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Cardio Renal II Midterm > Therapeutics - Ischemic Heart Disease > Flashcards

Therapeutics - Ischemic Heart Disease Flashcards

(51 cards)

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1
Q

what is the most common symptom of chronic coronary disease

A

angina

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2
Q

general distinction between the angina present in ACS vs IHD

A

ACS - angina at rest

IHD - angina upon exertion

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3
Q

explain the cause of the angina in CCD/IHD

A

imbalance between the myocardial supply and demand of oxygen

this is bc of athersclerotic plaques

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4
Q

name some ways that IHD risk factors can be modified

A

stop smoking
physical activity
manage stress
BP and lipid ctonrol
watch weight

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5
Q

angina pectoris lasts up to how long?

A

up to 30 mins

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6
Q

what is the scale for grading angina pectoris

when does revascularization start to become a potential?

A

Class 1 -class IV

class 1 - ordinary things dont cause angina

class 2 - slight limitation of ordinary activies

class 3 - marked limitation of normal activities

class 4 - cant do physical activities. angina at rest

revascularization starts at 3 and 4

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7
Q

true or false

edibles are associated with FEWER acute CV symptoms

A

true

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8
Q

name some drugs that can induce episodic angina

A

lot of caffeine
zyrtec
cisapride IV
nicotine
thyroid replacement
triptans
ephedra and pseudoephedrine

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9
Q

nonpharm treatment for IHD:

-vasculoprotective
-anti-ischemic

A

vasculoprotective - lifestyle changes and immunizations

anti-ischemic - revascularization

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10
Q

pharmacologic treatment for IHD:

-vasculoprotective
-anti-ischemic

A

vasculoprotective -
ACE/ARB
aspirin or plavix
statin
“AAS:

anti-ischemic
beta blockers
CCB
nitrates
ranolzaine

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11
Q

nonpharm vasculoprotective treatment includes managing weight

how can this be done? what if this isnt working?

A

DASH diet

may consider GLP-1 antagonists

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12
Q

true or false

the annual flu shot is a vasculoprotective option

A

true

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13
Q

as a recap, what are the pharmacologic classes that are VASCULOPROTECTIVE for IHD patients

A

antiplatelets
ACE/ARB
statin (high intensity)

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14
Q

what is considered the GOLD STANDARD vasculoprotective antiplatelet

why?
what is the alternative?

A

aspirin 75mg-100mg (baby aspirin)

reduced MI and cardiac death incidences in patients with CCD/IHD

alternative is clopidogrel - but really only give is aspirin allergic/intolerant

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15
Q

in a patient with CCD/IHD (NOT ACS), is DAPT done? if so for how long?

A

yes - DAPT is given only after PCI

the P2Y12 antagonist is stopped after 6 months (12 months at least if ACS), and baby aspirin continued forever

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16
Q

what is stable ischemic heart disease

A

just another term for chronic coronary disease
pt has stable plaques

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17
Q

as mentioned, ACEI/ARB are shown to be vasculoprotective in CAD patients

explain this further

A

ace inhibitors - specificallyy ramipril - has been shown to decrease morbidity and mortality in SIHD patients

ARB can be used if AE or intolerance to ACE, but ACE is definitely preferred

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18
Q

role of statins in IHD

A

they are vasculoprotective

patients with IHD are considered to have clinical ASCVD

therefore, a HIGH INTENSITY STATIN IS STARTED!
statins have a pleiotropic effect, meaning they stabilize plaques. however, these patients with IHD already have stable plaques! therefore, 80mg atorvastatin is not really needed and 40mg may be sufficient

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19
Q

true or false

ALL of these have been shown to decrease morbidity and mortality in IHD patients:
-antiplatelets
ACE/ARB
statin

A

TRUE

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20
Q

as recap, name the classes of drugs that are anti-ischemic for patients with IHD

A

beta blockers
calcium channel blockers
nitrates
ranolazine

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21
Q

true or false

beta blockers can reduce anginal symptoms

22
Q

beta blockers work on the supply or demand side to reduce anginal symptoms?

23
Q

true or false

beta blockers are 1st line for IHD patients

Study These Flashcards
A

true!! but calcium channel blockers and nitrates are equally considered 1st line as well

they can be used together if 1 isnt working

24
Q

name the 3 specific beta blockers used in IHD

Study These Flashcards
A

metoprolol succinate
carvedilol
bisoprolol

25
explain the specific times when beta blockers are/arent indicated for IHD
indicated for all IHD patients with angina symptoms HOWEVER, if the patient does not have anginal symptoms (they usually do tho), beta blockers can only be given in the patient has LVEF less than 50% or if they have a fib or other comorbidities
26
what is the target heart rate for IHD patients on beta blocker therapy
55-60 bpm
27
which specific beta blockers MUST BE AVOIDED in patients with IHD
those with intrinsic sympathomimetic activity
28
caution with metoprolol for IHD patients
be careful with depression! dont want HR to go below 55-60
29
true or false if needed, a calcium channel blocker can be added to beta blocker therapy for IHD patients
TRUE
30
true or false only non dihydropyridine calcium channel blockers can be used for IHD patients
FALSE any CCB can be used
31
which therapy has been shown to decrease instances of MVO (microvascular obstruction) after an intervention?
calcium channel blockers
32
CI to non dihydropyridine calcium channel blockers
EF less than 40%
33
in general, explain when we would use a DHP CCB vs non DHP CCB for a patient with IHD
normally we would give DHP, unless dealing with an arrhythmia or something that needs a non DHP
34
does nitroglycerin work on the supply or demand side
supply
35
for ACUTE ATTACKS, what dosage forms of nitroglycerin are given
sublingual nitroglycerin or translingual spray
36
true or false for patients with IHD, they should call 911 after the 3rd dose of NTG doesnt work
true
37
true or false isosorbide dinitrate and mononitrate are 2nd line for IHD patients
FALSE - 1 of the 3 first lines
38
concern with giving nitrates
tachyphylaxis (tolerance) need a nitrate free interval if dinitrate - it's taken BID and patient needs to be told to try to take exactly 12 hours apart
39
**explain the role of ranolazine in IHD patients and why this is its place in therapy
NOT 1ST LINE!!!!!!!!! only used as adjunctive therapy after all other therapies have failed/reached max tolerated dose bc of side effects like QT prolongation**** and other DDI concerns with some statins need to monitor EKG when a patient is on this - extra monitoring parameter
40
"hemodynamic control effect"
ranolazine causes QT prolongation tho
41
**interaction between ranolazine and simvastatin
levels of simvastatin will increase! ranolazine a CYP3A4 inhibitor
42
low dose aspirin in pregnancy
considered safe for pregnancy in low doses
43
pregnancy category clopidogrel
B - no toxicity shown in animals but not enough in humans
44
true or false aspirin + clopidogrel can be used together in IHD patients
true - especially after ACS
45
grapefruit juice and clopidogrel
efficacy of clopidogrel decreases - bc its a prodrug and needs to be bioactivated by CYP
46
*ranolazine DDI with diltiazem
increase blood levels and effects of ranolazine diltiazem is a CYP3A4 inhibitor
47
*true or false ranolazine is CI with CYP3A4 inducers
true
48
*3 QT prolonging drugs that interact with ranolazine
haloperidol cipro azithro
49
*4 CYP3A4 inhibitors that interact with ranolazine what is the interaction
azole antifungals clarithromycin diltiazem verapamil increased blood levels of ranolazine due to CYP3A4 inhibition - INCREASED CHANCE QT prolongation
50
"starting 5" for stable ischemic heart disease
-antiplatelet (aspirin alone usally cloppidogrel if aspirin cant be used. ONLY COMBINED for STENT/PCI FOR IHD) -ace inhibitor (preferred - then move to ARB) -high intensity statin -beta blocker, CCB, or long acting nitrate -sublingual NTG
51

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