Ischemic Heart Disease/ACS/HF

Question 1

Treatment for IHD

Answer 1

ABCDE
A - Antiplatelet and antianginal
B - Blood pressure and beta-blockers
C - Cholesterol and cigarettes
D - Diet and Diabetes
E - Exercise and education

Question 2

Drug Treatment for ACS

Answer 2

MONA-GAP-BA
M - Morphine
O - Oxygen
N - Nitrates
A - Aspirin

G - GP IIb/IIIa antagonists
A - Anticoagulants
P - P2Y12 inhibitors

B - Beta-blockers
A - ACEi

Question 3

Drugs for Secondary Prevention of ACS

Answer 3

• ASA 81 mg indefinitely
• P2Y12i for at least 12 months (may go past this if tolerating dual therapy and not high risk bleeder)
• Nitroglycerin indefinitely
• B-Blocker: at least 3 years; indefinitely for HR
• ACEi - Indefinitely if EF < 40%, HTN, CKD, diabetes
• Aldosterone Antagonists - same stipulations as ACEi but if still symptomatic at target ACEi doses
• Statin - Indefinitely, high-intensity

Question 4

Unstable Angina

Answer 4

• Chest Pain
• No Cardiac Enzymes
• No ST elevation
• Partial Blockage

Question 5

NSTEMI

Answer 5

• Chest Pain
• Cardiac Enzymes
• No ST elevation
• Partial Blockage

Question 6

STEMI

Answer 6

• Chest Pain
• Cardiac Enzymes
• ST elevation
• Full Blockage

Question 7

Drugs that Cause/Worsen HF

Answer 7

DI NATION
D - DPP4i
I - Immunosuppressants 
N - Non-DHP CCBs
A - Antiarrhythmics (Class I agents and dronedarone)
T - Thiazolidinediones (-glitazone)
I - Itraconazole
O - Oncology drugs
N - NSAIDs

Question 8

Initial HF Drugs

Answer 8

• ACEi, ARB, or ARNI - decrease mortality
• Beta-Blocker - decrease mortality
• Loop Diuretics - sxs relief

Question 9

Secondary HF Meds

Answer 9

• ARAs - additional diuresis and decreased mortality/morbidity
• SGLT2i - with or w/o diabetes
• BiDil (Hydralazine + Nitrates) - Black patients NYHA III-IV who can’t tolerate or are still symptomatic with ARNI/ACE/BB treatment
• Ivabradine - decreases hospitalization, sinus rhythm must be >= 70 bpm on max tolerated BB dose

Question 10

Additional HF Medications

Answer 10

• Digoxin - decrease cardiac hospitalization

- Vericiguat - decreases risk of hospitalization and CV death after hospitalization (not in guidelines yet)

Question 11

Target Enalapril Dose

Answer 11

10-20 mg PO BID

Question 12

Target Lisinopril Dose

Answer 12

20-40 mg PO QD

Question 13

Target Quinapril Dose

Answer 13

20 mg BID

Question 14

Target Ramipril Dose

Answer 14

10 mg QD

Question 15

Target Losartan Dose

Answer 15

50-150 mg QD

Question 16

Target Valsartan Dose

Answer 16

160 mg BID

Question 17

Target Metoprolol Succinate Dose

Answer 17

200 mg QD

Question 18

Target Carvedilol Dose

Answer 18

=< 85 kg: 25 mg BID

>85 kg: 50 mg BID

Question 19

Spironolactone Target Dose

Answer 19

25 mg QD or BID

Question 20

SGLT2i GFR Stipulations

Answer 20

• Don’t start Dapagliflozin if eGFR < 30

- Don’t start Empagliflozin if eGFR < 20

Question 21

Digoxin

Answer 21

• Typical Dose: 0.125-0.25 mg QD
• Decrease dose/frequency if CrCl < 50
• Decrease dose 20-25% switching PO to IV
• HF Target Range: 0.5-0.9 ng/mL
• A.Fib Target Range: 0.8-2 ng/mL

Question 22

Angina

Answer 22

-Chest Pain

Question 23

Stable Angina

Answer 23

• Predictable

- Usually due to atherosclerosis

Question 24

Prinzmetal’s Angina

Answer 24

• Vasospasm of coronary artery
• Can be cause at rest
• Can also be caused with explicit drug use

Question 25

Diagnosis

Answer 25

- History/physical - Lab test - BP, chol. panel, A1c - ECG - Cardiac stress test - exercise/drug-induced - Cardiac catheterization/angiography - true diagnosis