ChronicAnginaFC Flashcards
what are the types of angina
chronic (stable) prinzmetal (variant) unstable, silent
what is prizmental angina?
decreaase myocardial oxygen due to vasospasm, rare
which types of angina are due to supply ischemia
prinzmetal and unstable
which types of angina are due to demand ischmia
chronic (stable)
what are the non pharmacologic treatment goals in pt with angina
BMI < 25 waist < 35 women < 40 men 30 mins of exercise at least 5x a week
Stop smoking
what are the pharmacologic treatment options for angina
antiplatelets (asa is Doc, clopidogrel) antianginal (bb ccb nitrates ranolazine)
what Beta blockers should not be used in patients with angina
those with intrinsic sympathomimetic activity carteolol acebutalol pindolol penbutolol (CAPP)
what is the goal of therapy with BB for angina?
resting HR of 50-60bpm ,
1st line antianginal agent for chronic angina
beta blockers
beta blockers should not be used in patients with what type of angina
prinzmental (varient)
CCB are preferred in patients with what type of angina
prinzmetal variant
which form of CCB are more effective in angina DHP or Non-DHP
non dhp (verapamil diltiazem)
ASA contraindications
salicylate allergy active bleed
ASA side effects
heartburn dyspepsia increase BP renal impairment tinnitus (toxicity) GI bleed Gi upset bleeding
plavix
clopidogrel
clopidogrel maintenance dose
75 mg daily
clopidogrel should not be used in patients that are
poor 2C19 metabolizers (2C192 and 2C193)
clopidogrel contraindications
active bleed (ich pud)
clopidogrel side effects
bleeding rash TTP
what is thrombotic thrombocytopenic purpura
a rare and serious side effect of clopidogrel whch pts should report fever, weakness, extreme skin paleness, purple patches, yellowing of eyes/skin, neurological changes
what antiplatelet is 1st line in angina
asa (clopidogrel is used if pt has contraindication to asa)
DDIs colopidogrel?
strong cyp 2c19 inhibitors: cimetidine, -azoles, fluoxetine
-any agents that cause bleeding
what enzyme inhibition affects clopidogrel?
cyp 2c19,
if a patient will undergo major surgery or cabg surgery, when should they DC the clopidogrel?
5 days before the surgery
if a pt has a contraindication to asa what can be used instead
clopidogrel
caution should be used when asa is used with vancomycin loops 2/2
ototoxicity
___ should be avoided when pt is on clopidogrel due to their DD (PPISs)
omeprazole esomeprazole
if a pt takes a nitrate and the pain is still there when should they call 911
after 1st dose
are nitrates used as monotherapy for chronic angina
no only used in combination with CCB or beta blockers
nitrates MOA
decrease O2 demand by decreasing preload
ranexa
ranolazine
ranolazine contraindications
liver cirrhosis 3a4 inhibitors or inducers
ranolazine side effects
constipation QT prolongation dizziness
ranolazine is more effective in women or men
men
ranolazine is different from CCB/Nitrates/BB in that it
doesn’t effect HR or BP
nitrate contraindications
PDE5-I increase ICP severe anemia
nitrates side effects
headache flushing hypotension
how long is the nitrate free interval
10 - 12 hours
nitrostat
nitroglycerin SL tabs
nitromist
nitroglycerin spray
nitrolingual pump spray
nitroglycerin SL spray
nitro-dur
nitroglycerin patch
minitran
nitroglycerin patch
monoket
isosorbide mononitrate IR
imdur
isosorbide mononitrate ER
isosorbide mononitrate IR is BID and doses should be _ hours apart
7
how many times can a patient use their nitroglycerin SL/spray when having an anginal attack
1 dose at 5 minute intervals for a max of 3 doses
nitroglycerin storage
original amber bottle
where is the nitroglycerin patch applied
on upper arm above the elbows and on chest , (above knee level)
when a patient first gets their nitroglycerin spray what should they do upon first administration
prime with 5 sprays into air, if they havent used the pump in 6 weeks, they need to prime agaian
how is nitroglycerin spray taken
close mouth after each spray do not swallow too quickly or inhale do not shake spray before use
when are nitroglycerin SL tabs and spray indicated
acute chest pain prophylaxis 5 - 10 mins before activity that might cause chest paint
how long to keep the nitorglycerin patches on?
for 12-14hours , you mucs take it off for the next 10-12 hours foof
which of the antianginal drugs can be used in combination with the other classes of antianginals?
the ranolzine caue be used in chronic stable angina with CCB, nitrates and betal blockers.
