NURS 3110 Exam 2

Triglycerides

Are used for energy. They are composed of glycerol and other fatty acids. These fatty acids may be good (unsaturated) or bad (saturated). Make up most (~90%) lipids in our bodies.

Phospholipids

are used to build cell membranes; ex: lecithin

Steroids

are also used to build cell membranes but are also used to make vitamin D, bile acids, cortisol, estrogen, progesterone, and testosterone. Cholesterol is the best-known.

How do lipids (fats) get where they need to go in our bodies?

They do not dissolve in our blood stream, so the body (liver) produces lipoproteins. There are different types of lipoproteins, but they are all composed of cholesterol, triglycerides, phospholipids, and a protein carrier.

Types of Lipoproteins

Low-density lipoprotein (LDL)
Very low-density lipoproteins (VLDL)
High-density lipoprotein (HDL)

Low-density lipoprotein (LDL)

contain the most cholesterol

Very low-density lipoproteins (VLDL)

contain triglycerides

High-density lipoprotein (HDL)

contains the most protein. Also transports cholesterol

Dyslipidemia

means an individual has either an excess or deficiency of one or more lipoproteins. The
terms hyperlipidemia, hypercholesterolemia, and high cholesterol are also used

Causes of Dyslipidemia

Heredity; Acquired causes include dietary (high in saturated fat, trans fat, and refined carbohydrates), lack of exercise, some endocrine disorders.

The goal is to _______ HDL and _______ LDL.

Maximize; Minimize

An LDL/HDL ratio ___ in men and ____ in women is associated with increased risk of cardiovascular disease (CVD)

>5.0; >4.4

HMG-CoA Reductase Inhibitors (statins)

Medication for Dyslipidemia; include atorvastatin (Lipitor), Fluvastatin (Lescol), lovastatin,
rosuvastatin (Crestor), simvastatin (Zocor), pitavastatin (Livalo)

HMG-CoA Reductase Inhibitors (statins) Common Side Effects

include diarrhea, GI upset, arthralgia, nasopharyngitis

HMG-CoA Reductase Inhibitors (statins) Serious Adverse Events

include rhabdomyolysis, myositis, elevated liver enzymes, teratogenicity

Bile Acid Sequestrant

These drugs will bind to bile acids increasing excretion of cholesterol through the bowel. These were the first drugs commercially available for dyslipidemia and are the safest drugs for dyslipidemia; bile acid sequestrants have minimal systemic effects. Drugs in this class include cholestyramine (Questran), colesevelam (Welchol), and colestipol (Colestid)

Bile Acid Sequestrant Common Side Effects

GI-constipation, N&V, abdominal pain, bloating, indigestion

Bile Acid Sequestrant Serious Adverse Events

GI obstruction, vitamin deficiencies (due to decreased absorption)

Fibric Acid Drugs

Medication for Dyslipidemia that work by activating an enzyme that breaks down triglycerides (lipoprotein lipase). Include fenofibrate (Tricor), fenofibric acid (Trilipex), and gemfibrozil.

Fibric Acid Drugs Common Side Effects

myalgia, flu-like symptoms, N&V, increased liver enzymes and creatinine

Fibric Acid Drugs Serious Adverse Events

rhabdomyolysis, gall bladder disease, pancreatitis

(Zetia) ezetimibe

Medication for Dyslipidemia that works as a cholesterol absorption inhibitor

(Zetia) ezetimibe Common side effects

arthralgia, fatigue, diarrhea, increased liver enzymes

(Zetia) ezetimibe Serious Adverse Events

rhabdomyolysis

(Niaspan) niacin

Medication for Dyslipidemia; vitamin B3 (nicotinic acid) works by decreasing levels of VLDL

(Niaspan) niacin Common side effects

flushing, itching, HA, N&V, diarrhea

(Niaspan) niacin Serious Adverse Events

cardiac dysrhythmias

Omega-3-acid ethyl esters (Lovaza)

Medications for Dyslipidemia; the acids are found in fish oils and are very useful in lowering triglycerides

Omega-3-acid ethyl esters (Lovaza) Common Side Effects

GI-fishy taste, burping, indigestion

Omega-3-acid ethyl esters (Lovaza) Serious Adverse Events

hypersensitivity

There are other drugs which may be used for familial hyperlipidemia (high LDL)

Praluent, Repatha, Vascepa

Why does blood pressure increase abnormally?

Genetics and environment

“Causes” of hypertension include

Family history of hypertension; Male gender; Tobacco use; Diet/exercise factors; Secondary causes include certain diseases (Cushing’s disease, hyperthyroidism, chronic kidney disease, renal artery stenosis), certain medications (systemic steroids, OCPs, alcohol, amphetamines, caffeine, decongestants, erythropoietin)

Consequences of untreated hypertension include

Damage to the heart, brain, kidneys, and retina. Damage to the heart and kidneys may result in CHF, damage to the brain may result in stroke, kidney damage results in CKD.

Drugs for Hypertension

Diuretics; ACE inhibitors; ARBs; Calcium Channel Blockers (CCB); Adrenergic antagonists: beta blockers and alpha blockers; Direct Vasodilators

ACE Inhibitors

Drugs in this class include the “prils.” (benazepril, captopril, enalapril, lisinopril; Drugs that affect the renin-angiotensin-aldosterone system

ACE Inhibitors Common Side Effects

include HA, dizziness, orthostatic hypotension, rash, cough

ACE Inhibitors Serious Adverse Effects

include angioedema, acute renal failure, hyperkalemia, teratogenic.

ARBs

Drugs in this class include the “sartans” (valsartan, losartan, olmesartan); angiotensin II receptor blockers

ARB Common Side Effects

include HA, dizziness, orthostatic hypotension, diarrhea, fatigue

ARB Serious Adverse Events

include angioedema, acute renal failure, hyperkalemia, teratogenic

Calcium Channel Blockers

Drugs in this class include the “pines” (amlodipine, nifedipine) also diltiazem and verapamil; Their original use was for angina and dysrhythmia

Calcium Channel Blocker Common Side Effects

include flushing, HA, dizziness, peripheral edema, constipation, fatigue, sexual dysfunction

Calcium Channel Blocker Serious Adverse Events

include liver toxicity, heart failure/attack, angioedema, confusion

Adrenergic Antagonists

Block activation of beta and/or alpha receptors of the sympathetic nervous system; Beta blockers and Alpha blockers

Beta-adrenergic antagonists (beta blockers)

include the “olols” (propranolol, atenolol, metoprolol, nebivolol)

Alpha1-adrenergic antagonists (alpha blockers)

include the “zosins” (doxazosin, prazosin, terazosin)

Alpha2-adrenergic antagonists (centrally acting)

include clonidine and methyldopa

Alpha1-and Beta antagonists

include carvedilol and labetalol

Beta blockers have differing

degrees of selectivity

Degree of selectivity of Inderal (propranolol)

nonselective

Degree of selectivity of Tenormin (atenolol) and Lopressor (metoprolol)

have better selectivity

Degree of selectivity of Bystolic (nebivolol)

best selectivity

Beta Blocker Common Side Effects

include fatigue, decreased libido, bradycardia, exacerbation of asthma

Beta Blocker Serious Adverse Events

include agranulocytosis, SJS, laryngospasm, anaphylaxis, rebound hypertension

Alpha 1 Blockers

include Cardura (doxazosin), Minipress (prazosin), Hytrin (terazosin)

Alpha Blocker 1 Common Side Effects

include orthostatic hypotension, dizziness, fatigue

Alpha 1 Blocker Serious Adverse Events

include first-dose phenomena, tachycardia, dyspnea

Alpha 2 blockers

include clonidine and methyldopa

Alpha 2 blockers Common Side Effects

include peripheral edema, sedation, depression, HA

Alpha 2 blockers Serious Adverse Events

include liver toxicity, bone marrow depression

Direct Vasodilators

include hydralazine and minoxidil

Direct Vasodilators Common Side Effects

include orthostatic hypotension, fluid retention, palpitations

Direct Vasodilators Serious Adverse Events

include severe hypotension, heart attack, dysrhythmias, shock; lupus-like reaction (hydralazine)

Diuretics Uses

Drugs that increase the rate of urine flow. They are used in renal failure because of hypervolemia; water and sodium retention. Also used for Hypertension, Heart failure (CHF), Liver failure/cirrhosis, Pulmonary edema

Osmotic diuretics

work at the proximal convoluted tubule (PCT), pulling water into the nephron at the expense of electrolytes, mannitol and glycerin

Carbonic anhydrase inhibitors

Diuretics that also work at the PCT to inhibit reabsorption of bicarbonate, acetazolamide

Loop diuretics

work at the ascending nephron loop (Loop of Henle) and blocks the reabsorption of NaCl and water and increases excretion of potassium; furosemide

Thiazide diuretics

work at the proximal distal convoluted tubule (DCT) blocking NaCl and water and increasing excretion of potassium, hydrochlorothiazide

Potassium-sparing diuretics

work at the distal DCT blocking sodium reabsorption but does not increase excretion of potassium, spironolactone

Common Side Effects of Diuretics

include hypokalemia, hyponatremia, orthostatic hypotension, GI upset, fatigue

Serious Adverse Events of Diuretics

include severe hypokalemia and hyponatremia, vascular collapse, blood dyscrasias, dehydration

Side Effects & Adverse Events of Furosemide

ototoxicity

Side Effects & Adverse Events of Thiazide diuretics

hyperglycemia, allergic reactions

Side Effects & Adverse Events of Spironolactone

hyperkalemia, gynecomastia

Side Effects & Adverse Events of Osmotic diuretics

convulsions

Side Effects & Adverse Events of Carbonic Anhydrase Inhibitors

significant blood dyscrasias

Normal serum pH

7.35 to 7.45

Common assessments used to monitor fluid balance

measuring I/O (intake and output of fluids). Most output normally occurs through (surprise) the kidneys. Water output can also occur through our lungs, skin, feces, and sweat. I/O should be equal; we get thirsty when our output exceeds our input

Sodium normal range

135-145

Potassium normal range

3.5-5.0

Calcium normal range

4-11

Identify water distribution in the human body

Intracellular fluid is the fluid in our cells; this is about two-thirds of our total body fluid. Extracellular fluid is outside of our cells; plasma is the fluid in our bloodstream (intravascular space) interstitial fluid is the fluid between our cells. All these fluids move in our bodies through osmosis; water moves from areas of low solute concentration to areas of high solute concentration

Normal saline (NS) is

0.9% NaCl (isotonic)

Metabolic acidosis

occurs due to severe diarrhea, renal failure, diabetes, excessive alcohol intake, starvation (severe CNS depression).

Respiratory acidosis

ooccurs due to lack of breathing (hypoventilation, airway constriction, damage to the respiratory center in the CNS).

Metabolic alkalosis

occurs with hypokalemia due to diuretic therapy, severe vomiting, ingestion of substantial amounts sodium bicarbonate, severe constipation

Respiratory alkalosis

occurs due to hyperventilation (below normal CO2)

Acidosis

results in life threatening CNS depression

Alkalosis

results in life threatening cardiac arrythmia
and CNS depression.

Stroke volume

End diastolic volume(volume before contraction)−End systolic volume (volume after contraction)

Cardiac Output

Heart Rate x Stroke Volume

Ischemia

significant occlusion/narrowing, the heart muscle does not receive necessary oxygen

Angina pectoris

is defined as acute chest pain due to ischemia of a portion of the cardiac muscle. This will occur with events that increase the heart’s need for oxygen.

Angina

may be described as stable or unstable

Variant (Prinzmetal’s) Angina

represents coronary artery spasm

Silent Ischemia

Coronary artery disease that occurs without chest pain

Coronary Artery Disease (CAD)

Refers to narrowing or occlusion of the coronary arteries

Regardless of the type of ischemia

all will eventually lead to MI/death.