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Pharm - Ischemic Heart Disease
Exam 3
52
Pharmacology
Graduate
04/11/2010

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Cards

Term
What is another name for ischemic heart disease?
Definition
coronary artery disease
Term
What things fall under ischemic heart disease?
Definition
acute coronary syndrome
non-ST-segment elevation MI
ST-segment-elevation MI
MI with biomarkers only
unstable angina
variant or Prinzmetal's angina
Term
What are 4 manifestations of atherosclerosis other than ischemic heart disease?
Definition
heart failure
arrhythmias
cerebrovascular disease
peripheral vascular disease
Term
What do foam cells indicate?
Definition
atherosclerosis
Term
What are unstable plaques?
Definition
plaques that do no affect the lumen but are future areas for culprit lesions; may rupture
Term
What are culprit lesions?
Definition
lesions where plaque has formed over and narrows the lumen.

Less dangerous than unstable plaques to suddenly cause ischemia
Term
T/F
Angiograms may show the arteries as healthy when the patient is in fact at risk.
Definition
True - unstable plaques can exist and not be seen and these are more dangerous than the culprit lesions that can be seen.
Term
T/F
Coronary Artery Bypass Grafting (CABG) may be more adventageous than percutaneous coronary intervention in patients with multivessel disease.
Definition
True - future lesions are bypassed and plaque vulnerability is no longer an issue
Term
T/F
Ischemic heart disease can be an isolated condition.
Definition
False - often seen with diabetes and other conditions
Term
T/F
Diabetics have a decrease in blood flow to the heart after a meal.
Definition
True - normal patients have an increase.
Term
T/F
Dyslipidemia is directly related to the rate at which coronary heart disease events occur.
Definition
True
Term
T/F
Lowering LDL levels decreases the risk of a coronary artery disease event ever occurring.
Definition
True
Term
T/F
Patients presenting to PCP with chest pain are less likely to be having a heart attack than those presenting to ER.
Definition
True - patients tend to know how serious it is
Term
What is the most common anginal syndrome?
Definition
chronic stable angina
Term
Describe chronic stable angina.
Definition
discomfort, pressure, or squeezing sensation (sometimes burning, sticking or sharp)

substernal area, precardium, or epigastrum with radiation to L arm, jaw or neck

Precipitated by exercise, emotion, exposure to cold, eating, or smoking

relieved by rest, removal of provoking factors, or sublingual nitrates

few minutes - 20-30 min
Term
Describe how unstable angina pectoris presents.
Definition
1. recent onset that is provoked by minimal exertion
2. chronic stable angina that crescendos over time
3. prolonged chest pain at rest, clinically indistinguishable from acute MI
Term
What is prinzmetal's angina (variant angina)?
Definition
Myocardial ischemia caused by coronary artery spasm
Term
T/F
Prinzmetal's angina can occur in patients with or without coronary atherosclerosis.
Definition
True
Term
What change does variant angina cause on an EKG?
Definition
ST elevation
Term
When does pain occur in variant angina?
Definition
at rest, unprovoked
may follow circadian manner and occur in the early morning hours
Term
What lifestyle modifications do you recommend to a patient with angina?
Definition
stop smoking
modify diet - low fat, eat fish, eat 1800 calories or less
lose weight
increase physical activity
Term
What is the pharmacological treatment for stable angina pectoris?
Definition
1. Aspirin therapy
2. Beta blockers for previous MI
3. ACE-I (especially for DM and LVH)
4. Lipid therapy for LDL >/= 100
5. Regular exercise
6. stop smoking
7. avoid cocaine - causes vasoconstriction
Term
T/F
Aspirin therapy for stable angina is less effective in diabetes patients.
Definition
True
Term
What is the first line therapy for terminating infrequent acute episodes of angina?
Definition
short acting nitrates
Term
How is nitroglycerin administered?
Definition
sublingual
Term
How is nitorglycerin dosed?
Definition
0.4 mg

one tab every 5 minutes, up to 3 tabs as needed for chest pain
Term
T/F
Nitro should be stored in the refrigerator, but can last 3 months in pocket.
Definition
True
Term
What is the advantage to spray nitroglycerin?
Definition
shelf life of 1 year without refrigeration
Term
How is nitroglycerin taken prophylactically?
Definition
5-10 minutes before activity
Term
What are the side effects of nitroglycerin?
Definition
headache, dizziness, orthostatic hypotension, and reflex tachycardia
Term
What 2 things make orthastatic hypotension resulting from Nitro use worse?
Definition
CCB and alcohol
Term
Name 2 counterindications for Nitro use.
Definition
1. use of PDE-5 inhibitor - 24 hours after sildenafil and vardenafil, 48 hours after tadalafil
2. intracranial pressure
Term
When do you dose long acting nitrate?
Definition
QAM so that nitrate free interval begins in the evening
Term
Name 3 long-acting nitrates.
Definition
isosorbide dinitrate, isosorbide mononitrate, nitroglycerin transdermal patches
Term
What is tachyphylaxis?
Definition
the development of tolerance to nitrates in smooth muscle

this is why it is important to remove transdermal patches at night
Term
What is coronary steal syndrome?
Definition
a condition that is suggested if the nitrate does not reieve the pain. The vasodilatory effects of nitro may open other vessels and the atherosclerotic artery may still be bypassed.
Term
What is first line treatment for chronic angina?
Definition
beta blocker

reduces episodes of silent ischemia and reduces early morning peak ischemia
Term
T/F

Beta blockers used to treat chronic angina improve mortality after MI
Definition
True
Term
Why are beta blockers generally discontinued?
Definition
fatigue, depression, malaise, or sexual dysfunction
Term
When are CCBs preferred over Beta blockers to treat angina?
Definition
in patients with severe peripheral vascular disease symptoms at rest
Term
Name 4 CCBs used to treat angina.
Definition
amlodipine, diltiazem, verapamil, and nifedipine
Term
T/F
Amlodipine reduces the symptoms of angina and is okay to use with long-acting nitrates
Definition
True
Term
What drug should be avoided in a patient with variant (Prinzmetal's) angina?
Definition
beta blockers

potential to worsen vasospasm
Term
T/F
Short acting CCBs are used to treat the patient with variant angina.
Definition
False - only long-acting formulations. Short-acting increase cardiac events.
Term
T/F
Patients with variant angina should have immediate release nitro for acute attacks.
Definition
True
Term
What can be done for multiple daily acute angina attacks?
Definition
long-acting nitrate treatment
Term
What drugs are best to treat acute coronary syndrome post MI?
Definition
Beta blocker and ACE-I
ARBS are used only if ACE-I intolerant
Term
What is the first line therapy for patients with high coronary disease risk? What drug is added on in acute coronary syndromes (unstable angina, NSTEMI)?
Definition
Beta blocker

Add on ACE-I
Term
What over the counter medication is an important part of acute coronary syndrome treatment?
Definition
aspirin
Term
How does statin therapy help treat acute coronary syndrome?
Definition
reduces CRP and stabilizes plaques
Term
Which patients are most susceptible to the effects of beta blockers and CCB inotropic and chronotropic effects?
Definition
elderly - start low and go slow
Term
T/F
Asymptomatic bradycardia may be acceptable in elderly patients being treated with a beta blocker and a CCB.
Definition
True
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