Kristellar Cardio Test Two

Front 1

what are the other names for CAD?

Back 1

ischemic heart disease IHD or coronary artery disease CHD

Front 2

what disease does CAD include?

Back 2

stable/unstable angina and MI

Front 3

define atherosclerosis. how is it related to CAD?

Back 3

a disease of the arteries characterized by the deposition of plaques of fatty material on their inner walls...CAD is caused by the narrowing of arteries by atherosclerosis

Front 4

define chronic stable angina

Back 4

chronic occurrence of chest discomfort due to transient myocardial ischemia with physical exertion or other conditions that increase oxygen demand

Front 5

what can CAD cause?

Back 5

chronic stable angina or acute coronary syndrome

Front 6

what consists of acute coronary syndrome? how does it all start

Back 6

unstable angina and MI, comes form the rupture of atherosclerosic plaque

Front 7

Describe how patients find out they have CAD?

Back 7

Half have chronic stable angina the other half will have an MI

Front 8

What are the main coronary arteries? what do they break up into?

Back 8

left main and right coronary artery. the left main splits into the left anterior descending and the circumflex

Front 9

what is prinzmetals angina?

Back 9

vasospasm that causes a narrowing of the coronary arteries, not caused by atherosclerosis

Front 10

what are the modifiable risk factors for CAD?

Back 10

smoking, dyslipidemia, diabetes, HTN, physical activity, obesity, low consumption of fruit and veggies, alchohol

Front 11

what are the non modifiable risk factors for CAD?

Back 11

age greater than 45 for men, age greater than 55 for women, men or postmenopausal women, family history of premature CAD (aka first degree relative had it if male was less than 55 or female was less than 65)

Front 12

what determines oxygen supply to the heart?

Back 12

arterial P02, diastolic filling time (shorter), plaques vasospasm or thrombus

Front 13

what determines oxygen demand/consumption

Back 13

HR, contractility, ventricular wall tension (and this depends on BP, volume, wall thickness)

Front 14

when exactly will you experience the symptoms of chronic stable angina?

Back 14

during exercise or when atherosclerotic plaque occludes 50-70% of coronary artery

Front 15

how much do unstable plaques occlude an artery?

Back 15

asymptomatic, occlude less than 50%

Front 16

Describe the quality, location, duration of CAD?

Back 16

pressure/tightness/pain, anterior or chest (neck jaw shoulder and back of arm), several minutes

Front 17

what can accompany CAD pain? what can make it worse?

Back 17

dyspepsia, nausea, vomiting, diaphoresis

big meals or cold

Front 18

how would cardiac enzymes appear for a chronic stable angina patient?

Back 18

normal

Front 19

what does a stress test, test for? what do you do if it is positive? what does that test look for?

Back 19

monitor EKG for signs of ischemia during exercise

undergo coronary angiography

visualize coronary anatomy to identify narrowing of coronary arteries due to atherosclerotic plaques

Front 20

how can you determine between chronic stable angina and acute coronary syndrome?

Back 20

CSA is experienced in a pattern and is reproducible with exertion

ACS has prolonged symptoms that are unexpected and unrelieved by NTG

Front 21

what are the 6 treatment goals of treatment?

Back 21

prevent ACS/death, alleviate acute symptoms, prevent progression, reduce complications, minimize adverse treatment effects, prevent recurrent symptoms

Front 22

what drugs are used to treat chronic stable angina and reduce oxygen demand of the heart?

Back 22

short acting nitrates, BB, CCB, LA nitrates

Front 23

what are the treatments that increase oxygen supply of CSA?

Back 23

PCI which is subcutaneous coronary intervention or angioplasty

CABG which is coronary artery bypass grafting

Front 24

describe PCI surgery

Back 24

catheter into blood vessel into coronary artery, balloon inflation which is usually followed by stent placement

Front 25

three disease states that are major risk factors for CAD?

Back 25

htn, dm, dyslipedmia

Front 26

what drugs are used for acute coronary syndrome?

Back 26

anti-platelet agents, statins, acei/arb, SA NTG

Front 27

what should you give if a patient cannot not take ASA?

Back 27

clopidegrel

Front 28

when is dual antiplatelet therapy used?

Back 28

following acute coronary syndrome or PCI with stent placement

Front 29

when can you use anti-platelet agents for primary prevention?

Back 29

if they have a history of CAD

Front 30

who should receive a statin? what else should all these patients get?

Back 30

all patients with CAD regardless of baseline LDL

a ACE or ARB

Front 31

what should all patients with angina be prescribed?

Back 31

NTG

Front 32

should patients take NTG before exercise?

Back 32

not recommended, no studies and may cause more dizziness

Front 33

what should be used for patients that have frequent angina?

Back 33

BB, CCb, or LA nitrates

Front 34

what happens when a nitrate is combined with a PDE inhibiotr?

Back 34

severe hypotension which can reduce blood flow to vital organs

Front 35

what are the SL NTG counseling points?

Back 35

use in seated position, call 911 if symptoms do not improve/worsen after 5 minutes of the dose, store in glass container, do not store in the same container as other meds, no long term S/E do not hesitate to use, do not sue if sidenafil/vardenafil in 24 hours or tadalafil in 48 hours

Front 36

do BB prevent cardiac arrhythmias?

Back 36

yes but only during the time around an acute coronary syndrome event

Front 37

are BB good for long term?

Back 37

no there is no mortality benefit

Front 38

what are the contraindications for BB

Back 38

bradycardia less than 50bpm, asthma/copd, depression

Front 39

can BB be abruptly stopped?

Back 39

no, taper if they are hemodyamically stable, but you can d/c completely if they have hypotension or bradycardia

Front 40

what CCB's are best to use?

Back 40

verapamil and diltiazem

Front 41

what drug can be combined with a DHP CCB to prevent reflex tachycardia?

Back 41

BB

Front 42

what should be used first, a BB or a CCB?

Back 42

use a BB first unless intolerable, then go for the CCB

Front 43

a patient is using a BB but still has angina symptoms, what should you do?

Back 43

add a LA DHP CCB

Front 44

what should be used to treat prinzmetals angina?

Back 44

CCB's over BB

Front 45

what are the better CCB's to use if you have HF?

Back 45

ammlodipinde or felodipine, they have less negative inotropic effects

Front 46

what should never be used to treat angina?

Back 46

short acting nifepidine or nicardipine

Front 47

how do you avoid tolerance of nitrates?

Back 47

do not use them for 8-12 hours during the day

Front 48

why do we avoid nitrate monotherapy?

Back 48

reflex tachycardia and increase o2 consumption, and you will not be protecting during the off time

Front 49

can you use monotherapy nitrates in those with low BP?

Back 49

yes

Front 50

why is ranolazine last line?

Back 50

excessive cost and can cause QT prolongnation

Front 51

should a women with acute coronary syndrome recieve HRT?

Back 51

no, can increase thromboembolic events

Front 52

what NSaid should a patient with CAD use for a headache?

Back 52

naproxen only for shortest duration possible

Front 53

how should you administer aspirin and an nsaid?

Back 53

nsaid at least 30 mins after the aspirin or 8 hours before the aspirin

Front 54

what should be avoided in variant angina?

what should be used?

Back 54

BB b/c it can worsen vasospasm

use CCB or nitrate

Front 55

what should you monitor for CSA patients?

Back 55

symptoms, BP, HR, risk factors, kidney function, adherence, drug therapy

Front 56

what is essential in patient education?

Back 56

what to do if anginal symptoms occur and when to seek emergent care

Front 57

what is the underlying cause of acute coronary syndrome?

Back 57

the rupture of an atherscelortic plaque and eventual clot formation

Front 58

what is a STEMI? what is usually done if a patient has one?

Back 58

it is an MI characterized by ST elevation (flat part) on an EKG

reperfusion therapy with PCI within 12 hours of symptom onset

Front 59

what drugs should a STEMI patient receive?

Anything else if they undergo PCI?

Back 59

intranasal O2, SL NTG, ASA, P2Y inhibitor (clopidorgrel, prasugrel, ticagrelor), and an anticoagulation

add a GPIIb/IIIa inhibitor(abciximab or tirofiban) and UFH if undergoing PCI

Front 60

are the drugs used for the treatment of NSTEMI any different?

Back 60

initial therapy is the same but P2Y inhibitor is not used until later

Front 61

what drugs should all STEMI/NSTEMI patients receive indefinitely?

Back 61

ASA, BB ACEI and may add statin

Front 62

Under what conditions do you use PY2 inhibitor for a year?

Back 62

if patient undergoes PCI, or had a NSTEMI

Front 63

Under what condiitions would you use PY2 inhibitor for 14 days?

Back 63

non-PCI treatments and STEMI

Front 64

what proteins cause platelet adhesion and activation?

Back 64

Tissue factor and collagen on exposed smooth muscle

Front 65

Why is ventricular remodeling bad? What drugs can slow it?

Back 65

can lead to HF, ACEI, ARBS, B and aldosterone antagonists can work

Front 66

What may indicate ACS on an EKG?

Back 66

ST elevation, ST depression or t-wave inversion

Front 67

what are the two cardiac biomarker? which one is preferred?

Back 67

troponin and CK-MB

Troponin is preferred

Front 68

How should be troponin be checked?

Back 68

once in ED, then 6-9 hours later, and again 12-24 hours later if negative on the first two

Front 69

What should be done as soon as ST elevation is observed? How long can you wait for the treatments/

Back 69

fibrinolytics within 30 mins or PCI within 90 mins?

Front 70

Short term goals for ACS?

long term

Back 70

restore blood flow, prevent further cardiac injury, prevent death , relieve chest discomfort

reduce modifiable risk factors, prevent CV events, improve QOL

Front 71

General approach of treating an ACS?

Back 71

oxygen, avoid valsalva maneuver, pain management, chew ASA, anticoagulant, continuous EKG monitoring, and vital signs

Front 72

what are the anticoagulants used?

Back 72

UFH, enoxaparin, or bivalirudin

Front 73

when do you call a PCI secondary?

Back 73

after 12 hours since symptom onset

Front 74

what is the goal door to balloon time for STEMI?

Back 74

less than or equal to 90 minutes

Front 75

what is different about PCI in NSTEMI?

Back 75

usually do angiography first

Front 76

what is the other term for PY2 inhibitors?

Back 76

thienopyridine

Front 77

the contraindications of fibrinolytics are?

Back 77

acute internal bleeding, previous intracranial hemorrhage or ischemic stroke in the last 3 months, intracranial neoplasm, vascular lesions, aortic dissection, closed head or facial trama in the last 3 months

Front 78

what is the treatment option if PCI is not done for STEMI? how quickly should this be done?

Back 78

use fibriolytic, door to needle time is less than or equal to 30 minutes

Front 79

what are the fibrinolytics?

Of these, which one is not preferred?

Back 79

alteplase, reteplase, tenecteplase, and streptokinase

streptokinase, has worse outcomes

Front 80

what P2Y inhibitors are prodrugs

Back 80

clopidogrel and ticagrelor

Front 81

For patient who do not undergo PCI and could get a fibrinolyti, what is the door to needle time?

Back 81

less than 30 mins

Front 82

what are the indications for ASA?

Back 82

prevent stent thrombosis, reduce risk of death, recurrent MI and stroke

Front 83

How soon should patient with ACS get ASA?

Back 83

within 24 hours of hospital admission

Front 84

what are common drug interactions of with the thienopyridines?

Back 84

NSAIDs and Warfarin

Front 85

What is prasugrel contraindicated in? why?

Back 85

patients with prior CVA or TIA due to increased risk of intracranial hemorrhage

Front 86

how long should clopedigrel be used for if ACS and noninvasive strategy (thrombolysis)?

Back 86

1 month but should go for a whole year

Front 87

how long should clopedigrel be used for if STEMI and treated with thrombolytic?

Back 87

14 days but should go for 28 days

Front 88

what kind of stent should you use if there is a good chance the patient wont be compliant?

Back 88

use a bare metal for low adherent patients

Front 89

how long should you wait to have surgery if you had a bare metal stent placed?

what about a drug eluting stent?

Back 89

delay surgery for 4-6 weeks after BMS

Delay surgery 12 months after DES

Front 90

If you have a CABG coming up and you are on clopidogrel, how long before surgery should you stop using it?

what if you were on prasugrel?

Back 90

5 days pre op

7 days pre op

Front 91

what thienpydrodine is dose twice a day?

Back 91

ticagrelor is BID all other are QD

Front 92

what are the glyoprotein IIB/IIIa receptor inhibitors?

what is the MOA?

Back 92

abciximab, eptifbatide, and tirofiban

prevent cross linking between the IIb/IIIa receptors on platelets

Front 93

what gp IIb/IIIa receptor inhibitors get redosed based on kidney function?

Back 93

eptifibatide and tirofiban

Front 94

when are the gp IIa/IIIb inhibtors most commonly used?

Back 94

in combo with UFH following PCI

Front 95

What are the anticoagulants?

which ones do you need to watch kidney function?

Back 95

UFH, enoxaparin, bivalirudin, and fondaparinux (not used in stemi)

enox, biva, fonda

Front 96

what may be better than the UFH gp IIb/IIIa inhibitor combo for post PCI?

Back 96

bivalirudin, and it is cheaper

Front 97

when are anticoagulants usually discontinued?

Back 97

following PCI, may use 2-3 days if ACS w/o reperfusion

Front 98

common side effect of nitrates? what is done to combat this?

Back 98

headache, use APAP

Front 99

when should a patient call 911 when refering to NTG use?

Back 99

if their angina/discomfort is not resolved within 5 minutes after the first dose

Front 100

do ACS patients usually get CCB's? When do they?

Back 100

no, only if discomfort persists despite nitrate use and contraindication of BB

aka use BB first

Front 101

when should you use an aldosterone antagonist?

Back 101

when patient is on ACE and BB and LVEF (left ventricular ejection fraction) is less than or equal to 40 percent

Front 102

what is the main difference in treating Stemi versus nstemi?

Back 102

nstemi acs do not get fibrinolytics

Front 103

what are the long term goals following MI?

Back 103

control modifable risk factors, prevent HF, recurrent MI or stroke, death, stent thrombosis after PCI

Front 104

what should all these patients get

Back 104

statin, asa, bb, acei