NURS 305 Test 3: Cholesterol and Angina

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5

Adults over age 20 should get cholesterol screenings every __ years

40

Goal HDL is > ________ mg/dL

100

Goal LDL is < ________ mg/dL

200

Goal total cholesterol is < __________ mg/dL

150

Goal triglycerdes is < _________ mg/dL

True

True or False?
Drugs are NOT first line therapy in treating hyperlipidemia

LDL

High ________ contributes most to atherosclerotic disease. Therefore, we pick the cholesterol drug based on the amount we want to lower their ________

statins

Most effective drugs for lowering LDL!
Can also: elevate HDL and reduce triglycerides

Other benefits: plaque stability, reduce risk for CV events, increased bone formation

Statin

Regardless of cholesterol level, a patient post-MI will be on a ________ to reduce mortality r/t CHD!

Statin

AE: Headache, rash, GI, myopathy, rhabdomyolysis, hepatotoxicity
Contraindications: Use with other cholesterol drugs, Category X!

Tetratogenic

All cholesterol meds are considered _________ because cholesterol is needed for the developing baby

Evening

Cholesterol med dosing should be once daily in the ________ because cholesterol synthesis occurs mainly at night

Niacin

Water soluble vitamin used mainly to lower triglyceride levels, but it can also lower LDL and raise HDL
Can make HDL a "negative risk factor"

Niacin

Considered the "hot flash pill"; pretreat the patient with Aspirin before giving the immediate release form of __________

Niacin

AE:
- skin flushing/itching
- GI upset
- Hepatotoxicity
- Hyperglycemia
- Gouty arthritis

Cholestyramine

Bile Acid Sequestrant that can lower LDL and raise HDL (but not as effective)
- "Bulking agent" which can reduce diarrhea
- Can reduce the absorption of other drugs (give 1 hr before or 4 hrs after other meds

Constipation

Biggest side effect of cholestyramine.
Since BAS are not absorbed from the GI tract, adverse effects are limited to GI effects

Colesevelam

Preferred bile acid sequestrant because:
- Better tolerated
- Dose not decrease absorption of fat soluble vitamins
- Does not reduce absorption of other drugs

Colesevelam

MOA: Increases LDL receptor hepatocytes on the liver and preventing reabsorption of bile acids
Use: Reduce LDL

Ezetimibe

MOA: Inhibits cholesterol absorption to reduce plasma cholesterol and LDL

Ezetimibe

AE: Myopathy, Rhabdomyolysis, Hepatitis, Pancreatitis, Thrombocytopenia

NO GI effects!

Fibrates

Most effective drugs for lowering triglyceride levels
Can also raise HDL

Gemfibrozil

Primary Indication: Hypertriglyceridemia
Interactions: Displaces warfarin from albumin which increases risk of bleeding

INR

Measure ______ frequently in patients on Gemfibrozil to assess coagulation status

Gemfibrozil

AE:
- rashes
- GI disturbance
- Gall stones d/t increased biliary cholesterol
- Myopathy and Rhabdomyolysis
- Hepatotoxicity

Cholestin

Lovestatin in a lower dose that is available OTC

Angina

Three families to treat ________ by lowering O2 demand:
1) Nitrates
2) Beta Blockers
3) Calcium Channel Blockers

Demand

O2 ______ is determined by:
- heart rate
- myocardial contractility
- preload/afterload (most important!)

Supply

O2 ______ is determined by:
- Myocardial blood flow
- Myocardial perfusion (only in DIASTOLE)

Exertional

Chronic stable angina is AKA _________ angina because the pain results from increased O2 demand which can result from excitement, large meals, or cold exposure
Tx Goal: Decrease O2 demand

CAD

Most common underlying cause of chronic stable angina

Variant

Printzmetal's Vasospastic Angina is AKA _________ because the S/S may occur at any time, even during sleep, because the pain is d/t decreased O2 supply.
It does not matter what your activity level is!

Variant

Tx Agents for ________ Angina that increase O2 supply:
1) CCB's
2) Nitrates

Unstable

_________ angina is a medical emergency! Symptoms result from severe CAD complicated from vasospasm

MONA B

Anti-Ischemic Therapy for unstable angina is similar to how we treat MI's, with ______________

Aspirin

Part of antiplatelet therapy given for patient with unstable angina

Heparin

Part of anticoagulant therapy given for a patient with unstable angina is SubQ low molecular weight _________

Nitrates

Act directly on VSM to promote vasodilation mainly in the veins to decrease PRELOAD
Uses: stable angina, variant angina, vasodilator
*DOC for acute anginal attack

first pass effect

Nitro must be taken sublingually instead of PO d/t the __________

IV

Route of Nitro administration for perioperative control of BP and treatment of HF

Headache

Most common adverse effect of IV Nitro
Other AE's:
- Flushing!!!
- Dizziness/Orthostatic Hypotension
- Reflex Tachycardia

Nitro

There is an absolute contraindication against taking phosphodiesterase type 5 inhibitors (like Viagra) with ________because it will intensify the effects of hypotension

Tolerance

Make sure the patient has at least 8 hours of drug free hours per day to prevent the development of __________

Unstable angina

If the patient does not have relief within 5 min of 3rd dose of nitro, he probably has _________

90

Hold the dose of Nitro if SBP is < ________ mmHg

3-6

Keep Nitro in its dark glass bottle. Once bottle is opened, the pills only last ________ months

Fizz

If the Nitro tablet does not _______ under the tongue, get your prescription refilled

Stable

Beta blockers are only used for long term management of ________ angina
**Beta Blockers are not effective against vasospastic angina (Printzmetal's/Variant)!!

Afterload

CCB's dilate coronary arteries to decrease _________ and dilate peripheral arteries to decrease BP

CCB's

Used for stable and variant angina (Printzmetal's/Vasospastic)
Works by decreasing O2 demand

Reflex tachycardia

Adverse effect of Nifedipine r/t baroreceptor reflex

Bradycardia

Adverse effect of Verapamil and Diltiazem

Ranolazine

New class of antianginal agents
Unlike most other angi-anginal meds, _________ does not reduce HR, BP, or vascular resistance!

CABG

Treatment of choice for patients with multivessel disease

Beta Blockers

Decrease HR and decrease contractility

CCB

Decrease afterload by dilating arterioles

Nitrates

Decrease preload by dilating veins

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