b/w anticoagulants and thromolytics? |
|
Definition
| Anticoagulants prevent the formation of clots whereas thrombolytics dissolve life threatening clots (EVERY clot). |
|
|
Term
|
Definition
| Drugs that prevent the formation of clots. They change the clotting factor. They do not do anything to change a clot once it has already been formed. They are the most commonly prescribed coagulation modifier. They inhibit the clotting action of platelets. Increase the time to form clots. |
|
|
Term
|
Definition
Drugs that dissolve life threatening clots. They get rid of EVERY clot, so they increase the bleeding risk. They end en "-ase."
NO HERBALS!! |
|
|
Term
|
Definition
| It is the most prescribed anticoagulant drug. |
|
|
Term
|
Definition
PT/INR:
PT 12-15 sec
INR 2-4.5 |
|
|
Term
| What is a normal clotting time range (thromobolytic time -PT) ? |
|
Definition
|
|
Term
| Antidote to anticoagulants like warfarin? |
|
Definition
|
|
Term
| What is another name for warfarin? |
|
Definition
|
|
Term
| Medications to avoid while on warfarin: |
|
Definition
1. NSAIDs (they increase bleeding)
2. diuretics
3. SSRIs and other antidepressants
4. steroids
5 antibiotics (vaccines)
6. vitamin k
7. herbals like garlic, ginger, fever few (because they increase bleeding- anticoagulants effects) |
|
|
Term
| What are the factors that are responsible for blood pressure? |
|
Definition
1. cardiac output- volume of blood pumped per minute
2. peripheral resistance- friction in the arteries
3. blood volume- total amount of blood in the vascular system
4. vasomotor center (in medulla oblongata)
5. baroreceptors in aorta and internal carotid arteries
6. emotions
7. hormones and other agents
8. lifestyle changes |
|
|
Term
|
Definition
| volume of blood pumped per minute |
|
|
Term
| What is peripheral resistance? |
|
Definition
|
|
Term
|
Definition
| total amount of blood in the vascular system |
|
|
Term
| Where is the vasomotor center |
|
Definition
|
|
Term
| What are positive lifestyle changes that can be made in relation to the cardiovascular system? |
|
Definition
1. stop using tobacco products
2. limit sodium intake
3. eat foods rich in potassium and magnesium such as bananas, beans, spinach, and tomatoes
4. limit alcohol consumption
5. implement a medically supervised excersize plan
6. reduce stress level by implementing coping strategies
7. limit caffeine consumption
8. reduce dietary saturated fats
9. keep weight at an optimum level
10. have hyperlipidemia treated
11. have hypertension treated |
|
|
Term
| What dietary changes can be made to reduce hyperlipidemia? |
|
Definition
| increase soluble fiber in the diet by eating foods such as oat bran, apples, beans, grapefruit, and broccoli |
|
|
Term
|
Definition
| Drugs that are effective at reducing fluid volume and relieving symptoms of heart failure. |
|
|
Term
| How do diuretics work to relieve heart failure? |
|
Definition
1. reduce blood volume, edema, and congestion
2. the work load on the heart decreases, so cardiac output increases
3. often used in combination with other drugs to treat heart failure |
|
|
Term
| What should you watch for when using diuretics? |
|
Definition
| hyperkalemia, electrolyte imbalance, dehydration |
|
|
Term
| What are the risk factors for hypertention? |
|
Definition
age
weight
heredity
males
African American
tobacco use
high fat diet |
|
|
Term
| What population has a decreased risk factor for hyper tension? |
|
Definition
|
|
Term
|
Definition
| HF is the inability of ventricles to pump enough blood to meet the body's metabolic needs. |
|
|
Term
| What are the risk factors for heart failure? |
|
Definition
older adults
African American
male
high BP
myocardial infarction (5x greater risk) |
|
|
Term
| What are the treatment goals for heart failure? |
|
Definition
decrease peripheral resistance
slow it down
dialate blood vessels |
|
|
Term
| What is left-sided heart failure? |
|
Definition
| Left ventricle blood backs up into the lungs. S/sx are congestive heart failure, cough, shortness of breath, orthopenea, muscle damage to ventricle |
|
|
Term
|
Definition
| Inability to breath when laying flat. |
|
|
Term
| What is right-sided heart failure? |
|
Definition
| right ventricle blood backs up into the peripheral veins causing swelling feet and ankles (peripheral edema). Affects the liver. Fills organs with fluid. |
|
|
Term
| Which heart failure s more common? |
|
Definition
|
|
Term
|
Definition
| cardiac glycosides, ACE inhibitors, vasodialators, diuretics, phosphodiesterace inhibitors, beta blockers |
|
|
Term
| How do cardiac glycosides treat HF? |
|
Definition
| They help heart contract more forcefully and beat slower. Positive inotropic. The nave a NARROW margin of safety, because they can create dysrhythmias. |
|
|
Term
| What population should use non selecive adrenergic blockers with caution? |
|
Definition
|
|
Term
| How do ACE inhibitors treat HF? |
|
Definition
| 1st line drug. They lower peripheral resistance and reduce blood volume. This DIMINISHES AFTERLOAD and increases cardiac output, dialates veins, returns blood to the heart. It decreases preload, and peripheral edema. Ex. Lisinopril. May increase potassium levels. Do NOT take salt substitutes. Take BP one hour before meals. |
|
|
Term
| How do vasodialators treat HF? |
|
Definition
| LAST RESORT due to many side effects. They relax blood vessels and lower BP. |
|
|
Term
| How do diuretics treat HF? |
|
Definition
| They are used in combination with other drugs. They decrease blood volume, edema, and congestion. |
|
|
Term
| How do phosphodiesterase inhibitors treat HF? |
|
Definition
| Short- term, acute heart failure. VERY TOXIC. Usually an IV and on a heart monitor. They increase force of contraction and cause vasodilation. |
|
|
Term
| How do beta-adrenergic blockers treat HF? |
|
Definition
| Usually used in combination with other drugs. They decrease cardiac workload by DECREASING the AFTERLOAD. |
|
|
Term
|
Definition
| There is a defect in the formation or conduction of electrical impulses across the myocardium. Drug therapy SLOWS the impulse conduction. |
|
|
Term
| Why do digoxin levels need to be monitored? |
|
Definition
| They can cause serious dysrhythmias. |
|
|
Term
| What are some common direct-acting vasodialators? |
|
Definition
hydralazine (Apresoline)
ososorbide denitrate (Isordel) |
|
|
Term
| What do beta blocker drugs end in? |
|
Definition
|
|
Term
| What is the difference b/w beta 1 and beta 2 antagonists and nonselective beta antagonists? |
|
Definition
B1 -heart
B2 -lungs
nonselective- block both b1 and b2 |
|
|
Term
| What are beta blockers used for? |
|
Definition
| They are used to treat a large number of cardiovascular diseases like hypertension, myocardial infarction, heart failure, and dysrhthmias. |
|
|
Term
| What are the actions of ACE inhibitors? |
|
Definition
| They block the enzyme that changes angiotensin I to angiotensin II. This means there is no constriction of arterioles which DECREASES peripheral resistance, and there is no secretion of aldosterone which DECREASES blood volume. |
|
|
Term
| What are ACE inhibitors used for? |
|
Definition
| hypertension, heart failure, and MI |
|
|
Term
| What are the three angina types? |
|
Definition
| stable, unstable, and vasospastic |
|
|
Term
|
Definition
| Predictable and subsides with rest |
|
|
Term
|
Definition
| Unpredictable. More frequent and severe. Does not stop with rest. |
|
|
Term
| What is vasospastic (varient) angina? |
|
Definition
| spasm of the coronary artery (AKA Printzmetal's) |
|
|
Term
| What are some common drugs for angina? |
|
Definition
|
|
Term
| How do angina drugs work? |
|
Definition
They reduce myocardial demand for oxygen which:
slows the HR, REDUCES PRELOAD by dilating veins, reduces contractility, decreases BP REDUCING AFTERLOAD, relieves the symptoms only (not a cure). |
|
|
Term
| What are the types of organic nitrates? |
|
Definition
| Short-acting (nitroglycerin) and Long-acting (isosorbide denitrole) |
|
|
Term
| How do organic nitrates relieve angina? |
|
Definition
| They dilate veins and coronary arteries, relax both arterial and venous smooth muscle by vasodilation, reduce preload (less blood in chambers), reduce afterload (decrease cardiac output), treat variant angina by relaxing spasms. |
|
|
Term
|
Definition
| It is a short-acting organic nitrate. It works on acute angina already in progress. It can be taken sublingually, IV, or patch. |
|
|
Term
| What is isosorbide denitrole (Isordil)? |
|
Definition
| It is a long-acting angina med. It reduces s/sx of HF. It can be taken orally or as a patch. |
|
|
Term
| Ex. of Anaphylaxis shock? |
|
Definition
| From allergies. Sudden onset from food or insects. |
|
|
Term
|
Definition
| Trauma to brain or spinal cord. Drug overdose (depressed CNS) |
|
|
Term
| Ex. of Cardiogenic shock? |
|
Definition
| Heart disease (left HF, MI, PE) |
|
|
Term
|
Definition
| Recent infection, widespread inflammation, infection. |
|
|
Term
|
Definition
| Drugs therapy for symptoms. Antihistimine (Benedryl) , Give oxygen immediately, Support cardiac system, use a bronchodialator to relieve shortness of breath (Ibuterol), Use corticosteriods (hydrocortisone) to suppress inflammatory response. |
|
|
Term
| What is the good chlosterol? |
|
Definition
| HDL (high density lipid protein) |
|
|
Term
| What is the bad cholesterol? |
|
Definition
| LDL (low density lipid proteins) |
|
|
Term
| What are the drugs of choice for tx. lipid profile? |
|
Definition
|
|
Term
| What are statins the drug of choice for reducing blood lipid levels? |
|
Definition
Statins have multiple actions. They:
1. The liver produces less cholesterole.
2. Creates more LDL receptors on liver cells.
3. More LDL is removed from the blood.
Moreover, they interfere with the enzymes responsible for making/synthesizing cholesterol (increase HDL and decrease LDL and triglyserides.) They have LESS side effects than other meds. |
|
|
Term
| What are Antihyperlipidemic meds used for? |
|
Definition
| They help lower the risk of coronary artery disease. |
|
|
Term
| What is the purpose of vaccines? |
|
Definition
| Vaccines are biological drugs used to prevent illness. |
|
|
Term
|
Definition
| They create an immune response when the body produces antibodies. memory B-cells store information. Antibodies are quickly produced if later exposed to microorganisms. |
|
|
Term
| Who should get the anthrax vaccine? |
|
Definition
1. military
2. lab personnel
3. those that work with imported animal products |
|
|
Term
| What is a pt. at risk for with long-term cortisone tx? |
|
Definition
| Cortisone is a steroid. Long term use may cause a disease called Cushing Syndrome (fat moon face, buffalo hump, easily bruised, joint problems (joints may dissolve), fat abdomen. |
|
|
Term
|
Definition
ACTIONS: Sympathomimetic. Works directly on alpha receptors of CNS (no effect on beta receptors).
ADVERSE REACTIONS: Can cause burning, sneezing, and rebound congestion.
TEACHING: Wash hands carefully, rubbing eyes can cause blurred vision, too much can cause systemic effects |
|
|
Term
|
Definition
ACTIONS: cardiac glycoside, increases contractility, inotropic, effects impulse conduction, used for dysrhthmias, and HF
ADVERSE EFFECTS: dysrhthmias, hypokalemia
TEACHING: weight gain of 2+, must watch serum levels, and potassium levels, nausea, vomiting, blurred vision "HALO" effect
NURSING: Monitir pulse for 60 sec. If LESS than 60 bpm= HOLD; If blood dig level is GREATER than 1.8=HOLD and call MD |
|
|
Term
|
Definition
ACTIONS: loop diuretic, decreases workload in heart, CO increases
ADVERSE EFFECT: electrolyte imbalance, decreased potassium causing dysrhthmias
TEACH and NURSING: watch for hypokalemia, electrolyte imbalance, potassium levels, dehydration |
|
|
Term
| nitroglycerine (Nitrobid) |
|
Definition
ACTIONS: short acting vasodilator
ADVERSE EFFECTS: headache, decreased BP, reflex tachycardia
TEACHING: can repeat every 5 minutes for a max of 3 doses in 15 minutes, keep med out of sun, throw out if expired, do NOT use with Viagra |
|
|
Term
| diphenhydramine (Benedryl) |
|
Definition
ACTIONS: histamine blocker, temp relief of allergic reactions to motion sickness, blood infusions, Parkinson's Disease, allergies
ADVERSE EFFECTS: drowsiness, tachycardia, dry mouth
TEACHING: No alcohol use or CNS depressant. Increase fluid intake. |
|
|
Term
|
Definition
| They prevent clot formation in the veins by preventing aggregation. |
|
|
Term
| What are examples of antiplatelet drugs? |
|
Definition
Aspirin- inhibits thromboxane, used to prevent strokes and MI
ADP- receptor blocker "-same"
Glycoprotein- IIb/IIIa receptor blocker: inhibits enzyme, used to prevent stroke, MI, and PTCA |
|
|
Term
| What are hemostatics (antifibrinolytics)? |
|
Definition
| They shorten bleeding time. They prevent fibrin from dissolving clots, so they promote the FORMATION of clots. NO ESTROGEN or ORAL CONTR. |
|
|
Term
|
Definition
| SC or IV (in the hospital !) |
|
|
Term
| Lab tests/values for heparin? |
|
Definition
| APTT baseline values 25-40 sec. Maintence at 1.5-2 X baseline value. If APTT is GREATER than 80, decrease heparin. Monitor APTT every 4-6 hours during the first few days. |
|
|
Term
| What is the antidote for heparin? |
|
Definition
|
|
Term
| What is the test/lab values for warfarin? |
|
Definition
| PT/ INR - PT 12-15 sec; INR 2-4.5 |
|
|
Term
|
Definition
| Orally, can be taken at home. |
|
|
Term
|
Definition
| It is a natural anticoagulant. It can reduce chances of CVA by increasing blood flow to the brain, so its use must be monitored if taking other drugs. |
|
|
Term
| What is cardiogenic shock? |
|
Definition
| Failure of the heart to pump enough blood. Ex. MI, HF, pericardial infection |
|
|
Term
| What is hypovolemic shock? |
|
Definition
|
|
Term
| Ex. of hypovolemic shock? |
|
Definition
| Burn, hemorrage, vomiting, diarrhea, excessive sweating |
|
|
Term
| What is neurogenic shock? |
|
Definition
| Overstimulation of the parasympathetic system or understimulation of the sympathetic nervous system. Ex. trauma to spinal cord or medulla, severe stress, CNS depressants |
|
|
Term
| norepinephrine (Levarterenol) |
|
Definition
ACTIONS: sympathomimetic, vasoconstrictor, acts on alpha-adrenergic receptors in smooth muscle of blood vessels to raise BP.
ADVERSE REACTIONS: hypertention, reflex bradycardia |
|
|
Term
|
Definition
ACTIONS: nonselective adrenergic activator. Stimulates both alpha and beta. OPENS AIRWAYS!, Increases cardiac output.
ADVERSE REACTIONS: hypertention, dysrhthmia |
|
|
Term
|
Definition
ACTIONS: sympathomimetric. It is the precursor to epinephrine.
USES: Shock by increasing blood flow to the heart, raises BP
ADVERSE REACTIONS: dysrhthmias, hypotension |
|
|
Term
|
Definition
protein extracted from whole blood or plasma, maintains plasma pressure to carry substances through the blood.
ADVERSE REACTIONS: allergic reaction, chills, rash, dyspnea |
|
|
Term
| Lipid (cholesterol) levels |
|
Definition
Normal - less than 200
Borderline - 200-239
High - greater than 239 |
|
|
Term
|
Definition
ACTIONS: slows the biosynthesis of cholesterol by blocking enzymes that create cholesterol.
ADVERSE EFFECTS: few, PREGNANCY X, liver damage (rare)
INTERACTIONS: digoxin, oral contraceptives
TEACHING: Max effects 4-8 weeks |
|
|
Term
| What does half-life mean? |
|
Definition
| The half life referres to the time it takes for one half of the medication to to be broken down and eliminated from your body. |
|
|
Term
|
Definition
| Keeps a moderate amount of clotting to keep us from bleeding to death. |
|
|
Term
| What is the major side effects of diuretics? |
|
Definition
|
|
Term
| What does "inotropic" mean? |
|
Definition
| Heart contracts with a specific force or strength (contractility) . Ex. Cardiac glycosides, Positive inotropic |
|
|
Term
| What does "chronotropic" mean? |
|
Definition
| Heart contracts ata certain beat per minute. |
|
|
Term
| T or F. The faster the heart works, the more effective it is. |
|
Definition
|
|
Term
|
Definition
| Antidote for Digoxin toxicity. |
|
|
Term
|
Definition
| Most common ACE inhibitor, potassium levels may increase, do NOT take potassium salt substitutes, take BP one hour before meals |
|
|
Term
| T or F: All drugs for dysrhthmais have a narrow usage? |
|
Definition
| True. Too much can make matters worse. |
|
|
Term
| What is the single most important breakthrough in the treatment of stroke? Why? |
|
Definition
| Thrombolytic drugs. If used within 3 hours of a CVA, brain function can be completely restored. They break and dissolve clots. |
|
|
Term
| Lifestyle changes to reduce chance of CVA (stroke)? |
|
Definition
| Stop smoking, limit alcohol, limit sodium, excercise, reduce stress, reduce dietary fat, keep weight at optimum level, treat hyperlipidemia and hypertension |
|
|
Term
|
Definition
| pale, cold and clammy skin, lethargy, thirst, low bp, weak pulse, rapid shallow breath |
|
|
Term
| What should be the initial treatment for shock? |
|
Definition
ABCs of life support. Airway, Breathing, Cardiac;
THEN ID the cause. |
|
|
Term
| What is the initial drug of choice used to treat shock? Why? |
|
Definition
| Vasoconstrictor agents like epinephrine/ norepinephrine, because they increase bp so oxygen moves throughout the body to the brain. Monitor for dysrhthmias and hypertension. |
|
|
Term
|
Definition
| Large proteins called albumin. Used as a fluid replacement. |
|
|
Term
| What are some fluid replacement agents? |
|
Definition
| Water, blood, colloids, crystalloids |
|
|
Term
| T or F: Fluid output should always be > 50 mL/h |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| VLDL (triglyserides) should be? |
|
Definition
|
|
Term
| How to find the cholesterol ratio? |
|
Definition
total cholesterol / HDL (or LDL) = ratio
Males 5.0
Females 4.5 |
|
|
Term
|
Definition
1. killed ex. polio
2. live but weakened ex. MMR
3. toxoids ex. tetnus |
|
|
Term
|
Definition
|
|
Term
| How can you tell if digoxin is working? |
|
Definition
|
|
Term
|
Definition
| International Normalized Ratio- Blood test for anticoagulants, should be between 2-4.5. |
|
|
Term
| Why should a pt. restrict nicotine and caffeine? |
|
Definition
| They would counteract the effects of certain meds since they are stimulants. |
|
|
Term
| Most commom side effect of nitroglycerine therapy? |
|
Definition
|
|
Term
| A sudden occlusion of a coronary artery is called? |
|
Definition
|
|
Term
| Three basic types of lipids? |
|
Definition
1. triglycerides
2. phospholipids
3. steroids |
|
|
Term
|
Definition
| Lipid panel and Liver enzyme test |
|
|
Term
| Most common side effect of benedryl? |
|
Definition
|
|
Term
| Rebound congestion is the most common side effect of what class of meds? |
|
Definition
| sympathomimetics like Afrin |
|
|
Term
| Most common side effect of high-dose aspirin therapy? |
|
Definition
|
|
Term
| The amount of blood pumped by each ventricle per minute is called? |
|
Definition
|
|
Term
| What medication, used to treat dysrhythmias, is widely used as a local anesthetic? |
|
Definition
|
|
Term
| What medication, used to treat dysrhythmias, is widely used as a local anesthetic? |
|
Definition
|
|
Term
|
Definition
| The solid, insoluble part of a blood clot. |
|
|
Term
|
Definition
| Breaking up insoluble part of a blood clot |
|
|
Term
| Most common type of hypertension? |
|
Definition
|
|
Term
| The most common group of drugs used to tx hypertension? |
|
Definition
1. diuretics- 1st choice
2. calcium channel blockers- most common |
|
|
Term
| Heart failure develops when? |
|
Definition
| The heart muscle fails to pump effectively and sufficient blood does not circulate to the lungs and body tissue. |
|
|
Term
| Hypertension is defined as ? |
|
Definition
| Systolic bp >140 and Diagnostic >90 |
|
|
Term
| Digoxin has the following action? |
|
Definition
| Increases cardiac contractility without elevating the oxygen requirement of the myocardium. |
|
|
Term
| The primary goal of agrenergic therapy for all forms of shock is to: |
|
Definition
| Increase blood flow through the coronary and cerebral vessels. |
|
|
Term
| What is the primary nursing concern when digoxin and Lasix are given simultaneously? |
|
Definition
|
|
Term
| What must the nurse consider about the dosage of either digoxin or amiodarone when they are being administered together? |
|
Definition
| Amiodarone can increase the digoxin the in blood. |
|
|
