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Pharmacology II > Exam 1 - Ischemic Heart Disease > Flashcards

Exam 1 - Ischemic Heart Disease Flashcards

1
Q

Who die more suddenly of ACS?

A

Women

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2
Q

Low risk unstable angina (5)

A
  1. <70
  2. Exertion also pain lasting <20min
  3. Pain not rapidly accelerating
  4. Normal/unchanged ECG
  5. No elevation of cardiac markers
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3
Q

Normal % Cardiac event:

A

20-25%

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4
Q

Mildly Abnormal % Cardiac Events:

A

25-30%

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5
Q

Severely Abnormal % Cardiac events:

A

45-50%

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6
Q

3 things of O2 demand:

A
  1. HR
  2. Contractility
  3. Wall tension (afterload/preload)
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7
Q

2 things of O2 supply:

A
  1. Coronary BF

2. Arterial O2 content

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8
Q

When does ischemia occurs with balance?

A

O2 demand > O2 supply

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9
Q

6 things that increase myocardial oxygen demand:

A
  1. Tachycardia
  2. HTN
  3. Thyrotoxicosis
  4. HF
  5. Valvular heart disease
  6. Catecholamine analogues (bronchodilators, tricyclic antidepressants, cocaine)
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10
Q

5 things that reduce myocardial oxygen supply:

A
  1. Anemia
  2. Hypoxia
  3. Carbon monoxide poisoning
  4. Hypotension
  5. Tachycardia
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11
Q

Chronic narrowing of coronary arteries due to:

A

Atherosclerosis

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12
Q

With atherosclerosis, can resistance coronary vessels dilate?

A

No

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13
Q

With atherosclerosis, when you increase O2 demand with exercise, can you increase O2 supply?

A

No and thats when you get ischemia and angina

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14
Q

2 treatment goals of stable ischemic heart disease:

A
  1. Prevent MI and death

2. Reduce symptoms of angina and occurrence of ischemia

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15
Q

6 things to reduce ischemia and anginal symptoms:

A
  1. Sublingual nitroglycerin
  2. Beta blockers
  3. Calcium channel blockers
  4. Long-acting nitrates
  5. Ranolazine
  6. Non-pharmacological treatments (PCI/CABG)
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16
Q

What increase capacitance and decrease preload; venous?

A

Nitrates

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17
Q

What decrease resistance, pressure, and afterload; arterial?

A

Calcium channel blockers

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18
Q

What decrease HR and inotropy; heart?

A

Beat blockers

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19
Q

What 5 things prevent MI and death?

A
  1. Aspirin (consider adding P2Y12 inhibitor or rivaroxaban)
  2. Statins
  3. BP control (goal <130/80; BB/ACE-I/ARB)
  4. Control DM
  5. Non-pharmacological (diet, exercise, wt loss, stop smoking)
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20
Q

4 different acute causes of myocardial O2 supply-demand mismatch:

A
  1. Plaque rupture/erosion with occlusive thrombus
  2. Vasospasm or coronary micro vascular dysfunction
  3. Atherosclerosis & O2 supply/demand imbalance
  4. O2 supply/demand imbalance alone
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21
Q 
FINAL DIAGNOSIS: 
Ischemic discomfort
Acute coronary syndrome (atherothrombotic)
ST elevation 
\+ bio markers
A

ST elevation MI (type 1)

22
Q 
FINAL DIAGNOSIS: 
Ischemic discomfort
Acute coronary syndrome (atherothrombotic)
No ST elevation 
\+ bio markers
A

Non-ST elevation MI (type 1)

23
Q 
FINAL DIAGNOSIS: 
Ischemic discomfort
Acute coronary syndrome (atherothrombotic)
No ST elevation 
- bio markers
A

Unstable angina (thrombotic mediated)

24
Q 
FINAL DIAGNOSIS: 
Ischemic discomfort 
Supply-demand imbalance (nonthrombotic)
No ST elevation 
\+ bio markers
A

Non-ST elevation MI (type 2)

25
Q 
FINAL DIAGNOSIS: 
Ischemic discomfort 
Supply-demand imbalance (nonthrombotic)
No ST elevation 
- bio markers
A

Unstable angina (demand related)

26
Q

5 Non-ST Elevation-acute coronary syndrome treatments:

A
  1. Aspirin
  2. Nitroglycerin (NTG)
  3. Anti-thrombotic regimen (aspirin+P2Y12 inhibitor)
  4. Statins
  5. BB
27
Q

What does short term statins do?

A

Reduce inflammation and improve endothelial function

28
Q

What does long term statins do?

A

Cholesterol reduction

29
Q

Which stent has chance to cause stent thrombosis (platelets adhere to exposed stent struts and initiate thrombus formation)

A

Bare metal stent

30
Q

When does bare metal stents re-endothelialization compete?

A

1-3months

31
Q

Which stent require shorter courses of anti platelets?

A

Bare metal stents

32
Q

Which stent delays re-endothelialization by several months?

A

Drug-eluting stents

33
Q

Which stent prolong duration of stent thrombosis risk and require longer courses of anti platelets?

A

Drug-eluting stents

34
Q

What 2 considerations in patients for CABG?

A
  1. Significant disease in L main coronary artery

2. Disease in 3 or more coronary vessels + LV dysfunction (EF<40%)

35
Q

Critical time-dependent period (myocardial salvage)

A

0-3 hrs

36
Q

Time-independent period (open infarct-related artery)

A

6-12 hrs

37
Q

Mortality in 1st yr post ACS averages:

A

10%

38
Q

Percent of deaths due to CAD:

A

85%

39
Q

Percent of sudden deaths due to CAD and within first 3mths:

A

50%

40
Q

Percent of deaths due to CAD within first 3wks:

A

33%

41
Q

Big 5 Post ACS pharmacotherapy:

A
  1. Aspirin
  2. ACE-I/ARB
  3. BB
  4. Clopidogrel/prasugrel/ticagrelor
  5. Statins
42
Q

4 things to treat preop unstable CAD:

A
  1. IV nitrates
  2. IV heparin
  3. Treat arrhythmias
  4. Intra-aortic balloon pump
43
Q

8 operative myocardial protection:

A
  1. Hypothermia
  2. Hemodynamic modulation
  3. Cardioplegia
  4. Ischemic preconditioning
  5. Anesthetic preconditioning
  6. Remote ischemic preconditioning
  7. Ischemic post-conditioning
  8. Pharmacotherapy
44
Q

2 pharmacotherapy for operative myocardial protection:

A
  1. BB

2. Statins

45
Q

How does BB provide myocardial protection (3):

A

Decrease:

  1. HR
  2. Contractility
  3. O2 consumption
46
Q

What are the 3 ‘pleotropic effects’ of statin:

A
  1. Increased plaque stability
  2. Decreased platelet activity
  3. Decreased inflammatory markers
47
Q

4 postop myocardial protection:

A
  1. Control HR
  2. Reduce afterload
  3. Max O2 delivery
  4. Minimize O2 consumption
48
Q

Can symptoms of ischemia be absent in period setting due to anesthesia and analgesia?

A

Yes

49
Q

What does acute increase in cardiac troponin indicate?

A

MI

50
Q

3 other signs of ischemia:

A
  1. Tachycardia
  2. Hemodynamic instability
  3. Pulmonary congestion (reduce O2 sat/lung compliance/wheeze)
51
Q

3 medications to manage periop MI?

A
  1. Nitroglycerin
  2. BB
  3. Aspirin

Pharmacology II (8 decks)

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