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Pharm-T2-IHD
Ischemic Heart Disease
| Question | Answer |
|---|---|
| What is the difference b/t chronic stable angina and unstable angina? | Chronic is reproducible and rest makes it feel better. |
| What is the most common symptom of Ischemic Heart Disease? | Angina - Discomfort in chest when blood supply to Myocardium is decreased. |
| Goals of IHD Tx? | Prevent ACS and Death, Alleviate Acute Sx, Prevent recurrent symptoms, Avoid or min adverse events. |
| Primary strategies for preventing ACS and Death? | Modify CV Risk factors (biggest one you can do), Slow progression of coronary atherosclerosis, Stabilize Atherosclerotic Plagues. |
| With IHD/ACS what is the first pharmacotherapy to be used to Prevent ACS and DEATH? | Risk behavior, Antiplatelet Agents, Statins, ACEIs and ARBs //// NTG to relieve acute symptoms/// beta-blockers, CCB, long acting nitrates are to help prevent recurrent symptoms |
| What is the cornerstone of IHD prevention? | Treat Modifiable risk factors; Dyslipidemia, HTN, Diabetes Mellitus |
| Aspirin and clopidogrel with IHD, Combination recommended with status post (s/p) PCI with stent placement, how long with BMS stent and DES stent? | BMS: Atleast 1 month after //// At least 12 months after a DES |
| Statin are where in the line of options for treating ACS/IHD? | 2nd in line. PALS have been shown to decrease IHD: Pravastatin, Atorvastation, Lovastatin, Simvastatin |
| When is peak of cholesterol synthesis? | Cholesterol synthesis peaks at night and this is when patients should take there statin drugs. |
| Statins can be used in Pregnancy, true or False? | False |
| When measuring AST/ALT liver enzymes at what numbers would you discontinue the use of statin? | AST/ALT increases more than 3-5 X ULN |
| More than 8oz of what may inhibit the metabolism of some statins? | Grapefruit Juice |
| What Medications will interacted with statins? | Amiodarone, Cyclosporine, Macrolid |
| What meds interact with statins? | CAMP Grapefruit Juice (Cyclosporine, Amiodarone, Macrolide antibiotics, Protease Inhibitors, Grapefruit Juice . |
| ALL patients with history of angina should have SL nitroglycerin (NTG) or spray true or false? | True |
| Ranolazine | Refractory Angina |
| When would you avoid the use of beta blockers b/c it may worsen condition? | Variant (prinzmetal) Angina - worsening vasospasm possibly |
| If patient has taking Sildenafil or Vardenafil how long should you before taking NTG? | 24 hours |
| If patient has taking Tadalafil How long should you wait before taking NTG? | 48hrs, may cause severe hypo-tension and possible DEATH |
| What medications are taking as a PREVENTION of RECURRENT ischemic symptoms? | BBs, CCBs, Long-Acting Nitrates, Ranolazine |
| What is the first line therapy after a patient has experienced a MI or ischemis symptoms? | BBs (metoprolol and Carvedilol) |
| After BBs what is the next medication Rx to help prevent a reoccurrance of Ischemic symptoms and are negative chronotropes which are usually more effective antianginal medications by slowing AV node and Dec HR? | CCBs (Verapamil and Diltiazem) |
| IF you are going to use CCBs in combination with a BB what kind of CCBs should you use? | Long Acting DIHYDROPYRIDINE CCBs are preferred (Amlodipine or Felodipine) |
| IF a patient has severe hypotension should you still use long acting nitrates? | NO, hypotension out weighs use. |
| IF a patient has Refractory Angina what medication should you use? | Ranolazine |
Created by:
cmuox2000
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