Stable Angina Flashcards
(40 cards)
What are the two types of angina and what is the difference between them>
- Stable Angine: predictable chest pain caused by exerction or stress that is relieved by NTG or Rest
- Unstable Angina: ACS where chest pain increases with NO help from NTG or rest
What is the pathophysology of Chest Pain?
- Imbalence of myocardial oxygen demand [workload] and supply [Blood Flow]”
- Oxygen demand is normally decreased due to atherosclerosis [plaque] within the coronary arteries
“like Increased HR, contractility or left ventrcular wall tension
What is the chest pain called when it is called by Coronary Artery Vasospams?
- Vasopastic Anigna [can happen at rest]
What are the risk factors for Stable Angina?
- HTN
- Smoking
- Dyslipidemia
- Diabetes
- Obseity
- Inactive
What is the Cardiac Stress Test?
- Test to increase Oxygen demand by exercise [walking or cycling] or by medications [adenosine, dipyridamole, dobutatine…]
- As oxygen increases; looking to see if any chest pain, lightheadedness, changes to HR or BP
What are some of the Non-Drug Treatment for Stable Angina?
- Heart Healthy diet with >150 mins of activity weekly
- BMI 18.5 - 24.9 and Waist of < 35in in females and < 40in in males
- Quit smoking
- Alcohol drink 1/d in women and 1-2/d in men
- Chronic NSAIDS stopped
What are some of the treatment options that can help with the treatment goals of stable angina?
- ACE/ARBs = HTN
- Statins = Dyslipidemia
- Antiplatelets = preventing clots
- Antianginals = decrease demend or increase supply of oxygen
Antiplatent = Aspirin
Antianginals = BB, CCBs, nitrates
What is the treatment approach for stable angina?
- A: Antiplatelets and Antianginal
- B: Blood Pressure
- C: Cholesterol [statins] & Smoking [Cessation]
- D: Diet and Diabetes
- E: Exercise
What are the 2 antiplatelet drugs used?
- Aspirin [Bayer, bufferin, Ecotrin]
- Clopidogrel [Plavix]
What is the MOA of Aspirin?
- Irreversibly inhibits COX 1 & 2 = decrease in prostaglandin and tromboxane A2 [TXA2 is a vasoconstrictor and platelet aggreagator]
75 - 100mg daily
What iare the contraindications for Aspirin?
-
- Sailcylate Allergy
- Childern and Teens [Reyes Syndrome]
What are the warnings for Aspirin>
- Bleeding [even GI Bleeding] and Tinnitus [Signs of an overdose]
What are the side effects of Aspirin?
- Dyspepsia, Heartburn, Bleeding
What are some other notes about aspirin?
- Used FOREVER in stable angina
- Non-enteric coated is used in ACS; if Enteric coated, be sure to chew it
- Can use with PPIs to protect GI but risk of decreased bone density and increase infection
What is the MOA for clopidogrel?
- Prodrug that Irreversibly inhibits P2Y12 platelet activation and aggregation
What is the Boxed Warning for Clopidogrel?
- Prodrug so it need conversion from 2C19; if poor metabolizer then that could increase cardio issues
What are the contraindications for Clopidogrel
- BLEEDING [even GI]
What are the warnings for clopidogrel?
- Bleeding risk [stop 5 days before surgery]
- DO NOT use with Omeprazole or Esomprazole [Increase thrombosis risk]
- Thrombotic Thrombocytopenic Purpura [TTP]
What are some of the anitianginal treatments that are used?
- Beta Blockers
- CCBs
- Nitrates
- Ranolazine
What is the way that Beta Blockers are used in Antianginal treatment?
- Reduce myocardial demand by decreasing HR, Contractility, and left ventricular wall tension
- AVOID in vasospastic angina
What is the way that Calcium Channel Blockers are used in Antianginal Treatments?
- Reduce Myocardial Oxygen demand by; Non-DHP decreasing HR and Contractility & DHP decreasing SVR
- Avoid using Nifedipine IR; DHP are preferred to use with Beta Blockers
- PREFERRED in Vasospastic Angina
What are the way that Nirates are used in Antianginal treatments?
- Reduce myocardial oxygen demand by decreasing preload [because of the nitric oxide free radials causing vasodilation]
- SL tab and TL spray are the most common
What is the MOA of Ranolazine and how does it work as an antianginal treatment?
- Selectively inhibits the laste phase Na current and decrease intracelular Ca = decrease oxygen demand
What are the contraindications for Ranolazine?
- DO NOT use with strong 3A4 inhibitors or inducers
