Vascular disorders/diseases

Question 1

What is the most common side effect of the nitrate products?

Answer 1

headache. (due to cerebral vasodilation)

high doses can cause postural hypotension, facial flush, tachycardia

Question 2

True/False. Vessels can develop tolerance to nitrate products?

Answer 2

True, develops rapidly and become desensitized. Need to provide a daily 8-12 hour “nitrate-free” interval to restore sensitivity.

Question 3

Why are nitrate products used in the treatment of angina pectoris?

Answer 3

cause a rapid reduction in myocardial oxygen demand, which will rapidly relieve symptoms. They do this by inhibiting the coronary vasoconstriction or spasm, which increases perfusion (decrease preload and oxygen consumption)

Question 4

What is the route of administration of nitroglycerin?

Answer 4

Sublinquinal or transdermal, due to significant first pass metabolism at the liver

Question 5

True/False - Nitroglycerin does not relieve symptoms of Typical Angina.

Answer 5

False - one of the definitions of typical angina is that it is relieved by rest or nitroglycerin. If it does not relieve symptoms, then it could be atypical or non cardiac.

Question 6

How quickly does nitro provide relief of symptoms?

Answer 6

75% of patients have pain relief within 3 minutes

Question 7

If symptoms don’t improve with nitro within 5 minutes, what is the next plan of action?

Answer 7

Emergency medical services should be contacted and continue to take additional SL tablets (1 every 5 minutes for total of 3 tabs) until EMS arrives

Question 8

What medications are contraindicated with nitro?

Answer 8

PDE-5 inhibitors (viagra, etc:))

Question 9

What is the first line drug for chronic stable angina?

Answer 9

beta-blocker

Question 10

What effect do beta-blockers have on myocardial oxygen demand?

Answer 10

REDUCE IT. Decrease heart rate due to reflex tachycardia, BP, and myocardial contractility

Question 11

Beta-blockers are contraindicated in what?

Answer 11

vasospastic angina (due to unopposed alpha stimulation)

Question 12

What are the cardioselective (preferred) beta-blockers?

Answer 12

metoprolol, atenolol

Question 13

Can beta-blockers be used in combination with nitrates and calcium-channel blockers?

Answer 13

yes, can be used a mono therapy or later with the others if symptoms don’t improve

Question 14

Which medication type is first line for vasospastic angina, and 2nd line for chronic stable angina?

Answer 14

calcium-channel blockers

Question 15

Which type of calcium channel blocker can be used in combination with beta-blockers?

Answer 15

Dihydropyridines (amplodipine, nifedipine, felodipine).

Non-dihydropyridines cannot be given because they are negative inoptropes and can be harmful in heart failure if ejection fraction is less than 35%

Question 16

When is a 325mg ASA indicated?

Answer 16

Only in patients who cannot take Warfarin if they have Afib, or acutely when having coronary event, but never chronically besides that.

Question 17

A patient with a history of Afib presents with sudden onset of the 5 P’s: Pain, pallor, paresthesias, pulselessness, and paralysis” of the lower extremity. Is this an emergency?

Answer 17

Yes! Symptoms of an acute arterial occlusion!

Question 18

As soon as the diagnosis of an acute arterial occlusion is made, what is the immediate first step for treatment?

Answer 18

IV heparin! Helps keep the clot from propagating and also helps with pain symptoms

Question 19

A patient complains of a brief moments of confusion, dizziness, and headache. On physical exam you find bruits in the mid-cervical area, what is the likely diagnosis?

Answer 19

Occlusive cerebrovascular disease (TIA). a 1/3 of all stokes are arterial

Question 20

Patient complains of severe abdominal pain after eating meals and as a result has lost 10 pounds by avoiding meals due to the pain. No PE findings. What is likely diagnosis?

Answer 20

Mesenteric Insufficiency aka “intestinal angina”

Question 21

52 year old man, 20 pack year of smoking complains of severe cramping pain in his right calf when walking. He sits down and the pain goes away. On PE his distal right pulse is weak/absent. What is his likely diagnosis?

Answer 21

Occlusive disease of the common iliac artery.

Tell the guy to quit smoking!

Question 22

32 year old man with a 15 year pack year history presents with lesions on the tips of his toes and pain in the toes at rest. On PE his feet are cold, prolonged cap refill and dependent rubor are noted. What is likely diagnosis?

Answer 22

Thromboangitis Obliterans “Buerger Diease”

He has to quit smoking or you’re amputating that baby!

Question 23

Patient presents with a dull ache in her right half, no edema, no discoloration. States she just got home from a 12 hour flight last night and has been on oral contraceptives for 8 years. Whats her likely diagnosis?

Answer 23

DVT - order Doppler!

Question 24

What is the difference in presentation between chronic venous insufficiency and a varicose vein that is deep to the skin?

Answer 24

Both can have a brownish pigmentation of the skin. But the chronic insufficiency will have obvious pitting edema and probably large ulcerations around the ankle. The skin will also be taut and shiny.

Question 25

You work in a hospital and a patient is complaining of pain near their PICC line site and you notice a red, linear induration coming off the insertion site. What are you worried about?

Answer 25

Superficial Venous Thrombophlebitis