Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardio 1228 > Chronic Stable Angina/SIHD/IHD (edited) > Flashcards

Chronic Stable Angina/SIHD/IHD (edited) Flashcards

1
Q

Describe chest pain in angina

A

Squeezing, grip-like, heavy or suffocating and typically doesn’t vary with position or respiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What’s stable angina also known as?

A

Stable ischemic heart dx (SIHD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What’s stable angina or SIHD associated with?

A

Predictable chest pain often brought on by exertion or emotional stress and relieved within minutes by rest (or nitroglycerin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What causes stable angina?

A

Plaque build up on the inner walls of coronary arteries (atherosclerosis) causing narrowing in the arteries and reduced blood flow to heart=decreased myocardial oxygen supply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What’s Prinzmetal’s (variant or vasospastic angina) angina?

A

Angina that’s present in pts with NORMAL coronary arteries, where angina sx are as a result of vasospasm in the arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

List types of angina

A

Stable angina

Prinzmetal’s angina

Silent ischemia

Unstable angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What’s stable angina?

A

Decreased myocardial O2 supply to due to reduced blood flow from narrowed arteries by atherosclerotic plaque

Sx have been occurring for weeks but without worsening

Occurs with exertion-predictable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What’s Prinzmetal’s angina?

A

Decreased myocardial O2 supply due to vasospasm of the artery

Occurs at rest
often caused by illicit drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What’s silent ischemia?

A

Transient myocardial ischemia without sx of angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What’s unstable angina?

A

Severe, crushing chest pain unrelieved by rest; acute medical care is needed

unpredictable-chest pain increases

medical emergency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What’s the non-pharmacologic tx of CSA?

A 
Heart healthy lifestyle 
    saturated fats < 7% of total calories and 
    Trans fat < 1% of total calories
    Fresh fruits and vegetables 
    Low fat dairy pdts

Stop smoking

Maintain BMI of 18.5-24.9 kg/m2

Waist circumference
Females < 35 inches
Males < 40 inches

Encourage physical exercise
30-60 minutes of moderate-intensity aerobic activity, at least 5 days a wk, preferably 7 days a wk

limit alcohol (4oz wine, 12 oz beer, 1oz spirits)
1 female
1-2 male

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What’s a Heart healthy lifestyle in CSA?

A

saturated fats < 7% of total calories

Trans fat < 1% of total calories

Fresh fruits and vegetables

Low fat dairy pdts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How much saturated fat should be consumed in heart healthy lifestyle in CSA?

A

< 7% of total calories

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How much trans fat should be consumed in heart healthy lifestyle in CSA?

A

< 1% of total calories

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What’s the recommended BMI in CSA?

A

18.5 - 24.9 kg/m2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What’s the recommended waist circumference in CSA?

A

Males < 40 inches

Females < 35 inches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Whats the tx goals of CSA?

A

improve function by eliminating angina
prevent CV events (MI, HF)
decrease risk of cardiovascular death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What’s combo is most often used to meet the tx goals of CSA?

A

Antiplatelet (usually Aspirin; Plavix if ASA allergy or CI)
+ Antianginal (1st: BB. any CCB or LA nitrate if BB CI or need additional symptomatic relief; ranolazine can be used in place of or in addition to BB)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What’s the first line therapy for tx of CSA?

A

Beta blockers

(CCB or long-acting nitrates are used when bb is CI or when additional relief is needed; ranolazine can be used in place of or in addition to BB)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What’s recommended for immediate relief of angina?

A

Sublingual nitroglycerin or nitroglycerin spray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What med should ALL pts with CSA be on regardless?

A

Moderate or high dose statin (regardless of LDL values)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What vaccine is recommended in CSA?

A

Annual flu shot, ACIP recommends pneumococcal 13 & 23

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What’s the acronym that summarizes the non-pharmacologic and pharmacologic therapies in chronic therapy?

A

A - Antiplatelet and Antianginal drugs

B - Blood pressure and beta-blockers

C - Cholesterol (statins - SIHD is one of the ASCVD diseases) and quit Cigarettes

D - Diet and diabetes

E - Exercise and education

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

List Antiplatelet agents

A

Aspirin (Bayer, Ascriptin, Bufferin)

Clopidogrel (Plavix)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

SE of aspirin (Bayer, Ascriptin, Bufferin)?

A

Warning: Bleeding

Dyspepsia
Heartburn
GI upset
GI bleed/ ulceration
Tinnitus (in toxicity)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What’s the black box warning of Clopidogrel (Plavix)?

A

Prodrug: depends on CYP2C19 for the activation to active metabolite mainly.

Poor metabolizers exhibit higher cardiovascular events than pts with normal CYP2C19 fxn

27
Q

Which allele corresponds to fully functional metabolism of Clopidogrel (Plavix)?

A

CYP2C19*1 allele

28
Q

Which allele corresponds to nonfunctional metabolism of Clopidogrel (Plavix)?

A

CYP2C19*2 and *3 allele

29
Q

SE of Clopidogrel (Plavix)?

A

Bleeding

GI hemorrhage
Bruising/hematoma
Rash/pruritus

TTP (thrombotic thrombocytopenia purpura)

30
Q

When’s Clopidogrel (Plavix) used in CSA?

A

In pts with CI to aspirin (NSAID or salicylate allergy)

31
Q

List drugs that should be avoided in aspirin use, bcuz they increase bleeding risk

A

Anticoagulants

Antiplatelet (salicylates, dipyridamole, clopidogrel, prasugrel, ticagrelor)
Ginkgo, garlic, ginger, glucosamine, ginseng
vit E, willow bark, fish oil

NSAIDs
SSRIs
SNRIs

Dextran
Thrombolytics etc

32
Q

Effect of aspirin (and NSAIDs) on lithium and methotrexate levels?

A

They increase lithium and methotrexate levels

Avoid concurrent use

33
Q

List Ototoxicity agents that should not be used with aspirin

A 
Vancomycin
ahminoglycosides
Loop diuretics
cisplatin
salicylates
34
Q

List meds that shouldn’t be used with Clopidogrel (Plavix)

A

2C19 inducers
Cimetidine

Fluconazole

Ketoconazole

Voriconazole

Fluoxetine

Fluvoxamine

Omeprazole

Esomeprazole

35
Q

List Antianginal agents in CSA?

A

Beta blockers-titrate to HR 55-60 BPM-all agents equally effective for SIHD (CSA)

CCB- DHP if in combo with BB(excessive brady with non-DHP+BB) non-DHP can be used in place of BB though

Nitrates (SL-for immediate anginas relief LA-for BB CI or in addition to BB)

Ranolazine

36
Q

In what type of angina is beta blockers avoided?

A

Prinzmetal’s angina

37
Q

What’s the preferred agent for Prinzmetal’s (variant) angina?

A

CCB

38
Q

What type of CCB is CI in CSA?

A

Short-acting CCBs e.g. Nifedipine IR

39
Q

When should u call 911 in CSA?

A

If chest pain doesn’t go away after first dose of SL tabs or spray

40
Q

Uses of long-acting nitrates in CSA?

A

Not used alone for chronic therapy (used in combo with bb or CCB)

Req nitrate-free interval

41
Q

What’s the warning associated with Ranolazine (Ranexa) use?

A

Can cause QT prolongation

42
Q

SEs of Ranolazine?

A

Dizziness

Constipation

Headache

Nausea

43
Q

Effect of Ranolazine on HR or BP?

A

Ranolazine has little to no clinical effects on HR or BP

it inhibits late phase Na and decreases intracellular Ca= decreased myocardial oxygen demand

44
Q

What meds should be avoided with nitrate?

A

CI w/ PDE-5 inhibitors, riociguat

due to BP decrease

45
Q

What’s the dose of simvastatin that can be safely used with Ranolazine?

A

Limit simvastatin to 20mg/day if used with Ranolazine

46
Q

List Nitroglycerin formulations

A

Short-Acting:

  • Nitroglycerin SL tabs (Nitrostat) 0.3, 0.4, 0.6 mg
  • Nitroglycerin translingual spray 0.4mg/spray (Nitromist, Nitrolingual Pump Spray)
  • Nitroglycerin SL powder (GoNitro)

Long-Acting:
Isosorbide mononitrate IR/ER tabs/caps (Monoket)
isosorbide dinirtate IR/ER
nitroglycerin patch (Nitro-Dur,Minitran) 2% ointment (Nitro-BID)

47
Q

What’s the brand name and dose of Nitroglycerin SL tabs?

A

Nitrostat

0.3, 0.4, 0.6mg

48
Q

What’s the brand name and dose of Nitroglycerin SL spray?

A

Nitromist, Nitrolingual Pump Spray

0.4mg /spray

49
Q

What’s the brand name of Isosorbide mononitrate IR/ER tabs/caps?

A

Monoket

50
Q

SEs of nitroglycerin formulations

A

Warning:Hypotension, headache, Tachyphylaxis(decrease effectiveness/tolerance)

Headache
Flushing
Syncope
Dizziness
Lightheadedness
51
Q

How does pts dose the nitrate-free interval?

A

all Long-acting require: 10-12 hour nitrate-free period to reduce tolerance
for example
ointment- BID q 6 hr w/ 10-12 hr nitrate free
patch-wear 12 to 14 hr with 10-12 hr no patch (rotate site)

52
Q

In what container should the nitroglycerin IV be prepared?

A

Glass bottles or polyolefin bags (non-PVC)

53
Q

Can nitroglycerin SL tab be used prophylactically?

A

Yes, nitroglycerin SL tab can be taken prophylactically 5-10 minutes before activities that bring on chest pain)

54
Q

How should nitroglycerin tabs be stored? Effect

A

Room temperature

If stored and handled properly, the tabs should be stable until manufacturer provided expiration date

55
Q

NTG stored in original amber glass bottle?

A

Yes

NTG SL tabs should be kept in original amber glass bottle which is kept tightly capped

56
Q

How do u use NTG pump spray?

A

Don’t shake
Spray 5 times into air to prime (10 times for NitroMist)

If not used within 6 wks, prime the pump with 1 spray before use (2spray-NitroMist)

Press button firmly with forefinger to release spray onto or under the tongue

Close mouth after spray

Don’t eat or drink or rinse the mouth for 5-10 mins after dose

Use 1 spray Q5mins, but no more than 3 sprays in 15 mins

57
Q

What meds should be avoided in NTG use?

A

PDE-5 inhibitor

Sildenafil (Viagra, Revatio)

Tadalafil (Cialis, Adcirca)

Vardenafil (Levitra, Staxyn)

Avanafil (Stendra)

riociguat

58
Q

How do u use Isosorbide Mononitrate?

A

Take 1st dose when us wake up

Take 2nd dose 5 hrs later

59
Q

How should Isosorbide Mononitrate be used?

A

Take at the same times each day

Don’t change dosing times unless directed by healthcare provider

60
Q

Which of the SE of Isosorbide Mononitrate becomes tolerable as time goes on?

A

Headache

61
Q

Uses of Ranolazine?

A

Used to decrease the number of times u may get chest pain

NOT used to treat chest pain when it occurs (like NTG is)

62
Q

What’s angina?

A

Chest pain, pressure or discomfort

63
Q

NTG powder use

A

pour powder under tongue, close mouth and breath normally thru nose
let powder dissolve without swallowing
Don’t rinse or spit for 5 min after dose

64
Q

How antianginal Tx works in SIHD

A

BB: decrease O2 demand by decreasing HR and decreasing contractility

CCB: decrease O2 demand by
non-DHP decrease HR and contractility
DHP decrease SVR (decrease afterload)
increase O2 supply by increasing blood flow (all CCBs) thru coronary arteries

Nitrates: decrease O2 demand by vasodilation veins (decrease preload)
increase O2 supply by increasing blood flow thru collateral arteries (non-atherosclerotic)

Ranolazine: decreases O2 demand by decreasing ventricular tension and oxygen consumption (by inhibiting late phase Na and decreasing intracellular Ca)

Cardio 1228 (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions