Disease Management

Question 1

How do we manage stable ischemic heart disease?

Answer 1

Smoking cessation 
Exercise
Anti-platelet agents
Beta blockers
Statins
Renin angiotensin aldosterone inhibit 
Diet
Drinking - moderate

Question 2

ACE inhibitors

Answer 2

Mechanism: act on renin angiotensin system, which counteracts the normal vasoconstriction and Na resorption

Names: ramipril, lisinopril…

Indications: hypertension, coronary artery disease, congestive heart failure, post-MI (improves mortality), diabetes

Contraindications: renal artery stenosis, pregnancy

Question 3

Beta-blockers

Answer 3

Mechanism: block b adrenergic receptors, decreasing heart rate, blood pressure, contractility,

Names: metoprolol etc

Indications: HTN, CAD, acute MI, post MI, atrial fibrillation, SVT

Contraindications: sinus bradycardia, 2-3rd degree heart block, hypotension, caution in asthma.

Question 4

Thrombolytics

Answer 4

Mechanism: activate plasminogen to plasmin, which lyses fibrin in clots

Names: streptokinase, alteplase…

Indications: acute STEMI

Contraindications: bleeding issues

Question 5

Statins

Answer 5

Mechanism: inhibit HMG coenzymeA reductase- reduces liver synthesis of cholesterol

Names: atorvastatin (Lipitor)….

Indications: dyslipidemia, CAD, post-MI

Contraindications: liver disease

Question 6

Heparin

Answer 6

Mechanism: anti-thrombin agonists

Indications: acute MI, immediate anticoagulation needed

Contraindications: renal insufficiency, bleeding risks, thrombocytopenia

Complications: HIT

Question 7

Aspirin

Answer 7

Mechanism: inhibits cox2 production of thromboxane A2, decreases platelet aggregation

Indications: CAD, Post-MI, Acute MI, post-CABG

Contraindications: active bleeding, peptic ulcer disease

Question 8

ADP receptor antagonists

Answer 8

Mechanism: inhibit platelet activation

Names: clopidogrel (irreversible) ticagrelor (reversible)

Indications: unstable angina, NSTEMI, STEMI, CAD

Contraindications: coronary bypass surgery?

Question 9

Nitroglycerin

Answer 9

Mechanism: relax vascular smooth muscle- leads to venous and arterial relaxation- lower BP, lower pressure/tension, increased flow to coronary arteries

Indications: CAD, MI, CHF (part time)

Contraindications: viagra, glaucoma, high intracranial pressure

Side effects: dizziness, weakness, headache

Question 10

What are the proven therapies for smoking cessation?

Answer 10

Counselling: doubles efficacy (even very brief interventions)

Pharmacological

Question 11

What are the stages of change with addiction quitting?

Answer 11

Pre-contemplative
Contemplative
Preparation
Action
Maintenance

Question 12

What are the types of nicotine replacement therapy? Benefits?

Answer 12

Patch: gives steady nicotine baseline, lowers craving and decreases withdrawal intensity

Inhaler, gum, lozenge: good for breakthrough cravings

Question 13

Bupropion

Answer 13

Diminishes cravings
Indications: smoking!
Contraindications; seizure disorders, eating disorders, alcoholic

May be better as combo therapy

Question 14

Amiodarone

Answer 14

1. Class 3 antiarrhythmic
2. Lengthen potassium efflux phase
3. Indications:
4. Contraindications: pulmonary fibrosis, hepatotoxicity, thyroid issue, photo sensitivity