Brainscape's Knowledge GenomeTM

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


See full index

Pharm II exam 2 > Med management of Chronic stable angina and CAD > Flashcards

Med management of Chronic stable angina and CAD Flashcards

1
Q 
Which of the following is the PREFERRED antiplatelet strategy for patients with established coronary disease?
A. Dipyridamole 
B. Dipyridamole/ASA
C. ASA
D. Cilostazole
A
  1. ASA PO daily
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the ABC’s of tx for SA and CAD

A 
A-Aspirin, ACEI, Anti-anginals
B-Beta blockers, BP control
C-Cholesterol and cigarettes
D-Diet, DM management, Depression
E-Exercise (calorie targets physical activity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the recommendation for BP according to JNC8 and ADA?

A

Less than 140/90

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

What is the recommended LDL or LDL reduction from baseline?

A

Less than 70 or 40% reduction

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

The cumulative risk redcution of all 4 medication classes used in tx of SA and CAD is 70%. What are those 4 drug classes?

A

Aspirin
B blocker
Ace inhibitor
Lipid lowering

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

What are the Antiplatelet agents used in SA and CAD?

A 
Aspirin
Clopidogrel
Prasugrel
Ticagrelor
Dipyridamole
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which 3 antiplatelet agents have the same MOA?

A

The ones with Grel in them
Clopidogrel
Prasugrel
Ticagrelor

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

What is the MOA of Clopidogrel, Prasugrel, and Ticagrelor

A

Inhibits ADP-platelet activation

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

What is the MOA of Aspirin

A

Inhibition of TxA2 platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

MOA of dipyridamole

A

inhibits platelet adenosine and phosphodiesterase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When do we use Aspirin in the scope of SA and CAD?

A

As thromboprotection.

Treatment of ACS (chewed and swallowed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are major side effects of ASA

A

GI bleeding

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

What can be given as protection from the SE of ASA?

A

PPI

H2

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

What antiplatlet medication is marginally more effective than ASA in PAD?

A

Clopidogrel

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

What options are available for pt’s on omeprazole/PPI for GERD who are put on Clopidogrel?

A

Space 12 hours apart-or switch PPI to H2RA

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

What medication can be used both with ASA or as an alternative to ASA if ASA allergic or intolerant?

A

Clopidogrel

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

How soon before surgery should clopidogrel be d/c’s

A

7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What medication can be used instead of Clopidogrel, is marginally more effective, and avoids the interaction with PPI’s?

A

Prasugrel

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

contraindication for Prasugrel?

A

Hx of hemorrhagic events
stroke
TIA

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

How long after stent placement is the use of Clopidogrel, prasugrel or ticagrelor indicated for?

A

1 year post

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

Which antiplatelet is not safe for use in hepatic disease?

A

Ticagrelor

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

Which antiplateltes are reversible?

A

Ticagrelor

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

Which antiplatelets are not reversible?

A

Aspirin
Clopidogrel
Prasugrel

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

What is the MOA of Dipyridamole?

A

Platelet adenosine deaminase and phosphodiesterase inhibitor; increases cAMP to vasodilate and inhibits platelets

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

What other medication is Dipyridamole combined with as a fixed combo med?

A

ASA

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

What is Dipyridamole typically used for?

A

Very advanced PVD and CAD. Significantly reduces risk of stroke

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

What classes are considered Anti-anginals?

A

Beta Blockers
CCB’s
Nitrates (adjunctive)

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

Which anti-anginal class has the best data for reducing CV events?

A

Beta-blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Which anti-anginal class can often be given with a BBlocker and has mixed data/outcomes?

A

CCB’s

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

What are Nitrates used for?

A

adjunctive tx, only for symptoms

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

What are the 4 benefits that Beta-blockers provide by lowering myocardial oxygen demand?

A
  1. Reduction in ischemic time
  2. Decreased heart rate
  3. Decreased blood pressure and workload
  4. Decreased contractility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What group of patients would need following and caution when using a BBlocker?

A

pt’s with pulmonary dz

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

T/F B blockers are relatively contraindicated in pt’s with COPD?

A

True (RELATIVELY)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

White side effects might be caused by B Blocker?

A 
Slowed PR-interval, ventricular rate
Reduction of Renin output (reduced RAAS)
Rebound HTN (if suddenly discontinued)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

t/f Selective Beta 1 may still block beta 2 at high doses?

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What non-selective beta blockers exist?

A 
Labetalol
Carvedilol
Nadolol
Sotalol
Timolol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the benefit to using selective B Blockers?

A

Less likely to cause COPD exacerbation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What selective B Blockers exist

A 
Atenolol
Metoprolol
Esmolol
Bisoprolol
Nebivolol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What might occur with a patient who has liver dz if given a B Blocker?

A

Liver dz may increase bioavailability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What might occur with a patient who has renal z if given Beta blockers

A

slowly clear active metabolites

Toxicity effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What can BB mask?

A

thyroid storm or thyrotoxicosis

42
Q

What are the outcome benefits for pt’s on BB?

A
  • Reduces mortality in HTN pt’s
  • Improves survival in HTN patients after recent stroke
  • functionally-increases exercise tolerance
43
Q

What other cardiac meds should be avoided when using a BB?

A

Verapamil/diltiazem (non-dihydropyridines)

44
Q

What should be monitored clinically in pt’s who are on BBlocker?

A

HR
BP
ECG
Physical function

45
Q

What are the indicators to watch for intolerance/toxicity of BB?

A 
Activity intolerance (initially ok but should adapt within 30 days)
Postural hypotension
syncope
AV-block
Sexual dysfunction
Fatigue
Depresion
HA
Bronchospasm
46
Q

Which BB used in SA and CAD are selective?

A

Metoprolol
Bisoprolol
Atenolol
Nebivolol (newest)

47
Q

Is BB Carvedilol selective/non-selective?

A

non-selective PLUS selective for A1 blocker

48
Q

Name the strictly non-selective BB?

A

Carvedilol
Propanolol
Nadolol
Labetalol

49
Q

Which is one of the most relied upon BB’s in practice?

A

Metoprolol

50
Q

Who does Metoprolol benefit the most?

A

pt’s who need reduction CV events and pt’s with HTN, HF, LVD, or CAD

51
Q

Can Metoprolol be given in a pt with liver disease?

A

Yes-little protein binding

52
Q

What are the indications for bisoprolol?

A

works well for pt’s with HF and HTN

53
Q

Does Bisoprolol require any adjustments?

A 
Yes
renal dysfunction (d/t prolonged 1/2 life)
54
Q

For a stage III/IV unstable CAD pt is Bisoprolol a good choice?

A

NO - stage III/IV may precipitate an event on Bisoprolol

55
Q

Which BB is best for use in a pt with LVdysfunction cardiomyopathy?

A

Carvedilol

56
Q

When can Carvedilol NOT be used?

A

Liver dz

57
Q

What other benefit does Carvedilol have when giving?

A

reduced rebound tachy risk

58
Q

What medication, although not commonly used, is useful in pt’s with stable CAD and HA?

A

Propanolol

59
Q

Which BB reduces isotropy, chronotopy, cardiac work, as well as hepatic blood flow, and is therefore useful in pt’s with variceal bleeding?

A

Nadolol

60
Q

Which selective B1B is useful in reducing HR and BP for pt’s with asthma and COPD, as well as liver disease, due to it’s limited metabolism, but has no CV outcomes that support it’s use for HTN pt’s with CAD, HF?

A

Atenolol

61
Q

Which BB is useful for HTN crisis, pre-eclampsia but not for long term angina use.

A

Labetalol

62
Q

When is Esmolol used?

A

Ultrashort 1/2 life-reserved for perioperative use

63
Q

which medication is the most selective B1 antagonist with endothelium derived NO depended vasodilation?

A

Nebivolol

64
Q

Who cannot use Nebivolol?

A

Liver dz pt’s

65
Q 
Which anti-anginal could be appropriate for a pt with an EF less than 35%?
A. Milrinone
B. Verapamil
C. Diltiazem
D. Felodipine
A

Answer D. Felodipine (vasodilating CCB tolerated better)

A. Milrinone is for pt’s with really advanced HF
B. Verapamil and C. Diltiazem are difficult to manage and tolerate with decreased EF pt’s

66
Q

What are the 2 types of CCB’s

A

Dihydropyridines
and
Non-dihydropyridines

67
Q

What are the 2 non-dihydropyridines and where do they work in the body?

A

Verapamil
Diltiazem
Both lower myocardial oxygen demand by working at the heart to improve venous perfusion

68
Q

What are the Dihydropyridines

A 
Nefidipine
Amlodipine
Felodipine
Isradipine
nimodipine
nicardipine
nisoldipine
clevidipine
69
Q

Which drug is preferable when giving a dihydropyridine.
A. Long acting
B. Short acting?

A

A. Long acting has less side effects and gives best 24-hour control

B. Short acting associated with more rebound sympathetic activity, rebound HTN w/ tacky, dangerous BP

70
Q

Which is better for most pt’s needing better anginal mgmt?
A. Dihydropyrines
B. Non-dihydropyrines?

A

A. dihydropyridines

71
Q

What are SE of Dihydropyridines?

A

Peripheral edema

Bronchiole, Gastric uterine tissue also responds (cramping)

72
Q

Which medications are most effective for vasospastic angina?

A

Non-dihydropyridines are all equally effective for vasospastic angina, efficacy is increased by adding NTG

73
Q

What are the clinical monitoring parameters for CCB’s

A 
HR, BP, ECG, Physical function
Watch for intolerance
Hypotension
syncope
AV block
Fatigue
Depression
Peripheral edema
Gingival hyperplasia
Sexual dysfunction
wt. gain
74
Q

Which medication is better tolerated: Diltiazem or Verapamil?

A

Diltiazem

75
Q

What Interactions need to be watched for with use of Diltizem and Verapamil

A

MANY!!
CYP3A4
PGP

76
Q

What is the Most frequent pt reported ADR with CCB’s

A

Peripheral edema

77
Q

Can CCB Nifedipine be used with BB’s?

A

Yes-carefully

78
Q

Can Nifedipine be used SL or orally in HTN emergencies?

A

NO-it will increase rebound sympathetic CV mortality in CADpt’s

79
Q

Which CCB is very selectively used for CA vasodilation, and has no effect on HR? (almost never used)

A

Nicardipine

80
Q

Which medication is: a long acting alternative to nifedipine, and works very well for management but has a lot of Peripheral Edema associated with it, and can’t be used in Liver Dz?

A

Amlodipine

81
Q

What med is a good low cost alternative to amlodipine, has no effects on HR but never really took off as a branded product?

A

Felodipine

82
Q

Which CCB is considered last line and has been associated with LV dysfunction?

A

Bepridil

83
Q

Which medication would provide the most rapid improvement of myocardial oxygen supply in a pt with acute chest pain?

  1. SL NTG now
  2. Metoprolol now
  3. Captopril PO TID
  4. Amlopdipine PO now
A
  1. SL NTG now
84
Q

Where do nitrates primarily work?

A

on the venous system, although they also work on the arterial side too (just not as much).

85
Q

MOA of nitrates

A

Increases venous capacity, decreases ventricular preload, improves venous and later arterial filling

86
Q

Benefits of nitrates are primarily?

A

symptom relief

NO CV outcome benefits, reduces hospitalizations

87
Q

A pt should not use a nitrate any sooner than ____ hours after taking a dose?

A

12/24

88
Q

Oral nitrates have a ______ _____ metabolism

A

extensive first-pass.

89
Q

What is the significance of the extensive first-pass metabolism of Nitrates?

A

works very rapidly and lasts about 30 min

90
Q

When is it dangerous to take a nitrate?

A

dehydrated
not moving/upright
while using ETOH

91
Q

CV collapse may occur if taking ______ with a nitrate?

A

phosphodiesterase inhibitors

92
Q

What are the ADE’s of nitrates?

A

Rebound Tachy
Holding on to NA+
Extreme HA

93
Q

What are the clinical monitoring parameters for nitrates?

A

Therapeutic: anginal relief, activity tolerance

Intolerance/toxicity: activity intolerance, worsening angina, HoTN, HA, Blurry vision, edema, falls, reflux

94
Q

after 1 dose of NTG with no relief a pt should _____.

A

Call for a medic

95
Q

SL duration of NTG.

A

20-30min

96
Q

TD duration of NTG:

A

6-8hrs

97
Q

Other than NTG what additional Nitrates exist?

A

Isosorbide mononitrate

Isosorbide dinitrate

98
Q

Which of the two additional nitrates is MC used?

A

Mononitrate (don’t use dinatrate anymore Mono is much better med)

99
Q

What medication can be used if the pt is on a b blocker already and the anti-anginal doesn’t work to control sx?

A

Isosorbide mononitrate (as third drug)

100
Q

What cautions must be given to a pt on nitrates:

A

NO ETOH-CV collapse, arrhythmia
Maintain nitrate free intervals every 12 hours for regeneration to reduce tolerance
poorly tolerated by some-HoTN, Orthostasis, HA

101
Q

What medications CANNOT be given within 24 hours of giving a nitrate?

A

sildenafil, verdenafil, tadalafil (ED meds)

Pharm II exam 2 (3 decks)

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