Chronic Stable Angina Flashcards Preview

Fall 2014 - Pharm Cardio > Chronic Stable Angina > Flashcards

Flashcards in Chronic Stable Angina Deck (22):
1

What are the 3 main goals of angina therapy?

1. prevent progression to unstable angina, MI or death
2. provide relief of anginal sxs
3. modify risk factors for CAD

2

What therapies are used to prevent progression of chronic stable angina?

-anti-platelet therapy
-cholesterol control

3

What medications are used to provide relief of anginal sxs in chronic stable angina?

-BB
-CCB
-nitrates

4

How can a pt modify his or her risk factors for CAD?

-exercise and weight control
-BP control
-no smoking

5

What drug (and dose) should all patients (unless CI) be taking for their chronic stable angina?

-aspirin 75-162 mg per day

6

What is the goal of anginal pain treatment with BB? (think vital signs)

-target resting HR of 55-60 bpm

7

What are the cautions for BB use for relief of angina?

-type I DM (BB increase glucose levels)
-asthma (BB cause constriction in lungs)
-decompensated HF
-mod-severe peripheral vascular dz

8

What are the CIs for BB use for relief of angina?

-bradycardia (HR <50)
-2nd degree heart block

9

Which pts might be good candidates for trying a BB first for anginal relief?

-pts with hard indications and NO CI: 6 months post MI or systolic HF (EF <40%)

10

What should you not do if your pt is on a BB or you are considering a BB?

-do not start BB with HR<55
-do not increase dose with HR at goal

11

When should CCB dihydropyridines be used for angina relief?

-add to BB if HR < goal
-combine with long-acting nitrates in pts who can't take BB or non-DHP

12

When should CCB non-dihydropyridines be used for angina relief?

-HR> goal and a BB would be CI or no hard indication w/ cautions

13

CCB Adverse Effects

-orthostatic HoTN
-reflex tachycardia
-peripheral edema

14

CCB CIs

-left ventricular dysfunction
-bradycardia (<50 bpm)
-2nd or 3rd degree AV block

15

When should you NOT start a DHP?

-don't start with >2+ pitting edema
-don't start with orthostatic HoTN

16

MOA of Nitrates

-dilates peripheral veins at large doses
-dilates coronary arteries at all doses
-nitrates will not affect BP!

17

When might long acting nitrates be used?

-long term prophylaxis
-generally added on to other therapies (eg BB or non-DHP to improve sxs control)
-combine with DHP if pt can't tolerate BB or non-DHP

18

When might short acting nitrates be used?

-terminate acute anginal attack
-prevention of effort or stress-induced attacks

19

How should an angina patient respond to chest pain?

-stop activity, sit down, take one NTG
-if pain not improved or worse in 5 mins, take NTG and call 911
-can repeat q5 minutes for total of 3 doses

20

What is LA Nitrate Tolerance?

-decreases response or increased amount needed for same effect

21

What is a daily nitrate free interval? When should patients dose? What is the purpose?

-8-12 hour period of no nitrate meds
-dose at 8 am and 2 pm
-decreases nitrate tolerance

22

Role of ACE-I in Chronic Stable Angina

-not shown to be effective in reducing angina
-use to reduce morbidity and mortality in pts with HF, DM, CKD, HTN