Ischemic Heart Disease

Question 1

stable or unstable: no improvement with rest

Answer 1

unstable

Question 2

stable or unstable: nitroglycerin improves it

Answer 2

stable

Question 3

Prinzmetal’s angina

Answer 3

occurs at rest, caused by vasospasms of coronary arteries

Question 4

stable, unstable, variable: occurs at rest

Answer 4

variable/Prinzmetal’s

Question 5

what is CAD

Answer 5

reduced blood flow to the heart due to narrowing of arteries caused by plaque build up

Question 6

Recommended Antiplatelet therapy

Answer 6

aspirin

clopidogrel only if allergy to aspirin

Question 7

when is dual antiplatelet therapy recommended

Answer 7

post-stent placement or recent CABG

Question 8

first line therapy

Answer 8

beta blockers

Question 9

options if beta blockers are CI

Answer 9

CCBs or long-acting nitrates

Question 10

Statin therapy needed?

Answer 10

YES! High-intensity!

Question 11

Treatment approach for stable ischemic heart disease

Answer 11

ABCDE
antiplatelet/antianginal drugs 
blood pressure/beta blockers
cholesterol (statin) and cessation (smoking) 
diet and diabetes
exercise and education

Question 12

CYP consideration with clopidogrel

Answer 12

CYP2C19 converts to its active metabolite, avoid with CYP2C19 inhibitors and PPIs

Question 13

what HR should BB be titrated to?

Answer 13

55-60BPM

Question 14

stable, unstable, Prinzmetal: when to use bb

Answer 14

stable and unstable

Question 15

stable, unstable, Prinzmetal: CCB preferred

Answer 15

Prinzmetal

Question 16

nitroglycerin side effects

Answer 16

headache, flushing, syncope

Question 17

what do we do to avoid tolerance in long-acting nitrates

Answer 17

have a 10-12 hour nitrate-free interval

Question 18

counseling points with nitroglycerin spray

Answer 18

do not shake
spray onto or under tongue
do not inhale