Ischemic Heart Disease

Question 1

Angina

Answer 1

chest pain, pressure, tightness or discomfort

Question 2

Stable angina

Answer 2

predictable chest pain, often brought on by physical exertion or stress and relieved within minutes by rest or NTG

Question 3

Unstable angina

Answer 3

worsening chest pain that is not relieved by rest or nitroglycerin; medical emergency

Question 4

Prinzmetal’s angina

Answer 4

angina caused by vasospasm of coronary arteries
Often caused by illict drug use, like cocaine
unpredictable chest pain; can occur at rest

Question 5

Coronary artery disease (CAD)

Answer 5

plaque build up in the coronary arteries, which leads to decreased oxygen supply to the heart

Question 6

CAD diagnosis

Answer 6

Stress test

Question 7

Pharmacologic agents used for motionless stress test

Answer 7

Dipyridamole
adenosine
regadenoson
dobutamine

Question 8

Cardiac catherization

Answer 8

shows how much plaque build-up in the coronary arteries

Question 9

ASA MOA

Answer 9

irreversibly blocks COX1 and COX2 –> decr in PG and thromboxane A2 –> decr platelet aggregation

Question 10

P2y12 inhibitor for stable angina

Answer 10

clopidogrel

Question 11

1st line antianginal agent

Answer 11

Beta blockers

Question 12

2nd line antianginal agents

Answer 12

CCB (DHP and non-DHP)
Nitrates
Ranolazine

Question 13

Statin recommendation for stable angina (CAD)

Answer 13

High intensity statin

> 75 y/o: moderate intensity

Question 14

Preferred treatment for Prinzmetal’s angina

Answer 14

CCB

no beta blockers

Question 15

Ranexa MOA

Answer 15

inhibits Na current and decr intracellualr Ca; may decr myocardial oxygen demand

Question 16

Ranexa lowers both HR and BP (T/F)

Answer 16

False, has no effects on HR and BP

Question 17

Long-acting nitrates require a nitrate free interval, why?

Answer 17

To decrease tolerance (tachyphylaxis)

Question 18

Nitrate free interval duration

Answer 18

10-12 hours

Question 19

NTG ointment dosing

Answer 19

BID, 6 hours apart

10-12 hr free

Question 20

NTG patch dosing

Answer 20

Wear patch for 12-14 hrs, off for 10-12 hrs

rotate app site

Question 21

isosorbide mononitrate dosing

Answer 21

IR: BID, at least 7 hours apart
ER: in the AM

Question 22

Isosorbide dinitrate dosing

Answer 22

IR: BID-TID, 8am, 12pm, 4pm; 14 hrs free

ER/SR: daily or BID

Question 23

Max dose of simvastatin when taking Ranexa

Answer 23

20 mg/day

Question 24

NTG TL spray priming

Answer 24

Nitrolingual: 5 sprays for new products
1 spray after not using for 6 weeks
NitroMist: 10 sprays for new product
2 spays after not using for 6 weeks

Question 25

Preferred area to apply NTG patch

Answer 25

chest; in area that is hairless or has trimmed hair