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57 terms

NURS 305 Test 3: Cholesterol and Angina

STUDY
PLAY
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