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PATHO/PHARM II > CAD, Angina, MI > Flashcards

CAD, Angina, MI Flashcards

Review for Kaplan Pharm

1
Q

Patho of CAD: What is the most common cause of CAD?

A

Development of atherosclerosis in arteries supplying the myocardium is the most common cause?

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2
Q

Patho of CAD: What does development of atherosclerosis in arteries supplying the myocardium lead to?

A

O2 reduction to cardiac muscle

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3
Q

Patho of CAD: What would lead to angina?

A

Ischemia –> accumulation of lactic acid & metabolic wastes –> angina

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4
Q

Patho of CAD: What part of the heart is most susceptible?

A

LV most susceptible

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5
Q

Patho of CAD: What is it a prognosis for?

A

Prognosis for MI

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6
Q

Patho of CAD: What are other causes of MI?

A

Vasospasm

Cardiomyopathy

Thrombi

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7
Q

Patho of CAD: What are contributing factors to CAD?

A

DM

Stress

HTN

Smoking

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8
Q

Patho of CAD: What is stable angina initiated by?

A

Initiated w/ ↑ O2 demand w/ activity

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9
Q

Patho of CAD: How is stable angina reduced?

A

Reduced at rest

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10
Q

Patho of CAD: How does CAD progress?

A

Plaque ulceration –> inflammation –> platelets aggregation & thrombi

Platelets –> thromboxane A2 (vasoconstrictor) –> artery spasm

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11
Q

Patho of CAD: What is CAD a repeated cycle of?

A

Repeated cycle of aggregation of spasms

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12
Q

Patho of CAD: How does unstable angina occur? When does it occur?

A

Unpredictable

Occurs at rest

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13
Q

Patho of CAD: What are complications of CAD?

A

MI

HF

Dysrhythmias

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14
Q

Presentation & Management of CAD:

What are clinical manifestations?

A

Radiating angina ~ jaw, neck, arm, back

Indigestion-like sensation

N/V

Cool, clammy extremities

Diaphoresis

Fatigue

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15
Q

Presentation & Management of CAD:

How is diagnosis of CAD made?

A

Identifying contributing factors

PMH & PE

Exercise stress test

Echocardiogram

EKG ~ depression of ST-segment if chronic

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16
Q

Presentation & Management of CAD:

Diagnosis of CAD: What are identifying factors?

A

Lipid profile

Angiography

Nuclear imaging

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17
Q

Presentation & Management of CAD:

What is treatment of CAD?

A

PX of MI ~ modifiable risk factors

Angioplasty, bypass & laser procedures

Medications

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18
Q

Presentation & Management of CAD:

What are medications for CAD?

A

Antiplatelet agents,

anticoagulants,

thrombolytics

Lipid-lowering medications

Nitrates, BBlockers, CCBs ~ vasodilation increase O2

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19
Q

Angina: What is it?

A

Sudden pain beneath the sternum

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20
Q

Angina: How is the pain?

A

Often radiating to the left shoulder, left arm, jaw

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21
Q

Angina: What is the cause?

A

Insufficient O2 supply to the heart

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22
Q

Angina: What occurs?

A

Most ~ atherosclerosis of coronary arteries

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23
Q

Angina: O2 demand effects what?

A

HR

Myocardial contractility

Intramyocardial wall tension ~ preload & afterload

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24
Q

Angina: What do drugs target?

A

O2 demand

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25
Q

Angina:

Under normal conditions, what does an increase in O2 demand lead to?

A

increase in O2 demand –> dilation of coronary arterioles–> decrease in PR and increase in blood flow

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26
Q

Angina:

Under normal conditions, how is O2 supply during exertion?

A

Increased during exertion

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27
Q

Angina:
Under normal conditions, when does perfusion occur?

A

Perfusion occurs during diastole (relaxation)

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28
Q

Angina:
What are goals of treatment having to do with MI and death?

A

Meds for dysplipidemia and antiplatelets

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29
Q

Angina:
What are goals of treatment having to do with myocardial ischemia and anginal pain?

A

Meds for angina

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30
Q

Angina:
What are anti-anginal agents?

A

Organic nitrates-NTG

BBlockers- metroprolol

CCBs- verapamil

Ranolazine

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31
Q

Chronic Stable (Exertional) Angina aka?

A

Angina of effort

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32
Q

Chronic Stable (Exertional) Angina: What are triggers?

A

Physical activity

Emotional excitement

Large meals

Exposure to cold

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33
Q

Chronic Stable (Exertional) Angina: What is an underlying cause?

A

CAD

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34
Q

Chronic Stable (Exertional) Angina: What happens to arterial walls in an angina?

A

deposition of fatty plaque in arterial wall

Leading to partial occlusion–> angina

35
Q

Chronic Stable (Exertional) Angina: What happens to arterial walls in a MI?

A

Deposition of fatty plaque in arterial wall

Complete occlusion –> MI

35
Q

Chronic Stable (Exertional) Angina: How is O2 demand at rest?

A

At rest, O2 demand and supply in balance

Leads to dilation of distal vessel

36
Q

Chronic Stable (Exertional) Angina: What is treatment of risk factors for stable angina?

A

Meds for dyslipidemia and htn

Meds for DM

Smoking cessation

37
Q

Chronic Stable (Exertional) Angina: What is the treatment to reduce risk of MI?

A

Antiplatelet agents

38
Q

Chronic Stable (Exertional) Angina: How does angina treatment work?

A

Increases cardiac O2 supply

Decreases cardiac O2 demand

39
Q

Chronic Stable (Exertional) Angina:

Approach to angina treatment:
Decrease cardiac O2 demand does what?

A

Meds to decrease HR, contractility, afterload, preload

Only provide symptomatic relief

Won’t alter underlying patho

Nitrates, BBlockers, CCBs

40
Q

Chronic Stable (Exertional) Angina:

Approach to angina treatment:
What drugs decrease cardiac O2 demand?

A

Nitrates, BBlockers, CCBs

41
Q

Chronic Stable (Exertional) Angina:

Ranolazine
What does it help with? What does it NOT do?

A

No effect on HR, PR, BP

Helps myocardium generate energy more efficiently

42
Q

Nondrug TX for stable angina?

A

Avoid triggers
Smoking cessation
Establish regular pattern of aerobic exercise

43
Q

Chronic Stable Angina:

Antianginal meds to decrease O2 demand: Nitrates- what do they do?

A

Dilation of veins decreases preload

SL for breakthrough

Long-acting for last line maintenance

44
Q

Chronic Stable Angina:

Antianginal meds to decrease O2 demand: Beta Blockers- What do they do?

A

Decrease in HR and contractility

45
Q

Chronic Stable Angina:

Antianginal meds to decrease O2 demand: Beta Blockers- What is it a first line add on to?

A

1st line add-on to sublingual NTG for maintenance

46
Q

Chronic Stable Angina:

Antianginal meds to decrease O2 demand: Beta Blockers- What does it prevent?

A

PX reflex tachycardia

47
Q

Chronic Stable Angina:

Antianginal meds to decrease O2 demand: Beta Blockers- What are cases where you would always add a BBlocker?

A

Always add if (+) prior MI

48
Q

Chronic Stable Angina:

Antianginal meds to decrease O2 demand: CCBs

A

All agents: dilation of arterioles decreases afterload

49
Q

Chronic Stable Angina:

Antianginal meds to decrease O2 demand: CCBs- What are examples? What do they do?

A

Verapamil & diltiazem only: decrease HR & contractility

50
Q

Chronic Stable Angina:

Antianginal meds to decrease O2 demand: CCBs- Why would they be added?

A

Added if BBlocker failed or CI

51
Q

Chronic Stable Angina:

Antianginal meds to decrease O2 demand: CCBs- What should be avoided? Why?

A

Avoid nondihydropyridines if concurrent Bblocker

52
Q

Chronic Stable Angina:

Antianginal meds to decrease O2 demand:

What is done if there is failure of Long acting nitrate + BBlocker +CCB?

A

Coronary artery bypass graft CABG

Percutaneous coronary intervention PCI

53
Q

Variant (Vasospastic) Angina aka?

A

AKA Prinzmetal’s angina

54
Q

Variant (Vasospastic) Angina Patho?

A

CAD –> coronary artery spasm

Decrease blood flow to myocardium ~ insufficient O2 ~ angina

55
Q

Variant (Vasospastic) Angina: What does it frequently occur with?

A

Frequently occurring in conjunction w/ stable angina

56
Q

Variant (Vasospastic) Angina: What is the approach to treatment?

A

increase cardiac O2 supply (pain not due to demand)

56
Q

Variant (Vasospastic) Angina: Antianginal meds to increase O2 supply- What meds are not effective?

A

BBlockers & ranolazine NOT effective for this form

56
Q

Variant (Vasospastic) Angina: What do meds do?

A

Agents that promote vasodilation ~ relax spasm

56
Q

Variant (Vasospastic) Angina: Antianginal meds to increase O2 supply
What are they?

A

Nitrates & CCBs

56
Q

Variant (Vasospastic) Angina: Antianginal meds to increase O2 supply- What meds are first line, second, last?

A

Antianginal meds to increase O2 supply

1st line: LA nitrate or CCB

2nd line: combo of above

Last line: CABG

57
Q

Unstable Angina- Symptoms?

A

Angina at rest
New-onset exertional angina
Intensification of existing angina

57
Q

Unstable Angina- risk of death?

A

Risk of death > stable angina

57
Q

Unstable Angina- what is it considered?

A

Medical emergency

58
Q

Unstable Angina- Approach to TX

A

Reduce pain & PX progression to MI

Maintain O2 supply

decrease O2 demand

Anti-ischemic therapy w/ antiplatelet & anticoagulant agents

58
Q

Unstable Angina-includes what?

A

Nitroglycerin

BBlocker

Supplemental O2 if (+) cyanosis or respiratory distress

IV morphine sulfate

59
Q

Unstable Angina-Anti-ischemic therapy

Nitroglycerin- how is it given?

A

SL dose q5min x 3

60
Q

Unstable Angina-Anti-ischemic therapy

Nitroglycerin- Persistent ischemia or HTN hows it given?

A

IV

61
Q

Unstable Angina-Anti-ischemic therapy

BBlocker
When is IV given over PO?

A

Ongoing chest pain initial IV > PO

62
Q

Unstable Angina- Anti-ischemic therapy

When is supplemental O2 given?

A

Supplemental O2 if (+) cyanosis or respiratory distress

63
Q

Unstable Angina- Anti-ischemic therapy

IV morphine sulfate : for what?

A

Pain unrelieved by NTG

Pulmonary congestion or severe agitation

64
Q

Unstable Angina- Anti-ischemic therapy
When would Ace inhibitor be given?

A

ACE-I if (+) LVD or CHF

65
Q

Unstable Angina

Antiplatelet therapy

A

ASA indefinitely

Clopidogrel, prasugrel, or ticagrelor x 2m

66
Q

Unstable Angina

Antiplatelet therapy

When would Abciximab be given?

A

Abciximab if angioplasty planned

67
Q

Unstable Angina

Antiplatelet therapy

When would Eptifibatide or tirofiban be given?

A

Eptifibatide or tirofiban if high-risk w/ continuing ischemia (angioplasty not planned

68
Q

Unstable Angina

Anticoagulant therapy: What meds?

A

Enoxaparin SQ

Direct thrombin inhibitors ~ bivalirudin

Factor Xa inhibitors ~ fondaparinux

IV UF heparin

69
Q

Drug Classes Used for Angina

A

Organic Nitrates
Beta Blockers
Calcium Channel Blockers
Ranolazine

70
Q

Organic Nitrates- example?

A

Nitroglycerin

71
Q

Organic Nitrates- What is Mode of action of stable angina?

A

Direct action on VSM

Vasodilation

decrease in venous return causes decrease in preload ~ decrease in O2 demand

72
Q

Organic Nitrates- stable angina

How are effects?

A

Veins > arterioles

Relief due to effects on peripheral blood vessels, NOT coronary blood flow

73
Q

Organic Nitrates-
MOA for variant:

A

Relaxation of coronary artery spasm

Increase in O2 supply

74
Q

Organic Nitrates cont.

ADE

A

HA

Orthostatic Hypotension

Reflex Tachycardia

Tolerance

75
Q

Organic Nitrates cont.

ADE: HA

A

PATHO/PHARM II (27 decks)

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