Ischemic Heart Disease

Question 1

SIHD stands for?

Answer 1

stable ischemic heart disease

Question 2

SIHD: _______ chest pain that is brought on by ______ and relieved with _______ or ______

Answer 2

predictable chest pain;
brought on by exertion (or emotional stress)

relieved with NTG or rest

Question 3

What is prinzmetal angina

Answer 3

it is a vasospasm of the coronary arteries

-happens at rest

Question 4

Pathophys of IHD:

imbalance between ______ and _____

Answer 4

myocardial O2 demand (workload)
and
supply (blood flow)

Question 5

in SIHD: myocardial O2 supply is usually decreased due to ______

Answer 5

atherosclerosis

Question 6

Diagnosing SIHD:

_________ test and pharmacological stimulation can be used (ex of drugs that are used _______)

Answer 6

cardiac stress test (treadmill or pedaling)

drugs: regadenoson (lexiscan)

Question 7

Drug Treatment for SIHD:
Basics: Want an ______ agent and an ______ regimen and short acting NTG for all patients!!

Examples of those drugs?

Answer 7

an antiplatelet and antianginal

platelet: ASA or clopidogrel
Anginal: beta blockers!!! CCBs, long acting nitrates, ranolazine

Question 8

T or F:

SIHD is apart of ASCVD

Answer 8

true! give those kids a statin

Question 9

General Tx approach for SIHD:

ABCDE stands for?

Answer 9

A - antiplatelets and antianginal drugs
B - Blood pressure and beta blockers
C - cholesterol and cessation (cigs)
D - Diabetes and diet
E - exercise and education

Question 10

ASA or Clopidogrel MOA:

irreversibly inhibits COX 1 and 2 –> decreased prostaglandin and thromboxane

Answer 10

ASA

Question 11

ASA or Clopidogrel MOA:

Is a prodrug that irreversibly inhibits P2Y12 ADP mediated platelet activation and aggregation

Answer 11

clopidogrel

Question 12

what is Yosprala and when is it used in SIHD?

Answer 12

it is ASA + omeprazole pill

– used to prevent patients at risk for GI ulcers

Question 13

what CYP enzyme does clopidogrel need to become activated?

Answer 13

CYP2C19

Question 14

avoid using clopidogrel with what drugs due to CYP2C19 interactions?

Answer 14

omeprazole and esomeprazole

Question 15

for SIHD: titrate beta blockers to a HR of _______

and avoid acute abrupt withdrawl!!!

Answer 15

55 - 60 BPM

Question 16

For Prinzmetal angina: avoid using ________; _______ are recommended instead

Answer 16

avoid beta blockers

try using CCBs

Question 17

DHP or Non-DHP:

Decrease HR

Answer 17

Non-DHP

Question 18

DHP or Non-DHP:
decrease SVR (afterload)

Answer 18

DHP

Question 19

DHP or Non-DHP:

include amlodipine, nifedipine, felodipine

Answer 19

DHP

Question 20

DHP or Non-DHP:

include verapamil and diltiazem

Answer 20

Non-DHP

Question 21

Nitrates:

decrease preload or afterload

Answer 21

preload – veins are dilated more than arteries

Question 22

Call 911 when SL NTG does not provide relief after how many tablets?

Answer 22

after just 1, call 911 if not better

Question 23

avoid _____ DHPs like (________) in SIHD

Answer 23

short acting (nifedipine IR!)

Question 24

Ranolazine:
warning: ___________
Effects on HR or BP?

Answer 24

QT prolongation warning

little to no effect on HR and BP

Question 25

Nitrates:

Contraindicated with what drug class

Answer 25

PDE-5 inhibitors or riociguat

Question 26

Nitrates:

side effects?

Answer 26

headache, flushing, syncope, hypotension

Question 27

Nitrates:

For long acting: need a ______ nitrate free period to prevent tolerance

Answer 27

10 - 12 hours
Thus….
-for ointment: dosed BID 6 hours apart = 10 - 12 hour nitrate free period
-for patch: wear for 10 - 12 hours and then remove for nitrate free period

Question 28

Clopidogrel can cause TTP – what is TTP?

Answer 28

thrombotic thrombocytopenic purpura

pt may have weakness, extreme skin paleness, purplish skin

Question 29

SL Nitro tabs:

store where and how?

Answer 29

in room temp and in original amber glass bottles

Question 30

Nitro spray:

need to prime medication before first use –if > ____ weeks since use prime again

Answer 30

6 weeks

Question 31

Nitro spray:

T or F: shake prior to use

Answer 31

false!!! do not shake it

Question 32

Nitro spray:

spray onto or under the tongue??

Answer 32

either is fine – dont swallow too quickly afterwards

just don’t inhale it!

Question 33

Nitro ointment points??

how to apply and a side effect the other formulations dont have?

Answer 33

apply: measure dose with the applicator that comes with the tube

ointment can stain clothing

Question 34

Nitro patch:

preferred application site is??

Answer 34

chest! (hairless,dry, clean area of skin)

avoid any extremities past knee and elbow