JC Pharmacology Week 11 Chapters 10 and 28

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Questions and Answers

Which of the following is the MOST common cause of angina pectoris?

  • Coronary vasospasm
  • Hypertension
  • Mitral valve prolapse
  • Atherosclerotic plaque in coronary arteries (correct)

A patient reports chest pain that occurs at rest and is associated with ST-segment elevation on an ECG. Which type of angina is the MOST likely cause?

  • Stable angina
  • Unstable angina
  • Variant angina (Prinzmetal's) (correct)
  • Preinfarction angina

Which statement accurately describes stable angina?

  • It is unpredictable and occurs at rest.
  • It is often triggered by physical exertion or emotional stress and is relieved by rest or nitroglycerin. (correct)
  • It is a new-onset angina that occurs with increasing frequency.
  • It is also known as Prinzmetal or vasospastic angina.

A female patient reports symptoms of epigastric discomfort and back pain. What condition should the nurse consider?

<p>Coronary artery disease (C)</p> Signup and view all the answers

Which factor contributes to the development of coronary atherosclerosis?

<p>Myocardial ischemia (D)</p> Signup and view all the answers

Which of the following is the MOST appropriate nonpharmacologic intervention for managing coronary artery disease (CAD)?

<p>Encouraging regular physical activity and smoking cessation (A)</p> Signup and view all the answers

Optimal management of CAD aims to control or reverse factors for disease progression, irrespective of MI symptoms. What does this entail?

<p>Lifestyle changes and medications, if necessary (D)</p> Signup and view all the answers

A patient with angina is prescribed nitroglycerin. What is the PRIMARY mechanism of action of this medication?

<p>Dilating peripheral blood vessels, reducing preload and afterload (C)</p> Signup and view all the answers

How do beta-adrenergic blocking agents help to manage coronary artery disease (CAD)?

<p>By reducing heart rate and blood pressure, thereby reducing myocardial oxygen demand (A)</p> Signup and view all the answers

Which of the following BEST explains how calcium channel blocking agents are used in the management of angina?

<p>They reduce myocardial oxygen demand and increase myocardial blood supply. (C)</p> Signup and view all the answers

Ranolazine is prescribed for a patient with chronic stable angina. How does ranolazine function?

<p>It preserves cardiac function without decreasing heart rate or blood pressure. (B)</p> Signup and view all the answers

Which of the following adjunctive antianginal drugs has antithrombotic effects?

<p>Aspirin (C)</p> Signup and view all the answers

Why is morphine administered as an adjunctive antianginal drug?

<p>To relieve pain, reduce anxiety, and decrease preload (C)</p> Signup and view all the answers

What is the PRIMARY goal of thrombolytic drugs when used as adjunctive therapy for angina?

<p>To dissolve thrombi and restore blood flow (A)</p> Signup and view all the answers

Which consideration is MOST important when administering antianginal drugs to older adults?

<p>Monitoring for adverse effects due to age-related physiological changes. (C)</p> Signup and view all the answers

What is the BEST approach to manage a patient with angina and abnormal kidney function regarding drug therapy?

<p>Adjust dosage of antianginal drugs based on kidney function and monitor for adverse effects. (D)</p> Signup and view all the answers

Which information is essential for the nurse to provide to a patient being discharged on antianginal medications?

<p>The importance of adhering to the medication regimen and potential adverse effects. (A)</p> Signup and view all the answers

What is the MOST important nursing action when administering nitroglycerin to a patient experiencing angina?

<p>Checking blood pressure before and after administration (C)</p> Signup and view all the answers

Which assessment is the MOST important for a nurse to perform to determine the therapeutic effects of antianginal medications?

<p>Assessing the frequency, duration, and intensity of anginal episodes (D)</p> Signup and view all the answers

A patient taking antianginal medications reports experiencing persistent dizziness. Which nursing intervention is MOST appropriate?

<p>Educating the patient about potential orthostatic hypotension and safety measures. (A)</p> Signup and view all the answers

A patient with a family history of hyperlipidemia is concerned about their risk. What primary intervention should the nurse recommend to potentially mitigate this risk?

<p>Adopting a heart-healthy diet and regular exercise. (D)</p> Signup and view all the answers

Which laboratory finding is MOST indicative of a patient's elevated risk for developing atherosclerosis?

<p>Elevated low-density lipoprotein (LDL) cholesterol. (B)</p> Signup and view all the answers

A patient presents with metabolic syndrome. Which combination of findings would confirm this diagnosis?

<p>Elevated triglycerides, central obesity, hypertension (D)</p> Signup and view all the answers

A patient is diagnosed with secondary dyslipidemia. What condition might be the MOST likely cause?

<p>Obstructive liver disease. (A)</p> Signup and view all the answers

A patient's lipid panel shows elevated total and LDL cholesterol with normal HDL levels. What should be the nurse's INITIAL recommendation?

<p>Start a weight reduction diet and emphasize aerobic exercise. (A)</p> Signup and view all the answers

A patient's treatment plan includes a 'Mediterranean diet' to manage dyslipidemia. What dietary advice should the nurse provide?

<p>Emphasize fruits, vegetables, whole grains, and healthy fats. (D)</p> Signup and view all the answers

A patient has tried dietary and lifestyle changes for 6 months without significant improvement in lipid levels. What is the MOST appropriate next step in managing their dyslipidemia?

<p>Initiate pharmacotherapy. (A)</p> Signup and view all the answers

A patient asks how antidyslipidemic drugs work. Which explanation is MOST accurate?

<p>They alter the production, absorption, or removal of lipids and lipoproteins. (B)</p> Signup and view all the answers

A patient starts on a statin medication. What should the nurse emphasize regarding lifestyle?

<p>Continue healthy diet and exercise for optimal outcomes. (B)</p> Signup and view all the answers

A patient is taking an antidyslipidemic drug and reports muscle pain and weakness. What is the nurse's MOST appropriate initial action?

<p>Assess the patient for rhabdomyolysis and notify the healthcare provider. (C)</p> Signup and view all the answers

Which of the following is a critical aspect of managing dyslipidemia in older adults?

<p>Monitoring for potential drug interactions and adverse effects. (B)</p> Signup and view all the answers

A patient with abnormal kidney function requires antidyslipidemic therapy. What adjustment might be necessary?

<p>Dose adjustments and careful monitoring are essential. (D)</p> Signup and view all the answers

A patient is taking herbal supplements in addition to prescribed antidyslipidemic medications. Why is this a concern?

<p>Herbal supplements can interact with prescribed medications. (C)</p> Signup and view all the answers

What is the PRIMARY goal of antidyslipidemic therapy in managing cardiovascular disease?

<p>To decrease blood lipids. (B)</p> Signup and view all the answers

A patient is prescribed a low-fat diet as part of their dyslipidemia management. Which food choice should the nurse advise the patient to limit?

<p>Fried chicken. (B)</p> Signup and view all the answers

A patient taking statins reports persistent fatigue. What is the MOST appropriate initial nursing intervention?

<p>Assess for other potential causes, like thyroid dysfunction, and inform the provider. (D)</p> Signup and view all the answers

Why is smoking cessation an important recommendation for patients with dyslipidemia?

<p>It improves HDL cholesterol and reduces cardiovascular risk. (C)</p> Signup and view all the answers

A patient reports taking niacin to manage their cholesterol. What common side effect should the nurse educate the patient about?

<p>Facial flushing and itching. (C)</p> Signup and view all the answers

Which dietary supplement is MOST often recommended to increase soluble fiber intake for managing dyslipidemia?

<p>Psyllium. (B)</p> Signup and view all the answers

A patient with heart disease is prescribed Omega-3 fatty acids. Which of the following is the MOST likely intended benefit regarding dyslipidemia?

<p>Lowering triglyceride levels. (D)</p> Signup and view all the answers

Flashcards

Angina Pectoris

A clinical syndrome with chest pain due to myocardial oxygen deficit, often caused by atherosclerotic plaque.

Coronary Artery Disease (CAD)

Development and progression of plaque in coronary arteries, potentially leading from angina to myocardial infarction.

Types of Angina

The three main types are stable, variant (Prinzmetal), and unstable.

Angina Pectoris Definition

True. Angina pectoris is characterized by episodes of substernal chest pain

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Cardiac symptom differences

False. Cardiac symptoms differ according to gender. Females may report epigastric or back discomfort in response to CAD.

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Classic Angina Pain

Can be constricting, squeezing, suffocating, radiates to jaw/neck/arms, and may be mistaken for indigestion.

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Nonpharmacologic CAD Management

Lifestyle changes, obesity management and medication.

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Pharmacologic CAD Management

Organic nitrates, beta-blockers, calcium

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Adjunctive Antianginal Drugs #1

Aspirin, antilipidemics, antihypertensives, ACE inhibitors

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Adjunctive Antianginal Drugs #2

Morphine, Thrombolytic drugs

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Drug Therapy Considerations

Includes pharmacokinetics, action, use, adverse effects, and contraindications.

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Goals of Therapy

Relieve pain and prevent MI and sudden cardiac death.

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Antianginal Drug Use

Modified dose requirements and contraindications.

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Nursing Implications

Managing interactions, proper use, effects observed, adverse assessed

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Impact of Elevated Lipids

Elevated blood lipids are a major risk factor for atherosclerosis and vascular disorders.

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Dyslipidemic Drugs

Management of elevated blood lipid levels, a major risk factor for atherosclerosis and vascular disorders, proven effective in reducing morbidity and mortality.

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Blood Lipids Components

Includes cholesterol, phospholipids, and triglycerides, synthesized by the liver and intestine.

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Metabolic Syndrome

A group of cardiovascular risk factors linked with obesity, including waist circumference, triglycerides, HDL, BP, and fasting glucose.

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Dyslipidemia Risks

Associated with atherosclerosis and can lead to MI, ischemia, stroke, and peripheral arterial occlusive disease.

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Types of Dyslipidemia

Can be primary (genetic/familial) or secondary (dietary habits, DM, alcoholism, hypothyroidism, obesity).

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NCEP III Guidelines - Lipids

Total serum cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, guide treatment for cardiovascular disease.

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NCEP III Guidelines - Lifestyle

Assess conditions, stop medications causing high lipids, start low-fat/Mediterranean diet, increase soluble fiber.

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NCEP III - Lifestyle cont.

Weight reduction, aerobic exercise, smoking cessation, and hormone therapy.

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Antidyslipidemics - Goals

Antidyslipidemics decrease blood lipids, prevent/delay atherosclerotic plaque development, and reduce cardiovascular morbidity/mortality.

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When to start Drug therapy

After 6 months of dietary/lifestyle changes fail to decrease dyslipidemia to acceptable levels.

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Study Notes

Drug Therapy for Dyslipidemia

  • Drug therapy for Dyslipidemia covers Chapter 10
  • Wolters Kluwer is the publisher

Impact of Elevated Lipid Levels on Homeostasis

  • Elevated lipid levels are a major risk factor for atherosclerosis and vascular disorders.
  • Vascular disorders include CAD, stroke, and peripheral arterial insufficiency.
  • Elevated lipid levels have a large impact on homeostasis.

Dyslipidemic Drugs

  • Dyslipidemic drugs are used in the management of elevated blood lipid levels
  • These drugs are effective in reducing morbidity and mortality.

Blood Lipids

  • Blood lipids are derived from diet and synthesized by the liver and intestine.
  • Major blood lipids include cholesterol, phospholipids, and triglycerides.
  • Blood lipids are found in body cells and perform essential functions.
  • Lipoproteins transport lipids in plasma.
  • Each lipoprotein contains cholesterol, phospholipid, and triglyceride bound to protein.
  • Lipoprotein density is mainly determined by the amount of protein, such as HDL and LDL.

Metabolic Syndrome

  • Metabolic syndrome is a group of cardiovascular risk factors linked with obesity.
  • It includes waist circumference, triglycerides, HDL, BP, and fasting glucose.
  • Metabolic syndrome is linked with obesity, not diabetes mellitus.
  • Metabolic Syndrome is a group of cardiovascular risk factors

Dyslipidemia

  • Dyslipidemia is associated with atherosclerosis and many pathophysiologic effects.
  • These effects include MI and ischemia, stroke, and peripheral arterial occlusive disease.
  • Dyslipidemia can be primary meaning genetic or familial.
  • It can also be secondary meaning due to dietary habits or other diseases.
  • Secondary causes of Dyslipidemia include DM, alcoholism, hypothyroidism, obesity, and obstructive liver disease.

NCEP III Treatment Guidelines

  • NCEP III treatment guidelines take into consideration of blood levels of total and LDL cholesterol risk factors for cardiovascular disease.
  • Treatment under these protocols includes total serum cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides
  • Treatment starts by assessing for and treating conditions known to affect blood lipids.
  • Stop medications that increase blood lipids, if possible.
  • Initiate a low-fat diet.
  • Follow a "Mediterranean diet.”
  • Increase dietary intake of soluble fiber.
  • Take dietary supplements and cholesterol-lowering margarines
  • Start weight reduction diet if overweight or obese.
  • Emphasize regular aerobic exercise and smoking cessation.
  • Postmenopausal hormone replacement therapy may be considered.

Antidyslipidemics

  • These decrease blood lipids.
  • They reduce morbidity and mortality from cardiovascular disease.
  • Antidyslipidemics prevent or delay atherosclerotic plaque development and assist in the regression of existing atherosclerotic plaque.
  • These drugs alter production, absorption of lipids and lipoproteins, metabolism, and removal of lipids and lipoproteins.
  • Pharmacotherapy is initiated when 6 months of dietary/lifestyle changes fail to decrease dyslipidemia to acceptable levels.

Drug Therapy for Dyslipidemia

  • Drug therapy is initiated after 6 months of dietary/lifestyle changes fail to decrease dyslipidemia to acceptable levels.
  • Drug therapy is also recommended for patients with signs and symptoms of coronary heart disease, a strong familial history, or other risk factors.
  • Special populations like various ethnic groups, children, and older adults must be taken into consideration
  • Other populations include those with abnormal kidney function or hepatic impairment.
  • Home care and herbal and dietary supplement use also warrant special consideration

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