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PHRM841 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What are the three types of angina?

A

-prinzmetal’s variant angina
-chronic stable angina
-unstable angina

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2
Q

What causes prinzmetal’s variant angina?

A

vasospasm

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3
Q

What causes chronic stable angina?

A

fixed stenosis

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4
Q

What causes unstable angina?

A

thrombus

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5
Q

Do most coronary artery disease drugs act on myocardial oxygen supply or demand?

A

oxygen demand

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6
Q

How does increased heart rate, contractility, afterload, and preload affect oxygen consumption?

A

increase oxygen consumption

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7
Q

Is ischemia a physiological outcome or clinical symptom?

A

physiological outcome

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8
Q

Is angina a physiological outcome or clinical symptom?

A

clinical symptom

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9
Q

What characterizes stable versus unstable angina?

A

consistent symptoms of anginal episodes over last few months

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10
Q

What is the clinical presentation acronym for stable angina?

A

PQRST

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11
Q

What does PQRST stand for?

A

P: Precipitating factors and palliative measures
Q: Quality and quantity of pain
R: Region and radiation
S: Severity of pain
T: Timing and temporal pattern

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12
Q

What are typical stable angina symptoms?

A

-substernal chest pain
-short duration (usually 0.5 - 20 minutes)
-pain relief with nitroglycerin and/or rest

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13
Q

What ECG findings denote stable angina?

A

ST-segment depression during anginal episode

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14
Q

What is the treatment goal for dyslipidemia?

A

≥50% reduction in LDL

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15
Q

What are the preferred treatments for dyslipidemia?

A

-lifestyle modifications
-low saturated fat (<7%)
-low cholesterol (<200 mg/dL)
-moderate- to high-intensity statin

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16
Q

What is the treatment goal for hypertension?

A

BP: <130/80 mm Hg

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17
Q

What are the preferred treatments for hypertension?

A

-lifestyle modifications
-pharmacological treatment (beta blockers, ACEis, ARBs, etc.) as necessary

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18
Q

What is the treatment goal for diabetes mellitus?

A

HbA1c: <7%

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19
Q

What are the preferred treatments for diabetes mellitus?

A

-individualized based on each patient
-SGLT2-inhibitor or GLP-1 RA for patients with T2DM and high ASCVD risk

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20
Q

What is the treatment goal for smoking?

A

complete smoking cessation/exposure

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21
Q

What are the preferred treatments for smoking?

A

-systematic strategy
-pharmacotherapy

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22
Q

What are the treatment goals for weight management?

A

-BMI: 18.5-24.9
-waist circumference: 35 (women) or 40 (men)
-weight loss: 5-10% initially

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23
Q

What are the preferred treatments for weight management?

A

-diet/lifestyle counseling
-printed educational materials and encourage weight loss

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24
Q

What are the treatment goals for physical activity?

A

-30-60 minutes of moderate intensity activity 5-7 days per week
-cardiac rehabilitation/supervision

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25
Q

What are the preferred treatments for physical activity?

A

-brisk walking
-swimming
-cycling
-increased daily activities

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26
Q

What are risk factor modifications for stable angina?

A

-influenza vaccination
-alcohol consumption
-exposure to air pollution
-management of psychological factors

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27
Q

What medications decrease cardiovascular risk?

A

-aspirin
-P2Y12 inhibitors
-ACE inhibitors

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28
Q

What medications manage anginal symptoms?

A

-nitrates
-beta blockers
-calcium channel blockers
-ranolazine

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29
Q

What is the loading dose for aspirin?

A

162-325 mg

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30
Q

What is the maintenance dose for aspirin?

A

75-162 mg QD

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31
Q

What is the loading dose for clopidogrel?

A

300-600 mg

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32
Q

What is the maintenance dose for clopidogrel?

A

75 mg QD

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33
Q

What is the loading dose for prasugrel?

A

60 mg

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34
Q

What is the maintenance dose for prasugrel?

A

10 mg QD

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35
Q

What is the loading dose for ticagrelor?

A

180 mg

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36
Q

What is the maintenance dose for ticagrelor?

A

90 mg BID

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37
Q

What are the prodrug P2Y12 inhibitors?

A

clopidogrel and prasugrel

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38
Q

What is the dose of aspirin with concurrent use of ticagrelor?

A

≤81 mg

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39
Q

What conditions are colchicine contraindicated in?

A

severe renal and hepatic disease

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40
Q

What are the effects of nitrates on myocardial oxygen demand?

A

-increase heart rate
-decrease systolic pressure
-decrease left ventricular volume (significantly)

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41
Q

What are the effects of beta blockers on myocardial oxygen demand?

A

-decrease heart rate (significantly)
-decrease myocardial contractility
-decrease systolic pressure
-increase left ventricular volume

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42
Q

What are the effects of nifedipine on myocardial oxygen demand?

A

-increases heart rate
-no effect/decreases myocardial contractility
-decreases systolic pressure (significantly)
-no effect/decreases left ventricular volume

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43
Q

What are the effects of verapamil on myocardial oxygen demand?

A

-decreases heart rate (significantly)
-decreases myocardial contractility
-decreases systolic pressure
-no effect/decreases left ventricular volume

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44
Q

What are the effects of diltiazem on myocardial oxygen demand?

A

-decreases heart rate
-no effect/decreases myocardial contractility
-decreases systolic pressure
-no effect/decreases left ventricular volume

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45
Q

What are the effects of ranolazine on myocardial oxygen demand?

A

no effects

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46
Q

What is the dosing for nitroglycerin sublingual tablets?

A

0.3-0.6 mg SL PRN for angina; repeat dose 1-3 times Q5 minutes

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47
Q

What is the dosing for nitroglycerin spray?

A

0.4 mg SL PRN for angina; repeat dose 1-3 times Q5 minutes

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48
Q

What is the dosing for nitroglycerin powder packets?

A

0.4 mg SL PRN for angina; repeat dose 1-3 times Q5 minutes

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49
Q

What are counseling points for nitroglycerin sublingual tablets?

A

-keep in original dark glass container
-do not administer with safety cap
-place under tongue; do not swallow tablet
-remove cotton plug before dispensing
-do not store in bathroom or humid locations
-keep on hand at all times
-need refill every 6 months
-educate patient on proper administration and procedure

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50
Q

What are counseling points for nitroglycerin sublingual spray?

A

-spray under tongue; do not inhale
-do not shake bottle
-keep on hand at all times
-need refill every 3 years
-educate patient on proper administration and procedure

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51
Q

nitrate adverse effects

A

-headache
-hypotension
-dizziness
-lightheadedness
-facial flushing
-reflex tachycardia

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52
Q

What is the time period between avanafil and nitrates?

A

12 hours

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53
Q

What is the time period between sildenafil/vardenafil and nitrates?

A

24 hours

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54
Q

What is the time period between tadalafil and nitrates?

A

48 hours

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55
Q

What is the brand name for atenolol?

A

Tenormin

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56
Q

What is the maintenance dose for atenolol?

A

50-100 mg QD

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57
Q

What is the brand name for metoprolol tartrate?

A

Lopressor

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58
Q

What is the maintenance dose for metoprolol tartrate?

A

50-100 mg BID

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59
Q

What is the brand name for metoprolol succinate?

A

Toprol XL

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60
Q

What is the maintenance dose for metoprolol succinate?

A

100-200 mg QD

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61
Q

What is the brand name for propranolol LA?

A

Inderal LA

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62
Q

What is the maintenance dose for propranolol LA?

A

80-160 mg QD

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63
Q

Which beta blockers are B1 selective?

A

-atenolol
-metoprolol

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64
Q

Which beta blockers are non-selective?

A

-carvedilol
-propranolol

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65
Q

What are the adverse effects of beta blockers?

A

-sinus bradycardia
-sinus arrest
-AV block
-reduced left ventricular ejection fraction
-bronchoconstriction
-fatigue
-depression
-nightmares
-sexual dysfunction
-exercise intolerance
-intensification of insulin-induced hypoglycemia and peripheral vascular complication

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66
Q

What is the goal resting heart rate for patients on beta blockers?

A

50-60 bpm

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67
Q

What is the goal exercise heart rate for patients on beta blockers?

A

<100 bpm OR 75% of heart rate that typically causes angina

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68
Q

Are DHP CCBs more vascular or myocardial selective?

A

vascular selective

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69
Q

What is the brand name for amlodipine?

A

Norvasc

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70
Q

What is the maintenance dose for amlodipine?

A

5-10 mg QD

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71
Q

What is the brand name for felodipine-ER?

A

Plendil

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72
Q

What is the maintenance dose for felodipine-ER?

A

5-10 mg QD

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73
Q

What is the brand name for nifedipine-CC?

A

Adalat-CC

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74
Q

What is the maintenance dose for nifedipine-CC?

A

30-60 mg QD

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75
Q

What is the brand name for nifedipine-XL?

A

Procardia-XL

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76
Q

What is the maintenance dose for nifedipine-XL?

A

30-60 mg QD

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77
Q

What are the brand names for verapamil?

A

-Calan
-Isoptin

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78
Q

What is the maintenance dose for verapamil?

A

60-90 mg TID-QID

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79
Q

What are the brand names for verapamil-SR?

A

-Calan-SR
-Isoptin-SR
-Covera-HS
-Verelan

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80
Q

What is the maintenance dose for verapamil-SR?

A

240 mg QD

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81
Q

What is the brand name for diltiazem?

A

Cardizem

82
Q

What is the maintenance dose for diltiazem?

A

80-120 mg TID

83
Q

What is the brand name for diltiazem-SR?

A

Cardizem SR

84
Q

What is the maintenance dose for diltiazem-SR?

A

60-120 mg BID

85
Q

What is the brand name for diltiazem-CD?

A

Cardizem CD

86
Q

What is the maintenance dose for diltiazem-CD?

A

180-360 mg QD

87
Q

What is the brand name for diltiazem-XR?

A

Dilacor-XR

88
Q

What is the maintenance dose for diltiazem-XR?

A

180-540 mg QD

89
Q

What are the brand names for diltiazem-ER?

A

-Tiamate
-Tiazac

90
Q

What is the maintenance dose for diltiazem-ER?

A

180-360 mg QD

91
Q

What are the adverse effects for DHP CCBs?

A

-hypotension
-flushing
-headache
-dizziness
-peripheral edema
-reduced myocardial contractility
-reflex adrenergic activation

92
Q

What are the adverse effects for non-DHP CCBs?

A

-reduced myocardial contractility
-bradycardia
-AV block
-hypotension
-flushing
-headache
-dizziness
-constipation

93
Q

What are the monitoring parameters for DHP CCBs?

A

-signs/symptoms of edema
-blood pressure

94
Q

What is the monitoring parameter for non-DHP CCBs?

A

heart rate

95
Q

How long is the nitrate free period?

A

10-12 hours

96
Q

What is the dosing interval for nitroglycerin patch?

A

QD

97
Q

What is the dosing interval for isosorbide dinitrate tablets?

A

BID-TID

98
Q

What is the dosing interval for isosorbide mononitrate tablets?

A

BID (7 hours apart)

99
Q

What is the dosing interval for isosorbide mononitrate SR tablets?

A

QD

100
Q

What is the dosing for ranolazine?

A

500-1000 mg PO BID (titrate over 1-2 weeks)

101
Q

What drug class is considered first-line treatment for chronic stable angina?

A

beta blockers

102
Q

What are contraindications for beta blockers in the treatment of chronic stable angina?

A

-prinzmetal’s/vasospastic angina
-conduction disturbances
-bradycardia
-high degree AV block or sick sinus syndrome (with no pacemaker)

103
Q

Are non-DHP or DHP CCBs preferred for the treatment of chronic stable angina?

A

non-DHP CCBs

104
Q

What are contraindications for non-DHP CCBs in the treatment of chronic stable angina?

A

-HFrEF
-bradycardia
-high degree AV block or sick sinus syndrome (with no pacemaker)

105
Q

What is the contraindication for DHP CCBs in the treatment of chronic stable angina?

A

HFrEF

106
Q

Is monotherapy or combined therapy of nitrates preferred?

A

combined therapy

107
Q

When should nitrates be used with caution?

A

-hypertrophic obstructive cardiomyopathy
-severe aortic stenosis
-phosphodiesterase inhibitor use

108
Q

What combination therapy in the treatment of chronic stable angina should be avoided?

A

non-DHP CCBs and beta blockers

109
Q

What is the stepwise therapy for pain management for patients with chronic stable angina?

A

-nonpharmacological treatment
-acetaminophen
-ibuprofen or naproxen

110
Q

What NSAIDs should be avoided with concurrent use of aspirin?

A

celecoxib and diclofenac

111
Q

How far apart should aspirin and NSAIDs be taken?

A

take aspirin at least 2 hours prior to NSAIDs

112
Q

What causes a spontaneous myocardial infarction?

A

atherosclerotic plaque rupture

113
Q

What causes a myocardial infarction secondary to ischemic imbalance?

A

oxygen supply/demand mismatch to heart

114
Q

What is the most common type of ACS?

A

NSTEMI

115
Q

What are risk factors for ACS?

A

-older age
-male
-family history of CAD
-peripheral artery disease
-diabetes
-renal insufficiency
-smoking
-history of MI

116
Q

What are precipitating factors for ACS?

A

-recent exercise
-extreme weather (hot or cold)
-large meal
-emotions
-sexual activity
-walking against the wind
-smoking

117
Q

What populations are atypical symptoms more common in?

A

-elderly
-females
-diabetics
-impaired renal function
-dementia

118
Q

What are atypical symptoms of ACS?

A

-epigastric pain
-indigestion
-stabbing or pleuritic pain
-increasing dyspnea in the absence of chest pain

119
Q

How soon upon arrival at the emergency department should a patient receive an ECG?

A

within 10 minutes

120
Q

What type of ACS shows Q wave changes on an ECG?

A

STEMI

121
Q

How soon upon arrival at the emergency department should a patient’s troponin be measured?

A

ASAP

122
Q

What type of troponin is preferred?

A

high sensitivity troponin

123
Q

What unit of measurement is troponin measured in?

A

ng/L

124
Q

What level of troponin indicates a myocardial injury?

A

> 14 ng/L

125
Q

How often should troponin be measured?

A

3 levels every 3-6 hours for the first 12 hours

126
Q

What characterizes unstable angina?

A

-unexpected chest pain that may occur at rest, while sleeping, or with little physical exertion
-more severe than stable angina
-lasts longer than stable angina (may be >30 minutes)

127
Q

Is angina usually relieved by SL NTG in MI?

A

No

128
Q

What characterizes NSTEMI in an ECG?

A

ST depression or T wave inversion

129
Q

If the initial ECG is not diagnostic but the patient remains symptomatic and there is a high clinical suspicion for ACS, how often should serial ECGs be performed?

A

every 15-30 minutes for the first hour

130
Q

What does MONA stand for?

A

-morphine
-oxygen
-nitroglycerin
-aspirin

131
Q

What is the initial dose of morphine for the treatment of ACS?

A

4-8 mg IV, then 2-8 mg IV Q5-15 minutes (if angina continues)

132
Q

What are side effects of morphine?

A

-sedation
-respiratory depression
-nausea/vomiting

133
Q

What is the treatment goal for oxygen?

A

oxygen saturation >90%

134
Q

When should IV nitroglycerin be used for ACS?

A

persistent ischemia, HF, or HTN

135
Q

What is the dosing for IV nitroglycerin?

A

10 mcg/min, then titrate by 5 mcg/min Q5 minutes

136
Q

What is the maximum dose for IV nitroglycerin?

A

200 mcg/min

137
Q

When can be enteric-coated aspirin be used for ACS?

A

if the patient chews the aspirin

138
Q

What fibrinolytics are weight-based dosing?

A

tenecteplase and alteplase

139
Q

Is there a preference for any of the fibrinolytics?

A

No

140
Q

What are the reperfusion therapy options for a patient presenting with STEMI?

A

-percutaneous coronary intervention (PCI)
-fibrinolytic

141
Q

What is the door-to-needle time for reperfusion therapy for a patient with a STEMI?

A

within 30 minutes of hospital arrival

142
Q

What is the door-to-balloon time for reperfusion therapy for a patient with a STEMI?

A

within 90 minutes of hospital arrival

143
Q

When is a fibrinolytic preferred over a PCI for a patient with a STEMI?

A

if a PCI-capable hospital is ≥120 minutes away

144
Q

What are the reperfusion therapy options for a patient presenting with UA/NSTEMI?

A

-early invasive strategy
-ischemia guided strategy

145
Q

When is cangrelor used for patients with ACS?

A

if patient did not receive loading dose of P2Y12 inhibitor before PCI

146
Q

What are the loading doses for clopidogrel when a fibrinolytic is used concurrently?

A

-no loading dose (age >75)
-300 mg (age ≤75)

147
Q

What P2Y12 inhibitors are recommended for ischemia guided strategy?

A

-ticagrelor
-clopidogrel

148
Q

What is the contraindication for prasugrel?

A

history of TIA/stroke

149
Q

When should prasugrel be avoided?

A

-age ≥75
-<60 kg
-high bleeding risk

150
Q

When should you switch a patient from clopidogrel?

A

inadequate response (genetics or CV event)

151
Q

When should you switch a patient to clopidogrel?

A

-bleeding
-cost
-dyspnea (ticagrelor)
-adherence (ticagrelor)
-stroke/TIA (prasugrel)

152
Q

What P2Y12 inhibitors are preferred for early invasive strategy?

A

-ticagrelor
-prasugrel

153
Q

What P2Y12 inhibitor is preferred with concurrent use of fibrinolytics?

A

clopidogrel

154
Q

What are minor signs and symptoms of bleeding?

A

-bruising
-light nosebleeds
-bleeding gums when flossing

155
Q

What are major signs and symptoms of bleeding?

A

-blood in urine/stool
-coughing up blood
-cut that keeps bleeding after pressure for ≥10 minutes

156
Q

Does aspirin need to be held before a CABG?

A

No

157
Q

How long should ticagrelor be held before an elective CABG?

A

3 days

158
Q

How long should clopidogrel be held before an elective CABG?

A

5 days

159
Q

How long should prasugrel be held before an elective CABG?

A

7 days

160
Q

How long should P2Y12 inhibitors be held before an urgent CABG?

A

24 hours if possible

161
Q

When are GP IIb/IIIa inhibitors administered for patients with NSTEMI?

A

high risk features, such as positive troponin

162
Q

When are GP IIb/IIIa inhibitors administered for patients with STEMI?

A

large thrombus burden

163
Q

Can fondaparinux be used alone for patients undergoing a PCI?

A

No

164
Q

What is the contraindication for fondaparinux?

A

CrCl <30 mL/min

165
Q

When can unfractionated heparin be used in patients with ACS?

A

-ischemia guided strategy
-early invasive strategy
-fibrinolytic
-PCI

166
Q

When should unfractionated heparin be administered until for patients with UA/NSTEMI?

A

-48 hours (ischemia guided strategy)
-until PCI (early invasive strategy)

167
Q

When should unfractionated heparin be administered until for patients with STEMI?

A

-48 hours (fibrinolytic)
-until PCI (PCI)

168
Q

When can bivalirudin be used in patients with ACS?

A

-early invasive strategy
-PCI

169
Q

When can enoxaparin be used in patients with ACS?

A

-ischemia guided strategy
-early invasive strategy
-fibrinolytic

170
Q

When should enoxaparin be administered until for patients with UA/NSTEMI?

A

-duration of hospital stay up to 8 days (ischemia guided strategy)
-until PCI (early invasive strategy)

171
Q

When should enoxaparin be administered until for patients with STEMI?

A

duration of hospital stay up to 8 days (fibrinolytic)

172
Q

When can fondaparinux be used in patients with ACS?

A

-ischemia guided strategy
-fibrinolytic

173
Q

When should fondaparinux be administered until for patients with ACS?

A

duration of hospital stay up to 8 days

174
Q

How soon after an ACS should a beta blocker be initiated?

A

within first 24 hours

175
Q

What is the starting dose of metoprolol tartrate?

A

25-50 mg Q6-12 hours

176
Q

What is the starting dose of carvedilol?

A

6.25 mg BID

177
Q

What is the target dose of carvedilol?

A

25 mg BID

178
Q

What is the starting dose of propranolol?

A

40 mg BID-TID

179
Q

What is the target dose of propranolol?

A

80 mg QID

180
Q

What is the starting dose of atenolol?

A

25-50 mg QD

181
Q

Which beta blockers should be used in patients with HFrEF?

A

-metoprolol succinate
-carvedilol
-bisoprolol

182
Q

When should an IV beta blocker be administered in patients with ACS?

A

hypertensive or ongoing ischemia

183
Q

What is the dosing for IV metoprolol tartrate?

A

5 mg IV Q5 minutes up to 3 doses

184
Q

What type of beta blocker should be administered to a patient with active cocaine use?

A

non-selective beta blocker

185
Q

When should beta blockers be avoided in patients with ACS?

A

heart failure, but continue home dose of beta blockers

186
Q

What are the hold parameters for beta blockers?

A

-HR <50 bpm
-SBP <90 mm Hg and/or DBP <60 mm Hg

187
Q

What are the high-intensity statins?

A

-atorvastatin 40-80 mg QD
-rosuvastatin 20-40 mg QD

188
Q

How soon after an ACS should an ACE inhibitor be initiated?

A

after 24 hours

189
Q

What is the starting dose of captopril?

A

6.25-12.5 mg TID

190
Q

What is the target dose of captopril?

A

25-50 mg TID

191
Q

What is the starting dose of lisinopril?

A

2.5-5 mg QD

192
Q

What is the target dose of lisinopril?

A

≥10 mg QD

193
Q

What is the starting dose of ramipril?

A

2.5 mg BID

194
Q

What is the target dose of ramipril?

A

5 mg BID

195
Q

What is the starting dose of trandolapril?

A

0.5 mg QD

196
Q

What is the target dose of trandolapril?

A

4 mg QD

197
Q

What is the starting dose of valsartan?

A

20 mg BID

198
Q

What is the target dose of valsartan?

A

160 mg BID

199
Q

What are the contraindications for ARBs?

A

-hypotension/shock
-bilateral renal artery stenosis or history of worsening of renal function with ACE inhibitor/ARB exposure
-acute renal failure
-drug allergy/angioedema

200
Q

What are monitoring parameters for ACE inhibitors?

A

-serum creatinine
-potassium
-blood pressure
-angioedema

201
Q

By what percentage increase of serum creatinine should an ACE inhibitor be discontinued?

A

> 30%

PHRM841 (3 decks)

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