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NAPLEX 2022 > Ischemic Heart Disease > Flashcards

Ischemic Heart Disease Flashcards

1
Q

What is angina?

A

Chest pain, pressure, tightness caused by ischemia of the heart muscle or spasm of coronary arteries.

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2
Q

What is stable angina?

A

AKA as Stable Ischemic Heart Disease (SIHD)

predictable chest pain brought on by exertion and relieved within minutes by rest or nitroglycerin.

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3
Q

What is unstable angina?

A

Is a type of acute coronary syndrome (ACS) where chest pain is unrelieved by rest or nitroglycerin.

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4
Q

What is Prinzmetal’s angina?

A

Chest pain caused by vasospasm of coronary arteries and occurs at rest and caused by cocaine use.

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5
Q

Chest pain occurs when there is an imbalance of what?

A

Imbalance between myocardial oxygen demand (workload) and supply (blood flow).

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6
Q

What is performed to diagnose CAD and SIHD?

A

Cardiac stress test - increase myocardial oxygen demand with exercise (walking on treadmill) or IV medications.

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7
Q

Name the IV medications used in a cardiac stress test?

A
  1. Adenosine
  2. Dipyridamole
  3. Dobutamine
  4. Regadenoson (Lexiscan)
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8
Q

Treatment Approach for SIDH

A 
A - Antiplatelet and antianginal drugs
B - Blood pressure and beta-blockers
C - Cholesterol (statins) & cigarettes (cessation)
D - Diet and diabetes
E - Exercise & education
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9
Q

What is the recommended antiplatelet in SIHD?

A

DOC: Aspirin

Alt: Clopidogrel (if allergy to salicylates or contraindicated)

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10
Q

Name the antianginal agents.

A

First-line: Beta-blockers

Alt (if B-blockers CI): CCBs (DHP/Non-DHP), or long-acting nitrates

Substitution or add-on tx to B-blockers: Ranolazine

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11
Q

What agents are recommended in patients for immediate relief?

A

Short-acting nitroglycerin sublingual (SL)

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12
Q

Aspirin

MOA, Warnings & Contraindications

A

MOA: Irreversibly inhibits COX-1 and 2, which decreases prostaglandin and thromboxane A2

Warnings: Bleeding, tinnitus (salicylate OD)

Contraindications: salicylate allergy, children <18 due to Reye’s Syndrome

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13
Q

Clopidogrel

MOA, Boxed Warnings, & Warnings

A

MOA: Prodrug that irreversibly inhibits P2Y12 ADP-mediated platelet activation and aggregation

Boxed Warnings: Prodrug, converts to active metabolite by CYP450 2C19 (poor metabolizers)

Warnings: Bleeding risk; stop 5 days prior to elective surgery, no not use omeprazole or esomeprazole, TTP

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14
Q

Dual Antiplatelet Therapy (DAPT) agents

Length of duration for specific indications

A

——Aspirin + Clopidogrel——

  1. Bare metal stent (at least 1 month)
  2. Drug-eluting stent (at least 6 months)
  3. Post-CABG (12 months)
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15
Q

DAPT DDIs

A

Anticoagulants, NSAIDs, SSRIs, SNRIs and some herbals —–> Increase bleeding risk

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16
Q

What drug class is preferred in Prinzmetal’s angina?

A

Calcium Channel Blockers (CCBs)

17
Q

Nitroglycerin Formulations Used in SIHD

Nitrostat - Generic & Dose

A

Nitroglycerin SL tablet 0.4 mg

18
Q

Nitroglycerin Formulations Used in SIHD

Nitro-Bid - Generic & Strength

A

Nitroglycerin ointment 2%

19
Q

Nitroglycerin Formulations Used in SIHD

Nitroglycerin TL spray - Brand & Dose

A

NitroMist & Nitrolingual 0.4 mg

20
Q

Nitroglycerin Used in SIHD

Safety/Side Effects/Monitoring

A

CI: do NOT use with PDE-5 inhibitors

Warnings: Hypotension & tachyphylaxis

SE: HA, flushing, syncope

21
Q

Nitroglycerin Used in SIHD

Short-acting vs Long-acting Counseling Points

A

Short-acting nitrates: PRN for immediate relief of chest pain (call 911 if chest pain persist after 1st dose); keep in original amber glass bottle

Long-acting nitrates: Require a 10-12 hour nitrate-free interval to decrease tolerance
-Patch: wear on 12-14, off 10-12 hours (rotate sites)
-Ointment: dosed BID, 6 hours apart with 10-12 hour
nitrate-free

22
Q

Long-acting nitrates

How is isosorbide mononitrate IR dosed?

A

Dosed BID, 7 hours apart

23
Q

BiDil is the preferred formulation in HFrEF. What is generic?

A

Isosorbide dinitrate + Hydralazine

24
Q

What is the preferred application site for a nitroglycerin patch?

25
Q

Nitroglycerin SL tablet Counseling Points

A
  1. Place tab under tongue and let it dissolve.
  2. Slight burning and tingling sensation is not a sign of how well medication is working.
  3. Keet SL tab in original amber glass bottle.
  4. Call 911 if chest pain persists after 1st dose. Continue to take 2 additional doses at 5 min intervals. Do not exceed 3 doses within 15 min.
26
Q

Nitroglycerin TL Spray Counseling Points

A
  1. Do not shake.
  2. Spray onto or under the tongue.
  3. Do NOT inhale the spray.

NAPLEX 2022 (25 decks)

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