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NAPLEX Prep > Stable Angina > Flashcards

Stable Angina Flashcards

1
Q

What is angina?

A

Chest pain, pressure, tightness caused by ischemia of the heart muscle or spasm of the coronary arteries

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2
Q

What is the difference between stable and unstable angina?

A

Stable: predictable typically induced by stress and relieved with rest

Unstable: type of ACS that is not relieved with nitroglycerin or rest

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3
Q

What instigates chest pain?

A

Imbalance in myocardial oxygen demand and blood supply → ↑ tension, heart rate, contractility

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4
Q

What is coronary artery disease?

A

Reduced blood flow to the heart due to narrowing of arteries

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5
Q

What are the primary causes of vasospastic angin

A

Illicit drug use (cocaine)

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6
Q

How do we diagnose angina?

A

Cardiac stress test (exercise or IV medication)

Coronary angiography

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7
Q

Non drug treatment for angina?

A
  1. Heart healthy diet
  2. BMI: 18.5-24.8
  3. Waist circumference <35 in (females) and <40 in (males)
  4. Aerobic activity
  5. Smoking cessation
  6. Reduce alcohol intake
  7. Chronic NSAIDs should not be used
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8
Q

What is the treatment approach for stable angina?

A

Antiplatelet and antanginal drugs
Blood pressure
Cholesterol (statins) and cigarette cessation
Diet and diabetes
Exercise and education

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9
Q

Types of antianginals

A

BB, Non-DHP CCB, long-acting nitrates

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10
Q

MOA of aspirin

A

Irreversibly inhibit COX1 and 2 decreasing PG and TXA1

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11
Q

MOA of Plavix

A

Prodrug that irreversibly inhibits P2Y12 ADP-mediated platelet activation and aggregation

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12
Q

CI of asprin

A

Salicylate allergy
Avid in children and teenagers due to Reyes syndrome

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13
Q

What is a sign of ASA OD

A

Tinittis

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14
Q

ADR of ASA

A

Dyspepsia (acid), heartburn (acid), bleeding

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15
Q

Preferred ASA dosing for ACS

A

Non-enteric coated chewable tablet, however EC ASA (325 mg) can be chewed if needed

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16
Q

Duration of ASA for angina

A

Indefinitely

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17
Q

How to mitigate nausea when on ASA

A

Take with food

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18
Q

Importance of PPIs while on ASA

A

Protect the GI tract with chronic use

However chronic PPI → ↓ bone mineral density and ↑ infection risk

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19
Q

BBW of Clopidogrel

A

Requires CYP2C19 for activation → patient must test to check genotype for possible poor metabolizers

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20
Q

ADR of Plavix

A

Serious bleed (stop 5 days prior to surgery)
TTP
Premature dc → ↑ thrombosis

21
Q

DDI of Plavix

A

Additive bleeding risk with other drugs that cause bleeding

CI with aspirin

Avoid CYP2C19 inhibitors (Omeprazole and esomeprazole)

22
Q

Purpose of BB

A

Reduce myocardial oxygen demand by decreasing HR, contractility, and LV wall tension

23
Q

Indication for BB

A

Avoid in vasospastic angina

24
Q

Purpose of CCB

A

Reduce myocardial oxygen demand by:

Non-DHP: ↓ HR and contractility
DHP: reduce SVR

↑ O2 supply by increasing blood flow to coronary arteries

25
Q

Purpose of nitrates

A

Reduce myocardial oxygen demand by reducing preload (Free radical nitric oxide produces vasodilation of veins more than arteries)

26
Q

Which CCB are preferred?

A

DHP and used in combo with BB (due to risk of bradycardia from non-DHP)

27
Q

When are CCBs usd

A

Vasospastic angina

28
Q

What is the purpose of a nitrate free interval

A

Prevent nitrate tlerance

29
Q

CI of ranolazine

A

Strong CYP3A4 inhibitors and inducers

30
Q

Can ranolazine be used acutely

A

No

Only used as add ons

31
Q

ADR of Ranolazine

A

QTc prolongation

32
Q

Purpose of ranolazine

A

Decreasing ventricular tension and oxygen consumption → ↓ myocardial oxygen demand

No clinical effects on HR and BP

33
Q

Standard dose of short acting Nitrates

34
Q

CI of nitrates

A

Avoid PDE5I or sGCs

35
Q

ADR of nitrates

A

Hypotension, tachphylaxis (tolerance/decreased effectiveness)

HA, flushing, syncope

36
Q

Counseling of short acting nitrates

A

Used for PRN chest pain

Store SL table in original container

Call 911 immediately if persists after 1st dose
3 doses within 15 min (5 min apart)

37
Q

Counseling of SL tabs

A

Place under tongue and let dissolve

Slight burning or tingling is not a sign of the medication working

Keep in original container

38
Q

Counseling of TL spray

A

Prime Q6W if not used
Don’t shake
Spray under tongue

39
Q

How long is a nitrate free interval

40
Q

Counseling on path

A

Wear 12-14 hrs, off 10-12 hrs
Rotate sight

41
Q

Counseling of nitrate ointment

A

BID 6 hrs apart with 10-12 nitrate free interval

Measure dose using applicator and place on chest ointment side down

Can stain clothing

42
Q

Nitroglycerin SL tab

43
Q

Nitroglycerin TL spray

A

NitroMist, Nitrolingual

44
Q

Nitroglycerin ointment 2%

45
Q

Counseling of isosorbide mononitrate

A

IR is BID 7 hrs apart
ER QAM

46
Q

Counseling of isosorbide dinitrate

A

IR BID (7 hrs apart) or TID (8AM, 12 PM, and 4PM) 14 hr interval

47
Q

What nitrate is preferred for HFrEF

A

Isosorbide dinatrate with hydralazine

NAPLEX Prep (14 decks)

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