ischemia5

Question 1

what are the cardiac effects of beta blockers

Answer 1

decrease oxygen demand

decreasing HR, FOC, and BP

Question 2

what is the resting HR goal?

Answer 2

50 bpm

Question 3

what are the drugs of choice in exercise induced angina

Answer 3

beta blockers

Question 4

bb effect on heart rate can lead to what adverse effect

Answer 4

decrease in perfusion

Question 5

some studies showed beta blockers are better than CCB’s with improvement to what

Answer 5

symptomactic improvement

Question 6

why should BB’s not be used with nonDHPs

Answer 6

both work at SA and AV nodes

Question 7

what are two common adverse cardiac effects with beta blockers?
how is this avoided?

Answer 7

1. increased end-diastolic volume (increases oxygen demand)
2. increased ejection time (increases oxygen demand)
   avoided by concomitant use with nitrates

Question 8

increased end diastolic volume refers to what

Answer 8

more blood in the heart, increasing oxygen demand

Question 9

what are some contraindications with beta blockers

Answer 9

1. bradycardia
2. asthma
3. AV block
4. unstable left ventricular failure
5. raynauds syndrome

Question 10

why can beta blockers impair exercise tolerance?

Answer 10

decrease sympathetic response to exercise; no increase in HR cutting back time someone can exercise

Question 11

what are some adverse effects noted with BB’s

Answer 11

1. fatigue
2. erectile dysfunction
3. hypoglycemia
4. impaired exercise tolerance

Question 12

why is hypoglycemia common with BB’s

Answer 12

masks the tremors associated with low blood sugar

Question 13

what is the only symptom of hypoglycemia when taking BBs

Answer 13

sweating

Question 14

what are two types of drugs that can be used for variant angina

Answer 14

nitrates and Ca channel blockers

Question 15

what is a second line agent for chronic stable angina

Answer 15

ranolazine (Ranexa)

Question 16

when is ranolazine used

Answer 16

in pt’s who experience continued angina despite max medical management and revascularization

Question 17

ranolazine has cardiac effects how?

what is not effected

Answer 17

it decreases oxygen demand

no effect on oxygen supply, HR and BP

Question 18

what are some adverse effects are associated with ranolazine

Answer 18

1. dizziness
2. constipation
3. QT prolongation (K levels off)

Question 19

what should be monitored when on ranolazine

Answer 19

ECG and K levels

Question 20

what drug interactions are important to note with ranolazine

Answer 20

CYP3A4 inhibitors (verapamil and diltiazem)
digoxin
Simvastatin
Digoxin

Question 21

what is the max dose of ranolazine if taking verapamil or diltiazem

Answer 21

500 mg BID

Question 22

what is the max dose of simvastatin given in combo with ranolazine

Answer 22

20mg per day

Question 23

arterial relaxation results in:

a. increased afterload
b. decreased afterload
c. increased preload
d. decreased preload

Answer 23

b. decreased afterload

Question 24

which type of ischemic heart diseased is characterized by plaque rupture but normal tropronin levels?

a. stable angina
b. unstable angina
c. NSTEMI
d. STEMI

Answer 24

b. unstable angina

Question 25

list 3 acute coronary syndromes

Answer 25

1. unstable angina
2. STEMI
3. NSTEMI

Question 26

what is a common adverse effect of sublingual nitroglycerin?

a. bradycardia
b. headache
c. hypertension
d. impotence

Answer 26

b. headache

Question 27

which would cause the greatest increase in oxygen supply to the heart?

a. amlodipine
b. diltiazem
c. verapamil

Answer 27

a. amlodipine

Question 28

how does ranolazine work in myocardial ischemia

a. decrease HR
b. decrease BP
c. Na channel blocker
d. Ca channel blocker

Answer 28

c. Na channel blocker