Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CDM 2 Exam 1 > Lecture 2 - Ischemic Heart Disease > Flashcards

Lecture 2 - Ischemic Heart Disease Flashcards

1
Q

Ischemic Heart Disease occurs due to…

A

increase in myocardial O2 demand

or

Decrease in O2 supply to heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Angina Pectoris is…..

A

characterized by pain or discomfort, primarily in the chest, but may also be described in the jaw/shoulder/back or arm

commonly due to IHD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Prinzmetals “Variant” Angina

A

Occurs at rest
Due to coronary Vasospasm
Reversed w/ Nitroglyc and CCB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Silent Myocardial Ischemia

A

More common in femlaes

Type 1 = less common
Type 2 = more common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Type 1 Silent Myocardial Ischemia

A

Due to defective anginal warning system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Type 2 Silent Myocardial Ischemia

A

Angina poor indicator of ischemia

indicated higher risk patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Stable or Exertional Angina

A

Exertional pain lasting < 20 min, relieved by rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Unstable Angina, STEMI, or NSTEMI

A

Pain occurring at rest lasting > 20 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Alterable IHD Risk Factors

A 
Smoking
Dyslipidemia
DM
Hypertension
Physical inactivity
BMI >30
Low fruit/veggie consumption
Alcohol overconsumption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Unalterable IHD Risk Factors

A 
Gender = men + postmenopausal women
Age = Men >45, Women > 55
FH = father <55, mother <65
Environment = climate, air pollution, drinking water
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Subjective symptoms associated with angina

A 
SOB
SOB on exertion
palpitations
Chest pain
Lightheadedness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Objective symptoms associated with angina

A

BP, HR,
decreased Oxygen saturation on ABG
ECG changes
ST seg elevation or depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Measure of MVO2 (non-invasive)

A

Double product

HR X SBP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Determinants of Oxygen Supply (MVO2)

A

Arterial PO2
Diastolic Filling time
Coronary Blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Determinants of Oxygen Demand (MVO2)

A

Heart Rate
Myocardial Contractility
Ventricular wall tension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

IHD is the result of….

A

increase in Oxygen demand and decrease in Oxygen supply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Treating Angina

A
  1. Get symptoms
  2. Do workup
  3. Control risk factors
  4. Try 1’/2’ prevention
  5. Try antianginal therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Class I suggested wording

A

Is recommended/ is indicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Class IIa suggested wording

A

Should be considered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Class IIb suggested wording

A

May be considered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Class III suggested wording

A

Is not recommended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Management of Angina (for acute attacks) use…

A

SL nitroglycerin for acute attacks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

If Vasospastic angina, BP <130/80 then….

A

add LA nitrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

If Vasospastic angina, BP >130/80 then….

A

add CCB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

If not Vasospastic angina, heart rate >60 BPM then….

A
  1. Beta-blocker

2. Non-DHP CCB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

If angina symptoms not controlled on Beta-blocker & Non-DHP CCB then….

A

BP < 130/80 = Add Ranolazine/ LA nitrate

BP >130/80 = Add DHP CCB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Last line therapy for Angina?

A

Consider PCI or CABG surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Treatment outline for Angina

A
  1. Risk factor modifications
  2. Select appropriate anti platelet
  3. Assess comorbidities
  4. Select antianginal therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Nitrates effect on MVO2

A

HR: dec
Myocardial Contractility: 0
Systolic Pressure: dec
LV Volume: dec

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Beta-blockers effect on MVO2

A

HR: dec
Myocardial Contractility: dec
Systolic Pressure: dec
LV Volume: inc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Nifedipine effect on MVO2

A

HR: inc
Myocardial Contractility: 0 or dec
Systolic Pressure: 0 or dec
LV Volume: 0 or dec

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Verapamil effect on MVO2

A

HR: dec
Myocardial Contractility: dec
Systolic Pressure: dec
LV Volume: 0 or dec

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Diltiazem effect on MVO2

A

HR: dec
Myocardial Contractility: 0 or dec
Systolic Pressure: dec
LV Volume: 0 or dec

34
Q

How to reduce Myocardial Ischemia/Angina

A

Pharmacotherapy w/ Anti-Ischemics

Improve coronary blood flow mechanically (surgery)

35
Q

Nitrates effects….

A

Inc coronary blood flow (Oxygen supply)

Dec Ventricular wall tension (oxygen demand)

36
Q

Drug interacts w/ nitrates

A

PDE5 inhibitors contraindicated

Sildenafil/Vardenafil = 24hrs
Tadalafil = 48 hrs
37
Q

What to monitor with nitrates

A

ADR: Hypotension, headache, flushing

Monitor: BP, HR, PRN usage, anginal symptoms

38
Q

Nitrate Mechanism of Action

A

Converted to Nitric Oxide

Predominantly venous vasodilation

39
Q

Isosorbide would be ___ line therapy, after….

A

3rd, after Beta-Blocker and CCB

Can use as combo w/ either, but not as mono therapy

40
Q

Nitrate-free interval for Nitrates

A

should be at-least 10-14 hrs

tolerance form use can develop

Usually dosed around 7am, and not after 5pm

41
Q

Protocol for using Nitrate tab

A

Take 1 dose, if pain unimproved or worsening after 5 minutes then call 911. can take 2nd dose at that point

Make sure to store in original container

42
Q

Using nitrate for prophylaxis….

A

take immediately before planned exercise or exertion

43
Q

Nitrate storage considerations

A 
Keep in original container
Don't dump into prescription bottle
Don't dispense w/ safety cap
Don't store in Bathroom
Remove cotton plug from bottle
44
Q

Nitrate admin considerations

A 
Keep with you at all times
Pt should be sitting when taking
Describe how to use SL tab
How to use prophylactically
Call 911 if 1st tab don't work
Have to refill tab every 6 months
45
Q

Beta Blockers effect on MVO2

A

Oxygen supply = 0

Oxygen demand (Dec HR, Myocardial contract, Ventricular wall tension)

46
Q

When are Beta-blockers first line?

A

Post MI also when no prior MI

47
Q

What to monitor and ADR w/ Beta-blockers

A

Monitor: HR, BP, PRN nitrate usage, anginal symptoms, rescue inhaler use, glucose intolerance 9DM)

ADR: Hypotension, bradycardia, high glucose,

48
Q

Which Beta-blockers should you avoid for chronic ischemia?

A

Those with intrinsic sympathomimetic activity (ISA)

49
Q

Are beta-blockers appropriate for Prinzmetals Variant angina?

A

No, none other

50
Q

Beta-blocker considerations

A

Inappropriate for vasospasm

Caution in cocaine induced angina

Abrupt discontinuation of beta-blockers should be avoided…do over 2-3 weeks..could result in reflex tachycardia + ischemia

51
Q

Which Beta-blocker as renal elimination and should be careful with AKI?

A

Atenolol

52
Q

CCB effects on MVO2

A

Oxygen supply (inc Coronary blood flow)

Oxygen demand (dec HR, myocardial contractility, ventricular wall tension)

*** only Verapamil/Dilt will dec HR, Myocardial contract

53
Q

CCB indication

A

2nd line to Beta-blockers

Drug of choice in Prinzmetals variant angina

54
Q

CCB what to monitor and ADR

A

Monitor: (HR - non DHP), BP, PRN nitrate usage, anginal symptoms

ADR: constipation, lower extremity edema, Hypotension, bradycardia

55
Q

Which CCB are more likely to slow HR?

A

non-DHP

Verapamil and Diltiazem

56
Q

CCB of choice for ischemia in pt with concurrent HF?

A

Amlodipine, won’t dec contractility

57
Q

Which CCB have highest effect of Vasodilation?

A

Amlodipine or Nifedipine XL

Non-DHP (Verapamil/Diltiazem = moderate effect)

58
Q

Captopril Dose Frequency

A

TID

59
Q

Lisinopril Dose Frequency

A

Daily

60
Q

Valsartan Dose Frequency

A

1-2 Doses

61
Q

Atenolol Dose Frequency

A

Daily

62
Q

Carvedilol Dose Frequency

A

BID

63
Q

Metoprolol Dose Frequency

A

BID

QD for XL

64
Q

CCBs Dose Frequency

A

Daily

65
Q

Isosorbide DN Dose Frequency

A

2-3 X day

7am/noon/5pm

66
Q

Isosorbide DN SA tab Dose Frequency

A

1-2 X day

8am/2pm

67
Q

Isosorbide MN tab Dose Frequency

A

bid

7hrs apart

68
Q

Isosorbide MN ER Dose Frequency

A

QD

69
Q

When is Ranolazine (Ranexa) used

A

3rd/last line

When inadequate response with other anti-anginal agents in combo with standard therapy

70
Q

Ranolazine MOA

A

reduces calcium overload by inhibiting late sodium current

Minimal effects on HR and BP

71
Q

Ranolazine Dosing

A

500 mg po BID, titrate up to 1000mg BID

72
Q

Ranolazine Monitor and ADR

A

ADR: Constipation, headache, nausea, dizziness
Monitor: QT interval, hepatic function

73
Q

Ranolazine Max dose with Diltiazem or Verapamil?

A

500 mg BID

74
Q

Max simvastatin dose with Ranolazine?

A

20mg

75
Q

Max Metformin dose with Ranolazine?

A

1700mg daily, 850 BID

Ranolazine can be max 1000 mg BID

76
Q

Ranolazine contraindications

A

CYP3A4 Inhibitors and inducers

77
Q

Aspirin is 1st line in pt with…..

A

CAD, class I recommendation

Dosed 81mg daily

78
Q

NSAID - Aspirin Interactions

A

Take ibuprofen/Naproxen at least 30 min after or 8 hr before Aspirin dose

interaction with EC unclear

79
Q

Clopidogrel anti platelet therapy is __ Line

A

2nd line in pt with CAD

If cant tolerate aspirin
75 mg daily

80
Q

Risk factors increasing bleeding risk

A 
H/x of GI bleeding, peptic ulcer disease
>70+
Female
Lean body weight
Thrombocytopenia
Coagulopathy
CKD/DM
Using other meds that inc bleeding risk
81
Q

Only add 3rd anti-anginal drug if…..

A

2 drugs don’t control symptoms
pt awaiting revascularization
revascularization is not appropriate or acceptable

82
Q

Revascularization options

A

PCI - improves symptoms and not mortality

CABG

CDM 2 Exam 1 (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions