Stable Angina - Quiz 4

Question 1

What is angina?

Answer 1

Chest pain, pressure, and tightness that is caused by ischemia of the heart muscle or spasm of the coronary arteries

Question 2

What is the difference between stable and unstable angina?

Answer 2

Stable: predictable from exertion or emotional stress that is relieved by rest or SA nitroglycerin
Unstable: ACS not relieved by nitro or rest

Question 3

What causes chest pain?

Answer 3

Imbalance between myocardial oxygen demand and supply -> increased heart rate, contractility, or left ventricular wall tension

Question 4

How do we diagnose angina?

Answer 4

1. Cardiac stress test/imaging
2. CHitory or physical
3. CBC, CK-MB, troponins, aPTT, PT/INR, lipid panel, glucose
4. ECG
5. Cardiac cath/angiography

Question 5

Non pharm for angina?

Answer 5

1. Heart healthy diet
2. BMIL 18.5-24.9
3. Waist circumference <35 (females), <40 (males)
4. Aerobic activity
5. Limit alcohol and smoking
6. Avoid chronic NSAID use

Question 6

What is the treatment for stable angina?

Answer 6

1. Antiplatelet (secondary prevention)
2. Antianginal (to reduce chest pain)

Question 7

What is the recommended antiplatelet? Alternative?

Answer 7

Aspirin; Clopidogrel

Question 8

Treatment regimen for angina?

Answer 8

1. Antiplatelet and antianginal
2. Blood pressure
3. Cholesterol and smoking cessation
4. Diet and diabetes
5. Exercise and education

Question 9

Drugs used as antianginal maintenance?

Answer 9

1. Beta blockers
2. CCBs
3. LA nitrates

Question 10

Drugs used for angina symptoms?

Answer 10

SA and SL nitroglycerins or TL spray

Question 11

MOA of aspirin?

Answer 11

Irreversibley inhibits COX1 and 2 decreasing PG and TXA2 (potent vasoconstrictor and iducer of platelet aggregation)

Question 12

MOA of Clopidogrel?

Answer 12

Prodrug that irreversiblely inhibits P2Y12 ADP mediated platelet aggregation and activation

Question 13

Aspirin

Answer 13

Bayer, Bufferin, Ecotrin

Question 14

Dosing of Aspirin?

Answer 14

75-100 mg QD

Question 15

CI of aspirin?

Answer 15

Children -> Reyes syndrome
Other NSAIDs or salicylate allergies

Question 16

ADR of aspirin

Answer 16

1. Bleeding
2. Tinnitus (OD)
3. Dyspepsia
4. Heatburn

Question 17

What type of aspirin is used for ACS

Answer 17

Non-enteric coated chewables
* If EC aspirin is only available it should be chewed (325mg), they do not have rapid onset

Question 18

How to prevent GI bleed from aspirin?

Answer 18

PPIs

Question 19

Clopidogrel

Answer 19

Plavix

Question 20

Dose of plavix

Answer 20

75 mg

Question 21

BBW of Plavix?

Answer 21

CYP2C19 poor metabolizers

Question 22

CI of plavix

Answer 22

Serious bleeding
Comittantt aspirin use

Question 23

ADR of Plavix

Answer 23

Bleeding
* Stop 5 days prior to surgery
* Don’t use omeprazole or esomeprazole
* TTP

Question 24

Drugs that should not be taken with Plavix

Answer 24

CYP2C19 inhibitors (Omeprazole, Esomeprazole)

Question 25

How long is aspirin used for stable angina

Answer 25

Indefinitely

Question 26

What are the benefits of usign beta blockers for angina?

Answer 26

1. Decreased HR, contractility, left ventricular wall tension * Avoid in vasospastic angina

Question 27

Benefits of using CCBs>

Answer 27

1. Non-DHP decreases HR 2. DHP decreases afterload (SVR) * Avoid nifedipine IR * DHPs are preferrd with beta blockers * Preferred in vasospastic angina

Question 28

Benefits of using nitrates?

Answer 28

1. Decreases preload 2. Vasodilation of veins over arteries * For patients requiring fast relief

Question 29

Warning of using Ranolazine?

Answer 29

1. CI with strong CYP3A4 inhibitors or inducers 2. QT prolongation 3. Not for acute chest pain 4. No effect on HR and BP

Question 30

What is vasospastic angina?

Answer 30

Coronary artery vasospasm from illicit drug use or cocaine

Question 31

SA Nitrates used for angina?

Answer 31

1. Nitroglycerin SL 2. Nitroglycerin TL

Question 32

Nitroglycerin TL

Answer 32

Nitromist, Nitrolingual

Question 33

Nitroglycerin SL

Answer 33

Nitrostat

Question 34

Dose of Nitroglycerin

Answer 34

0.4 mg

Question 35

LA nitrates for angina

Answer 35

1. Nitroglycerin ointment 2% 2. Isosorbide mononitrate

Question 36

Ntroglycerin ointement 2%

Answer 36

Nitro-Bid

Question 37

Ci with nitrates?

Answer 37

PDE5Is

Question 38

ADR of nitrates

Answer 38

Hypotension, tachyphylaxis (tolerance/decreased effectiveless), HA, flushing, syncope

Question 39

Nitroglycerin TD patch

Answer 39

Nitro-Dur

Question 40

Counseling for SA nitrates?

Answer 40

1. PRN for immediate relief 2. Store nitrate SL in amber bottle 3. Call 911 immediately after 1st dose if it persists 4. 5 minut intervals for 2nd and 3rd dose 5. Max 3 doses within 15 min

Question 41

Counseling for LA nitrates?

Answer 41

Require 10-12hr nitrate free interval to reduce tolerance

Question 42

Counseling for nitrate patch

Answer 42

Wear 12-14 hrs off 10-12 hr, rotate site, chest is preferred

Question 43

Counseling for nitrate ointment?

Answer 43

1. BID, 6hrs apart with 10-12 hrs nitrate free interval 2. Measure dose with applicator 3. Can stain clothes

Question 44

Counseling for isosorbide monomitrate

Answer 44

**IR:** BID 7 hrs apart **ER:** QAM

Question 45

When is isosorbide dinitrate used?

Answer 45

With hydralazine for HFrEF

Question 46

Counseling for SL tabs>

Answer 46

1. Place under tongue and let it dissolve 2. Slight tinglig or burning is not a sign of med working 3. Room temp with secure cap

Question 47

Counseling for TL spray>?

Answer 47

1. Prime before first use or 6weeks 2. Don't shake 3. Spray onto tongue or under tongue 4. Dont inhale spray