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Cardiology 1 > Pharm - IHD > Flashcards

Pharm - IHD Flashcards

1
Q

Modifiable risk factors for CAD

A
  • Diet
  • Exercise
  • Smoking
  • Alcohol
  • Dyslipidemia
  • HTN
  • DM
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2
Q

Non-modifiable risk factors for CAD

A 
- Age
Men >45
Women >55
- Gender
- Family Hx
- Personality type
- Menopausal status
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3
Q

goals of therapy for chronic stable angina

A
  • Acute sx relief
  • Prevention of further chest pain episodes
  • Improved quality of life
  • Minimize adverse effects of tx
  • Prevent serious morbidity and mortality
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4
Q

Two antiplatelet therapies for chronic stable angina list

A

ASA

Clopidogrel

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5
Q

Chronic stable angina ASA dose

A

75 - 325 mg daily

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6
Q

Chronic stable angina ASA measures to decrease GI bleeding risk

A

81 mg ASA + PPI

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7
Q

Clopidogrel dose for chronic stable angina

A

75 mg daily

  • P2Y12 receptor inhibitor
  • 2nd line behind ASA
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8
Q

When use dual ASA clopidogrel tx with chronic stable angina

A

only if have had recent ACS or PCI/stent placement

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9
Q

MoA of nitrates, how it relieves/prevents ischemic chest pain

A
  • Relax smooth muscle = dilated veins = reduced preload, ventricular wall stress, myocardial oxygen demand
  • Reduced myocardial oxygen demand accounts for most of the anti-ischemic effects of nitrates
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10
Q

3 determinants of myocardial O2 demand

A
  • wall stress
  • heart rate
  • contractility
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11
Q

Preload def

A
  • left ventricular end diastolic volume
  • load present before contraction has started
  • amt of blood in ventricle at the end of diastole
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12
Q

Afterload def

A

pressure resistance left ventricle must overcome to circulate blood

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13
Q

dosing instructions (dose and frequency) for nitroglycerin for secondary prevention of chest pain in chronic stable angina

A

0.3-0.6 mg (0.4 is most common) every 5 minutes up to 3 doses

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14
Q

Counseling points for correct use of SL nitroglycerine

A
  • Keep in original container, lid on tight, room temperature
  • If tablets crumble easily, don’t use
  • If still potent, will feel tingling/burning under tongue when use
  • When receive, remove cotton stopper (easier access when have chest pain and cotton absorbs the nitro)
  • Once open bottle, use within 6 months
  • Take at onset of pain, if do not get usual response after 1st tablet, call 911
  • Saliva is needed, if have dry mouth, drink water before taking
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15
Q

ADR ASA

A

bleeding

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16
Q

ADR Clopidogrel

A
  • bleeding (less than ASA)

- neutropenia

17
Q

ADR Nitroglycerine

A
  • HA and flushing (vasodilation)
  • Sl tingling
  • Postural hypotension
  • Nausea
  • tachycardia
18
Q

ADR Beta Blockers

A
  • Fatigue
  • Bradycardia
  • Hypotension
  • Acute heart failure
  • Bronchoconstriction
  • Erectile dysfunction
  • CNS effects (nightmares, insomnia, hallucinations)
19
Q

ADR Calcium Channel Blockers

A
  • Constipation – verapamil
  • Peripheral edema – mostly dihydropyridines
  • Hypotension
  • Bradycardia – verapamil and diltiazem
  • Dihydropyridines: HA, lightheadedness, flushing
  • Non- dihydropyridines: worsening cardiac output
20
Q

ADR Nitrates

A
  • Postural hypotension
  • HA
  • Reflex tachycardia
  • Flushing
  • Lightheadedness
  • **same as nitroglycerine ☺
21
Q

appropriate dosing regimen for metoprolol tartrate (Lopressor) for the treatment of chronic stable angina

A

50-100 mg BID

22
Q

MoA BB to relieve or prevent ischemic chest pain

A
  • Antagonist for beta adrenergic receptors, blocks binding of norepinephrine and epinephrine
  • Reduce MVO2 by decreasing HR, contractility, and wall stress
23
Q

Contraindications for Beta-blocker in tx of chronic stable angina

A
  • 2nd or 3rd degree AV block
  • bradycardia
  • sick sinus rhythm
  • decompensated heart failure
24
Q

Contraindications for nitrates in tx of chronic stable angina

A

Concurrent use with phosphodiesterase-5 (Viagra, Cialis, etc.)

25
Q

dihydropyridine CCB (6)

A
  • pines
  • Nifedipine
  • Amlodipine
  • Felodipine
  • Nicardipine
  • Nisoldipine
  • isradipine
26
Q

non-dihydropyridines CCB (2)

A
  • verapamil

- diltiazem

27
Q

MoA of CCB

A
  • inhibits the influx of calcium into the smooth muscle cells of peripheral vasculature leading to relaxation and reduced vascular tone; it also slows heart rate and reduces the force of myocardial contraction
    i. slow conduction velocity
    ii. prolong refractory period
    iii. decrease automaticity
28
Q

appropriate intervention to decrease or avoid tolerance to nitrates

A

Minimum of 8 hours nitrate free interval a day

29
Q

role of ASA in tx of chronic stable angina

A

anti-platelet therapy

30
Q

role of clopidogrel in tx of chronic stable angina

A
  • anti-platelet therapy

- 2nd line to ASA

31
Q

role of SL nitroglycerine in tx of chronic stable angina

A
  • Prevent a predictable attack (take 5 min prior to activity)
  • Relieve angina after onset of unpredicted pain
32
Q

role of nitrates in tx of chronic stable angina

A
  • chronic use for sx control
  • Added to BB +/- CCB to control stable angina
  • NOT monotherapy
33
Q

role of beta blockers in tx of chronic stable angina

A

Chronic angina therapy, first line

34
Q

role of calcium channel blockers in tx of chronic stable angina

A

added to BB if needed bc BB weren’t successful or in place of BB if they are contraindicated/cause ADE

35
Q

Role in therapy of the following in the tx of Prinzmetal angina

  • ASA
  • clopidogrel
  • SL nitro
  • nitrates
  • BB
  • CCB
A
  • ASA: NO ROLE
  • Clopidogrel: NO ROLE???
  • SL Nitro: use in acute attacks
  • Nitrates: added to CCB if unresponsive to CCB alone
  • BB: NO ROLE
  • CCB: chronic treatment

Cardiology 1 (11 decks)

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