Angina/Arrhythmias

Question 1

ACEI for angina are indicated when

Answer 1

Ejection fraction <40% or with HTN, DM, kidney disease

Question 2

Nitrates mech of action

Answer 2

Dilation of peripheral veins reduce LV filling volume/pressure

Dilation of coronary arteries causes increased blood flow and oxygen supply to myocardium

Question 3

Why must nitro be given SL

Answer 3

1st pass effect inactivates it

Question 4

Isosorbide dinitrate

Answer 4

Long acting nitrate
Single dose 20-40mg should be started low and increased q1-2wks
Take on an empty stomach

Question 5

Isosorbide mononitrate

Answer 5

20mg bid at 7&3 to allow for nitrate free period to reduce nitrate tolerance

ER is 30-60mg qam

Question 6

Adverse effects of nitrates assoc with vasodilation

Answer 6

HA, flushing, dizziness, weakness, ortho hypo

Reflex tachycardia

Question 7

How to prevent nitrate tolerance

Answer 7

10-12h nitrate free interval daily

Question 8

Discontinuing nitrate therapy

Answer 8

Taper down

Question 9

Advantage of beta blocker with nitrates

Answer 9

Reduced HR can help counteract reflex tacchycardia

Question 10

Blocking beta1 receptors

Answer 10

Slow HR and reduces myocardial contractility reducing myocardial oxygen demand which improves or prevents angina s/s

Question 11

Blockage of beta2 receptors

Answer 11

Can lead to bronchoconstriction

Question 12

Selective beta1 blocker for angina

Answer 12

Atenolol

Metoprolol

Question 13

Atenolol for angina

Answer 13

Dosed once daily d/t long duration of action
Renally cleared (dosage adjustment for impairment)

Question 14

Metoprolol for angina

Answer 14

Tartrate (immediately release) 2-3x daily

Succinate (ER) once

Question 15

Calcium channel blockers for angina - 2 classes

Answer 15

Dihydrpyridines

Nondihydropyridines

Question 16

Dihydropyridine calcium channel blockers (drugs)

Answer 16

Nifedipine
Nicardipine
Felodipine
Isradipine
Amlodipine

Question 17

Nondihydropyridine calcium channel blockers

Answer 17

Diltiazem

Verapamil

Question 18

Verapimil v Diltiazem

Answer 18

Verapamil has a stronger effect on conduction and contractility

Diltiazem reduces HR to a lesser extent but is a more powerful vasodilator

Question 19

Contraindications for nondihydropyridine calcium channel blockers

Answer 19

Existing LV dysfunction
Conduction system disease
Heart block

Question 20

Adverse event of CCBs

Answer 20

Leg edema

Question 21

Clopidogrel dose

Answer 21

75mg qd

Question 22

1st line therapy for angina

Answer 22

Beta blockers unless angina is linked to coronary vasospasm, then use CCB

Question 23

2nd line therapy for angina

Answer 23

CCBs or long acting nitrate added to beta blocker

Question 24

Which beta blocker/CCB combo should be used with caution

Answer 24

Nondihydropyridine

Question 25

3rd line therapy for angina

Answer 25

CCB, beta blocker, and long acting nitrate

Question 26

Main ACEI used for HF

Answer 26

Enalapril Captopril Lisinopril

Question 27

Symptoms of fluid overload

Answer 27

Orthopnea Dyspnea on exertion Paroxysmal nocturnal dyspnea

Question 28

ARB used for HF

Answer 28

Losartan

Question 29

When would you prescribe an ARB over an ACEI for HF

Answer 29

If they cannot tolerate the ACEI