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PHRM 845 Therapeutics > CAD Sowinski > Flashcards

CAD Sowinski Flashcards

1
Q

significant coronary artery disease is defined as > ___-___% atherosclerotic reduction in a major coronary vessel

A

70-75%

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2
Q

what does PPQRST stand for?

A

precipitating factors
palliative measures
quality and quantity of the pain
region and radiation
severity of the pain
timing and temporal pattern

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3
Q

ECG findings for typical angina

A

ST-segment depression (during event)

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4
Q

Each of the following statements regarding chronic coronary disease is correct EXCEPT?

A. Stable angina is associated with pain that is increasing in severity and not relieved by NTG
B. Women and patients with diabetes may experience atypical symptoms
C. Angina is discomfort associated with ischemia
D. Prinzmetal’s or variant angina is associated with coronary vasospasm
E. Chronic coronary disease is usually associated with atherosclerosis

A

A. Stable angina is associated with pain that is increasing in severity and not relieved by NTG

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5
Q

LDL reduction goal for CV risk factor reduction

A

50% or more reduction (LDL goal < 90)

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6
Q

BP goal for CV risk factor reduction

A

< 130/80

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7
Q

A1C goal for CV risk factor reduction

A

< 7%

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8
Q

BMI goal range for CV risk factor reduction

A

18.5-24.9

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9
Q

CV risk factors: how many alcohol beverages per day is acceptable for male vs female patients?

A

males: 2 per day
females: 1 per day

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10
Q

how does aspirin prevent platelet aggregation?

A

by blocking thromboxane (TXA2) synthesis

(TXA2 promotes clotting)

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11
Q

loading dose for aspirin (range)

A

162-325 mg

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12
Q

loading dose range for clopidogrel

A

300-600 mg

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13
Q

loading dose for prasugrel

A

60 mg

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14
Q

loading dose for ticagrelor

A

180 mg

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15
Q

why is low dose aspirin beneficial vs higher doses?

A

-at low dose, it irreversibly inhibits COX-1, blocking TXA2 formation
-at higher doses it inhibits COX-2, blocking formation of prostacyclin (PGI2), which is the opposite effect of above

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16
Q

what is the maintenance dose for these P2Y12 inhibitors?

clopidogrel, prasugrel, ticagrelor, cangrelor

A

clopidogrel 75 mg daily
prasugrel 10 mg daily
ticagrelor 90 mg BID
cangrelor IV only

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17
Q

MOA of P2Y12 inhibitors

A

selectively inhibt ADP induced platelet aggregation with no effect on TXA2

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18
Q

main adverse effects of aspirin

A

GI bleeding, hematologic bleeding

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19
Q

which of the following P2Y12 inhibitors are prodrugs? SELECT ALL THAT APPLY

a. clopidogrel
b. prasugrel
c. ticagrelor

A

a, b

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20
Q

plavix MOA

A. Blocks activation of factors Xa and IIa
B. Decreases prostaglandin production
C. Blocks synthesis of COX-1 and -2 and decreases thromboxane A2 production
D. Selectively blocks synthesis of COX-2 and increases platelet activation
E. Inhibits P2Y12 ADP-mediated platelet activation and aggregation

A

E. Inhibits P2Y12 ADP-mediated platelet activation and aggregation

(C is high dose aspirin, D is celecoxib)

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21
Q

Pt with no history of a stent: what drug should they take if they have a CI or intolerance to aspirin?

A

clopidogrel

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22
Q

what is dual antiplatelet therapy?

A

aspirin + P2Y12 inhibitor

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23
Q

sirolimus, paclitaxel, everolimus, zotarolimus, and biolimus are used in drug eluting stents. What kinds of drugs are these?

A

anti-proliferative (anti-rejection)

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24
Q

Pt with elective PCI + drug eluting stent: what two drugs do they receive before procedure?

A

aspirin and P2Y12 inhibitor loading dose

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25
Q

dual antiplatelet therapy for pt with CABG

A

aspirin 81 mg + clopidogrel 75 mg daily

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26
Q

how long should a pt be on clopidogrel following a CABG?

A

12 months

27
Q

A 56-year-old patient had coronary artery bypass graft (CABG) surgery performed for refractory symptoms of angina despite maximally tolerated medical therapy and multiple PCIs. Which of the following medications should be initiated following CABG surgery and continued indefinitely? SELECT ALL THAT APPLY

A. Aspirin
B. Carvedilol
C. Enalapril
D. Nitroglycerin sublingual
E. Clopidogrel

A

A. Aspirin
D. Nitroglycerin sublingual

28
Q

if a pt is on aspirin and ticagrelor, the dose of aspirin must be < ___ mg due to risk of stroke

A

< 100 mg

29
Q

how does colchicine work for CV disease?

A

reduces inflammation (atherosclerosis is an inflammatory disease)

30
Q

how do nitrates dec myocardial O2 demand?

A

venous vasodilation causes reduced preload and dec LV volume

31
Q

how do nitrates inc myocardial O2 supply?

A

via endothelium-dependent vasodilation; dilation of epicardial arteries and coronary collateral vessels

32
Q

main advantage of NTG spray vs tablet

A

NTG spray has shelf life of 3 years, tablets are about 6 months

33
Q

true or false: NTG spray should be shaken before use, and sprayed under the tongue and inhaled

A

false

(Don’t shake, spray under tongue but don’t inhale)

34
Q

How should a pt be counseled on their nitromist PRN for chest pain? SELECT ALL THAT APPLY

A. Do not shake
B. Call 911 if the CP is not relieved after first dose
C. Inhale the medication with a quick, deep breath
D. Use twice daily at 7 AM and 3 PM to provide a nitrate free period
E. May cause a headache, flushing or drop in BP

A

A. Do not shake
B. Call 911 if the CP is not relieved after first dose
E. May cause a headache, flushing or drop in BP

35
Q

true or false: reflex tachycardia is an adverse effect of nitrates

A

true

36
Q

what drug class should nitrates be avoided with due to huge drop in BP?

A

PDE5 inhibitors such as sildenafil/tadalafil

37
Q

how long after taking tadalafil should a patient wait before taking a nitrate?

A

48 hours

38
Q

how long after taking sildenafil and vardenafil should a patient wait before taking a nitrate?

A

24 hours

39
Q

beta-blockers MOA

A

competitive, reversible inhibitors of beta-adrenergic stimulation by catecholamines

40
Q

what 3 desired effects do beta blockers have on myocardial oxygen demand?

A

-reduce heart rate (mainly during sympathetic stimulation)
-reduce myocardial contractility
-reduce arterial BP (afterload)

41
Q

what is the undesired effect of beta blockers on myocardial oxygen demand?

A

increased preload (force that stretches cardiac muscle prior to contraction)

42
Q

which two beta blockers have intrinsic sympathomimetic activity (ISA)?

A

acebutolol and pindolol

43
Q

which 2 CCBs should not be used due to profound BP drop leading to reflex tachycardia?

A

short acting DHPs (Nifedipine, nicardipine)

44
Q

nitrate tolerance is due to which enzyme?

A

ALDH2 (aldehyde dehydrogenase 2)

45
Q

true or false: it is appropriate to take ISMN tabs at 8 AM, 12 PM, and then at 4 PM

A

false (this is appropriate for ISDN not ISMN)

46
Q

how many hours apart should ISMN be taken?

A

7 hours apart (2 times/day: 8 AM and 3 PM)

47
Q

which of the following increases heart rate? SELECT ALL THAT APPLY

a. nitrates
b. beta-blockers
c. nifedipine (DHP)
d. verapamil
e. diltiazem
f. ranolazine

A

a. nitrates
c. nifedipine (DHP)

48
Q

ranolazine MOA

A

inhibition of late inward Na+ current in ischemic myocytes, which dec intracellular Na+, which leads to dec Ca2+ influx

49
Q

describe ranolazine’s effect on HR, BP, and myocardial contractility

A

has no effect on any of these

50
Q

USA indication for ranolazine

A

tx of chronic angina

(in Europe it is indicated as add-on therapy)

51
Q

The clinic pharmacist is performing a medication reconciliation and is reviewing the patient’s medications to ensure they are being taken properly. Which one of the following medications should be taken twice daily, with doses separated by 7 hours (e.g. at 8 AM and 3 PM)?

A. Isordil
B. Monoket
C. Nifedipine XL
D. Norvasc
E. NTG Patches

A

B. Monoket

(a is TID; c, d, and e are all once daily)

52
Q

three first line agents for stable angina

A

beta blocker, CCB, nitrates

53
Q

true or false: pts with stable HF and a history of an MI should never take beta blockers

A

false (these are compelling indications)

54
Q

CI’s for non-DHP CCBs (3)

A

-HFrEF
-HR < 50
-high degree AV block or sick sinus syndrome

55
Q

A 65 YO with CCD receives the following meds: Accupril 20 mg daily; Metformin 1000 mg daily; Trulicity 0.75 mg SC weekly; HCTZ 25 mg daily; Coreg 12.5 mg BID; NitroMist PRN for CP.

  • PE/Vitals: BP 138/87 mmHg; HR 87; RR 18
  • Which one of the following should be added to his regimen to better control his angina?

A. Diltiazem
B. Atenolol
C. Amlodipine
D. Clonidine
E. Aspirin

A

C. Amlodipine

56
Q

A 68-year-old male presents with complaints of angina when walking up flights of stairs. The pain is relieved with rest and only occasionally requires a dose of SL NTG for relief. He has a history of MI, HTN, and dyslipidemia. He quit smoking 3 years ago after his MI. His meds include aspirin 81 mg daily, metoprolol 25 mg XL once daily, and atorvastatin 80 mg daily.

Vital signs: BP is 158/92 mmHg, HR 82 bpm. Which of the following is most appropriate to treat this patient’s angina?

A. Lisinopril 5 mg daily
B. Ranolazine 1,000 mg twice daily
C. Increase metoprolol XL to 50 mg once daily
D. SL NTG 1 tablet as needed for angina

A

C. Increase metoprolol XL to 50 mg once daily

(a not for angina; b is wrong starting dose; d he is already on this)

57
Q

JJ is a 58-year-old male with a past medical history of hypertension, dyslipidemia, and chronic coronary artery disease. He presents to clinic with complaints of chest pain occurring with exertion several times per week. The chest pain is promptly relieved with one SL NTG tablet or upon resting. His current medications include aspirin 325 mg daily, metoprolol 100 mg BID, and rosuvastatin 20 mg PO hs. His vital signs are: HR 60 bpm and BP 145/95 mmHg. What one of the following is most appropriate therapy to improve the treatment of his CCD?

A. add clopidogrel 75 mg QD
B. add ISDN 10 mg every 12 hours
C. add amlodipine 5 mg PO QD
D. add verapamil SR 180 mg every 12 hours

A

C. add amlodipine 5 mg PO QD

58
Q

what drug class is ivabradine (Corlanor)?

A

HCN channel inhibitor (reduces diastolic depolarization)

59
Q

true or false: diclofenac and aspirin are ok to take together

A

false

60
Q

if taking both aspirin and a systemic NSAID, how many hours prior should you take the aspiring before the NSAID?

A

2 hours before

61
Q

does Prinzmetal’s angina occur upon exertion or at rest?

A

at rest

62
Q

first line drugs for management of vasospastic angina

A

CCBs

63
Q

Which of the following medications is preferred for treatment of Prinzmetal’s angina

A. ISDN
B. Plavix
C. Toprol XL
D. Ranolazine
E. Norvasc

A

E. Norvasc

PHRM 845 Therapeutics (34 decks)

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