IHD - CAD √ Flashcards by kyle choy

What work up should you do for someone with chest pain?

Hemoglobin
Fasting glucose
Fasting lipoprotein
Chest X-ray
Cardiac bio markers
Resting ECG

How well did you know this?

Not at all

Perfectly

What defines Class I-IV mean for angina

Class I - strenuous physical activities or prolonged = angina
Class II - Able to walk 2 blocks or 1 flight without angina and only occurs under stress = Angina
Class III - Walking 2 block or 1 flight causes = Angina
Class IV - can be caused at rest or any activity = Angina

How well did you know this?

Not at all

Perfectly

Can you rely on ECG for Ischemia

No bc 50% do not have a normal ECG

How well did you know this?

Not at all

Perfectly

words the describe the severity of Ischemia

How well did you know this?

Not at all

Perfectly

How do you confirm CAD

Cardio angiogram

How well did you know this?

Not at all

Perfectly

Risk factors for SIHD or CCD

Smoking one for the highest to lower 33%
Blood pressure
Lipid
Diabetes
Physical activity 30-60 for 5 days
Weight management - 18.5 and 24.9 BMI (5-10% if need weight loss)
Influenza
Alcohol consumption - 1 drink per day

How well did you know this?

Not at all

Perfectly

What are the drugs that we can use for MVO2 increase

Nitrate
Beta blocker
Nifedipine
Verapamil
Dilizaem
Aspirin

How well did you know this?

Not at all

Perfectly

Aspirin Side Effects

GI bleeding (can be a contraindication if had previously)
Gi upset with EC aspirin

How well did you know this?

Not at all

Perfectly

What medication can i use if im allergic to Aspirin

Clopidogrel 75 mg

How well did you know this?

Not at all

Perfectly

In practice, when are the 4 types of pt to use ACEi

IHD who have:
HTN
diabetes
LVEF ≤40%
CKD

How well did you know this?

Not at all

Perfectly

What can become an issue with chronic use of nitrates

Nitrate tolerance

How well did you know this?

Not at all

Perfectly

Benefits on Sublingual nitrate

Fast acting

How well did you know this?

Not at all

Perfectly

Isosobride dinitrae dosing

5-20 mg TID (onset 20-40 mins)

How well did you know this?

Not at all

Perfectly

Do I dose Isosobride Dinitrae TID q8hrs

no bc of the tolerance and last dose should be given at 7 pm

How well did you know this?

Not at all

Perfectly

Ismo, Monoket dosing

Ismo, monoket - 20 mg BID (onset 30-60mins)

How well did you know this?

Not at all

Perfectly

Imdur dosing

30 - 120 mg QD
Isosobride mononitrate

How well did you know this?

Not at all

Perfectly

What is a pro of Imdur?

after 6 weeks it is effect for 12 hours

How well did you know this?

Not at all

Perfectly

What is a pro of Isosobride Mononitrae

Can be used in hepatic failure patients and it isn’t eliminated through the liver

How well did you know this?

Not at all

Perfectly

Sublingal dosing for Nitrate

0.4 mg q 5min Prn

How well did you know this?

Not at all

Perfectly

Dosing for Nitrate ointment

2% 1/2 - 2 inchs TID - QID

How well did you know this?

Not at all

Perfectly

Dosing for Nitrate IV

5-300mcg/min

How well did you know this?

Not at all

Perfectly

Dosing for Nitrate Patch

0.2-0.8 mg/h for 12-16 then off for 8-12

How well did you know this?

Not at all

Perfectly

Can you build up a nitrate tolerance and how long should you go off nitrates?

Yes you can so you must give a nitrate free interval
10-14hr

How well did you know this?

Not at all

Perfectly

4 Consulting points for nitroglycerin

3mins 75% of people resolved next 2 15% of people resolved if it is CAD angina
NEED TO HAVE THEM SIT BEFORE ADMINISTRAITON
Keep away from light
Seek medical if 1 does doesn’t work

How well did you know this?

Not at all

Perfectly

What is the benefit of oral nitroglycerin agents

Prophylaxis against angina

What are the AD for Nitrates and what are the 4 bolded side effects

Common HEADACHE FACIAL FLUSHING Halitosis Rash -more with the patch Serious SYNCOPE and HYPOTENSION TACHYCARDIA Unexplained bradycardia Methomoglobinemia ( rare) Heparin resistances

What are the 3 contraindications for nitrates

HOCM (hypertrophic obstructive cardiomyopathy) Acute right ventricular MI - bc blood flow very sensitive (preload) Concurrent use of PDE-5i

Pt education points for sub nitroglycerin (test question)

What are the 6 ideal patients for I would use beta-blockers in?

ANGINA DUE TO PHYSICAL ACTIVITIES HTN SVT Post MI Anxiety induce angina LVEF ≤ 40% w/ or w/o MI

What are the treatment goals with beta-blockers and at what level of doses do we initiate

resting HR 50-60 bpm Start on the lowest dose

If patient is have adverse effect with BB how do we take them off?

tapering off over 2-3 weeks

What determines the duration of use for Beta-blockers

1 year if LV is normal after MI/ACS but indefinitely if reduced LV or can be chronic in IHD with stable Angina

Starting dose for Metropolol Tartate IR

Metoprolol - 25-450 mg PO 2-3x a day

Starting dose for Metropolol Succinate

25mg-450 po daily

When do we use Metropolol Succinate over Tartate

when pt LVEF ≤ 40%

Dosing for early ACS treatment with Metropolol

5 mg IV q 5 minutes x 3 for early ACS only

Carvedilol IR starting dose

IR*: 3.125 – 25 mg PO twice daily

Coreg CR starting dose

CR: 10 – 80 mg PO daily

what are 2 Benefits to using Carvedilol

Alpha and Beta blocking taking with food can reduce Hypotension side effect

What dose of Carvedilol do we give in a patient that is over 85 kg

50 mg po BID

Atenolol starting dose

50-200 mg PO daily

Out of the 3 beta blockers for IDH which one is renaly eliminated

Atenolol the rest are hepatically eliminated

What are the 4 ideal patients for CCB

Intolerance/contraindications to BB Pt with Conduction(electrical) heart disease (DHP only) Pt with vascular disease or severe ventricular dysfunction Pt with HTN

Which CCB can I use with Pt with conduction Heart disease?

Non-DHP (Verapamil and Diltiazem)

What CCB can we give to a patient that has a IHD but has a vascular problem or severe ventricular dysfunction

Amlodipine

What CCB can I use to treat someone that has a IHD but also has a Conduction system disease

DHP amlodipine Nicardipine Nifedipine Felodipine

What 2 patients in IHD is Ranazoline indicated for

Chronic effort Angina and presumed microvascular disease

For Ranexa when can I add it in my therapy regiment?

Only in combo when pt BP is >130/80 and Nitrates, Amlodipine or BB are maxed out

What are the DDI that are contraindicated in Ranazoline

Hepatic failure Strong CYP3A4 inhibitors (ketoconazole, clarithromycin, nelfinavir) CYP3A4 inducers (Carbamazepine, Phenytoin, Phenobarbital, St johns worts, Glucocorticoids)

Ranolazine effects which 5 drugs/effects

inhibitor Simvastatin Digoxin CYP2D6 (antidepressants and codine) prolongs QTC metformin

Ranexa side effects

nausea constipation dizziness headache

Ranolazine dosing

500 BID Max 1000 BID in 1 -2 weeks

What is does the regiment look like for all SIHD/CCD pts

1. Aspirin or clopidogrel 2. BB 3. Spray or sublingual nitro EVERYONE WILL HAVE 1-3 4. CCB or long nitrates if BB contra or if not reaching relive of symptoms 5. LDL and ACE for lipid and HTN 6. Ranolazie if still not effective treatment 7. Rivaroxaban 2.5 BID maybe

Therapy slide for SIHD/CCD must know if anything (PIC)

If the patient has Vasospastic Angina what medications do I add after giving them sublingual nitrates

IF BP < 130/80: add nitrate ER IF BP ≥ 130/80: add CCB (basically, I need a prophylactic medication)

Once the patient is on a sublingual nitrate what medications can I give to control their heart rate

HR >60 BB is the first line unless contra then use non-DHP CCB or Nitrate ER

When would I add Rivaroxaban?

In combo with ASA or clopidogrel in patients that are low to moderate bleeding risk but high risk individuals for IHD

What are the 3 types of PCI and which one do we do the most?

W/O stent - inflate the ballon and push the plaque back W/ stent - inflate the ballon and put a metal cage left behind to hold open artery W/ anti-proliferative drug - same as above just with drug to prevent restenosis

What are the complications with PCI

You can get restenosis - smooth muscles grows over the metal cage This is why we use the drug stents

When is CABG preferred over PCI

Left main coronary stenosis 3-vessel disease - 3 main lines are blocked Diabetic

What must be giving post CABG

Post-CABG statin therapy post CABG antiplatelet therapy

SIHD treatment guideline