Ischemic Heart Disease & Acute Coronary Syndromes

Question 1

Define stable angina

Answer 1

also known as stable ischemic heart disease
associated with predictable chest pain, often brought on by exertion or emotional stress and relived within minutes by rest or with nitroglycerin

Question 2

Define unstable angina

Answer 2

type of acute coronary syndrome

the chest pain increases (in frequency or duration) and is not relieved with nitroglycerin or rest

Question 3

Define prinzmetal’s angina

Answer 3

chest pain due to vasospasm of coronary arteries; it is unpredictable and can occur at rest but is not usually associated with underlying CAD

Question 4

Define acute coronary syndrome

Answer 4

acute chest pain that is severe and not relieved by rest or nitroglycerin; acute medical care is needed (includes UA, NSTEMI, STEMI)

Question 5

Define silent ischemia

Answer 5

transient myocardial ischemia without symptoms of chest pain

Question 6

common cause of stable angina or stable ischemic heart disease

Answer 6

atherosclerosis or CAD

Question 7

recommended antiplatelet for IDK

Answer 7

ASA

Question 8

What is the first line anti-anginal for IHD

Answer 8

beta-blockers

Question 9

ASA MOA

Answer 9

binds irreversibly cyclooxygenase-1 and 2 (COX 1 and 2) enzymes which results in decreased prostaglandin and thromboxane A2 production. TXA2 is a potent vasoconstrictor and inducer of platelet aggregation.

Question 10

Clopidogrel MOA

Answer 10

prodrug that irreversibly inhibits P2Y12 ADP-mediated platelet activation and aggregation

Question 11

which cyp enzyme converts clopidogrel from its prodrug

Answer 11

Cyp2C19

Question 12

DAPT for bare metal stent

Answer 12

1 month

Question 13

DAPT for drug-eluting stent

Answer 13

6 months

Question 14

DAPT post-CABG

Answer 14

12 months

Question 15

Which drug should be avoided in prinzmetal’s angina

Answer 15

BB

Question 16

Ranolazine MOA

Answer 16

selectively inhibits the late phase Na current and decreases intracellular Ca; may decrease myocardial oxygen demand by decreasing ventricular tension and O2 consumption

Question 17

Nitroglycerin CI

Answer 17

concurrent use with PDE-5 inhibitor

-cause a decrease in BP

Question 18

What is required when using a long acting nitrate to reduce tolerance

Answer 18

10-12 hour nitrate-free period

Question 19

Define ACS

Answer 19

results from plaque buildup in the coronary arteries that causes sudden, reduced blood flow and an imbalance between myocardial oxygen supply and demand

Question 20

3 things that ACS encompasses

Answer 20

NSTEMI
STEMI
UA

Question 21

classic symptoms of ACS

Answer 21

chest pain lasting > 10 min
severe dyspnea
diaphoresis
pain can radiate to the arms, back, neck, jaw, epigastric

Question 22

treatment for ACS

Answer 22

MONA-GAP-BA
morphine
oxygen
nitrates
asa

Gpllb/llla antagonist
anticoagulants
P2Y12 inhibitors

beta blockers
acei

Question 23

Define PCI

Answer 23

coronary revascularization procedure that involves inflating a small balloon inside a coronary artery to widen it and improve blood flow. Usually metal mesh, called a stent is placed into the artery afterward to keep the artery owpen

Question 24

MOA of morphine in ACS

Answer 24

produces arterial and venous dilation: leading to a decrease in myocardial O2 demand; provides pain relief

Question 25

List GPllb/llla receptor antagonists (3)

Answer 25

abciximab eptifibatide trofiban

Question 26

MOA GPllb/llla receptor antagonists in ACS

Answer 26

block fibrinogen from binding to the GPllb/llla receptors on platelets preventing platelet aggregationf

Question 27

List P2Y12 inhibitors

Answer 27

clopidogrel prasugrel ticagrelor

Question 28

Which P2Y12 inhibitors are irreversible

Answer 28

clopidogrel | prasugrel

Question 29

CI to prasugrel

Answer 29

history of TIA or stroke

Question 30

Fibrinolytics MOA

Answer 30

cause fibrinolysis (clot breakdown) by binding to fibrin in a thrombus (clot) and converting entrapped plasminogen to plasmin.

Question 31

Fibrinolytics are only used for what

Answer 31

STEMI

Question 32

time to deliver a PCI

Answer 32

90 minutes door-to-balloon-time | 120 minutes of first medical contact

Question 33

When should a fibrinolytic be administered

Answer 33

within 30 minutes of hospital arrival

Question 34

List fibrinolytics (3)

Answer 34

alteplase tenecteplase reteplase

Question 35

CI to finbrinolytics

Answer 35

history of recent stroke prior ICH severe uncontrolled HTN