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85 Cards in this Set
- Front
- Back
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What is ischemic heart disease
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blanket term for a number of syndromes--
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When does ischemic heart diease occur
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do to increased myocardial oxygen demand or decreased myocardial O2 supply to heart
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What is CAD
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any vascular disorder that narrow or occludes cornary arteries--usually atherosclerosis
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What is Angina Pectoris
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clinical syndrome which is carhacterize by pain or discomfortion in the chest,
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Typically angina is pain or discomfort in the chest by where else
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can go to jaw, shoulder, back or arm--
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Angina is most commonly due to
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ischemic heart disease---increase O2 demand or decrease O2 supply
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Subjective symptoms of angina
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SOB, DOE (dyspena on exertion
diaphoresis, palpitaiton, chest pain lightheadedness |
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Obective SIgns of angina
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BP (Hypo or hyper if stresses), HR (tachcardia) decreaes Oxygen saturation of ABG
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What are ECG cahgnes in angina
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ST segemnt elevation or depression T wave inversion
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Main ways to describe chest pain
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NPR DL
Nature/quality of pain Precipatioing factors; Reflieft with rest of nito Duration Location |
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What is the nature/ quality of pain
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elephant sitting on my chest
pressure |
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What type of pain is NOT cornaary ischemia
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sharp, and stabbing
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What is the duration of angina
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during exerction
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What are precipitating factors of angina
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physical activity
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Location of angina
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substernal
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What are other causes of chest pain besides angina
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CV non-ischemic
Chest wall Pulmonary Puschaitric GI |
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What are examples of pysciatric
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anxiety disorders
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Main one is GI (examples of differential diagnosis of angina
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Gerd--esophealdeal, ulcer, pancreatitis
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What tests are used to detect the presence of ischemia
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treadmill
pharmacologic stress testing |
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What are examples of pharamcologic stress testing
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dobutamine, and dipyramidine
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How do you viuzlieation atherosclerosis
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Computed Tomograpy
Cardiac cathererization/angiogram |
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What are goals of therapy for angina
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Relive anginal symtoms, frequecy, and severity and improve QOL
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What are therapuetic managment of ANGINA
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1. Anti-anginal therapy
2. Vascuyloproteict Therpay 3. Revasculatirzation |
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What is anti-anginal therapy
What is Vasculoprotective therapy What is revasculartization |
Anti-anginal--reduce symptom improve AVasculoproteictive---redue progession fo disease, prevent complicatoin
Revascualtion-- |
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What is anti0anginal therapy (reduces symptoms and improves QOL
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Nitrates
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Nitrates main effect on oxygen supply and demand
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Coronary blood flow
Wall tension (dialtes decreasing Preload, which decrease VR |
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When does Nitrate tolerance occur
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as little as 24hrs of continous exposure---must have at least 8 hr interval
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What happens during the nitrate free interval
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increases in epidosed of silenet ischemia, should be comibned with another medication to provide coverage during this time
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What nitrate prepations have fastest onset of action, and used in actuet CP
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IV and SL nitro
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What are Isosorbide dintrate (TID), and Mononirate (QDO and Nitroglycerin patch used for
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chronic CP
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How do you monitor therapeutic efficacy
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reduced number of anginal attacks,
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What are adverse effects of Nitro
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HA with all, hypotenison, increases HR, and contractility
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Proper use of Nitro
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Place under tonue, remove cotton ball, have at least 8 hrs of
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How do Beta blockers work with O2 supply and demand
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Directly decrease HR, Contracility, and Wall tension
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What are the most commonly prescribed agents
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Atenolol and Metoprolol
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What is selectivity of Atenolol and Metroporlol
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B1 selectivity
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Route of elmination for atenolol
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renal
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Route for elimination for metoprolol
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hepatic
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Dose of atenolol
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25-100 mg QD
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Dose of Metoroplol
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25-100mg BID
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What are goals of therapy of Beta-blocker
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tirate goal HR to 55-60 bpm
excerise HR <100-110 |
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What are adverse effects of beta blockers in what pts
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Asthma w/ bronchospasm
Bradycardia/ AV heart Block Congestive HF depression Diabeties Melliusi |
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When can Beta blockers be used with Congestive HF
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only in stable patietns and under the care of an expect
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What beta-blocker should be avoided in depression
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avoid propranolol
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Beta blockers may mask the symptoms of hypoglycemia, what symptoms is still present
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sweating
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What agents should be used with caution in renal failure
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atenolol and propranolol
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How do Calcium channel blockers (ALL) affect Oxygen supply and demand
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all Increase cornary blood flow, and decrease wall tension
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What calcium channel blockers increase cornary blood flow, decrease HR, contracility and wall tneison
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NON-Dihydropyridines (verapmil, diltizaem
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What are Diltizaem, and verapamils effects on vasodilation, HR, contractility
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moderate vasodialtion, decrease HR, and contracility
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What is usual dose of Diltizem, and verapmil
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120-480mg qd
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What is usualy dose of amlodopine
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2.5-10mg qd
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What are amlodopines effects of vasodialtion, HR, and contractility
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HIGH vasodilation, no effect on contracility, and mild reflex tachcardia
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What drugs should be avoided with Left ventricular ejection fraction and low HR
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NON-DHP (verapmil and diltizem)
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What CCB is best at lowering BP
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DHP (amlopdipine)
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What CCM causes constipation
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verapamil, diltizem
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What CCB interacts with CYP3A4
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non-DHP
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Peripheral edema is more common with
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DPH
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The conventional anti-ischemia medications work by (preventing ischemia)
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decreaseing oxygen demand and increasing O2 supply
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Ranolzine works by (treating ischemia how
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prevents ischemia Ca++ overload
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What are Ranoloaines effects on HR and BP
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no effects on HR or BP
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Ranolazines is available as an Extended release prepartion and has a half-life of
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7 hrs--BID dosing
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Ranolazine is not indicated as monotherapy current stdues only indicated effective when
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added to existing anti-anginal therapy
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Adverse effects of Ranolazine
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very well tolerated SEs-constipation, HA, nasuea, dizziness
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Ranolazine is metabolized by CYP3A4 and CYP2D6--making is contraindicated with
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STONG CYP3A4 inhibitors
Ketoconazole, Diltizem, Verapmil, |
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What does Ranolazine do to simvastatin
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doubles simvastatin plasam values
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Ranzoline is also a P-glycoprotein substrate and inhibitor which can
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increases Digozin levels 1.5 fold
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Drug-disease interactions
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cotraindicated in LIVER Failure, and caution with renal dysfution, and QT prolongation at baseline
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Dosing of Ranolazine
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500mg po BID and may titrate up to 1000mg BID
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All pts with chronic stable angina should be on
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SL NTG
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What is added First line to SL NTG
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Beta blockers
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What are 2nd line when Beta-blockers are contraindicated
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Non-dyhydropyridine (lower HR)
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IF a Beta-blocker therapy is not successful, then add
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DHP CCB amlodopine or Long-acting Nitrate (3rd)
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Where can you add ranolazine
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add on to BB CCB or long-acting nitrates when additiona anti-anginal control needed
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What is the best indicator of obesity
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waist circumference >35 women and >40 in men
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Can the meditratian diet lower your risk for MI greater than any drug?
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yes >10%
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ACE inhibtiors should be used in all CAD , especially
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diabetes of LV disfucnction
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ACE inhibitor decrease morbidity/mortaility in Actue MI and CHF by
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restoration fo endothelial fuction, and icnrease NO via inhbition of bradykinin
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Contraindications of ACE
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SBP <100, anigoedema, and intolerable cough
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ANY ACE inhibtior will do, however ramopril and indopril might be better, when do you add ACE or ARB in chronic unstable angina
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Get angina under control first, then add
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What are benefits of revascularization
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restore blood flow to heart
relieft of symptoms improve prognosis treat ACS (acute coronary syndrome) |
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What pts are given Coranry attery bypass surgery
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pts with mutil vessel disease and or LV dsyfuction
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What is most commmon revasculization
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PCI--or Percutaneous coronary intervention
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Can PCI be elective or during actue event
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both
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PCI usualy radio contrast dye and has potential for renal failure, how do you prevent
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given hydration with NS,or sodium bicarb,
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You can also given N0acetylcystein when
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for already renal dysfuction
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