Drugs For Angina And Mi

Front 1

Angina pectoris

Back 1

chronic condition characterized by episodic chest discomfort that occurs during transient coronary ischemia-- increased oxygen demands are not met.

Front 2

Stable angina

Back 2

attacks have similar characteristics and occur under the same circumstances always

Front 3

Unstable angina

Back 3

Attacks increase in frq and severity and often prelude MI

Front 4

Variant angina

Back 4

AKA Prinzmetal's angina. Due to acute coronary vasospasm and often occurs during rest or sleep. No relation to oxygen demand.

Front 5

Myocardial infarction

Back 5

Complete occlusion of coronary artery which can cause tissue death.

Front 6

Characteristics of angina

Back 6

Pain secondary to ischemia, sudden/severe/substernal pain which radiates to L shoulder. Induced by stress/exercise/emotion/eating/cold.

Front 7

Why vasodilate to treat angina?

Back 7

Increase perfusion to meet oxygen demands of the heart muscle.

Front 8

Why decrease contractility of the heart as treatment of angina?

Back 8

To decrease oxygen demand of the muscle-- make the heart work less.

Front 9

Are B blockers effective treatment for variant angina?

Back 9

NO-- cannot counteract vasospasm (cause of angina in this case)

Front 10

Adjunct treatments for angina

Back 10

Stabilize atherosclerotic plaques (statins), manage/treat modifiable RFs

Front 11

First line tx typical angina

Back 11

Beta blockers "olol" drugs.

Front 12

MOA beta blockers

Back 12

Block beta 1-- decrease HR, decrease BP, decrease contractility... decrease myocardial oxygen demand.

Front 13

Indications B blockers

Back 13

HTN, CHF, typical angina, MI, some arrhythmias, migraine

Front 14

CI B blockers

Back 14

sinus brady, SBP <100, heart block, cardio shock, ADHF. **If non-selective-- COPD, asthma, DM

Front 15

DDIs B blockers

Back 15

verapamil-- greatest potential for decreased contractility.

Front 16

Titrated HR for B blockers

Back 16

50 to 60

Front 17

B1 selective agents

Back 17

Metoprolol, Atenolol, Nebivolol

Front 18

Non-selective B blockers

Back 18

Propranolol, nadolol

Front 19

a1/B blockers

Back 19

Carvidilol, labetolol

Front 20

MOA CCBs

Back 20

bind to calcium ion channels in smooth muscle and cardiac tissue. Smooth muscle relaxation and suppression of cardiac activity. Decrease oxygen demand.

Front 21

Indications CCBs

Back 21

HTN, angina (*variant), arrhythmias

Front 22

CIs non-DHP CCBs

Back 22

SBP <100, HR <60, ADHF, EF <40%, AV block

Front 23

Non-DHP CCBs

Back 23

Verapamil, diltiazem

Front 24

ADRs immediate release nifedipine/short acting CCBs

Back 24

Increased risk MI, CHF, death due to CHD

Front 25

Preferred tx for variant angina

Back 25

non-DHP CCB

Front 26

Non-DHP CCBs

Back 26

Verapamil, diltiazem

Front 27

DHP CCBs

Back 27

Amlodipine, felodipine, nifedipine

Front 28

Indication for CCB as monotherapy for angina

Back 28

Pts w/ CI to BB

Front 29

MOA nitros

Back 29

release nitric oxide. diffusion into vascular smooth muscle cells. form cGMP. venous dilation. venous pooling. decrease preload. decrease ventricular diasolic vol. decrease ventricular pressure. decrease myocardial wall tension/oxygen demand

Front 30

Main problem with chronic use of nitros

Back 30

Tolerance develops

Front 31

MOA high doses nitros

Back 31

Arterial dilation, decrease PVR and afterload.

Front 32

Indications nitros

Back 32

angina, MI, CHF

Front 33

CI nitros

Back 33

aortic stenosis, concurrent use with other vasodilating agents.

Front 34

Tx for reflex tachy due to nitro overdose

Back 34

B blocker

Front 35

Tx for HA refractory to nitro use

Back 35

tylenol

Front 36

DDI nitros

Back 36

PDE 5 inhibtors-- severe hypotension/death. Isosorbide-- substrate.

Front 37

Indication SL/PO nitro

Back 37

relieve sx of acute myocardial ischemia, prevent effort enduced angina.

Front 38

Indication long acting nitros

Back 38

maintenance tx of angina

Front 39

Formulations organic nitrates

Back 39

Amyl nitrate (INH, X), nitroglycerine (SL/PO/IV/buccal/topical/TD, C), Isosorbide (PO/SL, C)

Front 40

Amyl nitrate

Back 40

Inhaled. Rapid onset. Brief DOA. Used for cyanide poisoning.

Front 41

Storage of nitroglycerine SL/PO tabs

Back 41

Dark, cool place in amber bottle-- deactivated by sun light.

Front 42

Ointment form of nitroglycerine

Back 42

Complicated use-- calibrated paper-- 1.5-2" Spread on chest wall TID w/ 8h free interval

Front 43

Patch form of nitroglycerine

Back 43

Available in several doses. Good for compliance. 0.1 to 0.8 mg/h dependent upon patch strength. On AM. Off PM.

Front 44

PO form nitroglycerine

Back 44

Must be administered QD or BID to minimize tolerance.

Front 45

IV form nitroglycerine

Back 45

Need special tubing-- Non-PVC. Must be nitrate free QHS. Acute use only.

Front 46

MOA Ranolazine

Back 46

Sodium current inhibitor

Front 47

Indications Ranolazine

Back 47

chronic stable angina in combo w/ CCB, BB, nitros.

Front 48

CI Ranolazine

Back 48

pre-exisitng QT interval prolongation, uncorrected hypokalemia, hepatic failure, drugs which prolong QT (FQs, psychotropics)

Front 49

Precautions Ranolazine

Back 49

Can prolong QT and induce Torsades de Pointes

Front 50

ADRs Ranolazine

Back 50

HA, dizziness, constipation, less effect on HR/BP. Prolong QT

Front 51

DDI Ranolazine

Back 51

CYP450 substrate

Front 52

1st Line Adjunct tx angina

Back 52

ASPIRIN

Front 53

Role of ACE-I in angina

Back 53

Help delay progression of CAD.

Front 54

Goals of angina tx

Back 54

Relieve acute sx, prevent ischemic attack, reduce risk MI/CV problems.

Front 55

Tx occassional episodes of angina

Back 55

SL NTG

Front 56

Tx predictable episodes of angina upon exertion

Back 56

SL NTG, isosorbide prophylaxis, BB can be used in reflex tachy

Front 57

Tx frequent episodes requiring regular SL NTG

Back 57

Long term NTG, BB, CCB. May need angioplasty or CABG

Front 58

Preferred tx angina in asthmatics

Back 58

non-DHP CCB, cardio selective BB

Front 59

Preferred tx angina in DM pts

Back 59

non-DHP CCB, nitrates/cardioselective BB are alternatives.

Front 60

Preferred tx angina in heart failure pts

Back 60

BBs/NTG most preferred. LEAST PREFERRED = non-DHP CCB-- decrease contractility.

Front 61

Preferred tx angina in HTN pts

Back 61

BB, non-DHP CCB

Front 62

Preferred tx angina in pts w/ PMHx MI

Back 62

BB

Front 63

Preferred tx angina in pts w/ bradycardia/HB

Back 63

DHP CCB

Front 64

Goals of tx of acute STEMI

Back 64

Limit infarct size, reperfuse obstructed coronary arteries, reduce morbidity and mortality, prevent post-MI cx

Front 65

Pharm management STEMI

Back 65

MONA Likes To Help STEMIs-- metoprolol/morphine, oxygen, nitros, aspirin/ACE-I, LMWH, tPA/thienopyridines, heparin, statin

Front 66

Dose of aspirin for tx acute MI

Back 66

162-325 mg PO stat. Continue with 81-325 mg PO QD indefinitely.

Front 67

CI IV nitroglycerine in acute MI

Back 67

SBP <90, HR <50.

Front 68

Recommended window of use for IV NTG in acute MI

Back 68

1st 24-48h

Front 69

Dosing IV morphine in acute MI

Back 69

2-4 mg/5min-- some pts req. 25-30 mg before pain subsides. Assists in vasodilation.

Front 70

Adjunct analgesic tx to morphine

Back 70

oxygen, NTG, reperfusion, BB

Front 71

Recommended timing of initiation of BB tx in acute MI

Back 71

start IV dose ASAP and continue post MI PO doses unless CI.

Front 72

Rationale of use of BB as tx for acute MI

Back 72

Reduction in morbidity and mortality-- reduces magnitude of infarct/incidence of assoc. cx in pts w/o tPA and reduce rate of reinfarction in pts w/ tPA

Front 73

Effect of CCB on morbidity and mortality in tx of acute MI

Back 73

None proven. Controversial use.

Front 74

LMWHs approved for tx in non-Q wave MI

Back 74

Enoxaparin and Dalteparin

Front 75

# days thienopyridines are to be held prior to CABG

Back 75

5 days

Front 76

# days plavix should be added to meds post acute MI

Back 76

14

Front 77

MOA thrombolytics

Back 77

plasminogen activator-- dissolve existing clots

Front 78

Absolute CI of fibrinolytics in pts w/ MI

Back 78

Previous hemorrhagic stroke, other strokes or CVA w/in 1 year, intracranial neoplasm, suspected aortic dissection, active bleed.

Front 79

Relative CI fibrinolytics in pts w/ MI

Back 79

Severe uncontrolled HTN (>180/110), recent trauma, head trauma, major surgery, pregs, active PUD, hx chronic severe HTN

Front 80

MC thrombolytic used

Back 80

Alteplase (tPA)-- 100 mg over 90 min total

Front 81

Indication of statins for pts s/p acute MI

Back 81

long term to delay progression of plaque formation, improves mortality

Front 82

Indications for ACE-I in pts s/p acute MI

Back 82

long term tx to delay progression and improve mortality.