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Clin phar > CAD > Flashcards

CAD Flashcards

1
Q

supplies oxygenated blood to the (posterior portion) back portion of the left atrium & ventricle

A

Left Circumflex Artery (LCA)

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2
Q

supplies oxygenated to the front portion of the ventricle to the septum of the heart

A

Left Anterior Descending Artery (LDA)

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3
Q

— supply oxygenated blood to the front portion of the right atrium

A

Right Marginal Artery (RMA)

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4
Q

supply oxygenated blood to the back poriton of the right ventricle

A

Posterior Descending Artery

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5
Q

form re-route when there is blockage so that the blood can reach other parts of the artery

A

collateral circulation

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6
Q

Vascular supply to the heart is impended by

A

Atheroma
Thrombosis
Spasm of the coronary artery

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7
Q

Accumulated fatty deposits and scar tissues

A

Atheroma

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8
Q

Atheroma leads to ________ and risk of ________

A

restriction in blood flow; thrombosis

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9
Q

patchy deposit of plaque

A

atheromas or atherosclerotic plaque

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10
Q

condition in which patchy deposit of plaque
(atheromas or atherosclerotic plaque) develop in the
wall of the medium and large sized arteries, leading to
reduced or blocked blood flow

A

Atherosclerosis

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11
Q

Atherosclerosis is a condition in which patchy deposit of plaque
(atheromas or atherosclerotic plaque) develop in the
wall of the medium and large sized arteries, leading to

A

reduced or blocked blood flow

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12
Q

T/F: Atherosclerosis can lead to stroke (in brain)

A

T

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13
Q

rupture, causing thrombosis

A

Unstable plaque

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14
Q

What do you give to patients with unstable plaque?

A

give antiplatelet medication just in case of rupturee (lead to coagulation/platelet adhesion)

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15
Q

T/F: Plaque rupture can cause MI

A

T

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16
Q

Blood clot

A

Thrombus

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17
Q

Fragment of blood clot travelling through vein

A

Emboli

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18
Q

Risk factors for CAD

A

atherosclerosis, htn, high cholesterol, diabetes, obesity, smoking + alcohol consumption

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19
Q

Etiology of CAD: Decrease blood flow to the myocardium

A

*Atherosclerosis
*Coronary spasm
*Traumatic Injury
*Embolic event

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20
Q

Etiology of CAD: Increased oxygen demand

A

*Diastole
*Systole
*Contractile state of the heart
*Increase in systolic wall tension
* Lengthening of ejection time
*Change in the heart rate

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21
Q

unbalanced oxygen supply and oxygen demand

A

Myocardial Ischemia

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22
Q

T/F: during MI, px can experience angina pectoris (chest pain)

A

T

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23
Q

Oxygen demand exceeds myocardial oxygen
supply

A

Myocardial Ischemia

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24
Q

Myocardial Ischemia may be silent if

A

the length is insufficient
* Afferent cardiac nerves are damages
* Inhibition of pain at the spinal or
supraspinal

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25
Q

Occurs when oxygen demand exceeds the oxygen supply

A

Myocardial Ischemia

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26
Q

T/F: during Myocardial infarction, heart muscles already died due lack of oxygenated blood for a long time

A

T

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27
Q

Transient chest discomfort that are
attributed to insufficient myocardial oxygen

A

Angina

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28
Q

Ordinary activity does not cause angina, such as walking and climbing stairs

A

Class I

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29
Q

Slight limitation of ordinary activity

A

Class II

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30
Q

Marked limitation of ordinary physical activity

A

Class III

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31
Q

Inability to carry on any physical activity without discomfort

A

Class IV

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32
Q

T/F: not all chest pain is classified as angina

A

T

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33
Q

Characterized by chest pain and breathlessness
on exertion, symptoms are relieved promptly
with rest

A

Stable Angina

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34
Q

Patient has a reproducible pattern of pain or
other symptoms

A

Stable Angina

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35
Q

Components to Consider in Anginal Pain

A

1.Quality of pain (suffocating type of pain)
2.Location of pain (chest pain)
3.Duration of pain (0.5 to 30 minutes)
4.Factor provoking pain
5.Factors that relieve pain

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36
Q

Symptoms of Stable Angina

A

Pressure over the sternum but not
always radiating
Pain usually lasting for 0.5 to 30 minutes
Precipitating factors include exercise, cold weather,
emotional stress
Relief occurs with rest and nitroglycerin

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37
Q

> 20 minutes occurring within a week of
presentation

A

Rest Angina

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38
Q

Previously diagnosed angina with distinctly more
frequency, longer duration or lower threshold

A

Increasing angina

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39
Q

-Rest Angina
-Increasing Angina
-decrease response to NTG

A

Unstable Angina

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40
Q

Nocturnal angina

A

Angina Decubitus

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41
Q

Angina Decubitus occurs when patient is in a

A

recumbent position

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42
Q

Coronary artery spasm that reduces blood flow

A

Prinzmetal Angina

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43
Q

Prinzmetal Angina is due to a

A

thrombi or plaque formation

44
Q

Prinzmetal Angina occurs at

A

rest rather than exertion

45
Q

ECG shows ST-elevation

A

Prinzmetal Angina

46
Q

only occurs when patient is lying down; upright position, relieved

47
Q

chest pain even if px is in upright position

A

prinzmetal

48
Q

Diagnostic Test

A

*Resting ECG
*Exercise test
* Myocardial scintigraphy
* Stress Echocardiography
*Coronary Angiography (gold standard)

49
Q

Treatment Goals for Angina

A

Prevent MI and death, thereby improving the patient’s
quality of life
Reduce symptomatology
Remove or reduce risk factors

50
Q

Chronic Stable Angina treatment

A

*A – Aspirin and Antianginal Therapy
*B – Beta blocker and BP
*C – Cigarette smoking and Cholesterol
*D – Diet and Diabetes
*E – Education and Exercise

51
Q

Recommendations

A
  • Weight reduction/ maintenance
  • Physical activity for 30 - 60 minutes/day x 7 day
  • LDL-C <100mg/dL
    *BP < 130mmHg
    *No smoking and no environmental exposure to smoke
    *Reduce intake of saturated fats
    *If Diabetic HbA1c <7%
52
Q

recommended physical activity for Chronic Stable angina

A

30 - 60 minutes/day x 7 day

53
Q

recommended LDL-C for Chronic Stable angina

54
Q

recommended BP for Chronic Stable angina

55
Q

recommended Diabetic HbA1c for Chronic Stable angina

56
Q

Management for Chronic Stable angina

A

*Anti-platelets/Anti-thrombotic
*ACEI’s and ARBS
*Statins
*Beta-blocker
*Calcium Channel Blocker
*Nitrates

57
Q

Anti-Thrombotic Agents

A

Aspirin
Clopidogrel
COX- 2 Inhibitor

58
Q

Acts via irreversible inhibition of platelet COX-1 and thus
thromboxane production

59
Q

Aspirin’s Antiplatelet action is apparent within an hour of taking _________

60
Q

Effect on platelet last for the lifetime of the platelet

61
Q

Optimal maintenance dose for aspirin

A

75 -150mg/day

62
Q

Lower dose of Aspirin have _________

A

limited cardiac risk protection

63
Q

Higher dose of aspirin _______

A

increase risk for GI side effect

64
Q

Inhibits ADP activation of platelet

A

Clopidogrel

65
Q

Useful alternative to aspirin in patients who are allergic or cannot
tolerate aspirin

A

Clopidogrel

66
Q

As effective as aspirin in patients with stable coronary disease

A

Clopidogrel

67
Q

Usual dose is 300mg once then 75 mg daily

A

Clopidogrel

68
Q

Less likely to cause gastric erosion and ulceration

A

Clopidogrel

69
Q

Reduces the production of Prostacyclin

A

COX- 2 Inhibitor

70
Q

More traditional non-selective NSAIDs increase
cardiovascular risk

A

COX- 2 Inhibitor

71
Q

NSAID with high _______ specificity increase the risk of MI

72
Q

SHOULD BE AVOIDED IN CHRONIC STABLE
ANGINA

A

COX- 2 Inhibitor

73
Q

Proven beneficial for post MI

A

ACE Inhibitor

74
Q

Vasodilatory effect caused by the inhibition of the
production of Angiotensin II

A

ACE Inhibitor

75
Q

Anti-inflammatory, anti-thrombotic and anti-proliferative
property

A

ACE Inhibitor

76
Q

Reduces ROS production

A

ACE Inhibitor

77
Q

Demonstrate the benefit of reducing cholesterol,
especially LDL-C, in patients with CHD

78
Q

Earlier studies focused on patients with
“elevated” cholesterol, but all patients with
coronary risk factors benefit from reduction of
their serum cholesterol level

79
Q

T/F: all patients with
coronary risk factors that is treated with statin benefit from reduction of their serum cholesterol level

80
Q

statins reduce cardiovascular risk by

A
  • Shift LDL cholesterol particle size to a larger particle, lesser atherogenic
  • Improve endothelial function
  • Prevention of pro-inflammatory mediators
  • Possibly improve atherosclerotic plaque stability
81
Q

No safe level for cholesterol for patients with CAD and there is a
continuum of risk down to very low cholesterol level

82
Q

Level of LDL-C of __________ and total cholesterol__________ are
recommended for patients with established CVD

A

<2mmol/L; <4mmol/L

83
Q

Considered first line agent in angina

A

Beta-Blocker

84
Q

Reduce mortality both in patients who suffered from
previous MI and patients with HF

A

Beta-Blocker

85
Q

Beta-Blocker reduce myocardial oxygen demand by blocking β- adrenergic receptor, there by ___________ (increasing/decreasing) the heart rate and
force of left ventricular contraction and lowering blood
pressure

A

decreasing

86
Q

Beta Blockers are useful in

A

exertional angina

87
Q

Patients treated optimally with B blockers should have a resting
heart rate of around

A

60 beats/minute

88
Q

B blockers are used in caution in patients with _________

89
Q

Tendency to cause bronchospasm and peripheral
vascular spasm

A

Beta Blockers

90
Q

Should not be stopped abruptly

A

Beta Blocker

91
Q

Contraindicated in the rare Prinzmetal’s
angina where coronary spasm is a major
factor

A

Beta Blocker

92
Q

Acts on a variety of smooth muscle and cardiac
tissue

A

Calcium Channel Blocker

93
Q

______ have been
implicated in the exacerbation of angina

A

Calcium Channel Blocker

94
Q

valuable in angina

A

Organic nitrates

95
Q

Dilate vein → decrease preload

96
Q

Dilate arteries to a lesser extent → decrease afterload

97
Q

Promote flow in collateral coronary vessel, diverting
blood from the epicardium to the endocardium

98
Q

Relax vascular smooth muscle by releasing nitric oxide

99
Q

Tolerance is one of the main limitation

100
Q

Nitrate preparation

A

*IV infusion
*Tablet / capsule
*Transdermal patch
* Sublingual tablet
* Spray

101
Q

Exhibits the properties as nitrate

A

Nicorandil

102
Q

Also activates ATP dependent potassium channel

A

Nicorandil

103
Q

main benefit of nicorandil

A

Reduction in unplanned admission to hospital with chest
pain

104
Q

Anti-ischemic agent

A

Ranolazine

105
Q

T/F:Ranolazinen is not commonly used in the management of chronic stable angina

106
Q

Inhibit inward sodium current during plata

A

Ranolazine

Clin phar (3 decks)

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