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NAPLEX > Chapter 29: Ischemic Heart Disease > Flashcards

Chapter 29: Ischemic Heart Disease Flashcards

1
Q

Another name for stable angina

A

Stable ischemic heart disease (SIHD)

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2
Q

SIHD is associated with

A

predictable chest pain, often brought on by exertion or emotional stress

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3
Q

Which type of angina is relieved by rest or nitroglycerin

A

Stable angina or SIHD

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4
Q

Unstable angina is a type of

A

acute coronary syndrome (ACS)

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5
Q

What is Prinzmetal’s angina

A

When chest pain is caused by vasospasm of the coronary arteries. Can occur at rest & often caused by illicit drug use, particularly cocaine

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6
Q

Chest pain occurs when there is an imbalance between _____ and _____

A

myocardial oxygen demand (workload)

supply (blood flow)

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7
Q

In stable ischemic heart disease (SIHD), myocardial O2 supply is often ↓ d/t _____ within the inner walls of the coronary arteries

A

plaque build-up (atherosclerosis)

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8
Q

What is performed to assess the likelihood of CAD and diagnose SIHD

A

Cardiac stress test

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9
Q

How is a cardiac stress test performed

A

Exercise on treadmill or stationary bike or IV meds

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10
Q

Which IV meds can be used in a cardiac stress test

A

dipyriadmole, adenosine (Adenoscan), regadenoson (Lexiscan) or dobutamine

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11
Q

What is the recommended antiplatelet drug for AIHD

A

Aspirin (clopidogrel can be used when there is an allergy or other CI to aspirin)

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12
Q

Antianginal treatment ____ myocardial oxygen demand or ____ myocardial oxygen supply

A

decreases

increases

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13
Q

Which drug class is first line for angina

A

Beta-blockers

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14
Q

What should be used as second line for angina or when additional symptomatic relief is needed

A

CCBs or long-acting nitrates

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15
Q

Which medication is recommended for immediate relief of angina in all pts

A

Nitroglycerin, as a SL tab, powder or translingual spray

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16
Q

Patients with SIHD should be treated with a ___-intensity statin

A

high

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17
Q

What is the treatment approach for stable ischemic heart disease

A

A- antiplatelet and antianginal drugs (BB, CCBs, and nitrates)
B- BP and BB
C - Cholesterol (statins) and cigarettes (cessation)
D- Diet and diabetes
E - exercise & education

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18
Q

Aspirin MOA

A

irreversibly inhibits COX-1 and COX-2 enzymes which results in decreased prostaglandin and thromboxane A2 production (TXA2)

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19
Q

Clopidogrel MOA

A

irreversibly inhibits P2Y12 ADP-mediated platelet activation and aggregation

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20
Q

ASA dosing

A

75-162 mg daily

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21
Q

Clopidogrel dosing

A

75 mg daily

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22
Q

Aspirin CI

A

NSAID or salicylic acid allergy: children and teenagers with vital infection d/t risk of Reye’s syndrome

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23
Q

Aspirin warnings

A

Bleeding, tinnitus (salicylate OD)

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24
Q

Aspirin SE

A

dyspepsia, heartburn, bleeding

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25
Q

How long is aspirin used for in SIHD

A

indefinitely

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26
Q

Which formulation of ASA is preferred in ACS

A

non-enteric coated, chewable ASA

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27
Q

What should a patient do in ACS if only EC aspirin is available

A

chew it (325 mg tab)

28
Q

Which two formulations of ASA should not be used when rapid onset is needed

A 
ER capsule (Durlaza)
DR tablet (Yosprala)
29
Q

What can be used to protect the gut with chronic NSAID use

A

PPIs (consider risks - decreased bone density and increased infection risk)

30
Q

Which CYP enzyme converts clopidogrel to its active metabolite

A

2C19

31
Q

Clopidogrel CI

A

active serious bleeding

32
Q

Clopidogrel should be stopped 5 days prior to:

A

elective surgery

33
Q

Clopidogrel should not be used with which 2 drugs

A

omeprazole and esomeprazole

34
Q

Clopidogrel can cause

A

thombotic thrombocytopenic purpura (TTP)

35
Q

When is clopidogrel used in SIHD

A

when there is a CI to aspirin

36
Q

Dual antiplatelet therapy (DAPT) with ASA and clopidogrel is reserved for which patients (& what is the duration)

A
  • bare metal stent placement (DAPT for at least 1 month)
  • Drug-eluting stent (DAPT for at least 6 months)
  • post-CABG (DAPT for 12 months)
37
Q

Aspirin is dosed at ___ mg daily in Dual antiplatelet therapy (DAPT) regimens and is continued indefinitely at 75-162 mg daily after this course of DAPT therapy

A

81 mg

38
Q

Mechanism of clinical benefit of BB in SIHD

A

decreases HR, decreases contractility, and decreases LV wall tension

39
Q

Which drug class is preferred for Prinzmetal’s angina

A

CCBs

40
Q

Mechanism of clinical benefit of CCBs in SIHD (non-DHP and DHP)

A

non-DHPs: decrease HR and contractility

DHPs: decrease SVR (afterload)

41
Q

Mechanism of clinical benefit of nitrates in SIHD

A

Decrease preload (free radical NO produces vasodilation of veins more than arteries)

42
Q

BB should be titrated ti resting HR of

A

55-60 BPM

43
Q

Which types of BB are preferred in SIHD

A

BB without ISA (metoprolol, atenolol)

44
Q

BB should be avoided in

A

Prinzmetal’s angina

45
Q

Which CCBs should be avoided in SIHD

A

short-acting DHPs (like nifedipine IR)

46
Q

When are DHP CCBs preferred in SIHD

A

when they are used in combination with BB (d/t risk of excessive bradycardia when non-DHPs are used with BB)

47
Q

When are long-acting nitrates used in SIHD

A

when BB are CI or as add-on therapy for treatment of symptoms

48
Q

Ranolazine CI

A

strong 3A4 inhibitors and inducers

49
Q

Ranolazine warning

A

QT prolongation

50
Q

Nitroglycerin formulas all come in which dose

A

0.4 mg

51
Q

Which meds are long-acting nitrates

A

Nitroglycerin ointment 2% (Nitro-BID)

Isosorbide mononitrate IR/ER tablet

52
Q

Nitrate CI

A

Do not use with PDE5 inhibitors

53
Q

Nitrate warnings

A

Hypotension, HA, tachyphylaxis (↓ effectiveness/tolerance with LA products)

54
Q

Nitrate SE

A

HA, flushing, syncope

55
Q

How long after opening nitroglycerin SL tab vial should the bottle be discarded

A

6 months

56
Q

Long-acting nitrates require a __-__ hour nitrate-free interval to decrease tolerance

A

10-12

57
Q

Nitroglycerin patch should be worn on for __-__ hours & rotate sites

A

12-14

58
Q

Nitroglycerin ointment is dosed how many times per day and how many hours apart

A

BID, 6 hours apart

59
Q

Isosorbide mononitrate IR is dosed BID, __ hours apart

A

7

60
Q

Isosorbide dinitrate in combination with ___ is the preferred formulation for systolic HF

A

hydralazine

61
Q

When using NTG SL tabs, powder or spray, when should 911 be called

A

if chest pain persists after the first dose

62
Q

Take ___ additional dose(s) at __ minute intervals of NTG while waiting for an ambulance to arrive

A

2

5

63
Q

Do NOT take more than __ doses of NTG within 15 min

A

3

64
Q

What is not a sign that NTG is working well

A

Slight burning or tingling sensation

65
Q

Counseling for NTG TL spray

A

Do not shake
Spray onto or under the tongue
Do not inhale the spray

66
Q

What is the preferred application site for NTG patches

A

Chest

67
Q

Counseling for NTG ointment

A

Measure the dose of ointment with the dose measuring applicator
Can stain clothing

NAPLEX (74 decks)

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