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PHRM 211 > CV 16 > Flashcards

CV 16 Flashcards

1
Q

Obstructive CAD

A

greater than 50% diameter stenosis and fractional flow reserve less than 0.8 during coronary angiography

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2
Q

INOCA

A

ischemia with no obstructive coronary arteries. Syndrome of pts with either symptoms and/or signs or ischemia but found to have no obstructive coronary artery disease (CAD)

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3
Q

Vasospastic Angina

A

reproduction of angina symptoms, ischemic ECG changes with greater than 90% constriction in major epicardial artery

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4
Q

Microvascular Angina

A

No obstructive CAD plus objective evidence of coronary microvascular dysfunction (as defined by abnormal response to intracoronary acetylcholine and/or systemic adenosine)

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5
Q

CAD

A

build up of fat and cholesterol which causes plaques in the coronary arteries, resulting in blocks of blood flow to the heart

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6
Q

what is angina/ischemia

A

chest pain or discomfort caused by CAD, when the heart muscle doesnt get adequate blood supply

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7
Q

Class 1 recommendation

A

Benefit > risk , is recommended, strong

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8
Q

Class 2a recommendation

A

benefit > risk, moderate, suggested

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9
Q

Class 2b

A

Weak, benefit greater than or equal to risk, can be considered.

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10
Q

class 3 moderate

A

no benefit, benefit = risk. not recommended

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11
Q

class 3 strong

A

risk > benefit, potentially harmful

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12
Q

risk factors for MACE

A

age, male sex, poor social support, poverty, access

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13
Q

Risk factors for MACE Medical history

A

elevated BMI, previous MI, HF, AF, DM, dyslipidemia, CKD, smoking, depression, poor adherance to therapy

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14
Q

4 goals of treatment for CCD

A

decrease cardiac death, nonfatal ischemic events, disease progression, symptoms and functional limitations

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15
Q

In patients with CCD, no NHP and supplements help

A

NO!

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16
Q

what type of diets should be recommended to CCD patients

A

vegetables, fruits, whole grains, lean protein.

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17
Q

Anti-anginal therapy for symptom relief

A

nitrates (SL and long acting products)
Beta Blockers
Calcium Channel Blockers
2nd line: Novel anti-anginals (ranolazine, ivabradine only if HFrEF

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18
Q

Therapy to prevent MI/Death

A

Anti-platelets (ASA +/- Clopidogrel/ticagrelor)
anti thrombotic agents (riveroxaban)
beta blockers (only if recent MI or HFrEF)
RAAS blockers (ACEI or ARB)
Immunization
Colchicine

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19
Q

what do you do if someone has vasospastic angina

A

dont treat with beta blockers, first with CCB then nitrates if still symptomatic

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20
Q

which drugs to avoid in vasospastic angina

A

drugs that cause vasospasm
- non selective beta blockers
- triptans for migraines
- 5-fluorouracil

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21
Q

NYHA classifications Class 1

A

Mild, no symptoms, can perform ordinary activities without any limitations

22
Q

NYHA Class II

A

mild - light limitation of ordinary activity, no symptoms at rest, ordinary activity results in symptoms

23
Q

NYHA class III

A

moderate - Marked limitation of physical activity, no symptoms at rest, less than ordinary activity results in symptoms.

24
Q

NYHA Class 4

A

severe - unable to do any physical activity without discomfort
symptoms at rest

25
Q

CCS Classification, more specific for Class 2 ad CLass 3

A

Class 2 - symptoms with walking greater than 2 level blocks and climbing greater than 1 flight of stairs at normal pace in normal conditions

Class 3 - symptoms with walking less than/=to 2 blocks or climbing less than/=to 1 flight of stairs at normal pace in normal conditons

26
Q

main goal of anti-anginal therapy

A

prevent episodes of angina and relieve symptoms

27
Q

main goal of secondary prevention treatment

A

prevent CV events and death

28
Q

what class of agents is most effective in preventing angina

A

none, but more SE with beta blockers

29
Q

3 Steps for medical therapy for angina patients with CCD

A

BB, CCB, LAN, then if symptoms continue, add a second antianginal from a differnet class, then add ranolazine for patients who remain symptomatic.

30
Q

what is recommended for short term immediate relief of angina

A

sublingual nitroglycerin or nitroglycerin spray.

31
Q

is ivabradine recommended?

A

only in patients with HFrEF, can be harmful in those with normal LV function.

32
Q

three main CI of beta-blockers

A

heart rate less than 60bpm
systolic arterial pressure <100mmHg
asthma
mod or severe LV failure

33
Q

which is the most cardioselective agent

A

bisoprolol

34
Q

Beta 1 side effects

A

hypotension, bradycardia, cardiac failiure

35
Q

beta 2 effects

A

bronchospasm, vasoconstriction, cold extremities, hyperglycemia, hypoglycemia

36
Q

two non dihydropridine agents CCB + side effects

A

verapamil, diltiazem
decreased AV node conduction
Decreased intropy and chronotropy

37
Q

3 dihydropyridine CCB + SE

A

amlodipine, felodipine, nifedipine XL

peripehral vasodilation

38
Q

main side effects and CI with CCB

A

constipation
dont use SL or Short acting Nifedipine due to reflex tachycardia

Avoid use of non DHP CCB with other AV nodal blocking agents like beta blockers

Avoid use of non-DHP CCB in HFrEF

39
Q

nitrate tolerance

A

continuous use of nitrates >24 hours decreases hemodynamic effects and antianginal effects, recommend 10-12 hours of nitrate free interval and dont use as MONOTHERAPY

40
Q

Nitrate CI

A

severe hypotension
interaction with phosphodiesterase inhibitors - sildenafil, vardenafil, tadalfil.

41
Q

Ivabradine key points

A

direct and selective inhibitor of the IF current in the sinoatrial node. limits its use to patients iwth sinus rhythm(exludes pts in AF or atrial flutter)

42
Q

If HR is fast, which CCB is preferred

A

non-DHP CCB

43
Q

If no indication for OAC, what is recommended

A

ASA 81mg, if they have had ACS, DAPT

44
Q

what is recommended as an alternative to aspirin

A

clopidogrel 75mg daily

45
Q

when can ASA + Clop be used in combo

A

post MI or PCI

46
Q

BB recommendations

A

if you are more than a year out from your MI, you should not be on a BB.

no benefit of a BB in pts who haveavnt had an MI and dont have HFrEF

47
Q

ACE evidence

A

in pts with hypertension and DM, ACE, ARBS should be used!

In pts without, can be considered.

48
Q

Low DAPT score

A

less than 2

49
Q

high dapt score

A

greater than or equal to 2

50
Q

adding a second antithrombotic drug to aspirin for long-term secondary prevention should be considered in pts with

A

high risk of ischaemic events and without high risk of bleeding.

51
Q

for patients starting warfarin, what should be considered

A

stop ASA if no recent ACS or extensive symptoms.

52
Q
A

PHRM 211 (25 decks)

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