Angina

Question 1

Compare/contrast mononitrate and isosorbide dinitrate

Answer 1

Both NTG maintainance therapy

Both have longer half-life than typical SL-NTG
Mononitrate 1x/d
Isosorbided dinitrate 3x/d

Question 2

markedly positive treadmill test

Answer 2

> 2 mmST sag
1 mm ST at HR

–> offer coronary angiography

Question 3

Intrinsically long acting calcium antagonist

Answer 3

Amiodipine
Antihypertensive
Ischemic heart disease

Question 4

Who to send for angiography + treatment

Answer 4

markedly positive for angina

Question 5

Important to use B1 blockers only in ______ patients

Answer 5

diabetic

–> B2 receptors in liver leads to glycogenolysis

Question 6

Lipid soluble, short acting Beta 1 selective blocker, relatively shorter half life

Answer 6

Metoprolol

Question 7

Water soluble, longer acting Beta 1 selective blocker, relatively longer half life

Answer 7

Atenolol

• avoid in renal insufficiency

Question 8

Vasodilatory drugs

Answer 8

Nitrates, Calcium Channel blockers

Question 9

Carvedilol

Answer 9

use for treating systemic heart failure

Question 10

Use for treating hypertension

Answer 10

Labetilol

Question 11

Revascularization therapies

Answer 11

Coronary artery bypass grafting

Percutaneous coronary interventions

Question 12

Medications to treat stable angina

Answer 12

Aspirin
Nitrates
Calcium Blockers
Beta Blockers

Question 13

Indications for revascularization

Answer 13

1) symptoms refractory to medications

2) improved survival (function of anatomy and LV function)

Question 14

Three families of calcium channel drugs

Answer 14

Verapamil (bradycardic)
Dilatiazem (bradicardic)
–> can affect HR/AV node

Nifedipine (not brady, don’t interfere with contractility)

Question 15

3-vessel coronary artery disease

Answer 15

all three major arteries have flow limiting lesions over 50%

Question 16

Amlodipine family, character

Answer 16

Nifedipine family
Long half like (36)
Takes one week to build therapeutic levels
Cannot use acutely
One of most commonly used

Question 17

Cut-off for revascularization usually falls around

Answer 17

3-vessel disease w/ abnormal systolic dysfunction or marked symtoms, L main disease

Question 18

Beta receptors targets

Answer 18

B1 - heart

B2 - bronchioles, arterioles

Question 19

Initial management

Answer 19

1) Aspirin then
2) Beta blocker then if needed
3) vasodilator (Ca or nitrate)

If symptoms persist, consider catheterization, repeat treadmill testing