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Rx Prep > Stable Angina - Quiz 4 > Flashcards

Stable Angina - Quiz 4 Flashcards

1
Q

What is angina?

A

Chest pain, pressure, and tightness that is 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 from exertion or emotional stress that is relieved by rest or SA nitroglycerin
Unstable: ACS not relieved by nitro or rest

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3
Q

What causes chest pain?

A

Imbalance between myocardial oxygen demand and supply -> increased heart rate, contractility, or left ventricular wall tension

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4
Q

How do we diagnose angina?

A
  1. Cardiac stress test/imaging
  2. CHitory or physical
  3. CBC, CK-MB, troponins, aPTT, PT/INR, lipid panel, glucose
  4. ECG
  5. Cardiac cath/angiography
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5
Q

Non pharm for angina?

A
  1. Heart healthy diet
  2. BMIL 18.5-24.9
  3. Waist circumference <35 (females), <40 (males)
  4. Aerobic activity
  5. Limit alcohol and smoking
  6. Avoid chronic NSAID use
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6
Q

What is the treatment for stable angina?

A
  1. Antiplatelet (secondary prevention)
  2. Antianginal (to reduce chest pain)
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7
Q

What is the recommended antiplatelet? Alternative?

A

Aspirin; Clopidogrel

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8
Q

Treatment regimen for angina?

A
  1. Antiplatelet and antianginal
  2. Blood pressure
  3. Cholesterol and smoking cessation
  4. Diet and diabetes
  5. Exercise and education
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9
Q

Drugs used as antianginal maintenance?

A
  1. Beta blockers
  2. CCBs
  3. LA nitrates
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10
Q

Drugs used for angina symptoms?

A

SA and SL nitroglycerins or TL spray

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11
Q

MOA of aspirin?

A

Irreversibley inhibits COX1 and 2 decreasing PG and TXA2 (potent vasoconstrictor and iducer of platelet aggregation)

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12
Q

MOA of Clopidogrel?

A

Prodrug that irreversiblely inhibits P2Y12 ADP mediated platelet aggregation and activation

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13
Q

Aspirin

A

Bayer, Bufferin, Ecotrin

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14
Q

Dosing of Aspirin?

A

75-100 mg QD

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15
Q

CI of aspirin?

A

Children -> Reyes syndrome
Other NSAIDs or salicylate allergies

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16
Q

ADR of aspirin

A
  1. Bleeding
  2. Tinnitus (OD)
  3. Dyspepsia
  4. Heatburn
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17
Q

What type of aspirin is used for ACS

A

Non-enteric coated chewables
* If EC aspirin is only available it should be chewed (325mg), they do not have rapid onset

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18
Q

How to prevent GI bleed from aspirin?

A

PPIs

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19
Q

Clopidogrel

20
Q

Dose of plavix

21
Q

BBW of Plavix?

A

CYP2C19 poor metabolizers

22
Q

CI of plavix

A

Serious bleeding
Comittantt aspirin use

23
Q

ADR of Plavix

A

Bleeding
* Stop 5 days prior to surgery
* Don’t use omeprazole or esomeprazole
* TTP

24
Q

Drugs that should not be taken with Plavix

A

CYP2C19 inhibitors (Omeprazole, Esomeprazole)

25
Q

How long is aspirin used for stable angina

A

Indefinitely

26
Q

What are the benefits of usign beta blockers for angina?

A
  1. Decreased HR, contractility, left ventricular wall tension
    * Avoid in vasospastic angina
27
Q

Benefits of using CCBs>

A
  1. Non-DHP decreases HR
  2. DHP decreases afterload (SVR)
  • Avoid nifedipine IR
  • DHPs are preferrd with beta blockers
  • Preferred in vasospastic angina
28
Q

Benefits of using nitrates?

A
  1. Decreases preload
  2. Vasodilation of veins over arteries
  • For patients requiring fast relief
29
Q

Warning of using Ranolazine?

A
  1. CI with strong CYP3A4 inhibitors or inducers
  2. QT prolongation
  3. Not for acute chest pain
  4. No effect on HR and BP
30
Q

What is vasospastic angina?

A

Coronary artery vasospasm from illicit drug use or cocaine

31
Q

SA Nitrates used for angina?

A
  1. Nitroglycerin SL
  2. Nitroglycerin TL
32
Q

Nitroglycerin TL

A

Nitromist, Nitrolingual

33
Q

Nitroglycerin SL

34
Q

Dose of Nitroglycerin

35
Q

LA nitrates for angina

A
  1. Nitroglycerin ointment 2%
  2. Isosorbide mononitrate
36
Q

Ntroglycerin ointement 2%

37
Q

Ci with nitrates?

38
Q

ADR of nitrates

A

Hypotension, tachyphylaxis (tolerance/decreased effectiveless), HA, flushing, syncope

39
Q

Nitroglycerin TD patch

40
Q

Counseling for SA nitrates?

A
  1. PRN for immediate relief
  2. Store nitrate SL in amber bottle
  3. Call 911 immediately after 1st dose if it persists
  4. 5 minut intervals for 2nd and 3rd dose
  5. Max 3 doses within 15 min
41
Q

Counseling for LA nitrates?

A

Require 10-12hr nitrate free interval to reduce tolerance

42
Q

Counseling for nitrate patch

A

Wear 12-14 hrs off 10-12 hr, rotate site, chest is preferred

43
Q

Counseling for nitrate ointment?

A
  1. BID, 6hrs apart with 10-12 hrs nitrate free interval
  2. Measure dose with applicator
  3. Can stain clothes
44
Q

Counseling for isosorbide monomitrate

A

IR: BID 7 hrs apart
ER: QAM

45
Q

When is isosorbide dinitrate used?

A

With hydralazine for HFrEF

46
Q

Counseling for SL tabs>

A
  1. Place under tongue and let it dissolve
  2. Slight tinglig or burning is not a sign of med working
  3. Room temp with secure cap
47
Q

Counseling for TL spray>?

A
  1. Prime before first use or 6weeks
  2. Don’t shake
  3. Spray onto tongue or under tongue
  4. Dont inhale spray

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