Stable Angina Flashcards
(14 cards)
Stable angina is a type of ___ which is associated with __ often brought on by __ or ___ and relieved within ___ by __ or ___
Unstable angina is a type of ___; this is a type of medical emergency where chest pain increases and is NOT _____
chronic coronary disease (CCD)
-predictable chest pain
-emotional stress
-exertion
-minutes, rest, short acting NTG
ACS
-relieved with ntg or rest
Pathophys:
- Chest pain occurs when there’s an ???
- Myocardial oxygen demand increases when heart is working harder due to? (3)
- With STABLE angina, myocardial oxygen supply is often decr due to?
- In accordance to #3, this is known as ____; this can cause what ?
- When chest pain is caused by ___ its called?
-This type of angina can occur at?
- imbalance between myocardial oxygen demand (workload) and supply (blood flow).
- an increased heart rate, contractility, or left ventricular wall tension
- atherosclerosis within inner walls of the coronary arteries
- Coronary artery disease; reduced blood flow to heart due to narrowing of arteries
- Coronary artery vasospasm, vasospastic angina
-at rest
- what are the risk factors for stable angina?
- To assess likelihood of CAD and diagnose stable angina, what tests need to be performed?
- What does the cardiac stress test do?
- When diagnosis of stable angina is certain, what can be performed to assess the extent of atherosclerosis and need for revasc?
- In general what are the components to evaluating stable angina? (5)
- HTN, smoking, dyslipidemia, diabetes, obesity, and physical inactivity
- cardiac stress test or cardiac imaging
- Incr myocardial oxygen demand with either exercise or IV medications
- Coronary angiography
- a. history and physical
b. CBC, CKMB, troponins, aPTT, PT/INR, lipid panel, glucose
b. ECG at rest and during chest pain
c. cardiac stress test/stress imaging
d. cardiac cath/angiography
NON DRUG TX:
- Pt’s should be encouraged to do what?
- Maintain BMI of?
- Maintain waist circumference of?
- How much exercise should they engage in?
- Smoking?
- Alcohol?
- Which med should NOT be used?
- follow heart healthy diet
- 18.5-24.9 kg/m^2
- < 35 inches in females, <40 inches in males
- > =150 mins of mod intensity (or >=75 mins of high intensity) AEROBIC activity per week
- Quit
- Limited to 1 drink/day for women and 1-2 drinks/day for men
- chronic NSAIDS
Drug TX :
1. Stable angina is a type of ____
2. Cormorbid conditions should be aggressively managed and include the use of ? (2)
- TX goals for stable angina are to improve quality of life and prevent future cardiac events which can be accomplished by which 2 drugs?
- Whats the recc antiplatelet? what about if there’s a CI or allergy to this drug?
- atherosclerotic cardiovasc disease (ASCVD)
- ACEI or ARB, high intensity statin
- Antiplatelet agent (for secondary prevention) and antianginal drug (to reduce chest pain)
- ASA
-Plavix
Antianginal tx does what?
which drugs can be used to prevent the sx’s? (3)
What’s recc if a patient remains symptomatic w/initial monotherapy?
what can be considered after the initial 3 therapies if needed?
Whats recc as immediate relief in all pt’s?
decr myocardial o2 demand or incr myocard oxygen supply
-beta blockers
-CCB’s (any)
-Long acting nitrates
adding second antianginal drug from diff therapeutic class
ranolazine
Short acting NTG such as SL tab or TL spray
Whats the A B C D E of treatment approach for stable angina?
Antiplatelet and antianginal drugs
blood pressure
cholesterol (statins) and cigs (cessation of smoking)
Diet and diabetes
exercise and education
- MOA of ASA?
- Clopidogrel is a ___ that irreversibly inhibits ___
- irreversibly inhibits COX 1 and COX 2 enzymes which decreases prostaglandin and thromboxane A2 (TXA2)
- pro drug
-P2Y12 ADP mediated platelet activation and aggregation
- Aspirin
-Brand names?
-Whats the formulation of the RX only aspirin?
-Dosing? - Clopidogrel
-brand name
-Dosing ? - CI for ASA?
-NSAID or __ allergy
-__ and __ w/viral infection due to risk of ____ - WARNINGS
B and T (a sign of salicylate overdose) - Side effects:
D, H, B - How often is it used in stable angina?
- Which formulation is preferred in ACS?
- If only EC ASA is available, it should be ___
- What should NOT be used if rapid onset is needed?
- What can be used to protect the GI tract from chronic asa usage?
- What are the risks that should be considered from chronic PPI use?
- bayer, bufferin, ecotrin
-ER capsule
-75-100 mg daily
- Plavix
-75 mg daily - salicylate
-children, teenagers , reyes syndrome - Bleeding, tinnitus
- Dyspepsia, heartburn, bleeding
- indefinitely
- non enteric coated, chewable asa
- chewed
- ER products (Durlaza)
- PPI’s
- decr bone density and incr infection risk
CLOPIDOGREL
- Boxed warning?
- CI’s?
- Warnings:
-____risk, stop how many days prior to elective surgery?
-Do not use with __ or __
-T___
- Generally well tolerated unless ___ occurs
- Notes: Only used in stable angina when there is ___
- Prodrug, effectiveness depends on conversion to an active metabolite by CYP450 2C19.
-PM of CYP2C19 can exihibit higher cardiac events.
-Tests to check CYP2C19 genotype can be used as therapeutic strategy - active serious bleeding (GI bleed, intracranial hemorrhage)
- bleeding, 5
-omeprazole, esomeprazole
-thrombotic thrombocytopenic purpura
- bleeding
- CI to asa
Antiplatelet DDI’s:
1. Most drug interactions due to additive effects when antiplatelets are used with other drugs that incr bleeding risk such as ?
- Clopidogrel: avoid moderate or strong _____ such as ____
- anticoags, NSAIDS, SSRI’s, SNRIs, some dietary supps
- CYP2C19 inhibs
-omeprazole, esomeprazole
- Beta Blockers :
-Mechanism of clinical benefit?
-Avoid in ? - CCB’s:
-Mechanism of clinical benefit?
-which CCB to avoid?
-Which CCBs are preferred when CCBs are used in combo with beta blockers?
-this is the preferred drug class for ? - Nitrates:
-Mechanism of clinical benefit?
-Whats recc for all pt’s for fast relief of anginal episodes? - Ranolazine:
-CI’s? (2)
-Warnings?
-not for ___ of chest pain
-has very little to no clinical benefit on ? (2)
- Decr HR , contractility, and left ventricular wall tension
-vasospastic angina - reduce myocard o2 demand:
NON DHPs: decr HR and contractility
DHPs: decr SVR (afterload)
-nifedipine IR
-DHP CCBs are preferred
-vasospastic angina
- reduce myocard o2 demand by decr preload (vasodilation of veins more than arteries)
-SL tab or TL spray
- Do not use with strong CYP3A4 inhibs or inducers , liver cirrhosis
-QT prolongation
-acute tx
-HR or BP
Nitrates used in stable angina:
- Short acting:
-Nitroglycerin SL Tab
a. brand name?
b. usual dose supplied?
-Nitroglycerin TL Spray
c. brand names?
d. usual dosage/supplied?
- What are the 2 Long acting formulations?
- Contraindications:
DO NOT USE WITH? - Warnings:
H, T - Side effects?
H, F, S - Short acting nitrates should be used _____
-How to store NTG SL tabs? - LA nitrates require a _____
- How long sshould the NTG Patch be worn for?
- Ointment is dosed how often?
- isosorbide mononitrate is dosed how often for the IR form?
- Whats the preferred combo for HFrEF?
- a. nitrostat
b. 0.4 mg
c. nitromist, nitrolingual
d. 0.4 mg/spray
- NTG ointment 2% (Nitro-Bid) and isosorbide mononitrate tab
- PDE5 Inhibs or soluble guanylate cyclase stimulators (Riociguat)
- Hypotension
tachyphylaxis (Tolerance/decr effectiveness) - headache, flushing, syncope
- PRN for immediate relief of chest pain
-in original amber glass bottle - 10-12 hour nitrate free interval to decr tolerance
- wear on for 12-14 hrs; off for 10-12 hours , rotate sites
- BID, 6 hrs apart with 10-12 hr nitrate free interval
- BID, 7 hrs apart
- isosorbide di-nitrate in combo with hydralazine
