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Notes/Facts/Brand vs Generic > Stable Ischemic Heart Disease > Flashcards

Stable Ischemic Heart Disease Flashcards

1
Q

Plavix *

A

clopidogrel
anti-platelet

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2
Q

Bayer *

A

aspirin
anti-platelet
Dosing: 75-162mg daily
70-100mg daily when combined with Xarelto

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3
Q

Bufferin *

A

aspirin
anti-platelet

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4
Q

Ecotrin *

A

aspirin
anti-platelet

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5
Q

Ascriptin

A

aspirin
anti-platelet

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6
Q

Yosprala

A

aspirin + omeprazole
delayed release tablet
anti-platelet

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7
Q

Durlaza

A

aspirin
ER-capsule
anti-platelet

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8
Q

Angina is _________

A

chest pain, chest pressure, chest tightness
or discomfort usually caused my ischemia of the heart muscle or spasm of the coronary arteries

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9
Q

The chest pain in angina is described as _________

A

squeezing, grip-like, heavy or suffocating and typically does not vary with position or respiration

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10
Q

Stable Angina, also known as ______

A

Stable Ischemic Heart Disease (SIHD)

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11
Q

Stable angina aka “Stable ischemic heart disease” is associated with _________, often brought on by _______ or _______. Is relieved within minutes by ________________

A

predictable chest pain
exertion
emotional stress
rest or with nitroglycerin

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12
Q

Unstable Angina is a type of ___________; this is a medical emergency where chest pain increases (in frequency, intensity, or duration) and is NOT _______________

A

acute coronary syndrome (ACS)

relieved with nitroglycerin or rest

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13
Q

The classic anginal symptoms of stable ischemic heart disease MAY NOT be present in _______

A

women, elderly patients, or those with diabetes; this can lead to misdiagnosis (GERD) or a delay in treatment

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14
Q

When chest pain is caused by vasospasm of the coronary arteries, it is called ________

A

Prinzmetal’s (variant or vasospastic) angina

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15
Q

What type of angina can occur at rest

A

Prinzmetal’s (variant or vasospastic) angina

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16
Q

Chest pain occurs when there is _________

A

an imbalance between myocardial oxygen demand (workload) & myocardial oxygen supply (blood flow)

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17
Q

Myocardial oxygen demand increases when ________

A

the heart is working harder due to an
-increased heart rate
-increased contractility
- or left ventricular wall tension [caused by increased preload (volume of blood returning to the heart) and/or increased afterload (systemic vascular resistance)]

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18
Q

preload

A

volume of blood “in ventricles” at end of diastole, ready to be pumped out

returning to the heart

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19
Q

afterload

A

resistance left ventricle must overcome to circulate blood

refers to the pressure against which your heart has to pump that blood

systemic vascular resistance

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20
Q

In Stable angina aka “stable ischemic heart disease”, myocardial oxygen supply is often _______ due to plaque build up within the inner walls of the coronary arteries

A

decreased

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21
Q

coronary artery disease (CAD), causes _______________ of the arteries and __________

A

narrowing
reduced blood flow to the heart

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22
Q

Risk Factors for Stable angina aka ‘stable ischemic heart disease’

A

hypertension
smoking
dyslipidemia
diabetes
obesity
physical inactivity

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23
Q

To assess the likelihood of CAD and diagnose stable ischemic heart disease a _________ is performed

A

cardiac stress test

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24
Q

The cardiac stress test increases myocardial oxygen demand with either exercise (walking in treadmill or pedaling on a stationary bike) or using ____________.

As myocardial oxygen demand increases, the patient is monitored for the development of symptoms (___)

A

IV medications

adenosine, dipyridamole, dobutamine or regadenoson(Lexiscan)

(chest pain, dyspnea, lightheadedness), changes in heart rate and blood pressure, transient rhythm disturbances or ST segment abnormalities on an ECG

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25
Q

Drug treatment for stable ischemic heart disease includes: _______ and ____ used together

A

antiplatelet & antianginal

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26
Q

antiplatelet treatment prevents _____

A

platelets from sticking together and forming a clot that can block an artery and reduce blood flow to the heart

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27
Q

what is the recommended antiplatelet in SIHD

A

aspirin

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28
Q

If there is an allergy to aspirin or some other contraindication then what antiplatelet is used

A

clopidogrel (Plavix)

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29
Q

The combination of aspirin and Plavix is only beneficial in SIHD when _______

A

there is a history of stent placement or recent CABG

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30
Q

Low dose Xarelto in combination with aspirin is FDA-approved to __________________

A

reduce the risk of cardiovascular events in patients with coronary artery disease (CAD) or peripheral artery disease (PAD)

31
Q

Antianginal treatment decreases myocardial oxygen demand or ______

A

increases myocardial oxygen supply

32
Q

what is first line as an antianginal for SIHD

A

beta blockers

33
Q

what are other agents that can be used as antianginal treatment if beta-blockers are contraindicated or when additional symptomatic relief is needed

A

CCBs DHP or non-DHP
long-acting nitrates

34
Q

Short-acting nitroglycerin, as a sublingual tablet, powder or translingual spray is recommended for __________

A

immediate relief of angina in ALL patients with SIHD

35
Q

Stable angina aka ‘stable ischemic heart disease’ is one of the __________. So patients should be treated with a ____________

A

(ASCVD) atherosclerotic cardiovascular diseases

High-intensity statin

36
Q

Treatment approach for SIHD remember ABCDE

A

A- antiplatelet AND antianginal drug
B- blood pressure AND beta-blocker
C- cholesterol (high intensity statin) and cigarette (cessation)
D- Diet and diabetes
E- exercise and education

37
Q

Non-drug treatment

A
38
Q

MOA of aspirin:

A

irreversibly inhibits cyclooxygenase-1 and cyclooxygenase-2 enzymes, which results in decreased prostaglandin (PG) and thromboxane A2 (TXA2) production

39
Q

thromboxane A2 is a potent ___________ and _______

A

vasoconstrictor

inducer of platelet aggregation

40
Q

MOA of clopidogrel

A

clopidogrel is a Prodrug

which irreversibly inhibits P2Y12 ADP-mediated platelet activation and aggregation

41
Q

what are the contraindications/warnings/side effects with aspirin

A

contraindications: NSAID or salicylate allergy, children and teenagers with viral infection due to the risk of Reye’s syndrome (symptoms include somnolence, N/V, confusion); rhinitis, nasal polyps or asthma (due to risk of urticaria “hives”, angioedema, or bronchospasm)

warnings: Bleeding [including GI bleed/ulceration, increased risk with heavy alcohol use or when used with other drugs that have bleeding risk (NSAIDs, anticoagulants, other antiplatelets], tinnitus (salicylate overdose)

Side effects: Dyspepsia, heartburn, bleeding, nausea

42
Q

Notes/Pearls with aspirin products

A

Used indefinitely “unspecified time period” in SIHD (unless contraindicated); decrease incidence of MI, CV events and death

Non-enteric coated, chewable aspirin is Preferred in ACS; if only enteric coated aspirin is available, it should be chewed (325mg)

Durlaza and Yosprala should NOT be used when rapid onset is needed (ACS, pre-PCI)

43
Q

__________ may be used to protect the gut with chronic aspirin use (Yosprala is indicated for those at risk of developing aspirin-associated gastric ulcers) consider the risks from chronic _____ use (_____________________)

A

PPIs
PPI
decreased bone density, increased infection risk

44
Q

Plavix

A

clopidogrel
Prodrug
Dosing 75mg daily
Indicated for:
ACS
patients with recent MI, stroke, or PAD

45
Q

Boxed Warnings with Plavix

A

Effectiveness depends on the conversion to an active metabolite, mainly CYP2C19.

Poor metabolizers of CYP2C19 exhibit higher cardiovascular events than patients with normal CYP2C19 function. Consider alternative treatments in patients identified as CYP2C19 poor metabolizers

46
Q

Contraindications/Warnings with Plavix

A

contraindications: active serious bleeding (GI bleed, intracranial hemorrhage)

warnings: Bleeding risk (stop 5 days prior to elective surgery) DO NOT USE with omeprazole or esomeprazole, premature discontinuation ( increase risk of thrombosis),

thrombotic thrombocytopenia purpura (TTP)

47
Q

Notes/Pearls with Plavix

A

Used in SIHD when there is a contraindication to aspirin;
can be used in combination with aspirin (Duel Antiplatelet Therapy)

48
Q

Stable angina aka Stable Ischemic heart disease, is usually treated with a ____________

A

single antiplatelet drug (aspirin or clopidogrel)

49
Q

(DAPT) Duel Antiplatelet therapy with ________ and _________ is reserved for those who have had placement of a bare metal stent, (DAPT for at least ______)

A

aspirin & clopidogrel
1 month

50
Q

(DAPT) Duel Antiplatelet therapy with ________ and _________ is reserved for those who have had placement of a drug-eluting stent (DAPT for at least _______)

A

aspirin & clopidogrel
6 months

51
Q

(DAPT) Duel Antiplatelet therapy with ________ and _________ is reserved for those who are post-CABG (DAPT for _______)

A

aspirin & clopidogrel
12 months

52
Q

(DAPT) Duel Antiplatelet therapy with ________ and _________ is reserved for those who have had placement of a __________, ____________ or ________

A

aspirin & clopidogrel
bare metal stent
drug-eluding stent
post-CABG

53
Q

aspirin is dosed at _________ in DAPT

A

81mg daily in Duel Antiplatelet Therapy

54
Q

Antiplatelet drug interactions are due to additive effects when used with other drugs which can increase bleeding risk. This includes: _________

A

anticoagulants, NSAIDs, SSRIs, SNRIs, some dietary supplements

55
Q

Nitrostat

A

nitroglycerin SL tablet
-Short Acting Nitrate
-0.3mg/0.4mg/0.6mg
-used in SIHD for fast/immediate relief of angina/chest pain
-store nitroglycerin SL tablets in the original amber glass bottle and keep tightly capped after each use (to maintain potency)

*Nitrate tolerance does NOT develop with SL/TL products

56
Q

NitroMist

A

nitroglycerin TL(translingual)”Lingual” spray
-Short Acting Nitrate
-medication is sprayed on or under tongue
-prime device before use
-0.4mg/spray
-used in SIHD for fast/immediate relief of angina

57
Q

Nitrolingual

A

nitroglycerin TL(translingual)”Lingual” spray
-Short Acting Nitrate
-medication is sprayed on or under tongue
-prime device before use
-0.4mg/spray
-used in SIHD for fast/immediate relief of angina

58
Q

GoNitro

A

nitroglycerin SL powder
-Short Acting Nitrate
-0.4mg/packet
-used in SIHD for fast/immediate relief of angina

59
Q

Nitro-Bid

A

nitroglycerin ointment 2%
-Long Acting Nitrate
-Dosed BID, 6 hours apart with a 10-12 hour nitrate free interval

60
Q

Nitro-Dur

A

nitroglycerin transdermal patch
-Long Acting Nitrate
-0.1/0.2/0.3/0.4/0.6/0.8mg/hr
-wear patch on for 12-14 hours, OFF for 10-12 hours; rotate sites; dispose of safely, away from children and pets

61
Q

Nitro-Time

A

nitroglycerin ER capsule
-Long Acting Nitrate
-2.5mg/6m/9mg

62
Q

isosorbide mononitrate IR

A

Long Acting Nitrate
10mg/20mg
Dosed BID, 7 hours apart (8am and 3pm)

63
Q

isosorbide mononitrate ER

A

Long Acting Nitrate
30mg/60mg/120mg
Dosed: once daily in the morning

64
Q

Isordil Titradose

A

isosorbide dinitrate IR
-Long Acting Nitrate
-5/10/20/30/40mg
Dosed BID (same as mononitrate) or TID (take at 8am, 12pm, and 4pm) for a 14-hour nitrate free interval (or similar)

65
Q

Short Acting Nitrates

A

Nitrate tolerance DOES NOT develop with SL/TL products

66
Q

Long Acting Nitrates

A

Are used when beta-blockers are contraindicated or as add on therapy if symptoms persist:

Require a 10-12 hour nitrate free interval to decrease tolerance ( longer for some products)

67
Q

Contraindications with Nitrate products

A

Hypersensitivity to organic nitrates, DO NOT Use with PDE-5 inhibitors or riociguat

68
Q

Warnings with Nitrate products
Side effects with Nitrate products

A

hypotension, headache, tachyphylaxis (deceased effectiveness/tolerance with long-acting products),

Headache, flushing, syncope

69
Q

Nitrate Drug Interactions

A
70
Q

isosorbide dinitrate in combination with hydralazine is the preferred combination ____________

A

for HFrEF

71
Q

Antianginal Treatment

A
72
Q

Counseling on aspirin

A

can cause:
bleeding/bruising
dyspepsia (indigestion)
tinnitus or loss of hearing with overdose

73
Q

All Nitroglycerin Products:
Can Cause

A

Orthostasis (a decrease in blood pressure that happens soon after standing or sitting up)

Flushing and headache. Often a sign the medication is working. Usually goes away with time.

Nitrate-free interval required with long-acting products

Drug interactions with PDE-5 inhibitors

74
Q

Counseling on Short Acting Nitrates

A

Take one dose at first sign of chest pain
Call 911 immediately if chest pain persists after the first dose.
Continue to take two additional doses at 5 minute intervals while waiting for the ambulance to arrive. Do not take more than 3 doses within 15 minutes.

Notes/Facts/Brand vs Generic (23 decks)

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