Term
| Pathophys Coronary Artery Disease (CAD) |
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Definition
| Also known as ischemic heart disease. Occurs due to lack of O2 to myocardium as a result of coronary artery narrowing (high cholesterol plaques). May present as angina or acute myocardial infarction (MI) |
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Term
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Definition
Decreased Oxygen Supply: decreased coronary blood flow, vessel caliber, perfusion pressure. Increased HR, ventricular wall tension.
Increased O2 Demand: Increased HR, contractility, ventricular wall tension, filling pressure (preload), resistance to ejection (afterload) |
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Term
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Definition
Angina (30 seconds - 30 minutes)
Burning/chest tightness/pressure
SOB
Pain w/radiation to the arms.
Precipitated by exercise, large meals, emotional stress. |
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Term
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Definition
Stable (exertional): most common. no pain at rest but increasing O2 demand mismatched w/decreased O2 supply, angina results. Rest and Nitro
Prinzmetal's (Variant): results from coronary spasm. Sx occur at rest and usually during night or morning. No chest pain w/exertion and not typically relieved by rest.
Unstable: chest pain w/minimal activity. Differing times of the day. preceeds a CV event such as MI. |
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Term
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Definition
Nitrates (direct vasodilators)
Beta Blockers (HR control/contractility)
Calcium Channel Blockers (contractility)
Aspirin (anti-platelet)
Surgery (angioplasty/stenting) |
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Term
| Nitrates: MOA, drugs, and ADE's |
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Definition
MOA: dilation of systemic veins and arterioles = reduction of preload and afterload.
Nitroglycerin and Isosorbide dinitrate/mononitrate.
ADE's: reflex tachycardia, dizziness, ortho hypotension, weakness, headache.
Precaution: avoid heat modality w/vasodilators can cause syncope. |
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Term
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Definition
| Nitroglycerin sublingual, tablets, IV, topical, patch. More effective if taken at immediate onset of angina. Can be taken 5-10 mins before activity that may cause angina. Patches placed above elbow, preferred on chest to max effect. Drug free periods are important to avoid tolerance. |
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Term
| Beta Blockers: MOA contraindications and nomenclature |
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Definition
MOA: reduce myocardial O2 demand via decreased contractility.
CI: asthmatics (non-specific BBs), bradycardia, hypotension and heart block
"lols" |
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Term
| Calcium Channel Blockers: MOA and drugs |
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Definition
MOA: reduction of contractility and cardiac tone resulting in decreased O2 demand. smooth muscle vasodilation w/reduction in preload/afterload.
Nifedipine/Amlodipine = greater smooth muscle effects.
Verapamil/Diltiazem reduce contractility and slow conduction of nodal tissue. |
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Term
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Definition
Morphine causes vasodilation/pain relief
Oxygen to stabilize O2 saturation
Nitrates cause vasodilation/pain relief
Aspirin to inhibit further platelet aggregation
Beta blocker to help decrease rates of re-infarction |
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Term
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Definition
1 - endothelial cell damage
2 - platelets bind to damaged vessel
3 - release thromboxane ADP, fibrinogen, Ca++
4 - recruit other platelets
5 - glycoprotein receptors IIb /IIIa on cell surface conformational change
6 - these receptors allow binding CLOT |
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Term
| Extrinsic vs Intrinsic clot systems |
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Definition
Extrinsic: measured by prothrombin time
Intrinsic: measured by activated partial thromboplastin time |
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Term
| 3 ways to prevent/treat clot |
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Definition
1) Inhibit platelet aggregation (antiplatelet agents) aspirin
2) Prevent extension of existing clot
(anticoagulants) heparin
3) Lyse the clot (thromolytic agents) streptokinase |
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Term
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Definition
Aspirin - irreversible binding to COX1 and COX2, inhibiting platelet aggregation
ADE's: bleeding bruising, GI irritation
Clopidogrel (Plavix) - ADP receptor antagonist by irreversibly blocking
ADE's: bleeding bruising |
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Term
| Anticoagulants: Heparinoids |
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Definition
Heparin: subQ to prevent DVT or IV
Enoxaparin (Lovenox)
Fondaparinux (Arixtra)
ADE's: bleeding, bruising, injection site pain |
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Term
| Anticoagulants: Warfarin (Coumadin) |
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Definition
MOA: vitamin K antagonist, inhibiting vitamin k dependent clotting factors
ADE's: bleeding (major/minor);bruising
vitamin k tabs to reverse effects of warfarin |
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Term
| Oral Factor Xa Inhibitors |
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Definition
Rivaroxaban (Xarelto)
Apixaban (Eliquis)
MOA: inhibits factor Xa and inhibits thrombin-induced platelet aggregation
ADE's: bleeding and bruising, duh |
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Term
| Direct Thrombin Inhibitor |
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Definition
Dabigatran (Pradaxa)
MOA: inhibits free and fibrin-bound thrombin preventing thrombin-platelet aggregation
ADE's: bleeding and bruising |
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Term
| PT Interventions w/antiplatelet/anticoagulants |
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Definition
Caution w/deep tissue work = bruising
Subjective info from patient about s/s of bleeding, and educate pts about bleeding. dark tarry stool, coughing up blood or coffee grounds, cuts not healing, blood in urine.
Careful changing dressings. |
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Term
| Contraindications for Anticoagulant patients |
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Definition
Debridement
Rigorous manual techniques
Deep tissue massage
Chest percussions |
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Term
| DVT and Pulmonary Embolism (PE) |
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Definition
low risk: minor surgery, full ambulatory
mod risk: undergoing general surgery, gynecologic surgery, on bed rest
high risk: major orthopedic surgery, spinal cord injury, major trauma, spinal cord injury |
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Term
| DVT and Pulmonary Embolism (PE) Mgmt |
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Definition
Non-pharm: mobilization, external compression, filter devices, PROM for bed rest pts.
Meds: low molecular weight heparin, unfractionated heparin, warfarin (Coumadin), novel oral anticoagulants |
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Term
| Management of Cholesterol |
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Definition
Statins
Bile Acid Resins
Ezetimibe
Fibric Acid derivatives/Fibrates
Nicotinic Acid |
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Term
| Committal step in cholesterol synthesis |
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Definition
| HMG-CoA conversion to MEVALONATE |
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Term
| Statins (HMG-CoA Reductase Inhibitors) |
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Definition
First line therapy for cholesterol mgmt.
MOA: inhibits HMG-CoA reductase
ADE's: muscle pain, myopathy or rhabdomyolysis |
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Term
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Definition
Simvastatin (Zocor)
Atorvastatin (Lipitor)
Rosuvastatin (Crestor)
Provastatin (Pravachol)
Lovastatin (Mevacor)
Fluvastatin (Lescol)
Pitavastatin (Livalo) |
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Term
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Definition
MOA: Bind bile salts secreted into duodenum preventing reuptake of bile salt-bound cholesterol
Cholestyramine (Questran)
Colesevelam (Welchol)
Colestipol (Colestid)
ADE's: GI Intolerance (abdominal pain, constipation, diarrhea, vomiting |
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Term
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Definition
Have fibro in name. inhibit triglyceride synthesis. increase HDL.
GI upset common |
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Term
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Definition
Niacin/Niaspan reduces free fatty acid metabolism from adpipocytes, reducing TG/LDL and total cholesterol
ADE's: flushing, GI upset, fatigue, increased uric acid |
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Term
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Definition
| Inhibits intestinal absorbtion leading to decreased LDL and TG |
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Term
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Definition
Muscle pain and soreness
Concern for rhabdomyolysis when used w/statins AND other lipin-lowering meds. |
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Term
| Intermittent Claudication |
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Definition
Pain with walking in calves, relieved with rest.
RF Mods: stop smoking, lower cholesterol, HTN control, diabetes control.
Meds:
Cilostazol (Pletal) vasodilate smooth muscle
Pentoxifylline (Trental): allows red/white cells squeeze through vessels, lowers fibrinogen and antiplatelet effects |
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