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Naplex 2023 > Stable Ischemic Heart Disease > Flashcards

Stable Ischemic Heart Disease Flashcards

1
Q

angina

A

chest pain, pressure, tightness

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2
Q

Stable angina

A

predictable chest pain from stress like exertion
relieved within minutes by rest or nitroglycerin

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3
Q

unstable angina

A

type of ACS
angina not relieved by rest or nitroglycerin

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4
Q

name of angina that can occur at rest

A

Prinzmetal’s
from vasospasm of coronary arteries

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5
Q

what causes chest pain

A

imbalance of myocardial oxygen demand and oxygen supply

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6
Q

what increases myocardial oxygen demand

A

inc HR
contractility
Left ventricular wall tension

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7
Q

atherosclerosis

A

plaque build-up in inner walls of coronary arteries = dec myocardial oxygen supply = CAD (reduced blood flow to heart)

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8
Q

risk factors for SIHD

A

HTN
smoking
dyslipidemia
diabetes
obesity
physical inactivity

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9
Q

what is used to assess likelihood of CAD and diagnosis SIHD

A

cardiac stress test

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10
Q

what does cardiac stress test do

A

inc myocardial oxygen demand with exercise like treadmill or IV drugs

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11
Q

what IV drugs are used for stress test

A

adenosine
dipyridamole
dobutamine
regadenoson/Lexiscan

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12
Q

non-drug treatment

A

heart healthy diet
BMI 18.5-24.9
wait <35 for female <40 for male
moderate aerobic activity for 30-60 min on 5-7 days/week
quit smoking
limit alcohol to 1 drink/day for women and 1-2/day for men

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13
Q

what drug categories are used for SIHD

A

antiplatelet + antianginal

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14
Q

recommended antiplatelet for SIHD

A

ASA

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15
Q

what is second choice for antiplatelet for SIHD

A

clopidogrel/Plavis is ASA allergy/another CI to ASA

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16
Q

goal of antianginal treatment

A

decrease myocardial oxygen demand or inc myocardial oxygen supply

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17
Q

what antianginal treatment is first-line

A

beta-blockers

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18
Q

what antianginal treatment should be used if can’t use BB

A

CCBs
long-acting nitrates
nitroglycerin SL for immediate relief in all patients

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19
Q

what cholesterol medication should be given

A

high-intensity statin
type of ASCVD

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20
Q

what drugs should be given for CAD + diabetes

A

ACEI/ARB for hypertension
other guideline-recommended for HTN, HF, diabetes - aggressive management

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21
Q

ASA MOA

A

irreversibly inhibit COX-1 and COX-2 = dec prostaglandin and thomboxane A2

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22
Q

clopidogrel MOA

A

prodrug
irreversibly inhibits P2Y12 ADP-mediated platelet activation and aggregation

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23
Q

ASA (Bayer, Bufferin, Ecotrin) dosing

A

Rx: ER capsule, delayed-release tablet
75-162 mg daily

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24
Q

ASA CI

A

salicylate allergy
children + teenagers with virus = Reye’s syndrome

25
Q

ASA warnings

A

bleeding
tinnitis (salicylate overdose)

26
Q

ASA side effects

A

dyspepsia
heartburn
bleeding

27
Q

ASA notes

A

use indefinitely in SIHD (unless CI)
non-enteric coated, chewable ASA preferred for SIHD; if only have enteric-coated, chew
Durlaza (ER capsule) and Yosprala (DR tablet) shouldn’t be used in rapid onset needed
PPI can protect gut; consider risks (dec bone density, inc infection risk)

28
Q

clopidogrel/Plavix dosing

A

75 mg daily

29
Q

clopidogrel BBW

A

prodrug = conversion to active metabolite by CYP450 2C19 - test CYP2C19 genotype

30
Q

clopidogrel CI

A

serious bleeding (GI bleed, intracranial hemorrhage)

31
Q

clopidogrel warnings

A

bleeding risk (stop 5 days before elective surgery)
don’t use with omperazole or esomeprazole - inc things like thombocyotopenic purpura (TTP)

32
Q

clopidogrel side effects

A

bleeding

33
Q

clopidogrel notes

A

use in SIHD when ASA is CI

34
Q

DAPT

A

ASA + clopdogrel
use in those with bare metal stent (use for at least 1 month), drug-eluding stent (use at least 6 months), or post CABG (use for 12 months)
81 mg in DAPT

35
Q

antiplatelet DI

A

additive bleeding risk - anticoagulants, NSAIDs, SSRI, SRNI, some dietary supplements

clopidogrel: avoid with CYP2C19 inhibitors omeprazole and esomeprazole

36
Q

BB clinic benefit

A

dec HR
dec contractility
dec L ventricular wall tension

37
Q

BB clinical notes

A

titrate to resting HR of 55-60 BPM
avoid abrupt withdrawal
BB without ISA preferred (metoprolol, carvedilol)
avoid in Prinzmetal’s angina

38
Q

CCB clinical benefit

A

preferred for Prinzmetal’s/varian angina
non-DHPs dec HR
DHPs dec SR/afterload

39
Q

CCB clinical notes

A

avoid short-acting DHPs (nifedipine IR, etc.)
DHPs preferred in combo with BB (avoid bradycardia)

40
Q

nitrates clinical benefit

A

dec preload (vasodilation of veins > arteries

41
Q

Nitrates clinical notes

A

SL tabls, powder, TL spray) recommended for all patients - fast relief

long-acting: when BB are CI or add-on if symptoms persist

42
Q

ranolazine CI

A

strong CYP3A4 inhibitors/inducer

43
Q

ranolazine warnings

A

QT prolongation

44
Q

ranolazine notes

A

note for acute treatment of chest pain
little-no effect on HR/BP

45
Q

nitroglycerin SL tablet (Nitrostat) dosing

A

0.4 mg

46
Q

nitroglycerin TL spray (Nitromist,Nitrolingual) dosing

A

0.4 mg/spray

47
Q

Nitroglycerin SL powder dosing

A

0.4 mg/packet

48
Q

types of long-acting nitrates

A

Nitroglycerin ointment 2% (Nitro-Bid)
isosorbide mononitrate IR/ER tablet

49
Q

nitroglycerin CI

A

use with PDE-5 inhibitors

50
Q

nitroglycerin warnings

A

hypotension
HA
tachyphylaxis (dec effectiveness/tolerance) with long-acting)

51
Q

nitroglycerin side effects

A

headache
flushing
syncope

52
Q

short-acting nitrates notes

A

PRN for immediate relief of chest pain
stores SL tabs in original amber glass bottle

53
Q

long-acting nitrates notes

A

require 10-12 hr free interval to dec tolerance
patch: wear 12-14 hours, rotate sites
ointment: dose BID, 6 hrs apart, 10-12 nitrate-free interval
isosorbide mononitrate IR: 7 hours apart

isosorbide dinitreate with hydralazine is preferred combo for HFrEF

54
Q

nitrate DI

A

do not use with PDE-5 inhibitors = significant dec in BP

55
Q

ranolazine DI

A

do not use with strong CYP3A4 inhibitors/inducers

56
Q

short-acting nitrates key counseling points

A

call 911 immediately if chest pain persists after 1st dose
can use 3 doses total 5 minutes apart

57
Q

nitroglycerin SL tablets key counseling points

A

put under tongue and let it dissolve
slight burning/tingling is not sign of medication working
keep in original amber glass bottle at room temp

58
Q

nitroglyceirn TL spray key counseling points

A

do not shake; spray onto or under tongue
do not inhale spray

59
Q

nitroglycerin patch key counseling points

A

chest is preferred application site

Naplex 2023 (21 decks)

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