Ischemic Heart Disease

Question 1

Recommended drug classes to use for SIDH (stable ischemic heart disease)

Answer 1

antiplatelet and antianginal regimen

Question 2

What is the antiplatelet of choice for SIDH? What is second choice?

Answer 2

aspirin

clopidogrel if ASA allergy or CI

Question 3

Treatment approach for SIHD

Answer 3

A - antiplatelet and antianginal drugs (beta blockers, CCBs, nitrates)
B - blood pressure and beta-blockers
C - cholesterol (high intensity statin) and cigarette cessation
D - diet and diabetes
E - exercise and education

Question 4

Aspirin MOA

Answer 4

irreversibly inhibits COX 1 and COX 2 causing decreased prostaglanding and thromboxane 2 production

Question 5

Clopidogrel MOA

Answer 5

irreversibly inhibits P2Y12 ADP-mediated platelet activation and aggregation

Question 6

Clopidogrel is a prodrug - what CYP enzyme converts it to its active form?

Answer 6

CYP2C19

Poor metabolizers have less active clopidogrel and higher risk of CV events

Question 7

Clopidogrel drug interactions

Answer 7

omeprazole and esomeprozole are CYP2C19 inhibitors and decrease concentration of active clopidogrel

Question 8

Mechanism of benefit in SIDH

beta blockers

Answer 8

First line
Reduced myocardial oxygen demand: decreased HR, contractility, and left ventricular wall tension
Preferred drugs: metoprolol, atenolol

Question 9

Mechanism of benefit in SIDH

CCB

Answer 9

Reduce myocardial oxygen demand: non-DHPs decrease HR and contracility; DHPs decrease SVR (afterload); increase myocardial oxygen supply

Question 10

What is prinzmentazl’s angina

Answer 10

angina caused by vasospasm of the coronary arteries

can occur at rest and is often caused by illicit drug use

Question 11

Mechanism of benefit in SIDH

nitrates

Answer 11

reduce myocardial oxygen demand: decrease preload; increase myocardial oxygen supply: increase blood flow through collateral arteries

Question 12

Ranolazine contraindications, warnings

Answer 12

CI: do not use with strong CYP3A4 inhibitors and inducers
Warnings: can cause Qtc prolongatoin

Question 13

Long acting nitrates require a ____ hour nitrate free interval and for what reason?

Answer 13

10-12 hours

decrease tolerance

Question 14

Nitroglycerine patch dosing

Answer 14

wear for 12-14 hours, off for 10-12 hours

rotate sites

Question 15

Nitroglycerine ointment dosing

Answer 15

dosed BID 6 hours apart with a 10-12 hour nitrate-free interval

Question 16

Isosorbide mononitrate IR dosing

Answer 16

BID 7 hours apart

Question 17

Nitrate drug interactions

Answer 17

PDE5 inhibitors - significant decrease in BP