Study Notes on Cardiology and Pulmonology

Chapter 40: Cardiology

Medication Classifications

  • Antihypertensive

    • Indications for use: Reduces and controls blood pressure.

    • Desired effects: Lowers blood pressure.

    • Side effects and adverse reactions: Headache, vertigo, gastrointestinal disturbances, rash, hypotension, nonproductive cough.

  • Antiplatelet

    • Indications for use: Post-treatment of stroke, heart attack, or angina.

    • Desired effect: Inhibits the function of platelets, thereby preventing the formation of clots.

    • Side effects and adverse reactions: Gastrointestinal distress, bleeding, weakness, or numbness.

  • Cholesterol lowering agents

    • Indications for use: Reduces low-density lipoprotein (LDL) and triglycerides; increases high-density lipoprotein (HDL).

    • Desired effects: Prevents absorption of cholesterol in the intestine.

    • Side effects and adverse reactions: Gastrointestinal discomfort, muscle pain and weakness, liver complications, hypersensitivity, cataracts, myopathy.

  • Diuretics

    • Indications for use: Increases urinary output, lowers blood pressure.

    • Desired effects: Inhibits reabsorption of sodium and chloride in the kidneys; promotes excretion of excess fluid in the body.

    • Side effects and adverse reactions: Dehydration, muscle weakness, fatigue, electrolyte imbalance.

  • Hematopoietic agents

    • Indications for use: Treats low neutrophil levels and anemia.

    • Desired effect: Promotes neutrophil and red blood cell production.

    • Side effects and adverse reactions: Pain in the arms and legs, bone pain, injection site reaction, headache, weight loss, insomnia.

  • Hemostatic agents

    • Indications for use: Controls acute or chronic blood-clotting disorder; promotes formation of absorbable, artificial clot.

    • Desired effects: Controls bleeding; acts as a blood coagulant (clots blood).

    • Side effects and adverse reactions: Hypersensitivity reactions, transient flushing, dizziness; newborn hyperbilirubinemia.

Generic Names and Trade Names

  • Beta-Blockers

    • Propranolol (Inderal XL, InnoPran XL)

    • Atenolol (Tenormin)

    • Metoprolol (Lopressor, Toprol XL)

    • Carvedilol (Coreg)

  • Angiotensin-Converting Enzyme (ACE) Inhibitors

    • Quinapril (Accupril)

    • Benazepril (Lotensin)

    • Lisinopril

  • Angiotensin II Receptor Antagonists

    • Losartan (Cozaar)

    • Valsartan (Diovan, Prexxartan)

  • Calcium Channel Blockers

    • Diltiazem (Cardizem, Cartia XT, Dilacor XR, Tiazac)

    • Amlodipine (Katerzia, Norvasc)

  • Alpha-Blockers

    • Doxazosin (Cardura)

  • Cholesterol Lowering Agents

    • Ezetimibe (Vytorin, Zetia)

    • Atorvastatin (Lipitor)

    • Rosuvastatin (Crestor, Ezallor)

    • Simvastatin (Flolipid, Zocor)

  • Diuretics

    • Triamterene (Dyrenium)

    • Furosemide (Lasix)

    • Hydrochlorothiazide (Microzide, Oretic)

  • Colony-Stimulating Factor

    • Pegfilgrastim (Neulasta)

    • Filgrastim (Neupogen)

  • Erythropoiesis-Stimulating Agents

    • Epoetin alfa (Epogen, Procrit)

  • Vitamin K

    • Phytonadione (Mephyton, Vitamin K)

Patient-Centered Care

  • Importance of Information and Education

    • Patients with cardiovascular diseases often require ongoing medication for treatment.

    • Key information for patients includes:

    • Name of the medication

    • Reason for the medication's prescription

    • Side effects/adverse reactions to report to the provider

  • Provider’s Role

    • The medical assistant should provide patients with well-organized information regarding their medication.

    • Best practices include reviewing the medication details and providing educational handouts for home reference.

Professional Behaviors of Medical Assistants

  • Critical Thinking

    • Medical assistants must employ critical thinking skills to effectively gather patient information regarding possible cardiac signs and symptoms.

    • This aids providers in making accurate diagnoses and developing effective treatment plans.

Summary of Scenarios in Practicum

  • Lizzy's Experience

    • Lizzy became more independent in her practicum and was excited to interview for a medical assistant position in a cardiology department in a nearby city.

    • She celebrated her completion of the practicum with her supervisor, Rebecca.

    • Lizzy received an offer for the medical assistant position which she accepted.

Vocabulary

  • Intercostal muscles: Muscles located between the ribs that assist with quiet respiration.

  • Mediastinum: The space in the thoracic cavity that lies between the lungs, containing the heart, trachea, and esophagus.

  • Paranasal sinuses: Hollow, air-filled cavities in the skull and facial bones that lighten the weight of the skull and enhance the resonance of speech.

  • Pharyngitis: Inflammation or infection of the pharynx, typically causing the symptoms of a sore throat.

  • Productive cough: A cough that produces phlegm or mucus.

  • Pulmonary hypertension: High blood pressure that affects the pulmonary system (pulmonary arteries and the right side of the heart).

  • Respiratory arrest: Stoppage of breathing.

  • Sputum: Mucous secretion coughed up from the lungs and expectorated through the mouth.

  • Surfactant: A mixture of proteins and fats that lines the alveoli to prevent the tissues from sticking together and collapsing during exhalation.

  • Thoracentesis: Aspiration of fluid from the pleural cavity.

Introduction to Pulmonology

  • Definition and Role

    • Pulmonology is the healthcare specialty focusing on respiratory diseases and disorders.

    • A pulmonologist specializes in the diagnosis, treatment, and prevention of respiratory system disorders.

  • Common Procedures

    • Pulmonary procedures and treatments are standard in ambulatory care settings.

    • Common treatments include:

    • Measuring peak flow rates

    • Performing spirometry

    • Assisting with nebulizer treatments and oxygen therapy

Anatomy of the Respiratory System

Upper Respiratory Tract

  • Structure

    • Composed from the nose to the larynx, located outside the chest cavity.

  • Functions

    • Warming and cleaning the inspired air

    • Serving as a passageway for air

    • Providing the sense of smell

Nose and Paranasal Sinuses

  • Pathway of Air

    • Air enters through the mouth or two nares (nostrils); the nasal septum separates the nares.

    • The air moves into the nasal cavity where it is cleaned, warmed, and moistened by surface capillaries, mucous membranes, and cilia.

    • Cilia move in a wavelike manner to push mucus and debris out of the respiratory tract.

  • Paranasal Sinuses

    • Connected to the nasal cavity; they include maxillary, frontal, sphenoid, and ethmoid sinuses.

Pharynx

  • Structure

    • Divided into three sections:

    • Nasopharynx: Connects to the eustachian tube, equalizing pressure in the ear with outside air.

    • Oropharynx: Located behind the mouth, part of both the respiratory and digestive systems.

    • Laryngopharynx: Between the epiglottis and esophagus, where the epiglottis closes off the trachea during swallowing.

Lower Respiratory Tract

  • Structures

    • Composed of the trachea, bronchial tubes, and lungs; lined with mucous membranes and cilia.

    • The trachea lies within the mediastinum and branches into the right and left bronchi.

Bronchioles and Alveoli

  • Function

    • Bronchi divide into bronchioles that end in alveoli (air sacs); gas exchange occurs here.

    • Each alveolus is surrounded by pulmonary capillaries, allowing O2 to move into the blood and CO2 to be expelled.

Physiology of the Respiratory System

Functions

  • Gas Exchange

    • The primary roles are to exchange oxygen (O2) for carbon dioxide (CO2) and maintain acid-base balance in the body.

  • Ventilation

    • Involves inspiration and expiration, where gases are moved between the lungs and the environment.

Inspiration and Expiration

  • Inspiration Process

    • Triggered by increased levels of CO2 in the blood; involves contraction of the diaphragm and intercostal muscles.

  • Expiration Process

    • Followed by relaxation of the diaphragm and intercostal muscles; typically requires minimal energy, but can necessitate accessory muscles in certain conditions (e.g., asthma).

Acid-Base Balance

  • Role of Respiratory System

    • It regulates CO2 levels in the blood; CO2 can combine with water to form bicarbonate, a buffer to maintain pH.

  • Conditions that Alter Acid-Base Balance

    • Hyperventilation decreases CO2 and bicarbonate, leading to respiratory alkalosis; hypoventilation increases CO2, leading to respiratory acidosis.

Life Span Changes

  • Developmental Changes

    • Changes in the respiratory system occur throughout a person's life, from infancy through adulthood, impacting lung function and respiratory health.