Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Therapeutics 601 > W5 Topics (Exam 3) > Flashcards

W5 Topics (Exam 3) Flashcards

(67 cards)

Start Studying
1
Q

race and sex most likely to develop CAD

A

black men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

non-modifiable CAD risk factors

A

male > 45y/o
female >55y/o
family history of premature CAD event (M <55y/o, F <65y/o)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

modifiable CAD risk factors

A

smoking, HTN, dyslipidemia, DM, obestity, lack of exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

CAD progression

A

plaque buildup - vessels vasodilate to make-up for buildup - O2 demand inc above baseline and vessels cannot dilate further - demand > supply = ischemia and angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Ischemic Heart Disease has 2 subsets:

A

Stable and Unstable IHD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Unstable IHD has 3 subsets

A

Unstable angina
NSTEMI
STEMI
all are ACS (acute coronary syndrome)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Stable Angina

A

chronic angina, precipitated by activity/upset and relieved at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Unstable Angina

A

inc freq/duration of angina @ lower level of activity/at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

NSTEMI

A

myocardial necrosis as a result of poor blood supply (from acute thrombosis)
NO ECG changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

STEMI

A

same as NSTEMI but with ECG changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

cardiac enzymes signaling myocardial necrosis

A

troponin (most specific)

CK, CKMB (less specific, rise quickly)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

angina quality

A

pressure, crushing, burning, tightness (acute)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

angina location

A

substernal (can radiate to neck, jaw, shoulder, chest, arm, upper abdomen)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

angina duration

A

0.5-20min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

angina precipitating factors

A

exercise, cold weather, stress, postprandial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

angina relieving factors

A

rest, SL nitroglycerin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

typical angina

A

follows angina characteristics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

atypical angina

A

meets only 2 of criteria

women/older adults/DM have a special presentation (anxiety, SOB, weakness, indigestion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

non-cardiac chest pain

A

does not meet/meets one criteria for angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

treatment of Stable IHD

A

Moderate/high statin
Aspirin 81mg
Clopidogrel if aspirin CI’d
both aspirin and Clopidogrel if high-risk

(dec risk of developing unstable ihd)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

treatment of angina (chest pain)

A

just improves QOL, does not dec risk of SIHD

1: SL nitro prn
2: beta blocker (SL nitro doesnt work/ >1 anginal episode/day)
3: CCB/long acting nitrate
4: Ranolazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

CCB for anginal chest pain: Non-DHP v DHP

A

both dec O2 demand

avoid Non-DHP if on beta-blocker, HFrEF, severe LV dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

long acting nitrate for angina

A

PO isosorbide mono/dinitrate or nitroglycerin patch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Ranolazine for angina

A

500mg BID

no effect on BP/HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Unstable angina/STEMI strategies
medical management or early invasive (immediate cardiac catheterization) OHSNAAP
26
O (in STEMI and NSTEMI treatment)
Oxygen, only if O2 sat <90%
27
S (in STEMI and NSTEMI treatment)
Statin (high intensity!) atorvastatin 40-80 rosuvastatin 20-40
28
N (in STEMI and NSTEMI treatment)
Nitroglycerin SL q5min up to 3 times IV if no response to SL CI'd within 24hr of Sildenafil/Avanafil and 48hr of Tadalafil
29
A (in STEMI and NSTEMI treatment)
Aspirin | LD give asap: non-enteric coated, chewable aspirin (324 or 325mg)
30
A (2) (in STEMI and NSTEMI treatment)
Anticoagulants IV unfractionated heparin for 48hr/ until PCI performed OR SQ enoxaparin for duration of hospital visit/until PCI performed
31
P (in NSTEMI treatment)
P2Y12 inhibitor LD: Ticagrelor 180mg, Clopidogrel 600mg MD: (for 12mon) Ticagrelor 90mg BID Clopidogrel 75mg QD ticagrelor PREFERRED only use Prasugrel if PCI
32
longterm treatment of ACS
SNAP + BAM
33
B (in long-term STEMI and NSTEMI treatment)
beta-blocker unless pt has signs of acute HF (fluid overload/tachycardia) use SR metoprolol succinate, carvedilol, bisprolol in pt with EF <40%
34
A (in long-term STEMI and NSTEMI treatment)
ACEi/ARB | all pt should receive
35
M (in long-term STEMI and NSTEMI treatment)
MRAs (Spironolactone or Eplerenone) for pt with EF < 40% who are on ACEi/ARB or beta blocker CI'd if pt: SCr >2.5mg/dL Males or >2.0mg/dL in Females K > 5.0mg/dL
36
P (in STEMI treatment)
LD: same as NSTEMI (Clopidogrel, Ticagrelor) BUT Prasugrel 60mg can be used only after visualization of coronary anatomy Ticagrelor and Prasugrel preferred over Clopidogrel
37
Platelet Patho
Adhesion, Activation, Aggregation
38
Adhesion
platelets adhere to exposed collagen and Von Willebrand Factor
39
Activation
release activating factors and GP IIb/IIIa receptors on platelet surface
40
Aggregation
cross-linking of platelets via GP IIb/IIIa receptor-fibrinogen binding; stabilize fibrin clot
41
P2Y12 inhibitors
inhibit ADP platelet activation PO: clopidogrel, prasugrel, ticagrelor IV: cangrelor
42
P2Y12 inhibitors recommendations
- given for 1 yr to pt who receive a stent | - clopidogrel/ticagrelor + aspirin for 12mon to ALL ACS pt
43
Clopidogrel characteristics
P2Y12 inhibitor - irreversible binding to ADP receptor - longer time to inhibit platelets 2-6hr 3-40%
44
Prasugrel characteristics
irreversible binding to ADP receptor | quick platelet inhibition 30min 60-70%
45
Ticagrelor characteristics
reversible, allosteric binding to ADP receptor | quick platelet inhibition 30min 60-70%
46
Clopidogrel dosing
LD: 300-600mg medical management, 600mg PCI, 300mg STEMI w thrombolytic MD: 75mg QD
47
Prasugrel dosing
N/A for medical management and STEMI w thrombolytic LD: 60mg PCI MD: 10mg QD PCI
48
Ticagrelor dosing
LD: 180mg medical management and PCI MD: 90mg BID and 60 after 1yr medical management and PCI N/A for STEMI w thrombolytic
49
Cangrelor
IV platelet inhibitor onset within 2min, normal platelet activity 1-1.5hr after discont *give to pt who have NOT been treated with a P2Y12 inhibitor or GP IIb/IIIa inhibitor
50
GP IIb/IIIa inhibitors
Abciximab, Eptifibatide, Tirofiban
51
GP IIb/IIIa inhibitors characteristics
IV agents, block aggregation step -administer at time of PCI (pt with NSTE-ACS not pre-treated with P2Y12i and pt with STEMI/ACS who were pre-treated with P2Y12i
52
anticoagulation therapy
unfractionated heparin (UFH) Low MW heparin (Enoxaparin) Bivalirudin Fondaparinux
53
anticoagulation therapy key points
- pt must be fully anticoagulated at time of PCI (dec risk of thrombus formation) - discont anticoag when PCI complete - Bivalirudin only option in pt with early invasive strategy - Do not use GP IIa/IIIb with bivalirudin (inc bleed risk)
54
Bivalirudin anticoag key point
only use in pt with planned early invasive strategy
55
Fondaparinux anticoag key point
contraindicated if CrCl <30ml/min
56
Intermittent claudication (PAD)
pain when walking, relieved with rest (severe have pain at rest)
57
Ulceration/infection/skin necrosis (PAD)
pt with DM and smokers at highest risk
58
Acute Arterial Occlusion
medical emergency! requires immediate revascularization to prevent limb loss
59
if pain is at buttocks, hips, thighs
blockage at aorta and iliac artery
60
if pain is at thigh/calf
blockage at femoral artery
61
if pain is at calf, ankle, foot
blockage at popliteal or tibial artery
62
ABI 1-1.4
normal
63
ABI 0.8-0.9
some PAD
64
ABI 0.5-0.8
moderate PAD
65
ABI <0.5
severe PAD
66
Acute Limb Ischemia (from PAD) treatment
immediate admin of heparin, revascularize immediately in 1 of 3 ways - thrombolytics (local admin to occlusion site) - endovascular (balloon stenting, thrombectomy) - surgical (thrombectomy, bypass surgery, amputation if cannot revascularize)
67
Longterm PAD treatment
- aspirin with symptomatic PAD *+clopidogrel after revascularization - antiplatelet therapy if asymptomatic - statin for ALL - ACEi/ARB if HTN - Cilostazol if intermittent claudication (symptoms)

Therapeutics 601 (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions