Medical Management of Stable CAD

Question 1

initial management of hypoxia and CP symptom presentation

Answer 1

for hypoxia initial management: O2

symptoms: titrated i.v opioids hsould be considered to relieve pain. A mild tranquilizer should be considered in anxious patients.

Question 3

investigations for initial management for chest pain

Answer 3

• stat ecg/ekg
• troponin
• CBC
• creatinine, urea, lytes
• glucose
• INR, PR/PTT

Question 4

for STEMIs, what can you do in addition to supportive therpay during disposition?

Answer 4

you can do reperfusion therapy via primary percutaneous intervention or thormbolytic therapy

Question 5

DDX of chest pain

Answer 5

Question 6

Mnemonic for behavioural and pharmacoloical therapies proven to prevent or reduce recurrent acute cardiovascular disease events:

SCEXAPABETASTATIRAAIDD

Answer 6

SC: smoking cessation

Ex: esercise therapy

APA: antiplatelet agents: ASA, clopigerol

Beta: beta blockers

Stati: statins

RAAI: reninangiotensin aldosterone inhibitors

D: diet

D: drinking

D* DEPRESSION TX

Question 7

Antiplatelet agents

Answer 7

1. ASA
2. Clopidogrel
3. Ticagrelor

If they have an acute coronary syndrome and don’t get revascularized with surgery via arthroplasty they will get asa plus clopidogrel/plavix. If they have a semi or nonstemi they will have ASA and ticagrelor (brilinta)

Question 8

APA mechanism of agent (ASA)

Answer 8

ASA has anti-platelet action

• decreases prostaglandins and thromboxanes
• causes cyclooxygenase inhibition (COX1 and COX2)
• irreversibly blocks thromboxane A2
• also causes anti-inflammatory actions and anti-pyretic actions

Question 9

APA mechanism (clopidogrel)

Answer 9

Clopidogrel
• Active Metabolite • Irreversibly inhibiting Platelet P2Y12 ADP Receptor

Question 11

mechansim of APA ticagrelor

Answer 11

agrelor
• Primary Compound and Active Metabolite

• Irreversibly inhibiting Platelet P2Y12 ADP Receptor

Question 13

APA contra-indications and major adverse side-effects

Answer 13

Question 14

beta blockers can be classified into :___ and ___-___.

Long term usage; usually over a year or two. If you do not have other heart problems/angina/htn/heart failure or heart rhythm problems, you probably won’t benefit from the beta blocker after one year.

Answer 14

betablockers can be selective or non selective.

Question 15

mechanism of action for beta blockers

Answer 15

• blocks beta receptor
• inhibit catecholamines in CV tissue
• lower heart rate and lowers blood pressure
• reduce myocardial contractility
• indicated in systolic failure.

Question 16

Bblocker contraindications

Answer 16

or asthma

Question 17

major adverse side effects for beta blockers

Answer 17

Question 18

****

Question 19

• ACE (Angiotensin Converting Enzyme) Inhibitors
• End in “___”
• Angiotensin Receptor Blockers
• End in “___”

Answer 19

• ACE (Angiotensin Converting Enzyme) Inhibitors
• End in “PRIL”
• Angiotensin Receptor Blockers
• End in “SARTAN”

They have the ability to reduce the incidence of actor cardiac events independent of the htn. You can put them on these drugs even if their bp is not super elevated for the cardiac event prevention if you present with a cardiac infarct.

Dependent on your level of vascular inhibition, you will benefit from an ARB or ACE inhibitor. ACE inhibitors have about 70% reduction of cardiac events.

Question 20

• Statins
• ___ ____ Reductase Inhibitors

• Lower LDL-C ~ 50%

Answer 20

Statins
• HMG CoA Reductase Inhibitors

• Lower LDL-C ~ 50%
- helps with dyslipidemia, lowers LDL

Question 21

major adverse side effects and contraindications of statins

Answer 21

major adverse side effects:

1. myalgia
2. myopathy/myositis
3. rhabdomyolysis
4. potential significant drug interactions

Contraindications:

• some meds
• documented statin intolerance

Question 23

thrombolytic therapy is used for __MI

Answer 23

STEMI.

Question 24

mechanism of action for thrombolytic therapy in ischemic heart disease

Answer 24

tpa: tissue plasminogen activator
- pharmacological mimics of tpa: converts plasminogen to plasmin. Plasmin lyses clot/breaks down fibrinogen and fibrin within clots.

Question 25

absolute and relative contraindications of thrombolytic therapy for STEMI and adverse reactions

Answer 25

severe adverse reactions

1. intracranial hemorrahage (frequently fatal)
2. systemic hemorrhage (often GI)
3. allergic reactions
4. stroke
5. reperfusion dysrhythmias

Question 26

mechanism of action for heparin therapy

Answer 26

• inactivates thrombin and activated factor X

-

Question 27

contraindications and severe adverse reactions of heparin therapy

Answer 27

Question 28

mechanism of action for fonda parinux therapy

Answer 28

• inhibits factor Xa
• inhibits thrombin formation
• reasonably specific (minimal effect on PT and a pTT)
• minimal risk of heparin inducted thrombocytopenia

Question 29

contraindications and adverse reactions of fondaparinux therapy

Answer 29

contraindications; shouldn’t be used if person has kidney failure/imprairment.

Question 30

to achieve health benefits, adults should accumulate at least __ minutes a week of moderate to vigorous intensity aerobic physical activity per week

Answer 30

150 mintues

Question 31

which diet has been seen to reduce CVD events?

Answer 31

mediterranean diet; 1/3 protein, 1/3 carbs, 1/3 fat

Question 32

the ____ and ____ in red meat is linked to atherosclerosis

Answer 32

L-carnitine and trimethylamine N-oxide is linked to atherosclerosis.

Question 33

diabetes therapies depending on if A1C is over or under 1.5?

Answer 33

you want to get to target within 3–6 months