Cardio Module Acs/ihd Set 2

Front 1

CCB mechanism in VASCULAR smooth muscle (3)

Back 1

1)block L-type Ca channels, blocking Ca from entering the cell and blocking the following cascade
2)Ca-calmodulin complex activates MLCK
3)Active MLCK acts w/ Actin to cause contraction

Front 2

CCB mechanism in cardiac myocyte (3)

Back 2

1)block L-type Ca channels, blocking Ca from entering the cell and blocking the following cascade
2)Ca-Troponin complex is formed
3)Ca-Troponin acts w/ actin/myosin to cause a contraction

Front 3

Benefit from CCB is derived from.... (4)

Back 3

1)ARTERIAL DILATION
2)decr in afterload
3)(-) inotropic = decr cardiac work
4)CORONARY VASCULAR DILATION = incr O2 delivery to ischemic areas of myocardium

Front 4

Advantage of dihydropyridine CCB's (2)

Back 4

1)mostly cause arterial dilation
2)do NOT depress myocardium as much as other CCB's

Front 5

ADR's of CCB (7)

Back 5

1)HA
2)dizzines/syncope
3)flushing
4)nausea
5)edema
6)bradycardia, AV block, heart failure
7)reflex incr in adrenergic tone to heart (reduce by giving BB)

Front 6

BB mechanism and use

Back 6

1)block effect of adrenergic nerve stimulation of heart
2)primary use in treating exertional angina attacks

Front 7

Major benefit of BB is derived from.... (6)

Back 7

1)(-) chronotroptic
2)(-) inotropic effects
3)these decr cardiac work
4)decr SBP
5)decr myocardial O2 consumption
6)decr adrenergic tone to periphery

Front 8

ADR of BB (3)

Back 8

1)bradycardia, AV block, heart failure
2)CNS depression (fatigue, insomnia, depression)
3)caution w/ asthma, DM pts

Front 9

Problem w/ BB and DM (2)

Back 9

1)block tachycardia in hypoglycemia
2)blocks glycogenolysis in hypoglycemia

Front 10

___ & ____ & ____ are all equivalent

Back 10

1)CHD
2)CAD
3)IHD

Front 11

#1 reason ppl die of an MI

Back 11

LV arrthymias

Front 12

ASA in PRIMARY prevention of IHD
a)dose
b)strengths available
c)half-life thing
d)inhibits ___ more than ___

Back 12

a)75-162mg qd (81mg in women)
b)81,325,500,650mg
c)half life of ASA is 2-6h, platelet half-life is 7-10d; need just qd dosing of ASA b/c of long half-life of platelet
d)50x more potent inhibitor of COX1 than COX2

Front 13

Plavix in PRIMARY prevention
a)dose
b)strengths available
c)it and ASA in Primary prevention

Back 13

a)75mg qd
b)75mg only
c)use ASA or plavix NOT both in primary prevention, plavix is mainly used if ASA not tolerated

Front 14

COX1 (4)

Back 14

1)constitutive
2)less affected by inflammatory stimuli
3)CAUSES PLATELET AGGREGATION
4)in platelets, kidney, stomach

Front 15

COX2 (5)

Back 15

1)inducible
2)incr 10x by inflammatory stimuli
3)INHIBITS PLATELET AGGREGATION
4)causes vasodilation
5)in monocytes, macrophages

Front 16

Angina is considered chronic stable angina if...

Back 16

stable for 3 months

Front 17

Taking NTG in SECONDARY intervention (2)

Back 17

1)take prn chest pain or prior to activites known to precipitate an an attack
2)take 1 dose, if pain not relieved in 5 min take another, if pain not relieved in 5 min take a 3rd. Call ambulance as taking 3rd dose

Front 18

1 dose of NTG will relieve pain in...

Back 18

75% of pts in 3min
15% ar relieved by 15min

Front 19

Other very important counsel pt w/ nitro

Back 19

HAVE PT DATE THE BOTTLE

Front 20

Antiplatelets in SECONDARY prevention (2) and schedule

Back 20

1)ASA 75-162mg qd (less than 100mg in pt w/ GI bleed)
2)Plavix 75mg qd

On both for a year after an event then drop the plavix

Front 21

When to start chronic stable angina MAINTENANCE therapy?

Back 21

have more than 3 attacks per week

Front 22

BB delay ST changes, is this good or bad?

Back 22

Good; ST changes means problem with ventricular muscle

Front 23

Good candidates for BB in MAINTENANCE therapy (3)

Back 23

1)previous MI
2)heart failure
3)concurrent HTN

Front 24

Which BB to be avoided? and which to use

Back 24

ISA BB, acebutolol, pindolol, labetalol

USA non-ISA BB (b/c these will reduce HR and the others wont); atenolol, metoprolol, carvedilol, propanolol, timolol

Front 25

BB in MAINTENANCE therapy "clinical points" (4)

Back 25

1)target resting HR is 55-60; max exercise HR of 100
2)start low dose and titrate up
3)do not abruptly withdraw due to rebound anginal episodes; taper off over 2days
4)frequently combined w/ nitrates

Front 26

Which CCB to NOT use in MAINTENANCE and why?

Back 26

1)short acting
2)IR nifedipine
3)nicardipine

induce tachycardia

Front 27

Which CCB to use? (and doses) (5)

Back 27

1)felodipine 5-10qd
2)amlodipine 5-10qd
3)nifedipine XR 30-180qd
4)diltiazem
5)verapamil

Front 28

DILTIAZEM DOSING IN MAINTENANCE (2 and bad SE)

Back 28

1)IR 30-180 qid
2)XR 120-320 qd/bid

negative inotropic

Front 29

VERAPAMIL DOSING IN MAINTENANCE (2 and bad SE)

Back 29

1)IR 80-160 tid
2)XR 120-480 qd

negative inotropic

Front 30

CCB's (IR DHP, XR DHP, non-DHP)
a)effect on HR
b)effect on contractility

Back 30

a)IR DHP sharp incr in HR, XR DHP little/none incr in HR, non-DHP's decr in HR
b)non-DHP's decr contractility

Front 31

Big ADR's of CCB (2)

Back 31

1)peripheral edema (dhp)
2)constipation (verap)

Front 32

Long acting nitrates dosing schedule (3)

Back 32

1)effects are minimal after 1wk of chronic, continuous use due to tolerance
2)NO can no longer be made due to depletion of co-factors
3)Need 8-12h nitrate-free to avoid tolerance

Front 33

Nitrates should not be given as....

Back 33

MONOTHERAPY

Front 34

Long Acting nitrates
a)brand
b)generic
c)dose

Back 34

a)isosorbide mononitrate (imdur) 30-240mg qd
b)isosorbide dinitrate (isordil) 5-20mg bid
c)transdermal ntg (nitro-dur) 0.1,0.2,0.4,0.6,0.8mg/hr

Front 35

Nitrate products w/...
a)fast onset (2)
b)slow onset (3)

Back 35

a)IV, SL (tablet/spray)
b)oral, ointment, patch

Front 36

Ranolazine
a)mechanism (3)

Back 36

1)partial FA oxidase inhibitor
2)reduce intracellular Na leading to reduced Ca overload
3)this reduces intra-myocardial wall tension and contractile dysfxn

Front 37

Ranolazine
a)reserved for....
b)Dose
c)CI in....
d)____ drug

Back 37

a)pts who do NOT have adequate response to other anti-anginals
b)500mg bid
c)pts w/ QT prolongation
d)anti-ischemic drug

Front 38

Ranolazine ADR's (5)

Back 38

1)dizziness
2)HA
3)constipation/nausea
4)elevated SCr/BUN
5)QT prolongation (incr time b/w ventricle depo and repo)

Front 39

Ranolazine Drug interactions (6)

Back 39

1)azole antifungales
2)diltiazem/verapamil
3)amiodarone
4)digoxin
5)statins
6)macrolides

Front 40

Coronary Artery Spasm (variant angina) treated w/...(4)

Back 40

1)SL NTG
2)CCB
3)LA NTG
4)avoid BB

Front 41

Silent myocardial ischemia treated w/...(2)

Back 41

1)SL NTG
2)BB alone or w/ CCB

Front 42

Syndrome X ischemia treated w/....(2)

Back 42

1)BB
2)ACEI

Front 43

Coronary Artery Spasm, silent myocardial ischemia, syndrome X NOT treated w/ ASA b/c....

Back 43

NOT associated w/ platelet aggregation

Front 44

Anticoagulation in SECONDARY prevention (2)

Back 44

1)use antiplatelets or antiplatelets & warfarin
2)ASA 75-162mg qd plus plavix 75mg qd for 1 month to 1yr; continue ASA alone after this

Front 45

When to use antiplatelet and warfarin in SECONDARY prevention and what INR wanted? (7)

Back 45

1)anterior acute MI
2)acute MI w/ LV dysfxn
3)concomitant heart failure
4)previous emboli
5)presence of mural thrombosis
6)A.Fib
7)want INR 2-2.5

Front 46

Inhibition of RAAS in SECONDARY prevention in WHO? (4)

Back 46

1)suspected anterior wall MI
2)MI w/ heart failure
3)pts w/ no CI to ACEI
4)pts w/ heart failure or LV dysfxn

Front 47

Inhibition of RAAS in SECONDARY prevention WHY? (3)

Back 47

1)decr recurrent MI
2)decr progression of heart failure
3)decr mortality

Front 48

Inhibition of RAAS in SECONDARY prevention HOW/WHEN? (3)

Back 48

1)wait until thrombolytic treatment is complete
2)BP is stabilized
3)but ultimately ASAP after MI

Front 49

Inhibition of RAAS in SECONDARY prevention CI (4)

Back 49

1)SCr greater than 3
2)hx of angioedema or hyperkalemia
3)bilateral renal artery stenosis
4)pregnancy

Front 50

Lisinopril
a)brand name
b)strengths available
c)common initial dose
d)goal dose

Back 50

a)zestril, prinivil
b)2.5, 5, 10, 20, 30, 40mg
c)5mg qd
d)10mg qd

Front 51

Captopril
a)brand name
b)strengths available
c)common initial dose
d)goal dose

Back 51

a)capoten
b)12.5, 25, 50, 100tab and 5mg/ml solution
c)6.25mg qd
d)50mg bid-tid

Front 52

Enalapril
a)brand name
b)strengths available
c)common initial dose
d)goal dose

Back 52

a)vasotec
b)2.5, 5, 10, 20mg
c)5mg bid
d)10mg bid

Front 53

Ramipril
a)brand name
b)strengths available
c)common initial dose
d)goal dose

Back 53

a)Altace
b)1.25, 2.5, 5, 10mg
c)2.5mg qd
d)10mg qd

Front 54

Anti-anginals in SECONDARY prevention in WHO?

Back 54

EVERYONE with diagnosis of IHD

Front 55

Anti-anginals in SECONDARY prevention WHY?

Back 55

immediate treatment of ischemia w/ it can incr myocardial O2 supply and decr myocardial oxygen demand

Front 56

Anti-anginals in SECONDARY prevention SL dose

Back 56

0.3-0.4mg prn

Front 57

BB in SECONDARY prevention in WHO? (5)

Back 57

1)MI/previous MI
3)over 65yo
4)vertricular ectopy
5)evidence of heart failure
6)pts who are hemodynamically stable

Front 58

BB in SECONDARY prevention WHY? (3)

Back 58

1)decr ventricular arrhythmias
2)decr recurrent ischemia or re-infarction
3)decr mortality

Front 59

BB in SECONDARY prevention in HOW/WHEN? (4)

Back 59

1)within a few days (24h if possible) of event
2)continue indefinitely
3)make sure BP(systolic) and HR are stable (over 100 and 60)
4)avoid ISA BB's

Front 60

Metoprolol 2 brand names

Back 60

1)lopressor (IR)
2)toprol (xr)

Front 61

Lopressor
a)available strengths
b)goal dose

Back 61

a)50, 100mg
b)100mg bid

Front 62

Toprol XL
a)available strengths
b)goal dose

Back 62

a)25, 50, 100, 200mg
b)200mg qd

Front 63

Atenolol
a)brand name
b)available strengths
c)goal dose

Back 63

a)tenormin
b)25, 50, 100mg
c)100mg qd

Front 64

Statins in SECONDARY prevention in WHO (1) and WHY (3)?

Back 64

1)all pts after ACS regardless of LDL

1)reduces progression of atherosclerosis
2)decr CV events
3)decr mortality

Front 65

Statins in SECONDARY prevention HOW/WHEN? (3)

Back 65

1)ASAP during acute event
2)use high dose (lipitor 80mg qd)
3)monitor liver enzymes and lipid panel

Front 66

Drug therapye after a stent placement (b/c they are thrombogenic) (3)

Back 66

1)ASA 325mg qd plus plavix 75mg qd for 1yr
2)then ASA indefinetly
3)rethrombosis is most common due to non-compliance w/ the regimen

Front 67

Drugs to avoid in pts w/ IHD (2)

Back 67

1)sympathomimetics
2)COX2's and NSAIDS (b/c no longer balanced w/ COX1)

Front 68

Vitamins/anti-oxidants in heart health

Back 68

VitE, VitC, B-carotene showed NO DIFFERENCE FROM PLACEBO

Front 69

Hormone replacement therapy and heart health (4)

Back 69

1)HRT did NOT decr CHD
2)more CHD events in 1st yr; fewer in 4th/5th years
3)higher risk of VTE, stroke, breast cancer
4)fewer cases of hip fractures

Front 70

Vasodilators generally have what structural feature?

Back 70

N-rich rings

Front 71

Hydralazine structural features (2)

Back 71

1)ortho N's in
2)naphazoline ring

Front 72

Minoxidil has what N rich ring

Back 72

pyrimidine ring

Front 73

Prazosin structural features (2)

Back 73

1)meta N's in...
2)quinazoline ring

Front 74

Sodium Nitroprusside contains/mechanism

Back 74

IS INORGANIC; has Fe and cyano--the cyano is turned to N = vasodilation

Front 75

Nitrates contain what (structurally)... (3)

Back 75

1)nitrous/nitric acid
2)ester of polyol's (poly alcohcol)
3)N's are NOT directly attached to a C; have O inbetween

Front 76

Nitrates 2 properties

Back 76

1)avoid moisture in storage to eliminate hydrolysis
2)nonpolar so rapid absorption thru biomolecules

Front 77

If a nitrate/ite has (0.25:1) next to it what does that mean?

Back 77

0.25min til onset of axn

1min is duration of axn

Front 78

Which act quicker Nitrous or nitric acid? and name ex

Back 78

Nitrous acids; amyl nitrite

Front 79

Relationship b/w # nitrous/ic acids in the nitrate and activity?

Back 79

NONE

Front 80

Enzyme that metabolizes nitrates? and location

Back 80

glutiathione-nitrate reductase (hepatic/first pass and extrahepatic)

Front 81

Structural similarites b/w classes of CCB's

Back 81

NONE

Front 82

1,4DHP derivative CCB properties (5)

Back 82

1)Usually has 2CH3
2)2 esters
3)an N @ 1 w/ an H
4)R group at 4
5)N-benzene ring

Front 83

Benzothiazepine derivative CCB properties (2)

Back 83

1)benzene and
2)7 member ring w/ S,N (thiazepine)

Front 84

Aralkylamine derivatives CCB properties (1)

Back 84

1)basic N w/ alkyl/aryl

Front 85

How do you make a CCB's half-life longer? (2)

Back 85

1)add lipophilic structural features like...
2)make one of those methyl's an ether

Front 86

LOOK AT DR. B'S NOTES AND RECOGNIZE THE DIFF CCB'S

Back 86

n/a

Front 87

Diltiazem
a)CCB derivative
b)metabolized to...
c)feature

Back 87

a)benzothiazepine
b)desacetyl derivative w/ 25-50% of parent activity
c)2 chiral C's

Front 88

Verapamil
a)CCB derivative
b)structural features (2)

Back 88

a)Aralkylamine
b1)chiral C near central N
b2)central basic N to which alkyl/aralkyl groups are attached affect both heart AND arterial bed

Front 89

In CCB's with chiral C's what isomer is more potent?

Back 89

+ isomer