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CRT > E3. CCD, IHD > Flashcards

E3. CCD, IHD Flashcards

1
Q

Is ischemic heart disease more common in men or women?

A

Men (risk increases as we age for both genders.)

Below the age of 60 the incidence rate is similar for both men and women.

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2
Q

Where is the highest prevalence of CAD in the United States?

A

South East United States (this mimics obesity and diabetes rates.

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3
Q

___________ have the highest risk of developing CAD

A

Black Men

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4
Q

What vasculature supplies oxygen to the myocardium?

A

Coronary Arteries

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5
Q

NSTEMI

A

Non-ST-Elevation Myocardial Infarction

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6
Q

STEMI

A

ST-Elevation Myocardial Infarction.

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7
Q

ACS

A

Acute Coronary Syndrome

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8
Q

Chronic Angina precipitated by activity or when upset, relieved at rest.

A

Stable Angina

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9
Q

T or F: Patients are considered to have CCD after they are discharged for an ACS event.

A

True.

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10
Q

What screenings are used to identify CCD in patients who display risk factors or symptoms of the disease. (2)

A

1) Stress Test
2) Cardiac Catheterization

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11
Q

Unstable Angina

A

Increased frequency or duration of angina episodes produced at a lower level of exertion or at rest.

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12
Q

Myocardial necrosis resulting from prolonged interruption of the blood supply, generally resulting from an acute thrombus but no ECG changes. (Usually a partial occlusion.)

A

Non-ST Elevation Myocardial Infarction

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13
Q

Myocardial necrosis resulting from prolonged interruption of the blood supply, generally resulting from an acute thrombus, with ECG changes. (Usually a complete occlusion.)

A

ST-Elevation Myocardial Infarction [STEMI]

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14
Q

Most specific cardiac enzyme

A

troponin
(takes 4-6 hours to rise)

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15
Q

Cardiac Enzyme which increases rapidly

A

CKMB

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16
Q

Quality of Angina

A

Pressure or heavy weight on chest, crushing, burning, or tightness.

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17
Q

Location of angina

A

Substernal, may radiate but not common.

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18
Q

Duration of Angina

A

0.5-20 minutes

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19
Q

Precipitating Factors of Angina

A
  1. Exercise
  2. Cold Weather
  3. Post-Prandial
  4. Emotional Stress
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20
Q

Relieving Factors of Angina (2)

A
  1. Rest
  2. Sublingual Nitroglycerin
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20
Q

Sublingual Nitroglycerin tablets should be replaced every ___________

A

6 months

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21
Q

Nitroglycerin nasal spray should be replaced every ________

A

3 years.

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22
Q

What should a patient do if their anginal pain is not relieved by 3 doses of nitroglycerin?

A

Call 911

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23
Q

What are the treatment goals of beta-blocker use for angina?(2 answers)

A
  1. Resting HR 50-60 BPM
  2. Exercise HR max 100 BPM
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24
Q

A patient with angina is placed on a beta-blocker, what additional cardio-protective effects does this class of medication have?(2)

A
  1. Antiarrhythmic
  2. May slow plaque progression
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25
Q

When should we avoid using NON-DHP CCB for treating angina?(2)

A
  1. Concomitant B-Blocker
  2. Severe Left Ventricle Dysfunction.
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26
Q

T or F: Ranolazine effects HR and BP.

A

F, it has no effect on either.

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27
Q

This drug requires a 10-14 hour free period.

A

Long-Acting Nitrates

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28
Q

The mechanism of this drug is to inhibit the late/persistent inward Na+ current.

A

Ranolazine.

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29
Q

Most significant ADE of Ranolazine

A

QT Prolongation.

30
Q

The metabolism of Ranolazine is regulated by what 2 enzymes and transporter?

A
  1. CYP3A4
  2. CYP2D6
  3. p-glycoprotein.
31
Q

This anti-anginal drug is great for patients already on BP lowering therapy as it does not have any effect on HR or BP.

A

Ranolazine.

32
Q

CABG

A

Coronary Artery Bypass Graft (Open-Heart Surgery to revascularize the heart.)

33
Q

What is the goal of CCD treatment?

A

To prevent the development of major adverse cardiovascular events.

34
Q

During platelet adhesion, platelets adhere to exposed collagen and ______________

A

Von Willebrand Factor.

35
Q

What are these considered:
1. ADP
2. Thromboxane
3. Thrombin
4. Serotonin

A

Platelet Activating Factors.

36
Q

In platelet activation, the ___________ receptor is activate on the platelet surface.

A

GIIb/IIIa receptor.

37
Q

During platelet aggregation, cross-linking of platelets occurs through ____________.

A

GIIb/IIIa receptor binding affinity.

38
Q

3 Steps of Platelet pathophysiology.

A
  1. Adhesion
  2. Activation
  3. Aggregation.
39
Q

PCI

A

Percutaneous Coronary Intervention

40
Q

SAPT

A

Single Antiplatelet therapy with low dose aspirin or a P2Y12 Inhibitor.

41
Q

DAPT

A

Dual Antiplatelet therapy is a combination of low dose aspirin and P2Y12 inhibitor.

42
Q

The mechanism of action of this drug is irreversible inhibition of thromboxane A2 leading to COX inhibition.

43
Q

The mechanism of action of this drug class is to inhibit ADP mediated platelet activation by blocking P2Y12 receptors.

A

P2Y12 Inhibitors.

(Clopidogrel, Prasugrel, Ticagrelor)

44
Q

What is the drug class of prasugrel?

A

P2Y12 inhibitor

45
Q

What is the drug class of ticagrelor?

A

P2Y12 Inhibitor

46
Q

What is the drug class of clopidogrel?

A

P2Y12 inhibitor.

47
Q

Which P2Y12 inhibitor is reversible?

A

Ticagrelor

48
Q

Which P2Y12 inhibitor is not a pro-drug?

A

Ticagrelor

49
Q

Which P2Y12 inhibitor is an allosteric inhibitor of the ADP binding site?

A

Ticagrelor

50
Q

Which P2Y12 Inhibitor has the slowest onset?

A

Clopidogrel

51
Q

For Clopidogrel, what is the time to peak platelet inhibition for both a 300 mg load and a 600 mg load?

A

300 mg = 6 hours

600 mg = 2 hours

52
Q

For Prasugrel, what dose leads to peak platelet inhibition in 1.5 hours?

53
Q

For Ticagrelor, what dose leads to platelet inhibition in less than 1 hour?

54
Q

Which P2Y12 inhibitor, is metabolized in a two step process by CYP2C19?

A

Clopidogrel

55
Q

Which P2Y12 inhibitor is metabolized by CYP3A4?

A

Ticagrelor.

56
Q

Rank the P2Y12 Inhibitors in regard to platelet inhibition.

A
  1. Prasugrel = Ticagrelor (60-70%)
  2. Clopidogrel (3-40%)
57
Q

__________ should be discontinued 5 days before surgery.

A

Clopidogrel

58
Q

___________ should be discontinued 7 days before surgery.

59
Q

___________ should be discontinued 3-5 days before surgery.

A

Ticagrelor

60
Q

This P2Y12 inhibitor is associated with the following ADE:
1. Bleeding
2. Dyspnea
3. Bradyarrythmias.

A

Ticagrelor

61
Q

This P2Y12 inhibitor is contraindicated in stroke/TIA.

62
Q

This P2Y12 inhibitor has a relative contraindication for the following:
1. <60 kg
2. >75 years of age.

A

Prasugrel.

63
Q

This P2Y12 Inhibitor has the following contraindications:
1. Cerebral Bleed
2. Severe Liver Disease

A

Ticagrelor

64
Q

Which P2Y12 inhibitor’s efficacy varies significantly due to patient specific pkpd parameters?

A

Clopidogrel

65
Q

Which P2Y12 inhibitor has a maximum aspirin dose and what is the dose?

A

Ticagrelor

Aspirin 100 mg–> higher will decrease efficacy of ticagrelor.

66
Q

In patients with CCD and hypertension. What are the three first line anti-hypertensives?

A
  1. ACEi
  2. ARB
  3. Beta-Blocker
67
Q

In patients with CCD and diabetes. What medication classes are recommended to improve cardiovascular outcomes.

A
  1. SGLT2i (cana, dapa, empa)
  2. GLP-1RA (Dula, Lira, Sema)
68
Q

For CCD, all patients should be initiated on a _____________.

A

High Intensity Statin (if tolerated)

69
Q

In CCD, when should icosapent ethyl be used.

A

Regardless of risk status, Icosapent ethyl should be used if:

LDL <100 mg/dL
and
TG are 150-499

70
Q

In CCD, when should PCSK9 inhibitors be used?

A

In very high risk patients, who have an LDL above 100 mg/dL despite maximally tolerated statin and ezetimibe therapy.

71
Q

In CCD, how often should a Fasting Lipid Panel be checked following statin initiation?

A

After 4-12 weeks of therapy.

72
Q

What is the #1 lifestyle contributor to CCD?

A

Tobacco use.

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