Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PRPS Block 2 > Stable Angina > Flashcards

Stable Angina Flashcards

1
Q

What is stable angina?

A

Pain, pressure or sense of heaviness in the chest beneath sternum.
Predictable - bought on by exertion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does NICE indicae as the 3 characteristics of angina pain?

A
  • constricting discomfot in chest, neck, shoulders, jaw and/or arms.
  • precipitated by physical exertion.
  • relieved by GTN in 5 mins.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What if you have 2 of the NICE characteristics of anginal pain?

A

Atypical angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is you have 3 characteristics of NICE anginal pain?

A

Typical angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What other tests should be done to rule in angina?

A
  • 12-lead ECG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What 3 factors make a diagnosis of angina more likely?

A
  • increasing age
  • male gender
  • CV risk factors - smoking, HTN, CAD etc.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What 3 tests should be done if patients has suspected angina and why?

A
  • Hb levels - anaemia can exacerbate chest pain.
  • Thyroid function - can exacerbate CAD
  • Fasting BG - diabetics have worse prognosis - need more aggressive Tx.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What 5 other conditions can be associated with chest pain?

A 
MI/ACS
GORD
Bone/muscle problems
Lung conditions 
Anxiety
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the strongest predictor of long-term survival for angina patients with IHD?

A

LVEF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What 2 factors are for acute treatment of angina?

A

Rest

GTN spray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What 4 main treatments are available for long-term mgmt of angina?

A

B-blockers,
CCBs
Nitrates
Nicorandil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What 2 novel agents are available for angina?

A

Ivabradine

Ranolazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What other 2 medications should patients with angina be on?

A

Anti-platelet

Statin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Explain why GTN is given sublingually?

A

Bypass hepatic metabolism and causes venous dilatation at lower doses than required for systemic absorption.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is important to note about GTN tabs?

A

Only last 8 weeks once opened.

Must be given in original glass container.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are GTN patches used for?

A

Provide constant GTN over 24 hours

17
Q

For what 3 reasons are the GTN patches critised?

A

Expensive

Development of nitrate tolerance

Limited effect of lower dose patches.

18
Q

Why is the nitrate free window important and how long should it be?

A

To prevent development of tolerance.

Should be 10-12h.

19
Q

Can S/L GTN be given prophylactically?

A

Yes - can take before planned exertion.

20
Q

In an angina attack - how should GTN be used?

A
  • use one spray under tongue and wait 5 mins.
  • if pain unresolved use another dose and wait 5 minutes.
  • if pain unresolved 5 mins after SECOND dose - call 999.
21
Q

Which drugs are severely C/I with GTN?

A

Vasodilators eg sildenafil - would cause massive hypotension.

22
Q

What are the first ling options for angina?

A

B-blocker

CCB

23
Q

MoA of B-blockers?

A

Inhibit B-adrenoceptorsto prevent sympathetic stimulation and lower HR, BP and myocardial contractility.

24
Q

MoA of CCBs in stable angina?

A
  • Cause systemic vascular dilatation.
  • reduce myocardial contractility.
  • slow sinus and AVN conduction
25
Q

What is the difference between dihydropyridine and non-dihydropyridine CCBs?

A

N❤︎N-DHP - verapamil,diltiazem

DHP - nifedipine, amlodipine, felodipine.

26
Q

Which combination of drugs should be avoided?

A

B-blockers + verapamil/diltiazem

27
Q

MoA nicorandil?

A

K-channel activator - increase efflux of K from cells = hyperpol = vasodilation.

28
Q

Is nicorandil licensed in the UK for stable angina?

A

No - commonly used as an”add-on” treatment.

29
Q

what is an important caution with nicorandil?

A

Can cause skin, mucosal and eye ulceration - ie risking GI ulcers.

30
Q

MoA ivabradine?

A

Selectively inhibits current of SAN - reduced HR - reduced oxygen demand.

31
Q

Ivabradine should one be started in patients with _____ rhythm and pulse __ bpm?

A

Sinus rhythm

70 bpm minimum

32
Q

Can ivabradine be combined with DHP CCB-s?

A

Yes

33
Q

Can ivabradine be combined with NON-DHP CCBs?

A

No - they will increase exposure of ivabradine.

34
Q

MoA ranolazine?

A

MoA largely unknown - does inhibit late sodium current in cardiac cells - reduced intracellular sodium and decreases calcium overload.

35
Q

What is important to remember about the different brand of diltiazem?

A

They are not always bioequivalent. Patient should remain on the same brand as far as possible. Any changes should be noted in terms of bioequivalence and explained to prescriber.

36
Q

What is thedifferent between XL/LA and SR/PR preparations of diltiazem?

A

XL/LA - once daily dose

SR/PR - BD dosing.

37
Q

What is the interaction between diltiazem and simvastatin?

A

Diltiazem increases simvastatin exposure - reduce simvastatin dose to 20mg daily.

38
Q

When should s PCI or CABG be considered for angina?

A

When >2 drugs are needed for angina control.

PRPS Block 2 (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions