Cardiovascular Conditions: Stable Ischemic Heart Disease

Question 1

Stable angina

Answer 1

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

Question 2

Unstable angina

Answer 2

acute coronary syndrome

medical emergency, chest pain increases and doesnt get better with rest or nitroglycerin

Question 3

Chest pain occurs when imbalance in….

Answer 3

myocardial oxygen demand (work load) and supply (blood flow)

Question 4

to assess likelihood of CAD and diagnose SIHD, what is performed

Answer 4

Cardiac stress test

Question 5

Non-drug treatment options

Answer 5

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

Question 6

Drug treatment options

Answer 6

Antiplatelet and antianginal

aspirin recommended, clopidogrel when allergy

Question 7

Anti anginal drug treatment options

Answer 7

1st line: beta blockers
CCBs when beta blockers contraindicated

Question 8

Patients with SIHD should be on what dose of statins?

Answer 8

High dose statins

Question 9

Aspirin mechanism of action

Answer 9

irreversibly inhibits COX-1 and COX-2 enzymes, leading to decreased prostaglandin and TXA2 production

Question 10

Clopidogrel mechanism of action

Answer 10

prodrug

irreversibly inhibits P2Y12 ADP-mediated platelet activation and aggregation

Question 11

Aspirin CI

Answer 11

NSAID or salicylate allergy
risk of Reye’s syndrome

Question 12

Aspirin warnings

Answer 12

Bleeding
tinnitus (if OD)

Question 13

Aspirin Side effects

Answer 13

Dyspepsia
Heartburn
bleeding

Question 14

Aspirin notes

Answer 14

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

Question 15

Clopidogrel Boxed warning

Answer 15

Test to see if CYP2C19 poor metabolizer since it is a pro drug

Question 16

Clopidogrel CI

Answer 16

active serious bleed

Question 17

Clopidogrel warning

Answer 17

bleeding risk: stop 5 days prior to elective surgery
Dont use with omeprazole/esomperazole

Question 18

when should DAPT be used

Answer 18

• had bare metal stent (use atleast 1 month)
• have drug-eluting stent (use atleast 6 months)
• post CABG (use atleast 12 months)

Question 19

Beta blockers in SIHD info

Answer 19

go low and slow, target HR of 55-60, avoid abrupt stopping

BB w/o ISA (metoprolol/carvedilol) preferred

** avoid for Prinzmetals angina **

Question 20

Preferred drugs for Prinzmetal’s angina?

Answer 20

Calcium channel blockers

avoid short acting DHP (nifedipine IR)
DHP preferred in combo with beta blocker

Question 21

Long acting nitrates are used as….

Answer 21

add on therapy or when BB contraindicated

Question 22

Ranolazine CI

Answer 22

dont use with strong CYP3A4 inducers
Liver cirrhosis

Question 23

Ranolazine Warnings

Answer 23

QT prolongation

Question 24

Ranolazine notes

Answer 24

has little to no clinical effect on HR/BP

not for acute treatment of chest pain

Question 25

Preferred nitrate combo in HFrEF

Answer 25

isosorbide dinitrate in combo with hydralazine

Question 26

Using nitrates with PDE-5 inhibitors? (dick drugs)

Answer 26

Long acting nitrates = no
Short acting nitrates = wait 12hrs avanafil, 24hrs sildenafil/vardenafil, tadalafil 48hrs)

Question 27

Ranolazine in combo with simvastatin limit

Answer 27

20mg/day of simvastatin

Question 28

Ranolazine in combo with diltiazem/verapamil limit?

Answer 28

500mg BID of ranolazine

Question 29

Isosorbide mononitrate BID dosing interval

Answer 29

8am and 3pm

taken 7hrs apart

Question 30

Long acting nitrate ointment dosing interval

Answer 30

does BID, 6hrs apart, with 10-12hr nitrate free interval

Question 31

Isorobide dinitrate BID and TID dosing

Answer 31

BID = 8am and 3pm
TID = 8am, 12pm, 4pm