Stable Angina

Question 1

Goals of therapy?

Answer 1

-Prevent angina, improve exercise tolerance
-reduce myocardial O2 demand
-increase myocardial O2 supply
-minimize risk of CV death and nonfatal MI
-treat modifiable risk factors

Question 2

Classes of drugs used to treat Stable Angina

Answer 2

1. nitrates
2. Beta blockers
3. CCBs
4. ivabradine?

Question 3

Non-selective BBs

Answer 3

carvedilol
labetalol

Question 4

cardioselective BBs

Answer 4

bisoprolol
metopolol
atenolol
acebutolol

Question 5

BBs with intrinsic sympathomimetic activity?

Answer 5

a less pronounced reduction in resting heart rate and cardiac output
-benefitial for asthma/COPD, bradycardia pts, younger pts
-ex: pindolol, acebutolol

Question 6

MoA of non-DHP CCB vs. DHP

Answer 6

non-DHP (v/d) = reduced HR/BP and heart contractility, reduce o2 demand on heart

DHP (f/a/n) = increased arterial vasodilation = reduce BP, reduce o2 demand, increase o2 supply to heart

Question 7

contraindications of non-DHP CCB

Answer 7

LVEF < 40%
AV nodal disease (2nd/3rd degree heart block)

Question 8

monitoring parameters of nitrates

Answer 8

syncope
hypotension
headache (due to vasodilation)

Question 9

MoA of nitrates

Answer 9

-vasodilation
-reduced preload
-reduced o2 demand

Question 10

dosage forms of nitrates

Answer 10

-po
-SL (IR)
-patches (nitrodur)

Question 11

how to use nitroglycerin SL

Answer 11

-use every 5 mins prn
-if no relief after 2nd spray, call 911

Question 12

When are BBs first line in stable angina?

Answer 12

if MI or HFrEF (EF <40%)
Target resting HR: 50-60 bpm
*if pt does not have either of those conditions, can use either BB or CCB

Question 13

When are long acting nitrates used?

Answer 13

used as adjunct/addition when BB and/or CCBs dont lead to adequate symptom control

Question 14

In what condition are patients taking beta blockers for the rest of their life?

Answer 14

HFrEF

Question 15

MoA of ivrabradine

Answer 15

-funny channels in SA node
-reduces HR
-no impact on BP
-only officially approved for HFrEF, not angina

Question 16

who should be on DAPT?

Answer 16

if recent ACS or stent

Question 17

In patients with stable ischemic heart disease, should they be using ASA 81 mg?

Answer 17

yes, indefinitely. if contraindicated, can use clopidogrel.

Question 18

Drug of choice in prinzmetal angina (angina due to constriction of blood vessels)

Answer 18

CCBs and nitrates
*avoid BBs

Question 19

What is the preferred drug if using a CCB to treat angina in a patient already using BB?

Answer 19

peripherally acting or DHP CCB (amlodipine/nifedipine XL)
-monitor HR and AV nodal function if combining non-DHP CCB

Question 20

Resting HR target in stable angina?

Answer 20

50-60 bpm

Question 21

Can NSAIDs be used in stable angina?

Answer 21

COX-2 inhibitors and most non-selective NSAIDs can increase risk of vascular events. if must be used, administer at lowest dose for shortest time.