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Flashcards in Ischemic Heart Disease Deck (40):
1

types of ischemic heart disease

Angina Pectoris
Chronic stable angina
Unstable Angina
Vasospastic (Prinzmetal's angina)
Myocardial Infarction

2

angina caused by paroxysmal chest squeezing or pressure (can have sensation of smothering or impending doom)

angina pectoris

3

angina exacerbated by physical activity and relieved by rest or SL nitrogen

chronic stable angina

4

angina- increasing pattern of pain in previously stable patients (less responsive to meds, lasts longer, occurs with rest or little exertion)

unstable angina

5

angina occurring in pts due to a spasm of the coronary artery (more likely in morning, at rest. NOT brought on by exertion or emotional stress) Seen in young pts, smokers, or illicit drug users

Prinzmetal's angina

6

how do you diagnose stable ischemic heart disease?

stress testing

7

drugs that decrease myocardial O2 demand

nitrates
calcium channel blockers
beta blockers

8

this drug increases myocardial O2 delivery by reversing coronary spasm

nitrates

9

these drugs relax resistance vessels (decrease afterload)

nitrates
CCB
beta blockers

10

these drugs relax capacitance vessels (decrease preload)

nitrates
CCB

11

these drugs block sympathetic influence on the heart (decrease contractility, HR, and O2 demand)

BB

12

these drugs dilate coronary arteries, increasing oxygen supply

nitrates

13

these drugs cause all segments of the vascular system to relax, resulting in pooling of blood in the veins (decreasing preload and work). They also dilate coronary vasculature and increase blood supply to the heart. Also decreases platelet aggregation

nitrates

14

this class has significant first pass effect in the liver, so you should distribute it transdermally or sublingually

nitrates

15

acute adverse effects of this drug include HA, orthostatic hypotension, facial flushing, and tachycardia

nitrates

16

tolerance with this drug occurs rapidly and manifests as tachyphylaxis (should be given 8 hours off per day)

nitrates

17

this drug interacts with sildenafil (viagra)

nitrates

18

mainstay formulation of nitroglycerin for immediate relief

sublingual

19

these are long acting nitrates, preferred for chronic stable angina

isosorbide dinitrate
isosorbide mononitrate

20

this class decreases myocardial O2 demand at rest and during exercise by decreasing HR and contractility, decreased CO

beta blockers

21

this class decreases sympathetic outflow
inhibits release of renin from kidneys (decreased BP, afterload, and preload)

beta blockers

22

can be used for angina, post MI, HTN, anxiety
avoid in asthma/COPD, CHF, PVD, and vasospastic angina

beta blockers

23

adverse effects include sexual dysfunction, fatigue, insomnia, bradycardia, altered HLD and TG, and rebound HTN for abrupt withdrawal

beta blockers

24

this class can be used in angina (vasospastic and classic), HTN, supraventricular arrhythmias

CCB

25

contraindicated in pts with unstable angina

CCB

26

this class blocks inward movement of ca by binding to L-type calcium channels. Decreases TPR and afterload, increases coronary flow

CCB

27

ADRS: hypotension, effects related to vasodilation, gingival hyperplasia,

CCB

28

this CCB increases constipation, give with a stool softener. Also worsens CHF (negative inotropic effects)

verapamil

29

these CCBs can cause myocardial depression

verapamil
diltiazem

30

these CCBs cause tachycardia

nifedipine
nicardipine

31

this is a late CCB. it is primarily metabolized by CYP3A, so you cant use it with inducers or strong inhibitors or CYP3A

ranolazine

32

treat angina, no concomitant disease

long acting nitrate, BB, CCB

33

treat angina, pt had a recent MI

long acting nitrate, BB

34

treat angina, pt has asthma, COPD

long acting nitrate, CCB

35

treat angina, pt has HTN

(long acting nitrate), BB, CCB

36

treat angina, pt has DM

long acting nitrate, CCB

37

treat angina, pt has CRF

long acting nitrate, (beta blocker), CCB

38

should you combine nitrates with CCB or BB?

Yes
nitrates can cause increase in HR or contractility, and CCB and BB prevent this. BB and CCB can increase work, and nitrates decrease LVEDV

39

All pts with angina pectoris should be on

ASA
BB
ACEI
LDL lowering therapy
SL Nitroglycerin
CCB or long acting nitrates

40

this drug shuld be used routinely in pts with acute and chronic ischemic heart disease. It exhibits an anti-thrombotic effect and reduces the risk of adverse events by 33% or risk of MI

ASA