Pharm Cad/mi

Front 1

2 primary forms of ischemic heart ds

Back 1

angina pectoris

MI

Front 2

prinzmetals angina

Back 2

due to acute coronary vasospasm and often occurs during rest or sleep.

Front 3

what do beta blockers do for MI and angina patients

Back 3

i. beta blockers can improve distribution of coronary flow by reducing intraventricular pressure

Front 4

2 goals of tx for angina

Back 4

increase O2 supply and decrease O2 demand.

Front 5

angina vs variant angina treatments

Back 5

typical angina tx with vasodilators and beta blockers to decrease O2 demand.

Variant angina use vasodilators to increase O2 supply by relaxing coronary smooth muscle and restoring normal coronary flow. Beta blockers don't work as well because they do not counteract vasospasm.

Front 6

what are the modifiable risk factors with angina

Back 6

HTN.

hyperlipidemia.

DM.

smoking cessation.

Front 7

first line for angina tx

Back 7

beta blockers

Front 8

HTN, CHF, typical angina, MI, certain arrhythmias, migraines are all indications for what drug?

Back 8

beta blockers

Front 9

contraindications for beta blockers

Back 9

sinus brady (<60), SBP <100, heart block, cardiogenic shock, ADHF. Non-selective agents are contraindicated for COPD, asthma and DM.

Front 10

DDI's of beta blockers

Back 10

verapamil which has the greatest potential for reducing contractility and decreasing CO.

Front 11

beta specific and or cardioselective

Back 11

metoprolol.

atenolol.

Nebivolol.

Front 12

non selective beta blockers

Back 12

nadolol and propranolol

Front 13

alpha 1 and beta blockers

Back 13

carvedilol and labetalol.

Front 14

pregnancy category of beta blockers

Back 14

C/D

Front 15

pregnancy category for CCB's

Back 15

C

Front 16

MOA for CCB's

Back 16

bind calcium ion channels in smooth muscle and cardiac tissue that leads to smooth muscle relaxation and suppression of cardiac activity which leads to O2 demand decreases.

Front 17

Indications of CCB's

Back 17

HTN, angina, arrhythmias. especially variant angina with diltiazem and verapamil

Front 18

contraindications for CCB's

Back 18

mostly for non DHP. SBP <100, HR <60, ADHF, EF < 40%., AV block.

Front 19

ADR's of CCB's

Back 19

constipation, fatigue, headache, flushing, dizziness, hypotension, bradycardia, reflex tachycardia, edema.

Front 20

Role of CCB's in angina

Back 20

Use Non-DHPs as initial therapy when BBs are contraindicated.

Use DHPs as add on therapy to BBs.

Use in combo w/ nitrates.

Non-DHP preferred for variant angina

Front 21

non-DHP CCB's

Back 21

verapamil and diltiazem.

Front 22

DHP CCB's

Back 22

amlodipine.

felodipine.

nifedipine (avoid IR formulation)

Front 23

DHP vs non-DHP CCB's MOA?

Back 23

DHP work more on the vascular smooth muscle to reduce BP.

Non-DHP work more on the cardiac tissue reducing the HR and BP.

Front 24

what happens to the dose of nitrates over time?

Back 24

it may need to increase because the patient can build tolerances.

Front 25

MOA of organic nitrates

Back 25

release of nitric oxide which leads to diffusion into vascular smooth muscle cells forming cyclic GM and venous dilation leading to venous pooling decreasing preload and decreasing ventricular diastolic volume and decreasing myocardial O2 demands.

Front 26

MOA of organic nitrates at higher doses

Back 26

arterial dilation leading to decreased PVR and decrease in left ventricular ejection pressure which is afterload.

Front 27

indications for organic nitrates

Back 27

angina, MI, CHF

Front 28

contraindications of organic nitrates

Back 28

aortic valve stenosis.

concurrent use with sildenafil, vardenafil, tadalafil.

Angle-closure glaucoma, head trauma or cerebrospinal hemorrhage, severe anemia and severe hypotension SBP <90.

Front 29

ADR's of organic nitrates

Back 29

HA, dizziness, weakness, postural hypotension, rash, tolerance, and anxiety.

Front 30

organic nitrates OD s&s

Back 30

reflex tachycardia and arrhythmias.

Front 31

DDI's of organic nitrates

Back 31

PDE 5 inhibitors like sildenafil, tadalafil, and vardenafil. Isosorbide is CYP3A4

Front 32

role in angina management with organic nitrates

Back 32

SL formulation to relieve acute symptoms of MI.

SL/PO to prevent effort induced angina (prophylactically).

Long acting formulations for maintenance therapy

Front 33

indications for amyl nitrate?

route?

Back 33

cyanide poisoning.

inhaled.

Front 34

what medication deteriorates in sunlight?

Back 34

organic nitrates

Front 35

how often do nitrates need replacing?

Back 35

every 3 to 6 months from when the bottle is opened.

Front 36

what special consideration needs to be considered when giving nitro IV?

Back 36

nitro tubing is required because nitro contains propylene glycol and will break down normal tubing.

Front 37

isosorbide pregnancy category

Back 37

C

Front 38

isosorbide given how often

Back 38

give TID at 8am, 1pm, and 6pm.

Front 39

how often to give nitro

Back 39

PO.

must be administered QD or BID only to minimize tolerance

Front 40

Ranolazine MOA

Back 40

sodium current inhibitor

Front 41

indications for Ranolazine

Back 41

Used for chronic stable angina in combination with CCB, beta-blockers or nitrates.

Front 42

indications of Ranolazine

Back 42

Used for chronic stable angina in combination with CCB, beta-blockers or nitrates.

Front 43

Contraindications Ranolazine

Back 43

pre-existing QT prolongation, uncorrected hypokalemia, hepatic failure, if taking drugs that prolong QT interval or drugs that are potent CYP3a4 inhibitors.

Front 44

Ranolazine precautions

Back 44

can prolong QT interval and induce torsades de pointes.

Front 45

Ranolazine ADR's

Back 45

dizziness,headache, constipation. Less effects on HR and BP than other classes. Prolongs QT interval

Front 46

DDI's Ranolazine

Back 46

CYP450

Front 47

aspirin MOA

Back 47

inhibits synthesis of prostacyclin and thromboxane A2 leading to prevent platelet aggregation leading to decreased thrombosis.

Front 48

aspirin role in angina

Back 48

primarily used to prevent ACS in patients with unstable angina.

Front 49

what are clopidogrel, prasugrel, ticagrelor

Back 49

Antiplatelet agents P2Y-12

Front 50

ACE inhibitors role in angina

Back 50

use all patients with CAD to help delay progression of CAD.

Do not relieve angina symptoms because do not directly affect O2 supply.

Front 51

consideration with concomitant diseases like DM. How to tx angina?

Back 51

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

Front 52

consideration with concomitant diseases like asthma. How to tx angina?

Back 52

non-DHP CCB or cardioselective BB most preferred.

Front 53

consideration with concomitant diseases like heart failure. How to tx angina?

Back 53

BB's and nitrates most preferred, non-DHP CCB least preferred

Front 54

consideration with concomitant diseases like HTN. How to tx angina?

Back 54

BB and non-DHP CCB most preferred

Front 55

consideration with concomitant diseases like prior MI. How to tx angina?

Back 55

BB most preferred

Front 56

consideration with concomitant diseases like bradycardia. How to tx angina?

Back 56

DHP CCB preferred

Front 57

consideration with concomitant diseases like heart block . How to tx angina?

Back 57

DHP CCB preferred

Front 58

goals of STEMI therapy

Back 58

limit infarct size.

reperfuse obstructed coronary arteries.

reduce morbidity and mortality.

prevent post MI complications

Front 59

aspirin with STEMI

Back 59

162 to 325 mg stat then 81 to 325 mg QD.

Front 60

morphine for MI

Back 60

2 to 4 mg IV every 5 minutes with some patients requiring higher doses up to 25 t 30 mg.

Front 61

what medication is Recommended for all post-MI patients with substantial left ventricular dysfunction and/or clinical CHF?

Back 61

Ace inhibitors

Front 62

what medication is Recommended To start IV dose ASAP and continue post MI with PO doses unless contraindicated

Back 62

beta blockers

Front 63

what do beta blockers do for post MI

Back 63

Reduction In morbidity and mortality - immediate beta-blocker therapy appears to reduce

(1) the magnitude of infarction and incidence of associated complications in subjects not receiving concomitant thrombolytic therapy and (2) the rate of reinfarction in patients receiving thrombolytic therapy.

Front 64

what do CCB's do for post MI patients

Back 64

a. Controversial in MI – do NOT affect morbidity and mortality.

b. Maybe given to pts intolerant to beta-blockers.

Front 65

when would diltiazem be given to post MI patient

Back 65

Diltiazem – may be useful in pts w/ non-Q-wave MI without LV dysfunction.

Front 66

anticoagulants post MI are?

Back 66

a. Weight-based Unfractionated heparin.

b. Low Molecular weight heparins.

c. Bivalirudin.

d.Fondaparinux .

Front 67

P2Y-12 Inhibitors are what?

Back 67

antiplatelet agents

Front 68

what are fibrinolytics for?

Back 68

Fibrinolytics are used to achieve rapid thrombolysis. Usually used in institutions without PCI capability or if patient cannot be transferred to an institution with PCI capability.

Fibrinolytic therapy provides a survival benefit for patients with acute MI.

Front 69

absolute contraindications of fibrinolytics in patients with MI's

Back 69

Previous hemorrhagic stroke

- Other strokes or CVA within 1 year

- Intracranial neoplasm

- Suspected aortic dissection

Front 70

relative contraindications of fibrinolytics in patients with MI's

Back 70

Severe uncontrolled HTN (> 180/110)

- Recent trauma, head trauma or major surgery

- Recent internal bleeding

- Pregnancy

- Active peptic ulcer

- History of chronic severe HTN

Front 71

when should statins be started post MI

Back 71

9. Patient should be started on statins post-MI if not already receiving for long term reduction in CV events,morbidity and mortality

Front 72

1. STEMI patients:If present to hospital w/ PCI capability, they should be treated with primary PCI (stent placement) within how many minutes of first medical contact?

Back 72

90

Front 73

If present to hospital w/o PCI capability and cannot be transferred to PCI center within how many minutes, they should be treated with fibrinolytics within how many minutes of hospital presentation unless contraindicated (Class IB rec)

Back 73

90 and 30

Front 74

PCI – stent placement (some pts require CABG therapy. If CABG therapy indicated, antiplatelets should be held for how many days if possible.

Back 74

5 to 7

Front 75

Is it better to have the heart in longer systole or longer diastole in MI?

Back 75

longer diastole

Front 76

what can I tell my patients to do in the winter to prevent vasospasm?

Back 76

breath warmed air, so use a face mask outside.

Front 77

Describe what kind of nitro should you prescribe?

Back 77

the ones that are in a foil container that can contain one per punch out pouch.

Front 78

Ismo isosorbide given how often

Back 78

BID – give 7 hrs apart need more of it

Front 79

mononitrate form – available PO only. Mononotrae is a longer acting metabolite of dinitrate form.

Back 79

mononitrate form – available PO only. Longer acting metabolite of dinitrate form.

Front 80

how often to give nitro over 15 minutes

Back 80

every 5 minutes take one 3 times.

Front 81

isosorbide imdu given how often

Back 81

once daily

Front 82

giving a pt a single 81mg dose of aspirin can reduce chance of cardiac event by how much?

Back 82

30%

Front 83

clopidogrel MOA

Back 83

works on ADP to inhibit platelet aggregation.

Front 84

Ticagrelor for UA are more potent than what?

Back 84

clopidogrel

Front 85

what 2 antiplatelet meds do you give for unstable angina

Back 85

Prasugrel

Ticagrelor

Front 86

give what to people quitting smoking to make them happy people quitting smoking?

Back 86

wellbutrin

Front 87

how to chew nicotine gum

Back 87

give it 4 or 5 chews then put it in the cheek.

Front 88

beta blockers are 1A in clinical research to reduce morbidity and mortality. True or false

Back 88

true

Front 89

we don't use fibrinolytics in N-STEMI, true or false?

You get what from this?

Back 89

True

white thrombus which is just platelets

Front 90

storage considerations of nitro

Back 90

UV light breaks it down. Keep it out of the sun and in a cool dry place otherwise you could pop 20 and get no response.

Front 91

Immediate release forms of this med and other short-acting CCBs have increased risk of MI, CHF and death due to coronary heart disease.

Back 91

nifedipine