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Theraputics Winter > IHD - CAD √ > Flashcards

IHD - CAD √ Flashcards

1
Q

What work up should you do for someone with chest pain?

A

Hemoglobin
Fasting glucose
Fasting lipoprotein
Chest X-ray
Cardiac bio markers
Resting ECG

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2
Q

What defines Class I-IV mean for angina

A

Class I - strenuous physical activities or prolonged = angina
Class II - Able to walk 2 blocks or 1 flight without angina and only occurs under stress = Angina
Class III - Walking 2 block or 1 flight causes = Angina
Class IV - can be caused at rest or any activity = Angina

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3
Q

Can you rely on ECG for Ischemia

A

No bc 50% do not have a normal ECG

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4
Q

words the describe the severity of Ischemia

A
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5
Q

How do you confirm CAD

A

Cardio angiogram

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6
Q

Risk factors for SIHD or CCD

A

Smoking one for the highest to lower 33%
Blood pressure
Lipid
Diabetes
Physical activity 30-60 for 5 days
Weight management - 18.5 and 24.9 BMI (5-10% if need weight loss)
Influenza
Alcohol consumption - 1 drink per day

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7
Q

What are the drugs that we can use for MVO2 increase

A

Nitrate
Beta blocker
Nifedipine
Verapamil
Dilizaem
Aspirin

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8
Q

Aspirin Side Effects

A

GI bleeding (can be a contraindication if had previously)
Gi upset with EC aspirin

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9
Q

What medication can i use if im allergic to Aspirin

A

Clopidogrel 75 mg

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10
Q

In practice, when are the 4 types of pt to use ACEi

A

IHD who have:
HTN
diabetes
LVEF ≤40%
CKD

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11
Q

What can become an issue with chronic use of nitrates

A

Nitrate tolerance

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12
Q

Benefits on Sublingual nitrate

A

Fast acting

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13
Q

Isosobride dinitrae dosing

A

5-20 mg TID (onset 20-40 mins)

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14
Q

Do I dose Isosobride Dinitrae TID q8hrs

A

no bc of the tolerance and last dose should be given at 7 pm

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15
Q

Ismo, Monoket dosing

A

Ismo, monoket - 20 mg BID (onset 30-60mins)

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16
Q

Imdur dosing

A

30 - 120 mg QD

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17
Q

What is a pro of Imdur?

A

after 6 weeks it is effect for 12 hours

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18
Q

What is a pro of Isosobride Mononitrae

A

Can be used in hepatic failure patients and it isn’t eliminated through the liver

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19
Q

Sublingal dosing for Nitrate

A

0.4 mg q 5min Prn

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20
Q

Dosing for Nitrate ointment

A

2% 1/2 - 2 inchs TID - QID

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21
Q

Dosing for Nitrate IV

A

5-300mcg/min

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21
Q

Dosing for Nitrate Patch

A

0.2-0.8 mg/h for 12-16 then off for 8-12

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22
Q

Can you build up a nitrate tolerance and how long should you go off nitrates?

A

Yes you can so you must give a nitrate free interval
10-14hr

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23
Q

4 Consulting points for nitroglycerin

A

3mins 75% of people resolved next 2 15% of people resolved if it is CAD angina
NEED TO HAVE THEM SIT BEFORE ADMINISTRAITON
Keep away from light
Seek medical if 1 does doesn’t work

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24
Q

What is the benefit of oral nitroglycerin agents

A

Prophylaxis against angina

25
Q

What are the AD for Nitrates and what are the 4 bolded side effects

A

Common
HEADACHE
FACIAL FLUSHING
Halitosis
Rash -more with the patch

Serious
SYNCOPE and HYPOTENSION
TACHYCARDIA
Unexplained bradycardia
Methomoglobinemia ( rare)
Heparin resistances

26
Q

What are the 3 contraindications for nitrates

A

HOCM (hypertrophic obstructive cardiomyopathy)
Acute right ventricular MI - bc blood flow very sensitive (preload)
Concurrent use of PDE-5i

27
Q

Pt education points for sub nitroglycerin (test question)

A
28
Q

What are the 6 ideal patients for I would use beta-blockers in?

A

Physical actives majority of angina
HTN
SVT
Post MI
Anxiety induce angina
LVEF ≤ 40% w/ or w/o MI

29
Q

What are the treatment goals with beta-blockers and at what level of doses do we initiate

A

resting HR 50-60 bpm
Start on the lowest dose

30
Q

If patient is have adverse effect with BB how do we take them off?

A

tapering off over 2-3 weeks

31
Q

What determines the duration of use for Beta-blockers

A

1 year if LV is normal after MI/ACS
but indefinitely if reduced LV
or can be chronic in IHD with stable Angina

32
Q

Starting dose for Metropolol Tartate IR

A

Metoprolol - 25-450 mg PO 2-3x a day

33
Q

Starting dose for Metropolol Succinate

A

25mg-450 po daily

34
Q

When do we use Metropolol Succinate over Tartate

A

when pt LVEF ≤ 40%

35
Q

Dosing for early ACS treatment with Metropolol

A

5 mg IV q 5 minutes x 3 for early ACS only

36
Q

Carvedilol IR starting dose

A

IR*: 3.125 – 25 mg PO twice daily

37
Q

Coreg CR starting dose

A

CR: 10 – 80 mg PO daily

38
Q

what are 2 Benefits to using Carvedilol

A

Alpha and Beta blocking
taking with food can reduce Hypotension side effect

39
Q

What dose of Carvedilol do we give in a patient that is over 85 kg

A

50 mg po BID

40
Q

Atenolol starting dose

A

50-200 mg PO daily

41
Q

Out of the 3 beta blockers for IDH which one is renaly eliminated

A

Atenolol the rest are hepatically eliminated

42
Q

What are the 4 ideal patients for CCB

A

Intolerance/contraindications to BB
Pt with Conduction(electrical) heart disease (DHP only)
Pt with vascular disease or severe ventricular dysfunction
Pt with HTN

43
Q

Which CCB can I use with Pt with conduction Heart disease?

A

Non-DHP (Verapamil and Diltiazem)

44
Q

What CCB can we give to a patient that has a IHD but has a vascular problem or severe ventricular dysfunction

A

Amlodipine

45
Q

What CCB can I use to treat someone that has a IHD but also has a Conduction system disease

A

DHP
amlodipine
Nicardipine
Nifedipine
Felodipine

46
Q

What 2 patients in IHD is Ranazoline indicated for

A

Chronic effort Angina and
presumed microvascular disease

47
Q

For Ranexa when can I add it in my therapy regiment?

A

Only in combo when pt BP is >130/80 and Nitrates, Amlodipine or BB are maxed out

48
Q

What are the DDI that are contraindicated in Ranazoline

A

Hepatic failure
Strong CYP3A4 inhibitors (ketoconazole, clarithromycin, nelfinavir)
CYP3A4 inducers (Carbamazepine, Phenytoin, Phenobarbital, St johns worts, Glucocorticoids)

49
Q

Ranolazine effects which 4 drugs

A

Simvastatin
Digoxin
CYP2D6
metformin

50
Q

Ranexa side effects

A

nausea
constipation
dizziness
headache

51
Q

Ranolazine dosing

A

500 BID
Max 1000 BID in 1 -2 weeks

52
Q

What is does the regiment look like for all SIHD/CCD pts

A
  1. Aspirin or clopidogrel
  2. BB
  3. Spray or sublingual nitro
    EVERYONE WILL HAVE 1-3
  4. CCB or long nitrates if BB contra or if not reaching relive of symptoms
  5. LDL and ACE for lipid and HTN
  6. Ranolazie if still not effective treatment
  7. Rivaroxaban 2.5 BID
53
Q

Therapy slide for SIHD/CCD must know if anything (PIC)

A
54
Q

If the patient has Vasospastic Angina what medications do I add after giving them sublingual nitrates

A

IF BP < 130/80: add nitrate ER
IF BP ≥ 130/80: add CCB
(basically, I need a prophylactic medication)

55
Q

Once the patient is on a sublingual nitrate what medications can I give to control their heart rate

A

HR >60
BB is the first line unless contra then use non-DHP CCB or Nitrate ER

56
Q

When would I add Rivaroxaban?

A

In combo with ASA or clopidogrel in patients that are low to moderate bleeding risk but
high risk individuals for IHD

57
Q

What are the 3 types of PCI and which one do we do the most?

A

W/O stent - inflate the ballon and push the plaque back

W/ stent - inflate the ballon and put a metal cage left behind to hold open artery

W/ anti-proliferative drug - same as above just with drug to prevent restenosis

58
Q

What are the complications with PCI

A

You can get restenosis - smooth muscles grows over the metal cage
This is why we use the drug stents

59
Q

When is CABG preferred over PCI

A

Left main coronary stenosis
3-vessel disease - 3 main lines are blocked
Diabetic

60
Q

What must be giving post CABG

A

Post-CABG statin therapy
post CABG antiplatelet therapy

Theraputics Winter (12 decks)

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