ischemia5 Flashcards
what are the cardiac effects of beta blockers
decrease oxygen demand
decreasing HR, FOC, and BP
what is the resting HR goal?
50 bpm
what are the drugs of choice in exercise induced angina
beta blockers
bb effect on heart rate can lead to what adverse effect
decrease in perfusion
some studies showed beta blockers are better than CCB’s with improvement to what
symptomactic improvement
why should BB’s not be used with nonDHPs
both work at SA and AV nodes
what are two common adverse cardiac effects with beta blockers?
how is this avoided?
- increased end-diastolic volume (increases oxygen demand)
- increased ejection time (increases oxygen demand)
avoided by concomitant use with nitrates
increased end diastolic volume refers to what
more blood in the heart, increasing oxygen demand
what are some contraindications with beta blockers
- bradycardia
- asthma
- AV block
- unstable left ventricular failure
- raynauds syndrome
why can beta blockers impair exercise tolerance?
decrease sympathetic response to exercise; no increase in HR cutting back time someone can exercise
what are some adverse effects noted with BB’s
- fatigue
- erectile dysfunction
- hypoglycemia
- impaired exercise tolerance
why is hypoglycemia common with BB’s
masks the tremors associated with low blood sugar
what is the only symptom of hypoglycemia when taking BBs
sweating
what are two types of drugs that can be used for variant angina
nitrates and Ca channel blockers
what is a second line agent for chronic stable angina
ranolazine (Ranexa)
when is ranolazine used
in pt’s who experience continued angina despite max medical management and revascularization
ranolazine has cardiac effects how?
what is not effected
it decreases oxygen demand
no effect on oxygen supply, HR and BP
what are some adverse effects are associated with ranolazine
- dizziness
- constipation
- QT prolongation (K levels off)
what should be monitored when on ranolazine
ECG and K levels
what drug interactions are important to note with ranolazine
CYP3A4 inhibitors (verapamil and diltiazem)
digoxin
Simvastatin
Digoxin
what is the max dose of ranolazine if taking verapamil or diltiazem
500 mg BID
what is the max dose of simvastatin given in combo with ranolazine
20mg per day
arterial relaxation results in:
a. increased afterload
b. decreased afterload
c. increased preload
d. decreased preload
b. decreased afterload
which type of ischemic heart diseased is characterized by plaque rupture but normal tropronin levels?
a. stable angina
b. unstable angina
c. NSTEMI
d. STEMI
b. unstable angina
