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CHAPTER 33 (ATHEROSCLEROSIS (plaque accumulation) (Risk/Comorbidities…

- - - - TX: DASH diet, meds
    - - TX: needs to be under control
    - - high fat, especially saturated
    - - Chronic Infections
        Chronic Kidney Disease
      - Hyperhomocysteinemia
  - - - :star:DIET:star: (should be individualized)
        
        lower satfat (omega 3, monosat, polyunsat OK)
        
        increase fish intake
        
        increase fruits and veg
        
        avoid red meat
        
        avoid processed foods/fast foods
        
        no egg yolks
        
        no whole milk/lowfat dairy is preference
        
        do not particularly need to limit sodium if not hypertensive
    - - :star:STATINS:star:
        
        give in PM
        
        concern for muscular issues (muscle pain and cramps)
        
        concern for liver (jaundice, ab pain) DO LFT
        
        :!!:RHABDOMYOLYSIS:!!:
        (serious concern with statin or statin concurrently given with other cholesterol drug)
      - Niacin
        
        flushing, ortho hypotension, pruritis
        
        premedicate with ASA 30m
        
        not super commonly used
      - Fibric Acid Derivatives (gemfibrozil)
        
        no impact on LDL, only triglycerides
      - Bile Acid Sequestrants (cholestyramine)
        
        tons of drug-drug interactions
        
        tastes bad
      - Ezetimbe(zetia)
        
        in combination with statin
      - Aspirin
        
        81mg, prophylactic, daily
        
        dt antiplatelet function
        
        GI PROBLEMS are real concern
  - - - Decreased bloodflow to the heart
        
        Angina
        (chest pain)
        
        P - HUGE
        Q - crushing, elephant
        R - substernal/epigastric, radiation on L arm and jaw
        S - very severe
        T - Onset/duration (rule out heartburn)
        
        Imbalance in O2 Supply/Demand
        
        pain is due to ischemic heart muscle (can be reversible for short period of time)
        
        DECREASED SUPPLY
        
        thrombi/emboli
        
        atherosclerosis
        
        TX: O2(depending on POX), drugs
        
        :star:NITROGLYCERIN:star:
        
        POTENT vasodilator
        
        Short acting (sublingual)
        
        can TANK BP (have them sitting/fall risk)
        
        can ri flushing/headache (this is ok, means it is working)
        :!!:EDUCATION::!!:
        
        1 tab q5 minutes up to 3 doses max (less if resolved, obvi)
        
        if doesn't resolve, call EMS (also if this is not your normal)
        
        they expire, should routinely replace q6m
        
        avoid moisture and light
        
        tingling when under the tongue means that it is working
        -AVOID CONCURRENT USE WITH ERECTOGENIC DRUGS (can ri severe hypotension that is unresponsive to treatment)
        
        INCREASED DEMAND
        
        activity increase
        
        cocaine
        
        TX: sit down, rest (not lying down)
        
        Myocardial Infarction
        (smaller diameter of coronary vessels results in low blood flow to heart)
      - breakage of unstable plaque
        
        Emboli
        
        CVA or PE