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APEA - Pre predictor > Angina & HTN > Flashcards

Angina & HTN Flashcards

1
Q

angina triggers can include (non dx answers)
7

A
  1. very hot or cold weather
  2. physical activity
  3. emotional stress
  4. large meals
  5. alcohol use
  6. smoking
  7. caffeine
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2
Q

3 types of angina

A

classic
Prinzmetal
unstable

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3
Q

classic angina

A

Discomfort described as pressure, tightness, or squeezing deep in chest from exertion or stress. Relived by rest and nitro. Lasts minutes

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4
Q

Discomfort described as pressure, tightness, or squeezing deep in chest from exertion or stress. Relived by rest and nitro. Lasts minutes

A

classic angina

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5
Q

Prinzmetal’s angina

A

results from coronary artery vasopasm; occurs in atypical patterns

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6
Q

results from coronary artery vasopasm; occurs in atypical patterns

A

Prinzmetal’s angina

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7
Q

Unstable angina

A

new onset; increases in frequency, intensity, or duration or occurs at rest

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8
Q

new onset; increases in frequency, intensity, or duration or occurs at rest

A

unstable angina

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9
Q

Angina assessment findings
9

A
  1. chest heaviness, discomfort, pain, squeezing
  2. substernal pain can radiate to left side
  3. SOB with or without activity
  4. palpitations
  5. belching, indigestion, NV
  6. dizziness
  7. diaphoresis
  8. fatigue
  9. Levine’s sign
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10
Q

Angina - symptomatic patterns include
4

A
  1. most often occurs with physical activity or stress
  2. promptly relieved within minutes
  3. relieved with rest or nitro
  4. occurs at any time, most often though between 6am and noon
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11
Q

angina - nonpharm management can include procedures
2

A
  1. percutaneous coronary intervention - balloon angioplasty with or without stent
  2. coronary artery bypass grafting
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12
Q

angina risk factor modification - physical activity recs

A

30-60 mins of mod intensity aerobic activity for 5-7 days/week

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13
Q

rx for symptom prevention or relief anti-ischemic meds class I recs
3

A
  1. sublingual nitro or spray nitro
  2. beta blocks for initial agents to relieve symptoms (BB slow the HR which help reduce the oxygen demands of the heart)
  3. CCB or long-acting nitrates when BB
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14
Q

rx for symptom prevention or relief anti-ischemic meds class IIa recs
3

A
  1. long-acting nondihydropyridine CCBs (verapamil or diltiazem) instead of BB as initial therapy is reasonable (CCB decrease O2 demands by lowering HR and contraction and has vasodilators effects)
  2. ranolazine (anti-anginal med) as sub for BB if BB initially is ineffective
  3. ranolazine can be used in combo with BB if BB alone failed
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15
Q

antiplatelet therapy to prevent MI and death class I recs
2

A
  1. aspirin 75-162 mg daily
  2. clopidogrel 75 mg daily if aspirin contraindicated
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16
Q

beta blocker therapy class I recs for angina (after and before MI)
2

A
  1. should be started and continued for three years in all patients with normal LV function after MI or ACS
  2. should be used in all patients with LV dysfunction with HF or prior MI
17
Q

ACE-I should be prescribed to who (angina)
4

A

all patients with stable angina who also have HTN, DM, LVEF 40% or less, or CKD

18
Q

lipid management

A

in addition to lifestyle changes, a moderate to high dose statin therapy should be prescribed

19
Q

nitro dose acute pain

A

1 tab, every 5 minutes, for 3 times. If unrelieved after 15 minutes, go to ER

20
Q

nitro side effects
3

A

headache
flushing
hypotension

21
Q

ACC/AHA HTN stages
4

A

Normal - SBP <120 and DBP <80
Elevated - SBP 120-129 and <80
Stage 1 - SBP 130-139 or 80-89
Stage 2 - SBP 140 or more or 90 or more

22
Q

JNC8 recs on when to start meds

A

140/90 until 60 or older
then 150/90

23
Q

in black patients with stage 2 HTN - start on what

A

two meds - thiazide and CBB are more effective

24
Q

stage 2 - start on how many meds

A

two

25
Q

beta blockers are not what for HTN

A

are not first line therapy

26
Q

HTN - thiazide diuretics what is preferred
& stop when?

A

chlorthalidone is preferred over HCTZ, stop if GFR <30

27
Q

are not recommended for first line for uncomplicated HTN, but consider with patients in HF, first 2-3 years post MI, ischemic heart disease, and migraine headaches

A

BBs

28
Q

HTN - CCBs (DHP) are encouraged in which conditions
5

A
  1. isolated systolic HTN
  2. asthma
  3. migraines
  4. ischemic disease
  5. consider for stroke prevention
29
Q

4 options for HTN rx single treatment or in combination

A
  1. thiazide diuretics
  2. CCBs
  3. ACE inhibitors
  4. ARBs
30
Q

2 thiazide meds

A

HCTZ
chlorithalidone

31
Q

thiazide diuretics - monitor what

A

K two weeks after starting, and after dose changes

32
Q

HTN first line agent

A

ACE inhibitors

APEA - Pre predictor (38 decks)

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