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57 Cards in this Set
- Front
- Back
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Oxygen-carrying capacity
a.) supply or demand determinant of ischemia? |
oxygen-carrying capacity
a.) supply |
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Coronary blood flow
a.) supply or demand determinant of ischemia? |
Coronary blood flow
a.) supply |
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Perfusion pressure
a.) supply or demand determinant of ischemia? |
Perfusion pressure
a.) supply |
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Vascular resistance
a.) supply or demand determinant of ischemia? |
Vascular resistance
a.) supply |
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Systolic wall tension
a.) supply or demand determinant of ischemia? |
Systolic wall tension
a.) demand |
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Heart rate
a.) supply or demand determinant of ischemia? |
Heart rate
a.) demand |
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Contractility
a.) supply or demand determinant of ischemia? |
Contractility
a.) demand |
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Cocaine
a.) decrease supply or increase demand? b.) causes |
Cocaine
a.) both decrease supply and increase demand b.) drug-induced ischemia |
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Ergot alkaloids
a.) decrease supply or increase demand? b.) causes |
Ergot alkaloids
a.) decrease supply b.) drug-induced ischemia |
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Oral contraceptives/estrogen
a.) decrease supply or increase demand? b.) causes |
Oral contraceptives/estrogen
a.) decrease supply b.) drug-induced ischemia |
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Beta AGONISTS
a.) decrease supply or increase demand? b.) causes |
Beta AGONISTS
a.) increase demand b.) drug-induced ischemia |
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Chronic stable angina
* type of ischemia (demand or supply) a.) secondary to b.) pain occurs when? c.) relieved by d.) ECG (2) |
Chronic stable angina
* demand ischemia a.) flow-limiting stenosis 50-70% b.) during exertion c.) rest or nitroglycerin d.) normal in pts w/o acute attack; T wave flattening or inversion |
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Prinzmetal's angina
a.) aka b.) type of ischemia (demand or supply) c.) secondary to d.) pain occurs e.) population (2) |
Prinzmetal's angina
a.) variant angina b.) supply ischemia c.) vasospastic coronary arteries d.) at rest; more painful than CSA e.) smokers, young people with fewer coronary risks |
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Silent ischemia
a.) symptoms b.) detection |
Silent ischemia
a.) no pain b.) via ECG |
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Ranolazine
a.) brand b.) dose c.) place in therapy d.) ADR e.) C/I (3) |
a.) Renexa
b.) 500-1000mg PO daily c.) last line for patients unresponsive to other anti-anginals d.) QT-prolongation e.) QT-prolongation, hepatic impairment (because metabolized by 3A4, avoid with diltiazem!), QT-prolonging medications (erythromycin, anti-arrhythmias, antipsychotics) |
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Isosorbide dinitrate
*duration a.) dose b.) brand |
Isosorbide dinitrate
*long acting a.) 5-80mg PO at 7 am, 12 pm, and 5 pm b.) Isordil |
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Isosorbide mononitrate
*duration a.) dose b.) brand |
Isosorbide mononitrate
* long a.) 20 mg PO at 8 am and 3 pm b.) Imdur |
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Diltiazem
a.) brand name (2) b.) class c.) indication d.) C/I e.) HR goal |
a.) Cardizem, Dilacor
b.) Non-DHP CCB c.) Prinzmetal's angina (1st line), 2nd line after b-blockers for CSA d.) EF <40% e.) 50-60 bpm at rest, <100 bpm during exercise |
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Metoprolol tartrate
a.) brand b.) dose c.) HR goal at rest d.) HR goal during exercise e.) indication f.) C/I |
a.) Lopressor
b.) 25-200 mg BID c.) 50-60 bpm at rest d.) <100 bpm during exercise e.) angina f.) prinzmetal's angina |
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Simvastatin
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j
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Atorvastatin
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j
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Nitrates (sublingual)
*duration a.) indication (2) b.) dose |
*short
a.) give to all IHD patients: for acute anginal attacks or prevention of exercise-induced angina b.) 0.4-0.6 mg SL prn |
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What are the supply determinants of ischemia? (2)
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1.) Oxygen carrying capacity
2.) Coronary blood flow (perfusion pressure, vascular resistance) |
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What are the demand determinants of ischemia? (3)
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1.) Systolic wall tension
2.) Heart rate 3.) Contractility |
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Class 1 angina
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No limitations during ordinary physical exercise (walking/ climbing stairs). Angina occurs during rapid, strenuous, or prolonged exercise
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Class 2 angina
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Slight limitation on ordinary physical exercise. Angina when walking >2 blocks or climbing >1 flight of stairs at normal pace
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Class 3 angina
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Marked limitation on ordinary physical exercise. Angina at 1-2 blocks of walking or climbing 1 flight of stairs.
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Class 4 angina
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Can't carry on ordinary physical activity without discomfort. May even experience angina at rest.
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Dobutamine
a.) used in b.) population c.) class/MOA d.) reversal |
Dobutamine
a.) pharmacologic stress tests (in combo with ECHO or radionucleotide) b.) patients with reactive airway disease c.) b-agonist/ increases HR = increase blood flow to see perfusion d.) b-blocker |
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Dipyridamole & Adenosine
a.) used in b.) avoid (2) c.) class/MOA d.) reversal |
Dipyridamole & Adenosine
a.) pharmacologic stress test (combo with ECHO and radionucleotide) b.) reactive airway disease, theophylline/caffeine c.) vasodilation = increased blood flow for radionucleotide perfusion d.) aminophylline |
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Regadenoson
* brand a.) used in b.) avoid (2) c.) class/MOA |
*Lexiscan
a.) pharmacologic stress testing (combo with ECHO or radionucleotide) b.) reactive airway disease, theophylline/caffeine c.) selective A2A adenosine agonist = increased blood flow for radionucleotide perfusion |
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Who should use pharmacologic stress testing? (2)
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1.) Patients that can't exercise (PVD, disabled, elderly, peripheral neuropathy
2.) Patients who can't achieve max HR (those taking chronotropic drugs like b-blockers and non-DHP CCB) |
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Exercise stress test
a.) Bruce protocol b.) Double product c.) poor prognosticators (3) |
Exercise stress test
a) Bruce protocol: gradual increases in workload b.) double product: HR x SBP. Measures myocardial consumption c.) short exercise duration, early onset angina, ST-segment depression, hypotension due to exercise |
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Radionucleotide
a.) agents (2) b.) image scan c.) analog |
a.) technetium-99m, thalium-201
b.) SPECT c.) potassium |
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Coronary angiography
a.) aka b.) MOA (2) c.) indication (2) |
Coronary angiography
a.) cardiac catherization b.) detects location and extend of atherosclerosis; provides access to PCI, if necessary c.) abnormal stress test findings, uncontrolled angina |
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3 cardiovascular risk reductions & goal
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1.) blood pressure: <130/80 mmHg
2.) dyslipidemia: LDL<100 or <70. If TG between 200-499, then non HDL<130 or <100. If TG >500, target TG 3.) diabetes: HbA1c <7% |
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Beta Blockers
a.) Place in therapy b.) drug and dose (1) c.) C/I d.) HR goal at rest and exercise |
Beta blockers
a.) first line for angina b.) metoprolol tartate/lopressor: 25-200 mg PO BID c.) Prinzmetal's angina d.) at rest: 50-60 bpm; exercise: <100 bpm |
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What drug is contraindicated when EF<40% and why?
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non-DHP CCB because they are negative inotropes
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Calcium Channel blockers
a.) class to use/drug & dose b.) place in therapy (2) c.) goal HR (2) d.) c/i e.) ADR (2) |
CCB
a.) non-DHP; diltiazem: Cardizem 30-90mg PO QID or Dilacor 120-480mg PO QD b.) first line for prinzmetal's angina, use when beta-blocker is c/i c.) rest is 50-60 bpm; exercise is < 100 bpm d.) EF < 40% for non-DHP e.) bradycardia (dont use if HR<50) and constipation. peripheral edema is in DHP |
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Minimum amount of time to be nitrate-free?
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10-12 hours
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NTG SL: list the 6 steps to take it
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1.) Sit or lie down
2.) Place under the tongue (may or may not burn) 3.) Don't swallow it 4.) Wait 5 minutes 5.) If symptoms aren't relieved, call 911 6.) Take 2 more doses at 5 minute intervals |
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Sublingual NTG
a.) how to dispense b.) refill (2) |
a.) keep in original glass bottle
b.) tablets get refilled every 6 months, spray gets refilled every 2 years |
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Isosorbide mononitrate ER
*duration a.) dose |
Isosorbide mononitrate ER
* long acting a.) 60-120 mg PO daily |
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What should all patients with angina get? (3)
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1.) NTG SL
2.) Aspirin 81 mg indefinitely 3.) Annual flu vaccine |
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Why should aspirin be given? (2)
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1.) Stabilizes coronary plaque
2.) Decreases mortality and acute MI by 50% |
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Which patients need ACEI? (4)
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1.) EF <40%
2.) HTN 3.) CKD 4.) DM |
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Which patients need ARB? (3)
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1.) alternative to ACE-inhibitor with HF, post-MI, or LVEF<40%
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Aldosterone antagonists
a.) patient population b.) C/I (2) |
a.) post-MI on ACEI+ bblocker who has EF<40% and HF or DM
b.) SCr >2-2.5 M/F, K>5 |
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Non-pharm therapy to control risk factors: Weight management
a.) goal BMI b.) life mod when waist circumference is c.) weight loss |
a.) 18.5-24.9 kg/m2
b.) >35 inches female, >40 inches male c.) 10% gradual weight loss from baseline |
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Non-pharm therapy to control risk factors: Diet
a.) reduce b.) increase |
a.) reduce saturated fat <7% of total calories. <200 mg/day cholesterol
b.) plant stanol (2g/day) and fiber (10g/day) |
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Non-pharm therapy to control risk factors: exercise (2)
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1.) moderate intensity workout 30-60 min 7 days a week (minimum 5 days a week)
2.) resistance training 2 days/week in addition to physical activity |
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B-blockers
a.) coronary blood flow b,) heart rate c.) arterial pressure d.) venous return e.) myocardial contractility |
B-blockers
a.) - b.) down c.) down d.) down e.) down |
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DHP CCB
a.) coronary blood flow b,) heart rate c.) arterial pressure d.) venous return e.) myocardial contractility |
DHP CCB
a.) increase b.) increase except amlodipine c.) decrease d.) - e.) decrease |
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Non-DHP CCB
a.) coronary blood flow b,) heart rate c.) arterial pressure d.) venous return e.) myocardial contractility |
Non-DHP CCB
a.) increase b.) decrease c.) decrease d.) none e.) decrease |
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Long-acting nitrates
a.) coronary blood flow b,) heart rate c.) arterial pressure d.) venous return e.) myocardial contractility |
Long-acting nitrates
a.) increase b.) increase/- c.) decrease d.) decrease e.) - |
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Simvastatin
a.) dose |
Zorcor
a.) 20 mg PO QHS |
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Atorvastatin
a.) dose |
Lipitor
a.) 10 mg PO daily or QHS |
