Coronary Artery Disease

Question 1

Coronary Heart Disease

Answer 1

caused by damage to the coronary arteries resulting in build-up of lipids and fibrous matter

Question 2

Plaques

Answer 2

lipid (fat) build-up

Question 3

Classification of CHD

Answer 3

Stable Angina- fixed plaque
Acute Coronary Syndrome
1. unstable angina - Unstable plaque
2. non-ST-segment elevation MI (NSTEMI) - partial occlusion
3. ST segment elevation MI (STEMI) - complete occlusion

Question 4

Angina

Answer 4

Sudden pain beneath the sternum; may radiate to left shoulder, arm and jaw

Question 5

Drug Therapy for Angina

Answer 5

Prevention - cholesterol-lowering and antiplatelet agents

Treatment of Pain- nitrates, beta-blockers, , CCBs, and ranolozaine

Question 6

Types of Angina

Answer 6

(fixed plaque)

1. Chronic Stable
2. Variant (Prinzmetal’s)
3. Unstable

Question 7

Chronic Stable Angina

Answer 7

• most common, caused by partial occlusion
  Triggered By- increase in physical activity, emotional excitement, large meals, cold exposure
  Therapeutic Agents - organic nitrate, beta-blockers, calcium channel blockers, ranolazine

Question 8

Variant Angina

Answer 8

aka prinzmetals, caused by vasospasm
-can occur at rest, while sleeping, normal activity
Therapeutic agents - calcium channel blockers, organic nitrates

Question 9

Unstable Angina

Answer 9

Caused by vasospasm and plaque rupture
- can happen at rest, exertion
Therapeutic Options- organic nitrates, beta-blockers, oxygen, iv morphine

Anti-platelet therapy- aspirin, clopidogrel, tricagrelor, prasugrel

Question 10

Nitrates

Answer 10

MOA: acts primarily on cells of vascular smooth muscle
Physiologic effect: vasodilation, greater effect on veins than arteries
ex. nitroglycerin (NTG)

Question 11

Nitroglycerin

Answer 11

given in stable and variant angina
reduces venous return to the heart and reduces preload and relaxes spasms in ca’s helping to increase oxygen supply

• rapidly metabolized by the liver
• large first-pass effect
• short half-life

Question 12

Adverse Effects- NTG

Answer 12

Headache
orthostatic hypotension
reflex tachycardia

Question 13

Drug Interactions - NTG

Answer 13

(can't be given at the same time)
anti-hypertensive agents
Beta-Blockers
Phosphodiesterase-5 (PDE5)
Non-dihydrophyridine calcium channel blockers

Question 14

Other Nitrates

Answer 14

Isosorbide dinitrate (IR) - 3x daily 
Isosorbide mononitrate (ER) - 2x daily *isomer to remember er*

Question 15

Ranolazine

Answer 15

used to increase efficiency of heart beating; may be added to BB, CCBs, or nitrates

Question 16

Adverse Effects of Ranolazine

Answer 16

QT prolongation
Elevation in BP
Constipation, dizziness, nausea, headache

Question 17

Drug Interactions with Ranolazine

Answer 17

CYP3A4 inhibitors
QT prolonging drugs
CCB - can inhibit except for Amlodipine

Question 18

Common counseling points for BB

Answer 18

• patients may be drowsy

- do not discontinue BB abruptly as patient may experience a ‘rebound tachycardia’

Question 19

Common counseling point for CCB

Answer 19

• avoid combining with beta-blockers

Question 20

Reduction of Risk Factors

Answer 20

• smoking cessation
• reduction of cholesterol
• reduction of hypertension
• adequate treatment of diabetes
• increase exercise

Question 21

Myocardial Infarction (MI)

Answer 21

heart attack, necrosis (death) of the myocardium due to ischemia (lack of oxygen)

Question 22

Tests For MI

Answer 22

EKG
CK-MB
Troponin I and T

Question 23

Immediate Treatments for STEMI

Answer 23

MONAB
morphine
oxygen
nitroglycerin
aspirin
beat-blockers

Question 24

What does Morphine do?

Answer 24

vasodilation - decreases myocardial oxygen demand

relieves pain

Question 25

What does Oxygen do?

Answer 25

Increases o2 saturation and supply to myocardium

Question 26

What does nitroglycerin do?

Answer 26

decreases preload increase collateral blood flow to the heart vasodilation helps treat ischemia-related pain

Question 27

What does aspirin do?

Answer 27

Suppresses platelet aggregation (clotting) | Immediately given

Question 28

What do Beta-blockers do?

Answer 28

Decrease HR and contractility | Decrease myocardial oxygen demand

Question 29

What are the Reperfusion Therapy Options?

Answer 29

1. Fibrinolytic | 2. Percutaneous Coronary Intervention (PCI)

Question 30

What are the drugs used to dissolve clots and examples?

Answer 30

Fibrinolytics | ex. Alteplasee (tPA) and reteplase

Question 31

What are the anticoagulants used in reperfusion therapy?

Answer 31

1. Heparin IV 2. Fondaparinuz SQ 3. Bivalirudin IV

Question 32

What are the antiplatelets used in reperfusion therapy?

Answer 32

1. Thienopyridines (CPT) - "grel" 2. Glycoprotein IIb/ IIIa inhibitors 3. Aspirin

Question 33

Why are ACE inhibitors or ARBS used after reperfusion therapy

Answer 33

1. decrease short-term mortality post MI | 2. decrease remodeling of the ventricles

Question 34

Complications of STEMI

Answer 34

1. Ventricular dysrhythmias 2. Cardio shock 3. Heart Failure 4. Cardiac Rupture

Question 35

What meds should all patients post-MI be taking

Answer 35

1. Beta-blocker 2. ACE-I or ARB 3. Antiplatelet drug (aspirin/aspirin+theinopyridine) 4. Statin