ChronicAnginaFC

Question 1

what are the types of angina

Answer 1

chronic (stable) prinzmetal (variant) unstable, silent

Question 2

what is prizmental angina?

Answer 2

decreaase myocardial oxygen due to vasospasm, rare

Question 3

which types of angina are due to supply ischemia

Answer 3

prinzmetal and unstable

Question 4

which types of angina are due to demand ischmia

Answer 4

chronic (stable)

Question 5

what are the non pharmacologic treatment goals in pt with angina

Answer 5

BMI < 25 waist < 35 women < 40 men 30 mins of exercise at least 5x a week
Stop smoking

Question 6

what are the pharmacologic treatment options for angina

Answer 6

antiplatelets (asa is Doc, clopidogrel) antianginal (bb ccb nitrates ranolazine)

Question 7

what Beta blockers should not be used in patients with angina

Answer 7

those with intrinsic sympathomimetic activity carteolol acebutalol pindolol penbutolol (CAPP)

Question 8

what is the goal of therapy with BB for angina?

Answer 8

resting HR of 50-60bpm ,

Question 9

1st line antianginal agent for chronic angina

Answer 9

beta blockers

Question 10

beta blockers should not be used in patients with what type of angina

Answer 10

prinzmental (varient)

Question 11

CCB are preferred in patients with what type of angina

Answer 11

prinzmetal variant

Question 12

which form of CCB are more effective in angina DHP or Non-DHP

Answer 12

non dhp (verapamil diltiazem)

Question 13

ASA contraindications

Answer 13

salicylate allergy active bleed

Question 14

ASA side effects

Answer 14

heartburn dyspepsia increase BP renal impairment tinnitus (toxicity) GI bleed Gi upset bleeding

Question 15

plavix

Answer 15

clopidogrel

Question 16

clopidogrel maintenance dose

Answer 16

75 mg daily

Question 17

clopidogrel should not be used in patients that are

Answer 17

poor 2C19 metabolizers (2C192 and 2C193)

Question 18

clopidogrel contraindications

Answer 18

active bleed (ich pud)

Question 19

clopidogrel side effects

Answer 19

bleeding rash TTP

Question 20

what is thrombotic thrombocytopenic purpura

Answer 20

a rare and serious side effect of clopidogrel whch pts should report fever, weakness, extreme skin paleness, purple patches, yellowing of eyes/skin, neurological changes

Question 21

what antiplatelet is 1st line in angina

Answer 21

asa (clopidogrel is used if pt has contraindication to asa)

Question 22

DDIs colopidogrel?

Answer 22

strong cyp 2c19 inhibitors: cimetidine, -azoles, fluoxetine
-any agents that cause bleeding

Question 23

what enzyme inhibition affects clopidogrel?

Answer 23

cyp 2c19,

Question 24

if a patient will undergo major surgery or cabg surgery, when should they DC the clopidogrel?

Answer 24

5 days before the surgery

Question 25

if a pt has a contraindication to asa what can be used instead

Answer 25

clopidogrel

Question 26

caution should be used when asa is used with vancomycin loops 2/2

Answer 26

ototoxicity

Question 27

___ should be avoided when pt is on clopidogrel due to their DD (PPISs)

Answer 27

omeprazole esomeprazole

Question 28

if a pt takes a nitrate and the pain is still there when should they call 911

Answer 28

after 1st dose

Question 29

are nitrates used as monotherapy for chronic angina

Answer 29

no only used in combination with CCB or beta blockers

Question 30

nitrates MOA

Answer 30

decrease O2 demand by decreasing preload

Question 31

ranexa

Answer 31

ranolazine

Question 32

ranolazine contraindications

Answer 32

liver cirrhosis 3a4 inhibitors or inducers

Question 33

ranolazine side effects

Answer 33

constipation QT prolongation dizziness

Question 34

ranolazine is more effective in women or men

Answer 34

men

Question 35

ranolazine is different from CCB/Nitrates/BB in that it

Answer 35

doesn't effect HR or BP

Question 36

nitrate contraindications

Answer 36

PDE5-I increase ICP severe anemia

Question 37

nitrates side effects

Answer 37

headache flushing hypotension

Question 38

how long is the nitrate free interval

Answer 38

10 - 12 hours

Question 39

nitrostat

Answer 39

nitroglycerin SL tabs

Question 40

nitromist

Answer 40

nitroglycerin spray

Question 41

nitrolingual pump spray

Answer 41

nitroglycerin SL spray

Question 42

nitro-dur

Answer 42

nitroglycerin patch

Question 43

minitran

Answer 43

nitroglycerin patch

Question 44

monoket

Answer 44

isosorbide mononitrate IR

Question 45

imdur

Answer 45

isosorbide mononitrate ER

Question 46

isosorbide mononitrate IR is BID and doses should be _ hours apart

Answer 46

7

Question 47

how many times can a patient use their nitroglycerin SL/spray when having an anginal attack

Answer 47

1 dose at 5 minute intervals for a max of 3 doses

Question 48

nitroglycerin storage

Answer 48

original amber bottle

Question 49

where is the nitroglycerin patch applied

Answer 49

on upper arm above the elbows and on chest , (above knee level)

Question 50

when a patient first gets their nitroglycerin spray what should they do upon first administration

Answer 50

prime with 5 sprays into air, if they havent used the pump in 6 weeks, they need to prime agaian

Question 51

how is nitroglycerin spray taken

Answer 51

close mouth after each spray do not swallow too quickly or inhale do not shake spray before use

Question 52

when are nitroglycerin SL tabs and spray indicated

Answer 52

acute chest pain prophylaxis 5 - 10 mins before activity that might cause chest paint

Question 53

how long to keep the nitorglycerin patches on?

Answer 53

for 12-14hours , you mucs take it off for the next 10-12 hours foof

Question 54

which of the antianginal drugs can be used in combination with the other classes of antianginals?

Answer 54

the ranolzine caue be used in chronic stable angina with CCB, nitrates and betal blockers.