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Board Review > ChronicAnginaFC > Flashcards

ChronicAnginaFC Flashcards

1
Q

what are the types of angina

A

chronic (stable) prinzmetal (variant) unstable, silent

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2
Q

what is prizmental angina?

A

decreaase myocardial oxygen due to vasospasm, rare

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3
Q

which types of angina are due to supply ischemia

A

prinzmetal and unstable

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4
Q

which types of angina are due to demand ischmia

A

chronic (stable)

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5
Q

what are the non pharmacologic treatment goals in pt with angina

A

BMI < 25 waist < 35 women < 40 men 30 mins of exercise at least 5x a week
Stop smoking

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6
Q

what are the pharmacologic treatment options for angina

A

antiplatelets (asa is Doc, clopidogrel) antianginal (bb ccb nitrates ranolazine)

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7
Q

what Beta blockers should not be used in patients with angina

A

those with intrinsic sympathomimetic activity carteolol acebutalol pindolol penbutolol (CAPP)

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8
Q

what is the goal of therapy with BB for angina?

A

resting HR of 50-60bpm ,

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9
Q

1st line antianginal agent for chronic angina

A

beta blockers

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10
Q

beta blockers should not be used in patients with what type of angina

A

prinzmental (varient)

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11
Q

CCB are preferred in patients with what type of angina

A

prinzmetal variant

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12
Q

which form of CCB are more effective in angina DHP or Non-DHP

A

non dhp (verapamil diltiazem)

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13
Q

ASA contraindications

A

salicylate allergy active bleed

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14
Q

ASA side effects

A

heartburn dyspepsia increase BP renal impairment tinnitus (toxicity) GI bleed Gi upset bleeding

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15
Q

plavix

A

clopidogrel

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16
Q

clopidogrel maintenance dose

A

75 mg daily

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17
Q

clopidogrel should not be used in patients that are

A

poor 2C19 metabolizers (2C192 and 2C193)

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18
Q

clopidogrel contraindications

A

active bleed (ich pud)

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19
Q

clopidogrel side effects

A

bleeding rash TTP

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20
Q

what is thrombotic thrombocytopenic purpura

A

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

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21
Q

what antiplatelet is 1st line in angina

A

asa (clopidogrel is used if pt has contraindication to asa)

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22
Q

DDIs colopidogrel?

A

strong cyp 2c19 inhibitors: cimetidine, -azoles, fluoxetine
-any agents that cause bleeding

23
Q

what enzyme inhibition affects clopidogrel?

A

cyp 2c19,

24
Q

if a patient will undergo major surgery or cabg surgery, when should they DC the clopidogrel?

A

5 days before the surgery

25
Q

if a pt has a contraindication to asa what can be used instead

A

clopidogrel

26
Q

caution should be used when asa is used with vancomycin loops 2/2

A

ototoxicity

27
Q

___ should be avoided when pt is on clopidogrel due to their DD (PPISs)

A

omeprazole esomeprazole

28
Q

if a pt takes a nitrate and the pain is still there when should they call 911

A

after 1st dose

29
Q

are nitrates used as monotherapy for chronic angina

A

no only used in combination with CCB or beta blockers

30
Q

nitrates MOA

A

decrease O2 demand by decreasing preload

31
Q

ranexa

A

ranolazine

32
Q

ranolazine contraindications

A

liver cirrhosis 3a4 inhibitors or inducers

33
Q

ranolazine side effects

A

constipation QT prolongation dizziness

34
Q

ranolazine is more effective in women or men

A

men

35
Q

ranolazine is different from CCB/Nitrates/BB in that it

A

doesn’t effect HR or BP

36
Q

nitrate contraindications

A

PDE5-I increase ICP severe anemia

37
Q

nitrates side effects

A

headache flushing hypotension

38
Q

how long is the nitrate free interval

A

10 - 12 hours

39
Q

nitrostat

A

nitroglycerin SL tabs

40
Q

nitromist

A

nitroglycerin spray

41
Q

nitrolingual pump spray

A

nitroglycerin SL spray

42
Q

nitro-dur

A

nitroglycerin patch

43
Q

minitran

A

nitroglycerin patch

44
Q

monoket

A

isosorbide mononitrate IR

45
Q

imdur

A

isosorbide mononitrate ER

46
Q

isosorbide mononitrate IR is BID and doses should be _ hours apart

A

7

47
Q

how many times can a patient use their nitroglycerin SL/spray when having an anginal attack

A

1 dose at 5 minute intervals for a max of 3 doses

48
Q

nitroglycerin storage

A

original amber bottle

49
Q

where is the nitroglycerin patch applied

A

on upper arm above the elbows and on chest , (above knee level)

50
Q

when a patient first gets their nitroglycerin spray what should they do upon first administration

A

prime with 5 sprays into air, if they havent used the pump in 6 weeks, they need to prime agaian

51
Q

how is nitroglycerin spray taken

A

close mouth after each spray do not swallow too quickly or inhale do not shake spray before use

52
Q

when are nitroglycerin SL tabs and spray indicated

A

acute chest pain prophylaxis 5 - 10 mins before activity that might cause chest paint

53
Q

how long to keep the nitorglycerin patches on?

A

for 12-14hours , you mucs take it off for the next 10-12 hours foof

54
Q

which of the antianginal drugs can be used in combination with the other classes of antianginals?

A

the ranolzine caue be used in chronic stable angina with CCB, nitrates and betal blockers.

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