Exam 3 patho pharm - from quizlet

cholesterol is important when making what

-bile

- hormones

- vitamen d

what is LDL

low density lipoprotein (bad cholesterol)

what can high concentration of LDL lead to

MI, stroke, peripheral vascular disease

what is HDL

high density lipoprotein (good cholesterol)

what does HDL do

returns excess cholesterol back to your liver and removes the excess from your body

what is a lipoprotein

combination of triglycerides and cholesterol

What do antihyperlipemics do?

lower cholesterol (in addition to diet therapy)

HMG-CoA reductase inhibitors end in what

-statin

treatments for high cholesterol (dyslipidemia/hyperlipidemia)

- bile acid sequestreants

- B vitamin niacin

- fibrates

- statins

what do statins do?

reduce cholesterol in blood

- most potent LDL reducer

- first line drug therapy for high cholesterol

- lower the rate of cholesterol production by slowing down the liver

examples of HMG-CoA reductase inhibitors

Atorvastatin (Lipitor) - most common

Lovastatin (Mevacor)

Pravastatin (Pravachol)

Simvastatin (Zocor)

Rosuvastatin (Crestor) - newer w/ less side effects

statin adverse effects

-mild, transient GI disturbances

-rash

-headache

-myopathy ( muscle pain )

-elevations in liver enzymes or liver disease

HMG-CoA reductase inhibitor drug interactions

-oral anticoagulants

- amiodarone

- GRAPEFRUIT JUICE

bile acid sequestreants do what

- Break down fat

- Stop liver from producing cholesterol

- can be used with statins

- prevent rabsorbtion of bile acids - (which are necessary for the absorption of cholesterol - when stopped, cholesterol reabsoption also stopped)

examples of bile acid sequestrants

Cholestyramine (Questran)

Colestipol (Colestid)

Colesevelam (Welchol)

Bile Acid Sequestrants nursing implications

- all drugs must be taken at least 1 hour before or 4/6 hours after the bile acid sequestrant

- these meds LOWER absorption of fat soluble vitamens (ADEK)

- increase fiber and fluid intake to relieve contipation and bloating

Niacin - Vitamin B3

- increase HDL and lowers LDL

- increase lipaase activity = increase breakdown of lipids

- high doeses are required

how is niacin dosed

By slow titration otherwise flushing (a histamine response) can occur, take with small doses of aspirin or NSAID to reduce flushing

fibric acid derivatives (fibrates)

- activates lipase leading to cholesterol breakdown

- increases secretion of cholesterol in bile

- inhibits tryglyceride synthesis

Examples of Fibric acid derivatives (fibrates)

Gemfibrozil

Fenofibrate

contraindications with fibric acid derivatives

- severe kidney disease

- cirrhosis ( severe liver scarring )

- gallbladder disease

fibric acid derivatives - drug interactions

- oral anticoagulants

- statins

cholesterol absoption inhibitor

ezetimibe

- often combined with statin

- increases HDL levels

- reduces total cholesterol, LDL and triglyceride levels

- inhibits absorption of cholesterol from small intestine

garlic is used as what

a lipid reducer

- interactions with warfarin and diazepam

- may enhance bleeding when taken with NSAIDs

omega 3 fatty acids are used for what

reduce cholesterol

- potential interaction with anticoagulant drugs

What are fat soluble vitamens

A, D, E, K

what is pericarditis

inflammation of the pericardium

what is pericardial effusion

accumulation of fluid in the pericardial cavity

what can pericarditis lead to

pericardial effusion

what can pericardial effusion lead to

cardiac tamponade

cardiac tamponade untreated can lead to

cardiac arrest

what is becks triad

hypotension, muffled heart sounds, JVD

dialated cardiomyopathy / congestive cardiomyopathy

dialated left ventricle (MOST COMMON)

hypertrophic cardiomyopathy

heart muscle becomes enlarged and blocks blood flow

restrictive cardiomyopathy

Heart is unable to fill well because the wall is not flexible

aortic stenosis

hardening of the aortic valve

valve doesnt open completly

no shunt

mitral stenosis

hardening of the mitral valve

valve doesnt open completly

valve regurgitation

backward flow of blood through a heart valve (mitral, aortic,tricuspid)

valve doesnt close completly

mitral valve prolapse syndrome

Abnormal sounds (murmurs) heard through a stethoscope These murmurs indicate that the mitral valve is not closing properly.

Chest pain, dyspnea, and fatigue

rheumatic fever

A bacterial infection that can be carried in the blood to the joints

group A beta-hemolytic streptococci

can eventually cause rhematic heart disease

infective endocarditis

inflammation of the endocardium.

can be caused by bacteria, viuses, fungi ect...

affects mitral and aortic valves

what do those with weakened immune systems do before the dentist?

they take antibiotics so that when they bleed, bacteria wiont enter their bloodstream and possibly travel to their heart, lowering their chances of infective endocarditis

when a pt has infective endocarditis, it is common to see...

janeway lesions (nonpainful hemorrhagic lesions on palms and soles), fever, heart murmer, petechial lesions on skin, osler nodes (painful nodules on pads of fingers and toes)

a fib can lead to

blood clots

calcium channel blockers and beta blockers both do what

lower HR

supraventricular dysrythmias

above ventricals

- AV junction

- Atria

Ectopic foci

rhythm coming from somehwere else and not AV or SA node

conduction blocks

Electrical impulses go down the usual pathway but encounter blocks and delays.

slows electrical impulses through the heart

sodium channel blockers do what

help correct irregular heart rhythms

sodium channel blockers can possibly cause

lupus

Lidocaine

sodium channel blocker

used for v-tach and v-fib

shelf stable (found in crash carts)

procainamide

sodium channel blocker

used to treat both atrial and ventricular tachy dysrhythmias

lidocaine toxicity looks like what

looks like pt is having a stroke

slurred speech, drowsiness, muscle twitching, seizures, respiratory depression

"numbing" and depressing body

flecainide

sodium channel blockers

used to treat A fib

depresses left ventricular function

beta blockers

decrease heart contractility, decrease HR, used to treat tachy dysrythmias, in addition to hypertension and angina

calcium channel blockers examples

verapamil, diltiazem, the rest end in -dipine (ex: nifedipine)

diltiazem

reduce AV node conduction

- used to treat A-fib, A-flutter, supraventricular tachycardia

what must the nurses ensure pts are recieving a correct amount of while taking calcium channel blockers

fiber

amiodarone

blocks alpha and beta adrenergric activity in the SNS

used in a fib and flutters that are resistant to other drugs

-when given IV, not shelf stable

- must have filter on IV tubing

- interacts with plastic, so is in a glass bottle

Sotalol

beta blocker and potassium blocker

used for tachydysrythmias

what must the nurse watch when a pt is on sotalol

HR might get too slow!

adenosine

severe dysrhythmia med

stops the heart for a few seconds

only administered IV

adenoside converts what heart rhythm to what heart rhythm?

converts PSVT to sinus rhythm

all anti-dysrhythmic drugs can cause...

dysrhythmias!

why? it slows the heart down so much that it can now cause brady dysrhythmias

what is a side effect of antidysrythmics

prolongation of the QT interval

- impulse may come fown during QT intercal and cause dysrhythmias

- if occurs in absolute refractory period, nothing happens

- once hit peak T wave, relative refreactory period started

----- significantly strong signal could start a contraction

-----ventricals are still repolarizing so this could cause v tach or v fib

antidysrythmic drugs cause _____________ so _______________ are contraindicated

blocks; second or third degree AV block and Bundle Branch block

what are contraindications of antidysrhythmic drugs

heart blocks (2nd or 3rd degree AV block, bundle branch block), cardiogenic shock (very very very low bp), sick sinus syndrome (random HR, can get really high and really low, only given when pt has pacemaker), if pt is taking any other antidysrhythmic drugs like warfarin and heparin

what electrolyte levels effect the heart the most

potassium

high potassium causes what in the heart

bradycardia

low potassium causes what in the heart

tachycardia

if dysrhythmias go untreated what can occur

heart failure

types of shock

Cardiogenic

Hypovolemic

Neurogenic

Anaphylactic

Septic

what is distributive shock

Shock due to widespread vasodilation

what is hypovolemic shock

results from large-scale blood loss

what is cardiogenic shock

Occurs when the heart is damaged and unable to supply sufficient blood to the body

decrease myocardial performance

what is neurogenic shock

type of distributive shock, related to low bp, loss of nerve signaling to spinal cord

typically due to spinal cord injury

what is anaphylactic shock

Severe allergic reaction

what is septic shock

infection causes low bp and organ failure

what does tubular transport do

keeps electrolyte levels normal

what do kidneys not excrete when failing

potassium

what is urodilatin

- inhibits water and sodium reabsorption

what is vitamen D necessary for

the absorption of calcium and phosphate

what is erythropoietin

released when decreased oxygen to the kidney

stimulate bone marrow to make RBCs

what does the creatinine number mean

shows kidney function

what do the BUN numbers mean

the higher the number the more dehydrated you are

urodynamic test - post void residual

urine in the bladder after peeing

what is different about pediatric renal function

they have....

- a decreased ability to remove excess water and solutes

- hard to maintain fluid and electrolyte balance

- increased risk for drug toxicity

what is different about older pts renal function

they have...

- decreased in renal blood flow

- delayed response to acid/base changes

- increased risk for drug toxicity

hydroureter

Dilation of the ureter and accumulation of urine in the ureter

hydronephrosis

dialation of renal pelvis and calyces proximal to a blockage

can cause renal failure

nephrolithiasis / renal calculi

kidney stones

symptoms of renal calculi

Pain in flank area, nausea, vomiting, decrease in urine osmolality, blood in urine, painful urination, frequent urination

risk factors of renal calculi

increased uric acid

increased urinary oxalate

infection

urinary stasis and retention

types of kidney stones

calcium, struvite, uric acid, cystine

how to prevent kidney stones

stay hydrated

limit sodium

control blood sugar

diet (low sugar)

what is a neurogenic bladder

-Lack of nerve supply to the bladder

-Person can't feel when bladder is full

-Must use catheter to void

Dyssynergia

bladder and sphinter contract at the same time

detrusor hyperreflexia

overactive bladder

contracts excessivly and involuntarily

detrusor areflexia

underactive (does not contract properly and leads to urinary retention)

hyperactive bladder treatment

bladder training, pelvic floor excersises, fluid management