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Pharm II > Ischemic Heart Disease > Flashcards

Ischemic Heart Disease Flashcards

1
Q

what mostly causes ischemic heart dz

A

by atherosclerotic narrowing of coronary arteries

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2
Q

what is the cardinal symptom of ischemic heart dz

A

chest pain (angina)

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3
Q

4 major factors that determine mycardial work

A

Heart rate
SBP
myocardial wall tension/ stress
myocardial contractility

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4
Q

why is it hard for the heart to increase O2 extraction with increased demand

A

heart extracts near maximal amount of O2 at rest

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5
Q

Angina characterized by paroxysmal chest “squeezing” or pressure, often accompanied by sensation of smothering and fear of impending death

A

Angina pectoris

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6
Q

Exacerbated by physical activity and relieved by rest or sublingual nitroglycerin

A

Chronic stable angina

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7
Q

Increasing pattern of pain in previously stable patient

Less responsive to medications, lasts longer, and occurs at rest or with less exertion

A

unstable angina

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8
Q

Occurs in patient with or without coronary heart disease and is due to a spasm of the coronary artery that decreases myocardial blood flow
More likely to experience pain at rest and in early morning hours
Pain not usually brought on by exertion or emotional stress or relieved by rest
Occurs most often in smokers, young patients, with illicit drug use (esp. cocaine) and with alcohol withdrawal

A

Vasospatic (Prinzmetal’s angina)

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9
Q

precipitating factors to angina

A 
exercise
use of arms above head
cold environment
walking against the wind
walking after large meal
emotional factors
coitus
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10
Q

If nitroglycerin relieves chest pain what is it more likely

A

ischemic heart dz

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11
Q

risk factors for ischemic heart dz

A 
HTN
hypercholesterolemia
smoking
family hx of premature CHD
DM 
CKD
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12
Q

what test should be done with those that have suspected stable ischemic heart dz?

A

stress testing

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13
Q

3 classes of drugs used for management of angina

A

nitrates
calcium channel blockers
beta blockers

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14
Q

what do all the drugs that help with angina do

A

decrease myocardial O2 demand

nitrates increase mycoardial O2 delivery by reversing coronary spasm

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15
Q

what drugs Relaxation of capacitance vessels (veins and venules) Decrease venous return- decrease heart size- decrease preload

A

nitrates

CCB

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16
Q

what drugs Blockade or attenuation of sympathatic influence on heart- decrease contractility- decrease HR- decrease Oxygen demand

A

BB

17
Q

what drugs Coronary dilation- important for relieving vasospastic angina- increase oxygen supply

A

Nitrates

18
Q

MOA of nitrates

A

Denitrated in smooth muscle cells NO activation of guanylate cyclasecGMP  increased Ca++ uptake by SR
relax smooth muscle and decrease platelet aggregation

19
Q

What is the method of administration for nitrates and why

A

Sublingual or transdermal due to significant first pass effect in liver

20
Q

ADRs of nitrates

A

HA
orthostatic HPOTN
facial flushing tachycardia

21
Q

What happens with tolerance to nitrates (occurs rapidly)

A

tachyphylaxis

22
Q

how much time should patients have off for transdermal patches per day of nitrates

A

8 hours to avoid tachyphylaxis

23
Q

what can not be used with nitroglycerin

A

Sildenafil (Viagra)

24
Q

everyone with ischemic heart dz should have what available to them?

A

nitroglycerin sublingual tablets (or buccal spray, topical)

25
Q

what are some long acting nitrates given orally qday or BID that is used in chronic stable angina

A

isosorbide dinitrate

isosorbide mononitrate

26
Q

when are beta blockers contraindicated

A

Variant angina

27
Q

who are CCB c/i in?

A

unstable angina

28
Q

Mechanism of clinical effects of CCB

A

Decrease myocardial contractile force – decreases oxygen demand
Decrease arteriolar tone and PVR – decreases ventricular wall stress
Increase myocardial O2 supply
Relieve and prevent vasospasm

29
Q

ADRs with CCB

A

HPOTN
gingival hyperplasia
constipation (verapamil)

30
Q

2 CCB that can lead to myocardial dperssion

A

verapamil

diltiazem

31
Q

what CCB may worsen CHF due to negative inotropic effects

A

verapamil

32
Q

what is a late CCB that is used in place of BB or in addition to a BB, newer therapy

A

Ranolazine

33
Q

if a patient has a cenet MI and angina what should you Rx

A

long acting nitrate, BB

34
Q

is a pt has angina and astham/ COPD what drugs Rx

A

long acting nitrate, Ca++ blockers

35
Q

Drugs for patients w/ DM and angina

A

long acting nitrate

Ca++ blockers

36
Q

Tx for angina in addition to angina what should be Rx

A

baby aspirin
BB (with prior MI)
ACEI (with CAD, DM or LV systolic dysfunction)
LDL lowering therapy (w/ CAD and LDL >100)
SL nitroglycerin
CCB or long actin gnitrates when BB c/I of in combo if BB not successful

Pharm II (16 decks)

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