Ischemic heart disease Flashcards
What are your ABCDE’s of SIHD?
How do aspirin and clopidogrel work?
What are aspirin’s side effects and special notes?
Antiplatelet and antianginal(BB,CCB, nitrates). Blood pressure and BB. Cholesterol and cigarettes. Diet and diabetes. Exercise and education.
aspirin binds irreversibly to cox 1 and 2 which decreases prostaglandin and thromboxane 2. Clopidogrel is a prodrug that irreversibly binds P2Y12 ADP mediated activation and aggregation.
CI’d in salciylate allergy, children and teenagers due to reyes syndrome. Watch for bleeding, dyspepsia, heartburn, nausea. Used in all SIHD patients unless CI’d. non enteric coated chewable is preferred in ACS, enteric should be chewed.
What is yosprala?
What test do you run on plavix?
How long does someone need dual antiplatelet therapy?
used for people who need aspirin but are at risk for gastric ulcers. Aspirin and omeprazole together.
Cyp2c19. Watch for serious bleeding, increased bleeding risk, avoid used with omeprazole or esomeprazole. Watch for TTP.. May be used in combination with aspirin or if aspirin is CI’d.
bare metal stent(one month), drug eluting stent(6 months), post CABG(12 months). Use aspirin 81 mg.
What do you titrate beta blockers to in SIHD and what angina does it not work in?
What agents are preferred for prinzmetals angina?
What to know about Nitrates?
55-60 BPM, avoid abrupt withdrawal. Prinzmetals angina. Lowers HR, contractility, left ventricular wall tension.
Calcium channel blockers. Avoid nifedpine IR(short acting), DHP’s are preferred in combo with beta blockers.
decrease preload, vasodilation of veins more than arteries. Call 911 if chest pain does not go away after first dose of SL tablet, powder or TL spray. Long acting nitrates used after beta blockers.
What to know about Ranolazine?
What to know about short acting and long acting nitrates?
What are your immediate drugs for ACS(MONA)?
Inhibits Na current and decreases intracellular Ca. Can cause QT prolongation, has little to no clinical effects on HR or BP.
CI’d in use with PDE-5 inhibitors or riociguat. Watch for hypotension, headache, flushing, syncope, tachyphylaxis. Short acting use prn for immediate chest pain relief, keep in original amber glass bottle. Ling acting require a 10-12 hour nitrate free period to decrease tolerance. Ointment is dosed BID at least 6 hours apart, patch is wear for 12-14 hours and rotate sites. Isosorbide mononitrate(monoket).
Morphine(decrease myocardial demand, provides pain relief),Oxygen(, Nitrates(decreased O2 demand by lowering preload, sublingual), Aspirin(non enteric chewable, maintenance dose should be continued indefinitely).
What are your next drugs after MONA? (GAP)?
What are your next drugs after MONA-GAP? (BA)?
What is prasugrel’sIeffient) special notes?
Glycoprotein 2b/3a receptor antagonists(abciximab, eptifibatide, and tirofiban). Anticoagulants(LMWH, UFH, bivalirudin). P2Y12 inhibitors(clopidogrel, prasugrel, and ticagrelor).
Beta blockers(low dose selective), oral ACE continued indefinitely.
CI’d in history of TIA or stroke, ACS who are to be managed with PCI, dispense in original container. Watch for TIA or stroke, TTP, bleeding. Effient is brand name.
What is Ticagrelor’s special things?
What to know about cangrelor?
What to know about the GRA’s?
Brilinta is brand name, 90 mg PO BID for 1 year and then 60 mg BID. Maintenance doses of aspirin above 100 mg should be avoided. Bleeding, dyspnea.
transition to oral p2y12 inhibitor, prasugrel 60 mg or clopidogrel 600 mg immediately after stopping cangrelor.
Abciximab(Reapro), not recommended for medical management. Eptifibatide(Integrilin). Watch for bleeding, thrombocytopenia, hypotension, must filter abciximab.
What to know about Alteplase(activase) and tenesteplase(TNKase)?
What drugs worsen heart failure? (DI NATION)?
Do loop diuretics, digoxin, and ivabradine(Corlanor) have mortality benefit in HF?
Only for STEMI, 90 minutes door to balloon, 120 minutes for medical contact, should be 30 minutes door to needle. Cathflo activase is name of alteplase(100 mg IV). Bleeding, hypotension, monitor Hgb, Hct, s/sx of bleeding.
DPP-4 inhibitors(alogliptin, sitagliptin), Immunosuppresants, nondhp CCB’s, Antiarrhythmics(class 1 agents), Thiazolidinediones, itraconazole, oncology agents, NSAIDS.
NO.
In what patient population has hydralizine and nitriates(BiDil) shown mortality benefit in HF?
What is furosemide’s(Laxis) and all loop diuretics safety/side effects/ and warnings?
What are the dose conversions of the loop diuretics?
Black patients with NYHA class 3 and 4 when added to ACE/ARB and BB or in other patients who can’t tolerate and ACE or ARB.
Sulfa allergy, this warning does not apply to erthacrynic acid. Decreased K, Na, Mg, Cl, Ca. Increased HCO3/metabolic alkalosis, hyperuricemia(UA), hyperglycemia, TG’s, total cholesterol. Orthostatic hypotension, photosensitivity, ototoxicity(erthacrynic acid more). Store furosemide injection at room temp.
Furosemide 40=1 bumetanide = 20 torsemide = 50 ethacrynic acid. Furosemide 1:2 IV to PO. Avoid NSAIDS.
What is entresto?
What to know about Spironolactone(aldactone)?
Sacubitril and valsartan(Neprilysin inhibitor and ARB). Boxed warning of injury and death to fetus, pregnancy, Use with ACE or Arb’s, ARB side effects, cough, 36 hour wash out with ACE inhibitor.
Hyperkalmia, anuria, significant renal impairment, addison’s disease and other conditions that raise K it’s CI’d. Add to class 2-4. Watch for gynecomastia, breast tenderness, impotence. Monitor BP, electrolytes, renal function, fluid status, and s/sx of HF. Triple combo of ACE, ARB, ARA is not recommended due to hyperkalemia and renal insuffiency.
