Angina And MI

Question 1

Rationale for treatment of angina

Answer 1

Increase O2 supply by vasodilation with nitrates and CCBs

Decrease O2 demand with beta blockers and CCBs

Question 2

1st line for typical angina

Answer 2

Beta blockers

Question 3

Cardioselective beta blockers

Answer 3

Metoprolol
Atenolol
Nebivolol

Question 4

Non selective beta blockers

Answer 4

Propranolol

Nadolol

Question 5

Alpha and beta blockers

Answer 5

Carvedilol

Labetalol

Question 6

Initial therapy for angina if beta blockers are contraindicated

Answer 6

Non-DHP CCBs

Question 7

CCBs preferred for variant angina

Answer 7

Non DHPs

Question 8

Add on therapy to beta blockers

Answer 8

DHP CCBs

Question 9

DHP CCBs used in angina

Answer 9

Amlodipine
Felodipine
Nifedipine

Question 10

MOA for organic nitrates

Answer 10

Release NO that diffuses into vascular smooth muscle and dilates veins to decrease preload and ventricular pressure to decrease myocardial O2 demand

Question 11

CI for nitrates

Answer 11

Aortic valve stenosis, use of Viagara, Levitra, Cialis; angle closure glaucoma, head trauma, cerebral hemorrhage, anemia, severe hypotension

Question 12

ADRs of nitrates

Answer 12

H/a dizzy weakness postural hypotension rash anxiety

TOLERANCE

Question 13

Monitoring parameters for nitrates

Answer 13

BP

HR

Question 14

Role of nitrates in managing angina

Answer 14

SL to relieve acute symptoms of myocardial ischemia
SL/PO to prophylax effort induced angina
Long acting formulas for maintenance if beta blockers and CCBs contraindicated

Question 15

Nitrate formulations

Answer 15

Amyl nitrate- rapid onset, used for cyanide poisoning
Nitroglycerin - SL ointment patch IV or PO
Isosorbide- dinitrate and mononitrate forms

Question 16

Ranolazine uses

Answer 16

Chronic stable angina as add on to CCB beta blocker or nitrate

Question 17

MOA ranolazine

Answer 17

Sodium current inhibitor

Question 18

CI for ranolazine

Answer 18

Prolonged QT
Hypokalemia
Hepatic failure
CYP 3a4 inhibitors

Question 19

Adjunct therapy to prevent ACS in patients with unstable angina

Answer 19

Aspirin

Question 20

Other anti platelet treatments for angina

Answer 20

Clopidogrel
Prasugrel
Ticagrelor

Question 21

Used in patients with CAD to prevent dz progression but do not relieve angina directly

Answer 21

ACE inhibitors

Question 22

How to treat predictable episodes of angina caused by exertion

Answer 22

Nitroglycerin or isosorbide

Question 23

Frequent episodes of angina should be treated with

Answer 23

Nitroglycerin beta blocker CCB or nitrate

Question 24

How to treat angina in asthma patient

Answer 24

Non DHP CCB or cardioselective beta blocker

Question 25

How to treat angina in DM patient

Answer 25

Non DHP CCB most preferred also nitrates and cardioselective beta blockers

Question 26

How to treat angina in heart failure patients

Answer 26

beta blockers and nitrates most preferred

Question 27

How to treat angina in HTN patient

Answer 27

Beta blocker and non DHP CCB

Question 28

How to treat angina in patient with prior MI

Answer 28

Beta blockers

Question 29

How to treat angina in patient with bradycardia or heart block

Answer 29

DHP CCB preferred

Question 30

Drugs for acute STEMI

Answer 30

Aspirin- all patients, start asap and continue forever IV nitroglycerin - for first day or two, not if hypotension or bradycardia Analgesics- morphine decreases pain and increases reperfusion Beta blockers- start asap and continue post MI to reduce magnitude of infarction and rate of reinfarction ACE inhibitors- post MI if left ventricle dysfxn or CHF CCBs- controversial, can be given if intolerant to beta blockers Anticoagulants- heparin, bivalrudin, fondaparinux P2Y inhibitors- clopidogrel, pasugrel or Ticagrelor Fibrinolytics- dissolve clots ex streptokinase, alteplase, reteplase, anistreplase, tenecteplase Statins

Question 31

If CABG indicated what do you do with anti platelet drugs

Answer 31

Hold for 5-7 days

Question 32

Are fibrinolytics used in Non-STEMI patients

Answer 32

No, only STEMI patients

Question 33

Variant angina is caused by

Answer 33

Acute coronary vasospasm