Ischemic Heart Disease

Question 1

types of ischemic heart disease

Answer 1

Angina Pectoris
Chronic stable angina
Unstable Angina
Vasospastic (Prinzmetal's angina)
Myocardial Infarction

Question 2

angina caused by paroxysmal chest squeezing or pressure (can have sensation of smothering or impending doom)

Answer 2

angina pectoris

Question 3

angina exacerbated by physical activity and relieved by rest or SL nitrogen

Answer 3

chronic stable angina

Question 4

angina- increasing pattern of pain in previously stable patients (less responsive to meds, lasts longer, occurs with rest or little exertion)

Answer 4

unstable angina

Question 5

angina occurring in pts due to a spasm of the coronary artery (more likely in morning, at rest. NOT brought on by exertion or emotional stress) Seen in young pts, smokers, or illicit drug users

Answer 5

Prinzmetal’s angina

Question 6

how do you diagnose stable ischemic heart disease?

Answer 6

stress testing

Question 7

drugs that decrease myocardial O2 demand

Answer 7

nitrates
calcium channel blockers
beta blockers

Question 8

this drug increases myocardial O2 delivery by reversing coronary spasm

Answer 8

nitrates

Question 9

these drugs relax resistance vessels (decrease afterload)

Answer 9

nitrates
CCB
beta blockers

Question 10

these drugs relax capacitance vessels (decrease preload)

Answer 10

nitrates

CCB

Question 11

these drugs block sympathetic influence on the heart (decrease contractility, HR, and O2 demand)

Answer 11

BB

Question 12

these drugs dilate coronary arteries, increasing oxygen supply

Answer 12

nitrates

Question 13

these drugs cause all segments of the vascular system to relax, resulting in pooling of blood in the veins (decreasing preload and work). They also dilate coronary vasculature and increase blood supply to the heart. Also decreases platelet aggregation

Answer 13

nitrates

Question 14

this class has significant first pass effect in the liver, so you should distribute it transdermally or sublingually

Answer 14

nitrates

Question 15

acute adverse effects of this drug include HA, orthostatic hypotension, facial flushing, and tachycardia

Answer 15

nitrates

Question 16

tolerance with this drug occurs rapidly and manifests as tachyphylaxis (should be given 8 hours off per day)

Answer 16

nitrates

Question 17

this drug interacts with sildenafil (viagra)

Answer 17

nitrates

Question 18

mainstay formulation of nitroglycerin for immediate relief

Answer 18

sublingual

Question 19

these are long acting nitrates, preferred for chronic stable angina

Answer 19

isosorbide dinitrate

isosorbide mononitrate

Question 20

this class decreases myocardial O2 demand at rest and during exercise by decreasing HR and contractility, decreased CO

Answer 20

beta blockers

Question 21

this class decreases sympathetic outflow
inhibits release of renin from kidneys (decreased BP, afterload, and preload)

Answer 21

beta blockers

Question 22

can be used for angina, post MI, HTN, anxiety

avoid in asthma/COPD, CHF, PVD, and vasospastic angina

Answer 22

beta blockers

Question 23

adverse effects include sexual dysfunction, fatigue, insomnia, bradycardia, altered HLD and TG, and rebound HTN for abrupt withdrawal

Answer 23

beta blockers

Question 24

this class can be used in angina (vasospastic and classic), HTN, supraventricular arrhythmias

Answer 24

CCB

Question 25

contraindicated in pts with unstable angina

Answer 25

CCB

Question 26

this class blocks inward movement of ca by binding to L-type calcium channels. Decreases TPR and afterload, increases coronary flow

Answer 26

CCB

Question 27

ADRS: hypotension, effects related to vasodilation, gingival hyperplasia,

Answer 27

CCB

Question 28

this CCB increases constipation, give with a stool softener. Also worsens CHF (negative inotropic effects)

Answer 28

verapamil

Question 29

these CCBs can cause myocardial depression

Answer 29

verapamil | diltiazem

Question 30

these CCBs cause tachycardia

Answer 30

nifedipine | nicardipine

Question 31

this is a late CCB. it is primarily metabolized by CYP3A, so you cant use it with inducers or strong inhibitors or CYP3A

Answer 31

ranolazine

Question 32

treat angina, no concomitant disease

Answer 32

long acting nitrate, BB, CCB

Question 33

treat angina, pt had a recent MI

Answer 33

long acting nitrate, BB

Question 34

treat angina, pt has asthma, COPD

Answer 34

long acting nitrate, CCB

Question 35

treat angina, pt has HTN

Answer 35

(long acting nitrate), BB, CCB

Question 36

treat angina, pt has DM

Answer 36

long acting nitrate, CCB

Question 37

treat angina, pt has CRF

Answer 37

long acting nitrate, (beta blocker), CCB

Question 38

should you combine nitrates with CCB or BB?

Answer 38

Yes nitrates can cause increase in HR or contractility, and CCB and BB prevent this. BB and CCB can increase work, and nitrates decrease LVEDV

Question 39

All pts with angina pectoris should be on

Answer 39

``` ASA BB ACEI LDL lowering therapy SL Nitroglycerin CCB or long acting nitrates ```

Question 40

this drug shuld be used routinely in pts with acute and chronic ischemic heart disease. It exhibits an anti-thrombotic effect and reduces the risk of adverse events by 33% or risk of MI

Answer 40

ASA