Ischemic Heart Disease Pharmacotherapy

Question 1

What factors increase myocardial oxygen demand? (6)

Answer 1

Question 2

What factors result in reduced myocardial oxygen supply? (5)

Answer 2

Question 3

When myocardial O₂ demand is greater than O₂ supply, what could it result in?

Answer 3

Ischemia

Question 4

What is the main cause of stable ischemic heart disease?

Answer 4

Question 5

What are Treatment Goals of Stable Ischemic Heart Disease (SIHD)? (2)

Answer 5

Question 6

Patients who are at high risk of ischemic heart disease are often prescribed Aspirin, what dose is clinically most effective?

Answer 6

Small dose, 75-162 mg/day

Question 7

Is clopidogrel or ASA more effective in preventing PAD symptomatic events?

Answer 7

Clopidogrel slightly, prevented 0.5% less events/year compared to ASA

Question 8

Part of the algorithm for treatment of stable ischemic heart disease is diet and exercise modifications, what can a low sodium/low calorie diet result in physiologically?

Answer 8

Weight loss
Reduction of sympathetic activity
Decreased blood pressure
Reduce stiffness of major conduit arteries
Improves renal sodium excretion
Improves function of small peripheral resistance vessels
Decreases peripheral resistance

Question 9

What is the goal of physical activity and weight management for patients with ischemic heart disease?

Answer 9

Question 10

What is the second most important therapy behind ASA in patients with ischemic heart disease?

Answer 10

High dose statin therapy (80mg Atorvastatin)

Question 11

What treatment would you give a patient with a contraindication to statin therapy or an adverse reaction?

Answer 11

Question 12

What is first line therapy for patients with CAD?

Answer 12

Question 13

What are the protective effects of beta blocker therapy beyond thier BP lowering effects?

Answer 13

Question 14

If BP is greater than 130/80 after diet and exercise program, what therapy should you start?

Answer 14

Question 15

When are ARBS/ACEI indicated?

Answer 15

Question 16

What is the goal and drug of choice for patients that have diabetes as well as CAD?

Answer 16

Question 17

What is the best vascular protective regimen for the following patient?

Answer 17

Question 18

What is the algorithm for stable ischemic heart disease?

Answer 18

Question 19

What is the appropriate treatment for sudden/acute angina?

Answer 19

NTG sublingually + ASA until resolved, if not - call 911

Question 20

What is the 2nd and 3rd line of defense for angina, if sublingual NTG or ASA is not effective?

Answer 20

Beta blockers
Calcium channel blocker or long-acting nitrate

Question 21

Main effect of beta blockers?

Answer 21

Question 22

Main effect of venous nitrates?

Answer 22

Question 23

Main effect of Ca²⁺ channel blockers?

Answer 23

Question 24

What are adverse symptoms/contraindications to beta blockers, Ca²⁺ channel blockers, or long acting nitrates?

Answer 24

Question 25

What is the last line of pharmacological defense before CABG or PCI surgery?

Answer 25

Ranolazine

Question 26

What are the main differences between PCI and CABG?

Answer 26

Question 27

What is the best pharmacological regimen for the following patient?

Answer 27

Question 28

What would be the proper new regimen for the following patient?

Answer 28

Question 29

What would be the proper medical treatment for the following patient?

Answer 29