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Naplex 2023 > Stable Ischemic Heart Disease > Flashcards

Stable Ischemic Heart Disease Flashcards

(59 cards)

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1
Q

angina

A

chest pain, pressure, tightness

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2
Q

Stable angina

A

predictable chest pain from stress like exertion
relieved within minutes by rest or nitroglycerin

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3
Q

unstable angina

A

type of ACS
angina not relieved by rest or nitroglycerin

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4
Q

name of angina that can occur at rest

A

Prinzmetal’s
from vasospasm of coronary arteries

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5
Q

what causes chest pain

A

imbalance of myocardial oxygen demand and oxygen supply

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6
Q

what increases myocardial oxygen demand

A

inc HR
contractility
Left ventricular wall tension

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7
Q

atherosclerosis

A

plaque build-up in inner walls of coronary arteries = dec myocardial oxygen supply = CAD (reduced blood flow to heart)

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8
Q

risk factors for SIHD

A

HTN
smoking
dyslipidemia
diabetes
obesity
physical inactivity

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9
Q

what is used to assess likelihood of CAD and diagnosis SIHD

A

cardiac stress test

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10
Q

what does cardiac stress test do

A

inc myocardial oxygen demand with exercise like treadmill or IV drugs

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11
Q

what IV drugs are used for stress test

A

adenosine
dipyridamole
dobutamine
regadenoson/Lexiscan

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12
Q

non-drug treatment

A

heart healthy diet
BMI 18.5-24.9
wait <35 for female <40 for male
moderate aerobic activity for 30-60 min on 5-7 days/week
quit smoking
limit alcohol to 1 drink/day for women and 1-2/day for men

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13
Q

what drug categories are used for SIHD

A

antiplatelet + antianginal

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14
Q

recommended antiplatelet for SIHD

A

ASA

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15
Q

what is second choice for antiplatelet for SIHD

A

clopidogrel/Plavis is ASA allergy/another CI to ASA

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16
Q

goal of antianginal treatment

A

decrease myocardial oxygen demand or inc myocardial oxygen supply

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17
Q

what antianginal treatment is first-line

A

beta-blockers

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18
Q

what antianginal treatment should be used if can’t use BB

A

CCBs
long-acting nitrates
nitroglycerin SL for immediate relief in all patients

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19
Q

what cholesterol medication should be given

A

high-intensity statin
type of ASCVD

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20
Q

what drugs should be given for CAD + diabetes

A

ACEI/ARB for hypertension
other guideline-recommended for HTN, HF, diabetes - aggressive management

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21
Q

ASA MOA

A

irreversibly inhibit COX-1 and COX-2 = dec prostaglandin and thomboxane A2

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22
Q

clopidogrel MOA

A

prodrug
irreversibly inhibits P2Y12 ADP-mediated platelet activation and aggregation

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23
Q

ASA (Bayer, Bufferin, Ecotrin) dosing

A

Rx: ER capsule, delayed-release tablet
75-162 mg daily

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24
Q

ASA CI

Study These Flashcards
A

salicylate allergy
children + teenagers with virus = Reye’s syndrome

25
ASA warnings
bleeding tinnitis (salicylate overdose)
26
ASA side effects
dyspepsia heartburn bleeding
27
ASA notes
use indefinitely in SIHD (unless CI) non-enteric coated, chewable ASA preferred for SIHD; if only have enteric-coated, chew Durlaza (ER capsule) and Yosprala (DR tablet) shouldn't be used in rapid onset needed PPI can protect gut; consider risks (dec bone density, inc infection risk)
28
clopidogrel/Plavix dosing
75 mg daily
29
clopidogrel BBW
prodrug = conversion to active metabolite by CYP450 2C19 - test CYP2C19 genotype
30
clopidogrel CI
serious bleeding (GI bleed, intracranial hemorrhage)
31
clopidogrel warnings
bleeding risk (stop 5 days before elective surgery) don't use with omperazole or esomeprazole - inc things like thombocyotopenic purpura (TTP)
32
clopidogrel side effects
bleeding
33
clopidogrel notes
use in SIHD when ASA is CI
34
DAPT
ASA + clopdogrel use in those with bare metal stent (use for at least 1 month), drug-eluding stent (use at least 6 months), or post CABG (use for 12 months) 81 mg in DAPT
35
antiplatelet DI
additive bleeding risk - anticoagulants, NSAIDs, SSRI, SRNI, some dietary supplements clopidogrel: avoid with CYP2C19 inhibitors omeprazole and esomeprazole
36
BB clinic benefit
dec HR dec contractility dec L ventricular wall tension
37
BB clinical notes
titrate to resting HR of 55-60 BPM avoid abrupt withdrawal BB without ISA preferred (metoprolol, carvedilol) avoid in Prinzmetal's angina
38
CCB clinical benefit
preferred for Prinzmetal's/varian angina non-DHPs dec HR DHPs dec SR/afterload
39
CCB clinical notes
avoid short-acting DHPs (nifedipine IR, etc.) DHPs preferred in combo with BB (avoid bradycardia)
40
nitrates clinical benefit
dec preload (vasodilation of veins > arteries
41
Nitrates clinical notes
SL tabls, powder, TL spray) recommended for all patients - fast relief long-acting: when BB are CI or add-on if symptoms persist
42
ranolazine CI
strong CYP3A4 inhibitors/inducer
43
ranolazine warnings
QT prolongation
44
ranolazine notes
note for acute treatment of chest pain little-no effect on HR/BP
45
nitroglycerin SL tablet (Nitrostat) dosing
0.4 mg
46
nitroglycerin TL spray (Nitromist,Nitrolingual) dosing
0.4 mg/spray
47
Nitroglycerin SL powder dosing
0.4 mg/packet
48
types of long-acting nitrates
Nitroglycerin ointment 2% (Nitro-Bid) isosorbide mononitrate IR/ER tablet
49
nitroglycerin CI
use with PDE-5 inhibitors
50
nitroglycerin warnings
hypotension HA tachyphylaxis (dec effectiveness/tolerance) with long-acting)
51
nitroglycerin side effects
headache flushing syncope
52
short-acting nitrates notes
PRN for immediate relief of chest pain stores SL tabs in original amber glass bottle
53
long-acting nitrates notes
require 10-12 hr free interval to dec tolerance patch: wear 12-14 hours, rotate sites ointment: dose BID, 6 hrs apart, 10-12 nitrate-free interval isosorbide mononitrate IR: 7 hours apart isosorbide dinitreate with hydralazine is preferred combo for HFrEF
54
nitrate DI
do not use with PDE-5 inhibitors = significant dec in BP
55
ranolazine DI
do not use with strong CYP3A4 inhibitors/inducers
56
short-acting nitrates key counseling points
call 911 immediately if chest pain persists after 1st dose can use 3 doses total 5 minutes apart
57
nitroglycerin SL tablets key counseling points
put under tongue and let it dissolve slight burning/tingling is not sign of medication working keep in original amber glass bottle at room temp
58
nitroglyceirn TL spray key counseling points
do not shake; spray onto or under tongue do not inhale spray
59
nitroglycerin patch key counseling points
chest is preferred application site

Naplex 2023 (21 decks)

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