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Naplex 2025 > Stable Angina > Flashcards

Stable Angina Flashcards

1
Q

What are the two types of angina and what is the difference between them>

A
  • Stable Angine: predictable chest pain caused by exerction or stress that is relieved by NTG or Rest
  • Unstable Angina: ACS where chest pain increases with NO help from NTG or rest
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2
Q

What is the pathophysology of Chest Pain?

A
  • Imbalence of myocardial oxygen demand [workload] and supply [Blood Flow]”
  • Oxygen demand is normally decreased due to atherosclerosis [plaque] within the coronary arteries

“like Increased HR, contractility or left ventrcular wall tension

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3
Q

What is the chest pain called when it is called by Coronary Artery Vasospams?

A
  • Vasopastic Anigna [can happen at rest]
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4
Q

What are the risk factors for Stable Angina?

A
  • Heart Disease
  • Vascular Disease and Stroke
  • HTN
  • Smoking
  • Dyslipidemia
  • Diabetes
  • Obseity
  • Inactive
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5
Q

What is the Cardiac Stress Test?

A
  • Test to increase Oxygen demand by exercise [walking or cycling] or by medications [adenosine, dipyridamole, dobutatine…]
  • As oxygen increases; looking to see if any chest pain, lightheadedness, changes to HR or BP
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6
Q

What are some of the Non-Drug Treatment for Stable Angina?

A
  • Heart Healthy diet with >150 mins of activity weekly
  • BMI 18.5 - 24.9 and Waist of < 35in in females and < 40in in males
  • Quit smoking
  • Alcohol drink 1/d in women and 1-2/d in men
  • Chronic NSAIDS stopped
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7
Q

What are some of the treatment options that can help with the treatment goals of stable angina?

A
  • ACE/ARBs = HTN
  • Statins = Dyslipidemia
  • Antiplatelets = preventing clots
  • Antianginals = decrease demend or increase supply of oxygen

Antiplatent = Aspirin
Antianginals = BB, CCBs, nitrates

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8
Q

What is the treatment approach for stable angina?

A
  • A: Antiplatelets and Antianginal
  • B: Blood Pressure
  • C: Cholesterol [statins] & Smoking [Cessation]
  • D: Diet and Diabetes
  • E: Exercise
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9
Q

What are the 2 antiplatelet drugs used?

A
  • Aspirin [Bayer, bufferin, Ecotrin]
  • Clopidogrel [Plavix]
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10
Q

What is the MOA of Aspirin?

A
  • Irreversibly inhibits COX 1 & 2 = decrease in prostaglandin and tromboxane A2 [TXA2 is a vasoconstrictor and platelet aggreagator]

75 - 100mg daily

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11
Q

What iare the contraindications for Aspirin?

-

A
  • Sailcylate Allergy
  • Childern and Teens [Reyes Syndrome]
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12
Q

What are the warnings for Aspirin>

A
  • Bleeding [even GI Bleeding] and Tinnitus [Signs of an overdose]
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13
Q

What are the side effects of Aspirin?

A
  • Dyspepsia, Heartburn, Bleeding
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14
Q

What are some other notes about aspirin?

A
  • Used FOREVER in stable angina
  • Non-enteric coated is used in ACS; if Enteric coated, be sure to chew it
  • Can use with PPIs to protect GI but risk of decreased bone density and increase infection
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15
Q

What is the MOA for clopidogrel?

A
  • Prodrug that Irreversibly inhibits P2Y12 platelet activation and aggregation
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16
Q

What is the Boxed Warning for Clopidogrel?

A
  • Prodrug so it need conversion from 2C19; if poor metabolizer then that could increase cardio issues
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17
Q

What are the contraindications for Clopidogrel

A
  • BLEEDING [even GI]
18
Q

What are the warnings for clopidogrel?

A
  • Bleeding risk [stop 5 days before surgery]
  • DO NOT use with Omeprazole or Esomprazole [Increase thrombosis risk]
  • Thrombotic Thrombocytopenic Purpura [TTP]
19
Q

What are some of the anitianginal treatments that are used?

A
  • Beta Blockers
  • CCBs
  • Nitrates
  • Ranolazine
20
Q

What is the way that Beta Blockers are used in Antianginal treatment?

A
  • Reduce myocardial demand by decreasing HR, Contractility, and left ventricular wall tension
  • AVOID in vasospastic angina
21
Q

What is the way that Calcium Channel Blockers are used in Antianginal Treatments?

A
  • Reduce Myocardial Oxygen demand by; Non-DHP decreasing HR and Contractility & DHP decreasing SVR
  • Avoid using Nifedipine IR; DHP are preferred to use with Beta Blockers
  • PREFERRED in Vasospastic Angina
22
Q

What are the way that Nirates are used in Antianginal treatments?

A
  • Reduce myocardial oxygen demand by decreasing preload [because of the nitric oxide free radials causing vasodilation]
  • SL tab and TL spray are the most common
23
Q

What is the MOA of Ranolazine and how does it work as an antianginal treatment?

A
  • Selectively inhibits the laste phase Na current and decrease intracelular Ca = decrease oxygen demand
24
Q

What are the contraindications for Ranolazine?

A
  • DO NOT use with strong 3A4 inhibitors or inducers
25
Q

What are the warnings for Ranolazine?

A
  • QT Prolongation
26
Q

What are some of other notes for Ranolazine?

A
  • NOT for acute chest pain
  • Little to no effect on HR or BP
27
Q

What are the short acting and long acting nirates that are used>

A
  • Short Acting: NTG SL Tabs [Nitrostat] & NTG TL Spray [Nitromist, Nitrolingual]
  • Long Acting: NTG Ointment 2% & Isosorbide Mononirate Tablet
28
Q

What are the contraindications for the Nirates?

A
  • DO NOT use with PDE 5 inhibitors
29
Q

What are the warnings for Nirates?

A
  • Hypotension, Tachphylaxis
30
Q

What are the side effects of the Nirates?

A
  • Headache, flushing, syncope, dizziness
31
Q

What are some other notes about the short acting nirates>

A
  • ONLY PRN
  • SL tabs must be in amber glass bottle
32
Q

What are some other notes about the long acting nitrates?

A
  • NEEDS a 10-12 h nitrate free time to decrease tolerance
  • PATCH: wear for 12-14h then off for 10-12h
  • OINTMENT: BID; 6h apart
  • ISMN: IR is dose BID; 7h apart
  • ISMN + Hydralazine is good for HFrEF
33
Q

What are some key counseling points for Aspirin?

A
  • Bleeding/Brusing
  • Dyspepsia
  • Allergic Reaction
  • Tinnitus [Overdose]
34
Q

What are some key counseling points for Clopidogrel?

A
  • Bleeding/Brusing
  • Trombotic Thrombocytopenic Purpura (TTP)
35
Q

What are some key counseling points for Nirates>

A
  • Can causes: Orthostasis, Flushing, Headache
  • NEED nirate free time with long acting
  • PDE5 drug interacrtions
36
Q

What are some counseling points for the Short Acting Nirates?

A
  • Take one with First Chest Pain Episode
  • 911 if chest pain continues; take 2 other doses 5 mins apart [NO MORE THAN 3]
37
Q

What are some counseling points for NTG SL Tablets?

A
  • Place under tongue to let it dissolve
  • The slight burning or tingleing is NOT a sign its working
  • Be sure to keep in a glass ambe bottle
38
Q

What are the counseling points of NTG TL Spray?

A
  • Prime is not used for more than 6m
  • DO NOT SHAKE; spray onto tongue or under
  • DO NOT INHALE
39
Q

What are the counseling points for NTG Patch?

A
  • CHEST is the best spot for it
  • Below elbows and knees is a BAD spot
40
Q

What are some counseling points for the NTG Ointment>

A
  • Use the dose appilcator to measure out dose
  • Spread using the appilcator (do not rub in) and tape apilcator down
  • Can STAIN clothes so cover good

Naplex 2025 (10 decks)

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