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NAPLEX COPY > Chronic Stable Angina (CSA) > Flashcards

Chronic Stable Angina (CSA) Flashcards

1
Q

Describe chest pain in angina

A

Squeezing, grip-like, heavy or suffocating and typically doesn’t vary with position or respiration

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2
Q

What’s stable angina also known as?

A

Stable ischemic heart dx (SIHD)

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3
Q

What’s stable angina or SIHD associated with?

A

Predictable chest pain often brought on by exertion or emotional stress and relieved within minutes by rest (or nitroglycerin)

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4
Q

What causes stable angina?

A

Plaque build up on the inner walls of coronary arteries (atherosclerosis) causing narrowing in the arteries and reduced blood flow to heart

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5
Q

What’s Prinzmetal’s (variant or vasospastic angina) angina?

A

Angina that’s present in pts with NORMAL coronary arteries, where angina sx are as a result of vasospasm in the arteries

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6
Q

List types of angina

A

Stable angina

Prinzmetal’s angina

Silent ischemia

Unstable angina

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7
Q

What’s stable angina?

A

Decreased myocardial O2 supply to due to reduced blood flow from narrowed arteries by atherosclerotic plaque

Sx have been occurring for weeks but without worsening

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8
Q

What’s Prinzmetal’s angina?

A

Decreased myocardial O2 supply due to vasospasm of the artery

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9
Q

What’s silent ischemia?

A

Transient myocardial ischemia without sx of angina

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10
Q

What’s unstable angina?

A

Severe, crushing chest pain unrelieved by rest; acute medical care is needed

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11
Q

What’s the non-pharmacologic tx of CSA?

A 
Heart healthy lifestyle 
    saturated fats < 7% of total calories and 
    Trans fat < 1% of total calories
    Fresh fruits and vegetables 
    Low fat dairy pdts

Stop smoking

Maintain BMI of 18.5-24.9 kg/m2

Waist circumference
Females < 35 inches
Males < 40 inches

Encourage physical exercise
30-60 minutes of moderate-intensity aerobic activity, at least 5 days a wk, preferably 7 days a wk

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12
Q

What’s a Heart healthy lifestyle in CSA?

A

saturated fats < 7% of total calories

Trans fat < 1% of total calories

Fresh fruits and vegetables

Low fat dairy pdts

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13
Q

How much saturated fat should be consumed in heart healthy lifestyle in CSA?

A

< 7% of total calories

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14
Q

How much trans fat should be consumed in heart healthy lifestyle in CSA?

A

< 1% of total calories

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15
Q

What’s the recommended BMI in CSA?

A

18.5 - 24.9 kg/m2

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16
Q

What’s the recommended waist circumference in CSA?

A

Males < 40 inches

Females < 35 inches

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17
Q

Whats the tx goals of CSA?

A

Reduce the risk of an acute coronary syndrome (unstable angina/ myocardial infarction) and provide symptomatic relief from angina pain

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18
Q

What’s combo is most often used to meet the tx goals of CSA?

A

Antiplatelet (usually Aspirin; Plavix is allergy or CI to aspirin) + Antianginal

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19
Q

What’s the first line therapy for tx of CSA?

A

Beta blockers

CCB or long-acting nitrates are used when bb is CI or when additional relief is needed

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20
Q

What’s recommended for immediate relief of angina?

A

Sulpblingual nitroglycerin or nitroglycerin spray

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21
Q

What med should ALL pts with CSA be on regardless?

A

Moderate or high dose statin (regardless of LDL values)

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22
Q

What annual vaccine is recommended in CSA?

A

Annual flu shot

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23
Q

What’s the acronym that summarizes the non-pharmacologic and pharmacologic therapies in chronic therapy?

A

A - Antiplatelet and Antianginal drugs

B - Blood pressure and beta-blockers

C - Cholesterol (statins) and cigarettes

D - Diet and diabetes

E - Exercise and education

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24
Q

List Antiplatelet agents

A

Aspirin (Bayer, Ascriptin, Bufferin)

Clopidogrel (Plavix)

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25
Q

SE of aspirin (Bayer, Ascriptin, Bufferin)?

A

Dyspepsia

Heartburn

GI upset

GI bleed/ ulceration

Bleeding

Renal impairment

Hypersensitivity

26
Q

What’s the black box warning of Clopidogrel (Plavix)?

A

Effectiveness depends on the activation to an active metabolite mainly by CYP2C19.

Poor metabolizes exhibit higher cardiovascular events than pts with normal CYP2C19 fxn

27
Q

Which allele corresponds to fully functional metabolism of Clopidogrel (Plavix)?

A

CYP2C19*1 allele

28
Q

Which allele corresponds to nonfunctional metabolism of Clopidogrel (Plavix)?

A

CYP2C19*2 and *3 allele

29
Q

SE of Clopidogrel (Plavix)?

A

Bleeding

Bruising

Rash

TTP (thrombotic thrombocytopenia purpura)

30
Q

When’s Clopidogrel (Plavix) used in CSA?

A

In pts with CI to aspirin

31
Q

List drugs that should be avoided in aspirin use, bcuz they increase bleeding risk

A

Anticoagulants

Other Antiplatelet

Ginkgo

Dextran

NSAIDs

SSRIs

SNRIs

Thrombolytics etc

32
Q

Effect of aspirin (and NSAIDs) on lithium and methotrexate levels?

A

They increase lithium and methotrexate levels

Avoid concurrent usr

33
Q

List Ototoxicity agents that should not be used with aspirin

A

Vancomycin

Loop diuretics

Others

34
Q

List meds that shouldn’t be used with Clopidogrel (Plavix)

A

Cimetidine

Fluconazole

Ketoconazole

Voriconazole

Fluoxetine

Fluvoxamine

Omeprazole

Esomeprazole

35
Q

List Antianginal agents in CSA?

A

Beta blockers

CCB

Nitrates

Ranolazine

36
Q

In what type of angina is beta blockers avoided?

A

Prinzmetal’s angina

37
Q

What’s the preferred agent for Prinzmetal’s (variant) angina?

A

CCB

38
Q

What type of CCB is CI in CSA?

A

Short-acting CCBs e.g. Nifedipine IR

39
Q

When should u call 911 in CSA?

A

If chest pain doesn’t go away after first dose of SL tabs or spray

40
Q

Uses of long-acting nitrates in CSA?

A

Not used alone for chronic therapy (used in combo with bb or CCB)

Req nitrate-free interval

41
Q

What’s the warning associated with Ranolazine (Ranexa) use?

A

Can cause QT prolongation

42
Q

SEs of Ranolazine?

A

Dizziness

Constipation

Headache

Nausea

43
Q

Effect of Ranolazine on HR or BP?

A

Ranolazine has little to no clinical effects on HR or BP

44
Q

What meds should be avoided with nitrate?

A

PDE-5 inhibitors

45
Q

What’s the dose of simvastatin that can be safely used with Ranolazine?

A

Limit simvastatin to 20mg/day if used with Ranolazine

46
Q

List Nitroglycerin formulations

A

Nitroglycerin SL tabs (Nitrostat) 0.3, 0.4, 0.6 mg

Nitroglycerin sublingual spray 0.4mg/spray (Nitromist, Nitrolingual Pump Spray)

Isosorbidr mononitrate IR/ET tabs/caps (Monoket)

47
Q

What’s the brand name and dose of Nitroglycerin SL tabs?

A

Nitrostat

0.3, 0.4, 0.6mg

48
Q

What’s the brand name and dose of Nitroglycerin SL spray?

A

Nitromist, Nitrolingual Pump Spray

0.4mg /spray

49
Q

What’s the brand name of Isosorbide mononitrate IR/ER tabs/caps?

A

Monoket

50
Q

SEs of nitroglycerin formulations

A

Headache

Dizziness

Lightheadedness

Flushing

Hypotension

Tachyphylaxis

Syncope

51
Q

How does pts dose the nitrate-free interval?

A

10-12 hour nitrate-free period to reduce tolerance

52
Q

In what container should the nitroglycerin IV be prepared?

A

Glass bottles or polyolefin bags (non-PVC)

53
Q

Can nitroglycerin SL tab be used prophylactically?

A

Yes, nitroglycerin SL tab can be taken prophylactically 5-10 minutes before activities that bring on chest pain)

54
Q

How should nitroglycerin tabs be stored? Effect

A

Room temperature

If stored and handled properly, the tabs should be stable until manufacturer provided expiration date

55
Q

NTG stored in original amber glass bottle?

A

Yes

NTG SL tabs should be kept in original amber glass bottle which is kept tightly capped

56
Q

How do u use NTG pump spray?

A

Spray 5 times into air to prime

If not used within 6 wks, prime the pump with 1 spray before use

Don’t shake

Press button firmly with forefinger to release spray onto or under the tongue

Close mouth after spray

Don’t eat or drink or rinse the mouth for 5-10 mins after dose

Use 1 spray Q5mins, but no more than 3 sprays in 15 mins

57
Q

What meds should be avoided in NTG use?

A

PDE-5 inhibitor

Sildenafil (Viagra, Revatio)

Tadalafil (Cialis, Adcirca)

Vardenafil (Levitra, Staxyn)

Avanafil (Stendra)

58
Q

How do u use Isosorbide Mononitrate?

A

Take 1st dose when us wake up

Take 2nd dose 5 hrs later

59
Q

How should Isosorbide Mononitrate be used?

A

Take at the same times each day

Don’t change dosing times unless directed by healthcare provider

60
Q

Which of the SE of Isosorbide Mononitrate becomes tolerable as time goes on?

A

Headache

61
Q

Uses of Ranolazine?

A

Used to decrease the number of times u may get chest pain

62
Q

What’s angina?

A

Chest pain, pressure or discomfort

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