Cardiovascular Conditions: Stable Ischemic Heart Disease Flashcards
Stable angina
also known as stable ischemic heart disease
associated with predicable chest pain often brought on by exertion and relieved within minutes by rest or using nitroglycerin
Unstable angina
acute coronary syndrome
medical emergency, chest pain increases and doesnt get better with rest or nitroglycerin
Chest pain occurs when imbalance in….
myocardial oxygen demand (work load) and supply (blood flow)
to assess likelihood of CAD and diagnose SIHD, what is performed
Cardiac stress test
Non-drug treatment options
Heart healthy diet
BMI: 18.5 - 24.9
female waist < 35 in
male waist < 40 in
moderate aerobic activity 5-7 days per week
quit smoking, limit drinking
Drug treatment options
Antiplatelet and antianginal
aspirin recommended, clopidogrel when allergy
Anti anginal drug treatment options
1st line: beta blockers
CCBs when beta blockers contraindicated
Patients with SIHD should be on what dose of statins?
High dose statins
Aspirin mechanism of action
irreversibly inhibits COX-1 and COX-2 enzymes, leading to decreased prostaglandin and TXA2 production
Clopidogrel mechanism of action
prodrug
irreversibly inhibits P2Y12 ADP-mediated platelet activation and aggregation
Aspirin CI
NSAID or salicylate allergy
risk of Reye’s syndrome
Aspirin warnings
Bleeding
tinnitus (if OD)
Aspirin Side effects
Dyspepsia
Heartburn
bleeding
Aspirin notes
PPI can be used to protect gut, consider risks
use EC w/ food to dec nausea
non-EC preferred in ACS, if not available then chew EC
Clopidogrel Boxed warning
Test to see if CYP2C19 poor metabolizer since it is a pro drug
Clopidogrel CI
active serious bleed
Clopidogrel warning
bleeding risk: stop 5 days prior to elective surgery
Dont use with omeprazole/esomperazole
when should DAPT be used
- had bare metal stent (use atleast 1 month)
- have drug-eluting stent (use atleast 6 months)
- post CABG (use atleast 12 months)
Beta blockers in SIHD info
go low and slow, target HR of 55-60, avoid abrupt stopping
BB w/o ISA (metoprolol/carvedilol) preferred
** avoid for Prinzmetals angina **
Preferred drugs for Prinzmetal’s angina?
Calcium channel blockers
avoid short acting DHP (nifedipine IR)
DHP preferred in combo with beta blocker
Long acting nitrates are used as….
add on therapy or when BB contraindicated
Ranolazine CI
dont use with strong CYP3A4 inducers
Liver cirrhosis
Ranolazine Warnings
QT prolongation
Ranolazine notes
has little to no clinical effect on HR/BP
not for acute treatment of chest pain
Preferred nitrate combo in HFrEF
isosorbide dinitrate in combo with hydralazine
Using nitrates with PDE-5 inhibitors? (dick drugs)
Long acting nitrates = no
Short acting nitrates = wait 12hrs avanafil, 24hrs sildenafil/vardenafil, tadalafil 48hrs)
Ranolazine in combo with simvastatin limit
20mg/day of simvastatin
Ranolazine in combo with diltiazem/verapamil limit?
500mg BID of ranolazine
Isosorbide mononitrate BID dosing interval
8am and 3pm
taken 7hrs apart
Long acting nitrate ointment dosing interval
does BID, 6hrs apart, with 10-12hr nitrate free interval
Isorobide dinitrate BID and TID dosing
BID = 8am and 3pm
TID = 8am, 12pm, 4pm
