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PHM 601 Week 5 Ischemic Heart Disease > Ischemic Heart Disease Therapies > Flashcards

Ischemic Heart Disease Therapies Flashcards

1
Q

SL NTG indication

A

if anginal attacks are infrequent or use prior to activities that cause angina

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2
Q

storage of SL NTG

A

original container, replace tablets every 6 months and spray every 3 years

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3
Q

how to take SL NTG

A

sit down and dissolve under tongue, may repeat up to three doses every 5 minutes and call 911 if pain is not relieved

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4
Q

beta blocker indications

A

chronic prophylaxis for patients with 1 or more anginal episodes per day

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5
Q

how do beta blockers work for angina

A

decreases HR and contractility therefore decreasing oxygen demand

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6
Q

beta blockers treatment goal

A

resting HR between 50-60 BPM and max exercise HR of 100 bpm

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7
Q

additional protective effects of beta blockers

A

antiarrhythmic and may slow the progression of plaques

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8
Q

mechanism non-DHP calcium channel blockers for angina

A

decrease HR and contractility, decreasing the oxygen demand

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9
Q

mechanism of DHPs for angina

A

decrease afterload, decrease oxygen demand

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10
Q

when to avoid non-DHPs

A

concomitant beta blocker and severe LV dysfunction (HFrEF)

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11
Q

when to use a CCB over a beta blocker

A

beta blockers are first line because of their additional anti-arrhythmic benefits

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12
Q

long acting nitrate indications

A

a third line agent for anginal chest pain (equal to CCBs) that can be used as a substitute or in addition to a beta blocker

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13
Q

nitrate intolerance

A

nitrate intolerance is when there’s a lack of efficacy after consistent exposure, must provide a 10-14 hour nitrate free period (usually during sleep)

isosorbide dinitrate is usually dosed TID every 6 hours so that there isn’t any drug at night, isosorbide mononitrate is dosed in the morning and wears off at night

the idea is to give the patient the nitrate free period while they are asleep and unable to feel any chest pain

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14
Q

ranolazine MOA

A

inhibits persistent/late inward Na current in the ventricles which will decrease contractility

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15
Q

ranolazine effect on HR and BP

A

ranolazine has no effect on HR or BP

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16
Q

AEs of ranolazine

A

QT porlongation

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17
Q

metabolism of ranolazine

A

CYP3A4, 2D6, and pGp

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18
Q

if a patient has diabetes and IHD, list the three agents that can be used to get dual benefit

A
  1. metformin
  2. GLP 1 antagonists (dulaglutide, liraglutide)
  3. SGLT2 inhibitors (empagliflozin, canaglifozin)
19
Q

pneumonic for medical treatment of acute ACS (NSTEMI and UA)

A 
O - oxygen
S - statin
N - NTG
A - aspirin
A - anticoagulant
P - P2Y12 inhibitor
20
Q

indication for oxygen in ACS

A

only if the patient has an arterial oxygen saturation less than 90%, if the patient is in respiratory distress, or has other high risk features of hypoxemia

21
Q

dosing for a statin during ACS

A

initiate or continue a high intensity statin in all patients, earlier the administration the better!

atorvastatin 40/90
rosuvastatin 20/40

statins have significant pleiotropic effects and can help to stabilize an thrombus in the coronary artery

22
Q

dosing for NTG in treatment of ACS

A

SL NTG every 5 minutes for 3 doses, then assess need for IV NTG. Administer IV NTG for persistent ischemic, HF, or HTN

23
Q

nitrate contraindications

A

recent use of phosphodiesterase inhibitor (sildenafil/avanafil = 24 hours, tadalafil = 48 hours): reason for the contraindication is that these PDE5 inhibitors work on the same pathway as NTG and can cause profound HTN so severe the patient loses a pulse

24
Q

dosing for aspirin in treatment of ACS

A

should be CHEWED
should not be enteric coated
162-325mg loading dose immediately for quick administration and action

25
Q

dosing for anticoagulants for the treatment of ACS

A

IV unfractionated heparin for 48 hours or until PCI is performed

OR

subcutaneous enoxaparin for duration of hospitalization or until PCI is performed

26
Q

loading doses of P2Y12 inhibitors for the treatment of ACS

A

ticagrelor (Brilinta) 180mg x 1

clopidogrel 600mg x 1

27
Q

maintenance doses of P2Y12 inhibitors

A

patient should be on P2Y12 inhibitor for 12 months after UA or NSTEMI:

ticagrelor: 90mg BID
clopidogrel 75mg daily

28
Q

why is ticagrelor preferred over clopidogrel

A

preferred because it has increased amount of platelet inhibition and better cardiac outcomes

29
Q

what’s the P2Y12 inhibitor for PCI

A

prasugrel, ONLY used if the patient has a PCI/catheterization!

30
Q

loading dose of prasugrel

A

60mg x1

31
Q

maintenance dose of prasugrel

A

10mg daily

32
Q

mechanism of GIIB/GIIIA inhibitors

A

potent antiplatelet agents that block the binding site for fibrinogen, increase patient’s bleeding risk

33
Q

pneumonic for LONG TERM treatment of ACS

A

SNAP BAM

34
Q

what are the drugs in BAM for long term treatment of ACS?

A

B- beta blocker for at least three years or indefinitely
A- ACEi/ARB indefinitely
M- mineralocorticoid receptor antagonist indefinitely

35
Q

indication for beta blockers

A

long term treatment in all patients after ACS, any beta blocker is okay unless the patient has HF (should use metoprolol succinate, carvediol, or bisoprolol)

36
Q

indication for ACEi/ARBs

A

long term treatment of ACS for patients who have LVEF less than 40% and those with HTN, diabetes, or stable CKD. May use ARB instead of ACE in patients who are intolerant.

HOPE trial shows mortality benefit in patients with a normal EF, if the patient can tolerate, the patient should receive! If the patient can’t tolerate BB and ACEi/ARB, use only BB.

37
Q

indication for mineralocorticoid receptor antagonist

A

long term treatment of ACS, spironolactone or eplerenone, patients with an EF <40% who are also on an ACEi and beta blocker

38
Q

when are mineralocorticoid receptor antagonists contraindicated?

A

SCr >2.5 mg/dl in men, >2mg/dL in women

Potassium >5 meq/L

39
Q

treatment plan for a patient with a STEMI?

A

MUST have early invasive treatment: immediate cardiac catheterization or fibrinolytic administration in addition to OSNAAP (simultaneously)

40
Q

mechanism of fibrinolytic therapy

A

work to degrade fibrin clots and restore blood flow, considered revascularization, and will significantly increased bleeding risk. Works by activating plasminogen to plasmin that will degrade fibrin clots

41
Q

what is the only P2Y12 agent that can be administered with a fibrinolytic?

A

only use clopidogrel as a P2Y12 agent because clopidogrel has lower antiplatelet potency and theoretically lowers bleeding risk

42
Q

when to use a fibrinolytic

A

fibrinolytics are less effective than PCI and so a PCI is preferred but in the situation where a time to PCI is greater than 90 minutes, a fibrinolytic should be used (better than nothing)

43
Q

fibrinolytic specificity for plasmin

A

alteplase (tPA) is the least specific and will bind to both free plasmin and fibrin bound plasmin

reteplase is slightly more specific for plasmin bound to firbin

tenecteplase is the most specific for plasmin bound to fibrin

44
Q

what drugs in SNAP BAM will improve mortality?

A 
everything except NTG!
Statin
aspirin 
P2Y12 inhibitor
beta blocker
ACEi/ARB
MAR
= all improve mortality

PHM 601 Week 5 Ischemic Heart Disease (4 decks)

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