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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
A patient with angina is placed on a beta-blocker, what additional cardio-protective effects does this class of medication have?(2)
1. Antiarrhythmic 2. May slow plaque progression
25
When should we avoid using NON-DHP CCB for treating angina?(2)
1. Concomitant B-Blocker 2. Severe Left Ventricle Dysfunction.
26
T or F: Ranolazine effects HR and BP.
F, it has no effect on either.
27
This drug requires a 10-14 hour free period.
Long-Acting Nitrates
28
The mechanism of this drug is to inhibit the late/persistent inward Na+ current.
Ranolazine.
29
Most significant ADE of Ranolazine
QT Prolongation.
30
The metabolism of Ranolazine is regulated by what 2 enzymes and transporter?
1. CYP3A4 2. CYP2D6 3. p-glycoprotein.
31
This anti-anginal drug is great for patients already on BP lowering therapy as it does not have any effect on HR or BP.
Ranolazine.
32
CABG
Coronary Artery Bypass Graft (Open-Heart Surgery to revascularize the heart.)
33
What is the goal of CCD treatment?
To prevent the development of major adverse cardiovascular events.
34
During platelet adhesion, platelets adhere to exposed collagen and ______________
Von Willebrand Factor.
35
What are these considered: 1. ADP 2. Thromboxane 3. Thrombin 4. Serotonin
Platelet Activating Factors.
36
In platelet activation, the ___________ receptor is activate on the platelet surface.
GIIb/IIIa receptor.
37
During platelet aggregation, cross-linking of platelets occurs through ____________.
GIIb/IIIa receptor binding affinity.
38
3 Steps of Platelet pathophysiology.
1. Adhesion 2. Activation 3. Aggregation.
39
PCI
Percutaneous Coronary Intervention
40
SAPT
Single Antiplatelet therapy with low dose aspirin or a P2Y12 Inhibitor.
41
DAPT
Dual Antiplatelet therapy is a combination of low dose aspirin and P2Y12 inhibitor.
42
The mechanism of action of this drug is irreversible inhibition of thromboxane A2 leading to COX inhibition.
Aspirin
43
The mechanism of action of this drug class is to inhibit ADP mediated platelet activation by blocking P2Y12 receptors.
P2Y12 Inhibitors. (Clopidogrel, Prasugrel, Ticagrelor)
44
What is the drug class of prasugrel?
P2Y12 inhibitor
45
What is the drug class of ticagrelor?
P2Y12 Inhibitor
46
What is the drug class of clopidogrel?
P2Y12 inhibitor.
47
Which P2Y12 inhibitor is reversible?
Ticagrelor
48
Which P2Y12 inhibitor is not a pro-drug?
Ticagrelor
49
Which P2Y12 inhibitor is an allosteric inhibitor of the ADP binding site?
Ticagrelor
50
Which P2Y12 Inhibitor has the slowest onset?
Clopidogrel
51
For Clopidogrel, what is the time to peak platelet inhibition for both a 300 mg load and a 600 mg load?
300 mg = 6 hours 600 mg = 2 hours
52
For Prasugrel, what dose leads to peak platelet inhibition in 1.5 hours?
60 mg
53
For Ticagrelor, what dose leads to platelet inhibition in less than 1 hour?
180 mg.
54
Which P2Y12 inhibitor, is metabolized in a two step process by CYP2C19?
Clopidogrel
55
Which P2Y12 inhibitor is metabolized by CYP3A4?
Ticagrelor.
56
Rank the P2Y12 Inhibitors in regard to platelet inhibition.
1. Prasugrel = Ticagrelor (60-70%) 2. Clopidogrel (3-40%)
57
__________ should be discontinued 5 days before surgery.
Clopidogrel
58
___________ should be discontinued 7 days before surgery.
Prasugrel
59
___________ should be discontinued 3-5 days before surgery.
Ticagrelor
60
This P2Y12 inhibitor is associated with the following ADE: 1. Bleeding 2. Dyspnea 3. Bradyarrythmias.
Ticagrelor
61
This P2Y12 inhibitor is contraindicated in stroke/TIA.
Prasugrel
62
This P2Y12 inhibitor has a relative contraindication for the following: 1. <60 kg 2. >75 years of age.
Prasugrel.
63
This P2Y12 Inhibitor has the following contraindications: 1. Cerebral Bleed 2. Severe Liver Disease
Ticagrelor
64
Which P2Y12 inhibitor's efficacy varies significantly due to patient specific pkpd parameters?
Clopidogrel
65
Which P2Y12 inhibitor has a maximum aspirin dose and what is the dose?
Ticagrelor Aspirin 100 mg--> higher will decrease efficacy of ticagrelor.
66
In patients with CCD and hypertension. What are the three first line anti-hypertensives?
1. ACEi 2. ARB 3. Beta-Blocker
67
In patients with CCD and diabetes. What medication classes are recommended to improve cardiovascular outcomes.
1. SGLT2i (cana, dapa, empa) 2. GLP-1RA (Dula, Lira, Sema)
68
For CCD, all patients should be initiated on a _____________.
High Intensity Statin (if tolerated)
69
In CCD, when should icosapent ethyl be used.
Regardless of risk status, Icosapent ethyl should be used if: LDL <100 mg/dL and TG are 150-499
70
In CCD, when should PCSK9 inhibitors be used?
In very high risk patients, who have an LDL above 100 mg/dL despite maximally tolerated statin and ezetimibe therapy.
71
In CCD, how often should a Fasting Lipid Panel be checked following statin initiation?
After 4-12 weeks of therapy.
72
What is the #1 lifestyle contributor to CCD?
Tobacco use.

CRT (16 decks)

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