Cardio 10 Deck 4

Question 1

Angina

Answer 1

Clinical syndrome characterized by chest and/or arm discomfort

Caused by an imbalance between myocardial oxygen supply and demand (ischemia)

Associated with coronary artery disease

Pain is reproducible with physical exertion or emotional stress

Relieved by nitroglycerine

Question 2

Goals of Drug Therapy for Angina

Answer 2

Elimination of anginal pain
Blood pressure (BP) less than 130/85 mm Hg and pulse less than 70 beats per minute
Reduce the risks of myocardial infarction (MI) and death

Question 3

Treatment is aimed at (angina)

Answer 3

Increasing myocardial oxygen supply
Reducing myocardial oxygen demand
Minimizing or removing the occlusion

Question 4

Treatment of Angina

Answer 4

Lifestyle changes
Surgical intervention
Pharmacological management

Question 5

Drug classes for Angina

Answer 5

Aspirin
Nitrates
Beta blockers (BBs)
Calcium channel blockers
Angiotensin-converting enzyme inhibitors (ACEs)
Statins

Question 6

Coronary Vasodilators

Answer 6

Agents that serve to increase myocardial oxygen supply
Nitrates (nitroglycerin, isosorbide)
Prototype: nitroglycerine (NTG)
Calcium channel blockers (CCBs)

Question 7

Nitro dose

Answer 7

one every 5 min up to three times. Usually told to ED

Question 8

CCB use

Answer 8

will be on daily to prevent angina. Serve to increase myocardial oxygen supply

Question 9

Nitrates Action low dose

Answer 9

Low doses of NTG dilate the veins, decreasing venous return to the heart.
Decreases preload

Question 10

Nitrates Action high dose

Answer 10

Higher doses dilate arterial vessels.

Decreased vascular resistance (afterload)

Question 11

Nitrates some dilation of

Answer 11

coronary arteries occur.

Atherosclerotic vessels do not dilate.

Question 12

NTG Precautions and Contraindications

Answer 12

Contraindicated in hypersensitivity or idiosyncratic responses

Question 13

Nitrate transdermal patch

Answer 13

Transdermal patches: allergy to adhesive may limit their use

Question 14

NTG pregnancy category

Answer 14

C

Question 15

BBs decrease the

Answer 15

force of myocardial contractility and decrease heart rate and conduction velocity.

Question 16

BBs decrease systemic

Answer 16

vascular resistance and BP (afterload).

Question 17

Decreased myocardial oxygen demand =

Answer 17

decreased anginal pain.

Question 18

CCBs cause

Answer 18

arterial smooth muscle relaxation, which leads to peripheral vasodilation and decreased afterload.

Question 19

CCBs may cause

Answer 19

coronary vasodilation.

Atherosclerotic vessels do not dilate.

Question 20

CCB caution

Answer 20

may have swelling in lower extremities. Simply because of the action of the drug

Question 21

ACEs act on

Answer 21

the renin-angiotensin-aldosterone (RAS) system

Question 22

ACE cause

Answer 22

Decreased peripheral vascular resistance

Decreased afterload

Question 23

ACE indirectly

Answer 23

reduce the secretion of aldosterone
Decreased sodium and water retention
Reducing extracellular fluid volume and preload

Question 24

Aspirin

Answer 24

decreases platelet aggregation to prevent cycle of vasoconstriction and platelet buildup

Question 25

Statins are preventive. They reduce

Answer 25

in low-density lipoprotein cholesterol levels, which plays a significant role in decreasing the formation of atherosclerotic plaque

Question 26

Rational Drug Selection for angina

Answer 26

Grading of Angina by the New York Heart Association and the Canadian Cardiovascular Society

Question 27

All patients with angina should be on

Answer 27

aspirin 81 to 325 mg/day

Question 28

If patient cannot tolerate aspirin,

Answer 28

then clopidogrel (Plavix) 75 mg daily may be substituted.

Question 29

NTG for exertional angina

Answer 29

Sublingual tablet (0.3 to 0.4 mg) or translingual spray is used for immediate symptom relief.

Question 30

Class 1 grading of Angina NY

Answer 30

Proven coronary artery disease without symptoms

Question 31

Class 2 grading Angina NY

Answer 31

Mild symptoms: angina and slight limitation during ordinary activity

Question 32

Class 3 grading Angina NY

Answer 32

Marked limitations: angina during less-than-routine physical activity (walking short distances)

Question 33

Class IV grading Angina NY

Answer 33

Severe limitations: angina during minimal activity or rest

Question 34

Class 1 Grading Canadian

Answer 34

Ordinary physical activity, such as walking or climbing stairs, does not cause angina.

Question 35

Class 2 Grading Canadian

Answer 35

Slight limitation of ordinary activity. Angina occurs on walking or climbing stairs rapidly, walking uphill, walking or stair climbing after meals, in cold wind, under emotional stress, or only during the few hours after awakening.

Question 36

Class 3 Grading Canadian

Answer 36

Marked limitations of ordinary activity.

Question 37

Class 4 Grading Canadian

Answer 37

inability to carry on any physical activity without discomfort. Angina may occur at rest.

Question 38

Drugs for Stable Angina

Answer 38

ACE Angiotensin II BB CCB

Question 39

ACE are recommended for

Answer 39

for all symptomatic patients with chronic stable angina to prevent MI or death and to reduce symptoms

Question 40

Angiotension II are recomended for

Answer 40

who are intolerant to ACEIs

Question 41

BB are recommended as

Answer 41

initial therapy by all the guidelines for all patients

Question 42

CCB are initial drug choice for

Answer 42

Initial drugs of choice for coronary artery vasospasm–associated angina