Stable Ischemic Heart Disease Flashcards
What is SIHD?
Stable Ischemic heart disease means a patient have stable angina (chain pain or tightness
What is Acute Coronary Syndrome?
Unstable Angina that is not relieved by nitroglycerin or rest
Why does chest pain occur?
THere is an imbalance between myocardial oxygen demand and supply. Heart works harder to meet supply bu increasing contractility (inotropic) and HR (chronotropic) and lift ventricular wall tension
What is CAD?
Coronary Artery Disease = narrowing of arteries due to atheroscleosis or plaque build up
What medications can be used for a stress test?
Adenosine
Dipyridamole
Dobutamine
Regadonoson (Lexiscan)
What are the ABCDE of SIHD?
A - antiplatelet and antianginal
B - blood pressure and BB
C - cholesterol (statins) and cessation of smokin
D = diet and diabetes
E- exercise
A patient with stable angina presents to your clinic and asks how long she has to be on Bufferin?
Bufferin is Aspirin
indefinitely
When is it appropriate to use DAPT in patients with SIHD?
When there is a placement of a stent or post CABG
bare metal stent (at least 1 month of DAPT)
drug eliting stent (at least 6 months)
CABG (12 months of DAPT)
When is Plavix indicated in SIDH?
-NSAID or salicylate allergy
- Reye’s syndrome
When should you stop clopidogrel before a major surgery?
5 days prior STOP plavix
BLEEDING RISK!!!!
What OTC medication is contraindicated with clopidogrel?
Esomeprazole (Nexium)
Omeprazole (prilosec)
What is first line for anti-anginal treatment in SIHD?
Beta blockers
AVOID in Prinzmetal’s angina!!!!!!!!!
Short acting: NTG treatment
What else can you add on to beta blockers for angina (chest pain) in SIDH?
DHP CCBs
Long-acting Nitrates (NTG ointment or Isosorbide mononitrate)
Ranolazine (Ranexa)
What is the preferred treatment for Prinzmetal’s angina?
DHP CCBs
What are some counseling points for long-acting nitrates?
- require a 10-12 hour nitrate free interval to DECREASE tolerance
- do not use with Cialis or Viagra (PDE-5 inhibitors)
How long should you wear the nitroglycerin patch?
12-14 hours and rotate sites
— this is the nitrate free interval to decrease tolerance
How long should you wair between isosorbide mononitrate IR doses?
7 hours (8 AM and 3 PM)
How long should you wait between each application of Nitroglycerin ointment?
6 hours apply BID
What are some counseling points for short-acting NTG products?
SL tablets - keep in amber glass bottle, tingling is not a sign of how the medication is working, let is dissolve
TL spray - do NOT shake, spray on or under the tongue, do NOT inhale
Call 911 immediately if chest pain persists after 1st dose!!!!!
What SIDH drug can cuase tinnitis with overdose?
Aspirin (Bayer, Bufferin, Ecotrin)
