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PATHO/PHARM II > CAD, Angina, MI > Flashcards

CAD, Angina, MI Flashcards

Review for Kaplan Pharm (83 cards)

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1
Q

Patho of CAD: What is the most common cause of CAD?

A

Development of atherosclerosis in arteries supplying the myocardium is the most common cause?

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2
Q

Patho of CAD: What does development of atherosclerosis in arteries supplying the myocardium lead to?

A

O2 reduction to cardiac muscle

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3
Q

Patho of CAD: What would lead to angina?

A

Ischemia –> accumulation of lactic acid & metabolic wastes –> angina

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4
Q

Patho of CAD: What part of the heart is most susceptible?

A

LV most susceptible

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5
Q

Patho of CAD: What is it a prognosis for?

A

Prognosis for MI

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6
Q

Patho of CAD: What are other causes of MI?

A

Vasospasm

Cardiomyopathy

Thrombi

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7
Q

Patho of CAD: What are contributing factors to CAD?

A

DM

Stress

HTN

Smoking

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8
Q

Patho of CAD: What is stable angina initiated by?

A

Initiated w/ ↑ O2 demand w/ activity

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9
Q

Patho of CAD: How is stable angina reduced?

A

Reduced at rest

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10
Q

Patho of CAD: How does CAD progress?

A

Plaque ulceration –> inflammation –> platelets aggregation & thrombi

Platelets –> thromboxane A2 (vasoconstrictor) –> artery spasm

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11
Q

Patho of CAD: What is CAD a repeated cycle of?

A

Repeated cycle of aggregation of spasms

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12
Q

Patho of CAD: How does unstable angina occur? When does it occur?

A

Unpredictable

Occurs at rest

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13
Q

Patho of CAD: What are complications of CAD?

A

MI

HF

Dysrhythmias

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14
Q

Presentation & Management of CAD:

What are clinical manifestations?

A

Radiating angina ~ jaw, neck, arm, back

Indigestion-like sensation

N/V

Cool, clammy extremities

Diaphoresis

Fatigue

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15
Q

Presentation & Management of CAD:

How is diagnosis of CAD made?

A

Identifying contributing factors

PMH & PE

Exercise stress test

Echocardiogram

EKG ~ depression of ST-segment if chronic

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16
Q

Presentation & Management of CAD:

Diagnosis of CAD: What are identifying factors?

A

Lipid profile

Angiography

Nuclear imaging

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17
Q

Presentation & Management of CAD:

What is treatment of CAD?

A

PX of MI ~ modifiable risk factors

Angioplasty, bypass & laser procedures

Medications

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18
Q

Presentation & Management of CAD:

What are medications for CAD?

A

Antiplatelet agents,

anticoagulants,

thrombolytics

Lipid-lowering medications

Nitrates, BBlockers, CCBs ~ vasodilation increase O2

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19
Q

Angina: What is it?

A

Sudden pain beneath the sternum

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20
Q

Angina: How is the pain?

A

Often radiating to the left shoulder, left arm, jaw

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21
Q

Angina: What is the cause?

A

Insufficient O2 supply to the heart

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22
Q

Angina: What occurs?

A

Most ~ atherosclerosis of coronary arteries

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23
Q

Angina: O2 demand effects what?

A

HR

Myocardial contractility

Intramyocardial wall tension ~ preload & afterload

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24
Q

Angina: What do drugs target?

A

O2 demand

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25
Angina: Under normal conditions, what does an increase in O2 demand lead to?
increase in O2 demand --> dilation of coronary arterioles--> decrease in PR and increase in blood flow
26
Angina: Under normal conditions, how is O2 supply during exertion?
Increased during exertion
27
Angina: Under normal conditions, when does perfusion occur?
Perfusion occurs during diastole (relaxation)
28
Angina: What are goals of treatment having to do with MI and death?
Meds for dysplipidemia and antiplatelets
29
Angina: What are goals of treatment having to do with myocardial ischemia and anginal pain?
Meds for angina
30
Angina: What are anti-anginal agents?
Organic nitrates-NTG BBlockers- metroprolol CCBs- verapamil Ranolazine
31
Chronic Stable (Exertional) Angina aka?
Angina of effort
32
Chronic Stable (Exertional) Angina: What are triggers?
Physical activity Emotional excitement Large meals Exposure to cold
33
Chronic Stable (Exertional) Angina: What is an underlying cause?
CAD
34
Chronic Stable (Exertional) Angina: What happens to arterial walls in an angina?
deposition of fatty plaque in arterial wall Leading to partial occlusion--> angina
35
Chronic Stable (Exertional) Angina: What happens to arterial walls in a MI?
Deposition of fatty plaque in arterial wall Complete occlusion --> MI
35
Chronic Stable (Exertional) Angina: How is O2 demand at rest?
At rest, O2 demand and supply in balance Leads to dilation of distal vessel
36
Chronic Stable (Exertional) Angina: What is treatment of risk factors for stable angina?
Meds for dyslipidemia and htn Meds for DM Smoking cessation
37
Chronic Stable (Exertional) Angina: What is the treatment to reduce risk of MI?
Antiplatelet agents
38
Chronic Stable (Exertional) Angina: How does angina treatment work?
Increases cardiac O2 supply Decreases cardiac O2 demand
39
Chronic Stable (Exertional) Angina: Approach to angina treatment: Decrease cardiac O2 demand does what?
Meds to decrease HR, contractility, afterload, preload Only provide symptomatic relief Won't alter underlying patho Nitrates, BBlockers, CCBs
40
Chronic Stable (Exertional) Angina: Approach to angina treatment: What drugs decrease cardiac O2 demand?
Nitrates, BBlockers, CCBs
41
Chronic Stable (Exertional) Angina: Ranolazine What does it help with? What does it NOT do?
No effect on HR, PR, BP Helps myocardium generate energy more efficiently
42
Nondrug TX for stable angina?
Avoid triggers Smoking cessation Establish regular pattern of aerobic exercise
43
Chronic Stable Angina: Antianginal meds to decrease O2 demand: Nitrates- what do they do?
Dilation of veins decreases preload SL for breakthrough Long-acting for last line maintenance
44
Chronic Stable Angina: Antianginal meds to decrease O2 demand: Beta Blockers- What do they do?
Decrease in HR and contractility
45
Chronic Stable Angina: Antianginal meds to decrease O2 demand: Beta Blockers- What is it a first line add on to?
1st line add-on to sublingual NTG for maintenance
46
Chronic Stable Angina: Antianginal meds to decrease O2 demand: Beta Blockers- What does it prevent?
PX reflex tachycardia
47
Chronic Stable Angina: Antianginal meds to decrease O2 demand: Beta Blockers- What are cases where you would always add a BBlocker?
Always add if (+) prior MI
48
Chronic Stable Angina: Antianginal meds to decrease O2 demand: CCBs
All agents: dilation of arterioles decreases afterload
49
Chronic Stable Angina: Antianginal meds to decrease O2 demand: CCBs- What are examples? What do they do?
Verapamil & diltiazem only: decrease HR & contractility
50
Chronic Stable Angina: Antianginal meds to decrease O2 demand: CCBs- Why would they be added?
Added if BBlocker failed or CI
51
Chronic Stable Angina: Antianginal meds to decrease O2 demand: CCBs- What should be avoided? Why?
Avoid nondihydropyridines if concurrent Bblocker
52
Chronic Stable Angina: Antianginal meds to decrease O2 demand: What is done if there is failure of Long acting nitrate + BBlocker +CCB?
Coronary artery bypass graft CABG Percutaneous coronary intervention PCI
53
Variant (Vasospastic) Angina aka?
AKA Prinzmetal’s angina
54
Variant (Vasospastic) Angina Patho?
CAD --> coronary artery spasm Decrease blood flow to myocardium ~ insufficient O2 ~ angina
55
Variant (Vasospastic) Angina: What does it frequently occur with?
Frequently occurring in conjunction w/ stable angina
56
Variant (Vasospastic) Angina: What is the approach to treatment?
increase cardiac O2 supply (pain not due to demand)
56
Variant (Vasospastic) Angina: Antianginal meds to increase O2 supply- What meds are not effective?
BBlockers & ranolazine NOT effective for this form
56
Variant (Vasospastic) Angina: What do meds do?
Agents that promote vasodilation ~ relax spasm
56
Variant (Vasospastic) Angina: Antianginal meds to increase O2 supply What are they?
Nitrates & CCBs
56
Variant (Vasospastic) Angina: Antianginal meds to increase O2 supply- What meds are first line, second, last?
Antianginal meds to increase O2 supply 1st line: LA nitrate or CCB 2nd line: combo of above Last line: CABG
57
Unstable Angina- Symptoms?
Angina at rest New-onset exertional angina Intensification of existing angina
57
Unstable Angina- risk of death?
Risk of death > stable angina
57
Unstable Angina- what is it considered?
Medical emergency
58
Unstable Angina- Approach to TX
Reduce pain & PX progression to MI Maintain O2 supply decrease O2 demand Anti-ischemic therapy w/ antiplatelet & anticoagulant agents
58
Unstable Angina-includes what?
Nitroglycerin BBlocker Supplemental O2 if (+) cyanosis or respiratory distress IV morphine sulfate
59
Unstable Angina-Anti-ischemic therapy Nitroglycerin- how is it given?
SL dose q5min x 3
60
Unstable Angina-Anti-ischemic therapy Nitroglycerin- Persistent ischemia or HTN hows it given?
IV
61
Unstable Angina-Anti-ischemic therapy BBlocker When is IV given over PO?
Ongoing chest pain initial IV > PO
62
Unstable Angina- Anti-ischemic therapy When is supplemental O2 given?
Supplemental O2 if (+) cyanosis or respiratory distress
63
Unstable Angina- Anti-ischemic therapy IV morphine sulfate : for what?
Pain unrelieved by NTG Pulmonary congestion or severe agitation
64
Unstable Angina- Anti-ischemic therapy When would Ace inhibitor be given?
ACE-I if (+) LVD or CHF
65
Unstable Angina Antiplatelet therapy
ASA indefinitely Clopidogrel, prasugrel, or ticagrelor x 2m
66
Unstable Angina Antiplatelet therapy When would Abciximab be given?
Abciximab if angioplasty planned
67
Unstable Angina Antiplatelet therapy When would Eptifibatide or tirofiban be given?
Eptifibatide or tirofiban if high-risk w/ continuing ischemia (angioplasty not planned
68
Unstable Angina Anticoagulant therapy: What meds?
Enoxaparin SQ Direct thrombin inhibitors ~ bivalirudin Factor Xa inhibitors ~ fondaparinux IV UF heparin
69
Drug Classes Used for Angina
Organic Nitrates Beta Blockers Calcium Channel Blockers Ranolazine
70
Organic Nitrates- example?
Nitroglycerin
71
Organic Nitrates- What is Mode of action of stable angina?
Direct action on VSM Vasodilation decrease in venous return causes decrease in preload ~ decrease in O2 demand
72
Organic Nitrates- stable angina How are effects?
Veins > arterioles Relief due to effects on peripheral blood vessels, NOT coronary blood flow
73
Organic Nitrates- MOA for variant:
Relaxation of coronary artery spasm Increase in O2 supply
74
Organic Nitrates cont. ADE
HA Orthostatic Hypotension Reflex Tachycardia Tolerance
75
Organic Nitrates cont. ADE: HA

PATHO/PHARM II (27 decks)

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