coronary artery disease

Question 1

what does artherosclerosis cause

Answer 1

angina (STABLE / UNSTABLE) and MI (STEMI/NSTEMI)

Question 2

What are medical emergency

Answer 2

unstable angina, nstemi/stemi MI

Question 3

stable angina and symptoms

Answer 3

ischameic chest pain trigger by reduced oxygen

symptoms: chest pain, radiate pain left arm neck and jaw , pain at least

Question 4

drugs used in tx

Answer 4

short acting nitrate:
(GTN s/l- 8 week expiry)
- isosorbide dinitrate

longacting nitrate:
gtn transdermal
isosorbide dinitrate mr (lasts 12hr; bd)
isosorbide mono (bd) mr = OM

vasodilator - ivrabradine, ranolazine , nicorandil (be careful skin mucose/eye)
other CCB and beta blocker

Question 5

tx of acute attack angina

Answer 5

1) gtn s/l lasts 20-30mins
sit down 1 dose repeat after 5mins if needed max 3 dose call 999

usually take gtn before exercise or when required

Question 6

angina prophylaxis

Answer 6

1) beta blocker
alt : rate limit CCB avoid (beta blocker and verapamil in HF)
2) 2nd line is beta blocker + dihydropyridine ccb (amlodipine felodipineetc) max 2 drugs
if one drug c/I = vasodilator dual therapy
if both drugs c/I = vasodilator mono

Question 7

Nitrates moa

Answer 7

potent coronary vasodilator reduce venous return and cardia output

Question 8

tolerance with nitrates

Answer 8

keep nitrate free period with long acting prep or transdermal patches
- maintain effectiveness by keeping plasma level low
1)leave patch off for 8-12 hrs overnight
2) in isosorbide dinitrate M/r (bd) and isosorbide mononitrate bd - take next dose after 8hrs instead of 12
3) MR isosorbide mono is OD so it doesn’t impact tolerenbce

Question 9

s/e nitrate

Answer 9

avoid abrupt withdrawal nitrate and ccb
dyspepsia heart burn, tachycardia, postural hypotension ,dizzy ,h/a

injection (gtn and isorbide mononitrate in MI) = severe hypotension sweat apprehension, restless, muscle twitch

Question 10

interaction nitrate

Answer 10

increase hypotension ex. PDE5 inhibitor like sildenafil
ACEI/ARB, ALPHA BLOCKER beta blocker, ccb , antidepressant, anti psychotic , diuretic, sglt2 I , anti parkinson drug

Question 11

long term tx (unstable angina and n-stemi)

Answer 11

low dose aspirin+ high intense statin. clopidogrel (12m), anti anginal

Question 12

stemi long term tx

Answer 12

low dose aspirin + high intense statin+ clopidorgrel 4 weeks + acei, beta blocker

Question 13

medical emergency unstable angina and non stemi

Answer 13

• aspirin 300mg dispersible or chew
• GTN s/l prn

Question 14

stemi medical emergency

Answer 14

MOAN
morphine diamorphine iv
oxygen
aspirin 300mg
GTN

Question 15

PCI

Answer 15

stent opens artery allow blood flow
offer dual antiplatelet therapy
- aspirin (indefinitely )
- clopidogrel (stable anginaa) prevent thrombosis with stent
with bare metal stent give clopidogrel 1 month and drug eluting give 6 month