SIHD final part Flashcards
sowinski pg 121-end
how should an initial drug be chosen?
based upon the patient characteristics and concomitant conditions
mostly considered BB
what are compelling indications for BB?
stable HF
history of MI
when are BB especially useful in?
Atrial fibrillation
high resting HR
migraine headaches
in what pt populations should BB be avoided?
vasospastic/prinzmetal’s angina
conduction disturbances
what are the CI of BB?
bradycardia (HR under 50)
high degree AV block or sick sinus syndrome (with no pacemaker)
when would non-DHP CCBs be prefered?
CI to BB
unacceptable SE to BB
what populations would benefit from non-DHP CCBs compared to BB?
chronic lung disease
HTN
DM
peripheral vascular disease
when are non-DHP CCBs CI?
HFrEF
bradycardia under 50
high degree AV block
sick sinus syndrome (with no pacemaker)
when are DHP-CCBs CI?
HFrEF (Except amlodipine and felodipine)
should nitrates be used a monotherapy?
not prefered due to nitrate free period and tolerance
use in combo with BB/non-DHP
what do the roles of BB and non-DHP CCBs play when used in combination with nitrates?
blunts nitrate-induced increase in HR
when should nitrates not be used?
use in cautions in pts with HOCM, severe aortic stenosis, and PDI use
when are BB favored?
prior ACS/MI (non-ISA)
HF/LVD
sinus tachycardia, SCV tachycardia, A fib
ventricular arrythmias
migraines
hyperthyroidism
when are CCBs favored?
HTN
DM
PVD/Raynaud’s
severe asthma/copd
prinzmetal’s angina
what clinical conditions differentiate between non-DHP and DHP CCBs favoring?
DHP - bradycardia/AV block
Non-DHP - sinus tachycardia, SV tachycardia, A fib (same as BB)
what conditions limit BB use?
bradycardia/AV block
sick sinus syndrome
HF deconpensation
severe depression
severe asthma/COPD
what conditions limit CCBs?
non-DHP only –> bradycardia/AV block, sick sinus syndrome
HF
severe hypertrophic obstructive CM
severe aortic stenosis
what conditions limit nitrates?
ED treated with PDE5
severe hypertrophic obstructive CM
severe aortic stenosis
what are the three gold star standards of combination therapy?
nitrates and BB
nitrates and non DHP-CCBs
DHP CCB and BB
why should BB and non-dhp CCBs be avoided?
decrease in HR
if a person were to use triple therapy for symptoms, what drugs would it be?
BB
nitrates
CCB
what is the definition of stable angina pectoris?
discomfort in chest caused by myocardia ischemia and associated with disturbances in myocardial funtion without myocardial necrosis
symptoms have not changes in the past 2 months
