Term
| antiplatelet therapies for angina |
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Definition
• Aspirin75–162mg/day(I,LOEA)
• Alternative Clopidogrel 75mg/day(I,LOEB)
• Hig hrisk SIHD-ASA+Clopidogrel(IIb,LOEB) |
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Term
| beta adrenergic antagonists for angina and MOA |
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Definition
Block cardiac B-1 receptors
• Decrease heart rate/↑ diastolic filling • Decrease contractility/CO
• Reduce wall tension- Reduce O2 Demand
Goal HR 50–60 bpm |
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Term
| beta blocker agonists indications for angina |
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Definition
• Symptomatic SIHD(I,LOEB)
• MI/ACS with normal EF—start and continue three years (I, LOE B)
• HF/ prior MI with LVEF<40%—carvedilol, metoprolol succinate, or bisoprolol (I, LOE A)
• All other patients w/ASCVD(IIb,LOEC) |
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Term
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Definition
| acebutolol, atenolol, betaxolol, bisoprolol, esmolol, metoprolol |
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Term
|
Definition
carvedilol, labetalol
nadolol, propanolol, sotalol |
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Term
Adverse effects:
• Cardiac—fatigue, dizziness, ↓reserve • Hypotension
• Bradycardia—attenuate with ISA BBA --CI sev. brady, high degree AV block, SSS w/pacer, refractory HF
• Caution reactive airway disease—attenuate with cardioselective BBA
• PAD—attenuate w/ low dose cardioselective BBA or BBA with α- blocking
• Diabetes-- Mask hypoglycemic symptoms
• CNS—nightmares, depression, insomnia
• Impotence
• Abrupt withdrawal—rebound phenomena |
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Definition
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Term
| calcium channel blockers MOA |
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Definition
• InhibitCa++channel influx in cardiac and vascular smooth muscle
• Decrease heart rate
• Decrease contractility/CO -- Reduce O2 Demand, Increase Coronary Blood Flow
• Non-DHP CCB goal HR 55–60bpm
• Monotherapy not recommended with DHPCCB due to reflex tachycardia -- DHP titrate to reduction in symptoms and BP |
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Term
|
Definition
• Symptomatic SIHD with intolerance or CI to BBA (I, LOE B)
• Combo w/ BBA—persistent symptoms
• Symptomatic SIHD—long-acting non-DHP alternative to BBA (IIa, LOE B) |
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Term
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Definition
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Term
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Definition
| Amlodipine, Clevidipine, Felodipine, Isradipine, NiCARdipine, NIFEdipine, Nimodipine |
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Term
adverse effects:
• Constipation
• Bradycardia/AV block/↓CO
• Avoid combo with BBA unless rate control afib |
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Definition
Non-DHP CCBs
constibation esp Verapamil in elderly |
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Term
• Hypotension, reflex tachycardia, flushing, headache
• Peripheral edema
• Caution in severe Ao valve stenosis |
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Definition
DHP CCB
peripheral edema esp amlodipine
reflex tachycardia (avoid short-acting DHP) |
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Term
has drug interactions:
• CYP3A4
• Cyclosporine
• Carbamazepine
• Li
• Amiodarone
• Digoxin (50–70% inc dig lvl in 1st week) |
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Definition
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Term
|
Definition
• Block I(f) → reduce diastolic depolarization slope → lower HR
• Nonegativechronotropicorlusitropiceffect
• NoeffectonBP
• No guideline update since U.S.availability |
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Term
has adverse effects:
• Phosphenes—enhanced visual brightness
• Symptomatic bradycardia |
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Definition
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Term
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Definition
• Direct smooth muscle relaxation --- ↑ NO → activate guanylate cyclase → Ca++ uptake SR → dephosphorylation of myosin-LC
• Reduce preload(veins>arteries)
• Myocardial wall tension -- Reduce O2 Demand
• Epicardial coronary artery dilation -- Increase O2 Supply |
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Term
|
Definition
• All SIHD patients
• Acute angina symptoms—SL NTG tab or spray—(I, LOE B)
• Activation of EMS if unrelieved by 1st dose
• Symptomatic SIHD with intolerance or CItoBBA (1, LOE B)
• Combow/BBA—persistent symptoms |
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Term
| Nitrates agents and differences |
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Definition
Isosorbide dinitrate (ISDN)
• Schedule nitrate-free period
Isosorbide mononitrate
• Active metabolite of ISDN
• No first pass metabolism
• Excellent bioavailability
• Asymmetric dosing (nitrate-free period) |
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Term
has adverse effects:
• Hypotension
• Flushing/headache
• Tachycardia—attenuatedwithcomboBBA
Tolerance—loss of antianginal effect
• Oxidation of sulfhydral groups and formation of disulfide bonds
• Develops fast and recovers fast (10–14 hours free) • Combat w/ACEI, carvedilol, hydralazine
• Dose dependent
Avoid in severe Ao valve stenosis |
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Definition
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Term
Drug interactions w
• PDE5 inhibitors (sildenafil (Viagra), tadalafil (Cialis) or vardenafil (Levitra)
• Profound hypotension |
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Definition
|
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Term
|
Definition
• Inhibits late I(Na), ↓ Ca++
• ↓cardiac metabolic action/fatty acid oxidation -- Reduce O2 Demand
• No effect on HR or BP |
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Term
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Definition
| • SIHD—Combine with refractory symptoms (IIa, LOE A) or in place with intolerance to BBA (IIa, LOE B) |
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Term
has adverse effects
QT prolongation
• 15 msec at therapeutic concentrations
• Avoid combo with other QT prolonging drugs
Constipation
• Nausea
• Dizziness
• Headache
• Accumulation in CKD
• CI in clinically significant hepatic impairment
Beneficial
• Reduction in VT, bradycardia, and afib
• Improved Hgb A1c |
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Definition
|
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Term
has drug interactions:
• CYP3A4 inhibitors
• Ketoconazole and other azole antifungals
• Macrolide antibiotics
• HIV protease inhibitor
• Grapefruit products/juice
Simvastatin–increase simva/metabolite lvls
Digoxin increased digoxin lvls |
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Definition
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Term
| ACEI/ARB indication for angina |
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Definition
• ACEi—All SIHD patients w/ HTN, DM, LVEF<40% or CKD (I, LOE A)
• ARBs—above w/ intolerance to ACEi (I, LOE A)
• ACEi reasonable in SIHD w/ vascular dz (IIa, LOE B)
• ARBs—above w/ intolerance to ACEi (IIa, LOE C) |
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Term
| chelation therapy for angina |
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Definition
• EDTA->complex with Ca++andcadmium-> excretion of soluble complexes -> regression of plaques -> relief of angina/oxidative stress in vascular wall
• Improve coronary bloodflow |
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Term
has adverse effects:
• 18% lost to follow-up
• Hypocalcemia
• Renal failure
• Death |
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Definition
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Term
| Enhanced External Counterpulsation (EECP) |
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Definition
-angina
• Technique with inflatable cuffs wrapped around LEs ↑venous return/augment DBP
• 1-hour session 5 days/week X 35 |
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Term
has adverse effects:
• 55% reported AEs • Leg and back pain • Skin abrasions |
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Definition
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Term
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Definition
• Estogen in post-menopausal women
• Vit C, E, or beta-carotene
• Folate, B6, or B12—for elevated homocysteine levels
• Garlic, CoEnz Q10, selenium, chromium |
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Term
| revascularization methods |
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Definition
• PCI (preferred in lower risk pts)
CABG preferred in higher risk
• Diabetes mellitus
• Complex multivessel disease |
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Term
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Definition
• Blocks Angiotensin Converting Anzyme (ACE)
• Prevents conversion of angiotensin I to angiotensin II
• Decreases angiotensin II mediated vasoconstriction
• Decreases afterload; lowers blood pressure |
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Term
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Definition
| Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Zestril), Ramipril (Altace), Trandolapril (Mavik) |
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Term
| ARB MOA and place in therapy |
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Definition
• Selectively blocks angiotensin II from binding AT1 receptor
• Decreases angiotensin II mediated vasoconstriction
• Decreases afterload; lowers blood pressure
• Place in therapy
• Intolerant of ACEIs or ARNIs |
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Term
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Definition
| Candesartan (Atacand), Losartan (Cozaar), Valsartan (Diovan) |
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Term
ADEs
• First dose hypotension
• Hyperkalemia
• Acute kidney injury- Actually thought to be renoprotective
• Cough ~10%- Anytime on therapy; ACEI >> ARB
• Angioedema ~0.1–0.5%- Within days of initiation; greater risk in African-Americans |
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Definition
ACEI/ARB
ACEI Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Zestril), Ramipril (Altace), Trandolapril (Mavik)
ARB Candesartan (Atacand), Losartan (Cozaar), Valsartan (Diovan) |
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Term
| Sacubitril/Valsartan MOA Diagram RAAS, NPS, affects |
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Definition
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Term
|
Definition
| Pts on Sacubitril/Valsartan lived 2 years longer and had fewer adverse effects. |
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Term
| One side effect to worry about w Sacubitril/Valsartan |
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Definition
|
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Term
| Contraindications to Sacubitril/Valsartan |
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Definition
• History of angioedema to ACEI/ARB
• Concomitant ACEI use within 36 hours |
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Term
| MRA Metabolic corticoid antagonists agents |
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Definition
| Eplerenone (Inspra), Spironolactone (Aldactone) |
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Term
| MRA Metabolic corticoid antagonists MOA |
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Definition
| • Block aldosterone-mediated Na/K antiporter activity in collecting duct |
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Term
ADE
Hyperkalemia, gynecomastia |
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Definition
MRA Metabolic corticoid antagonists
• Hyperkalemia, gynecomastia (spironolactone)
Eplerenone (Inspra), Spironolactone (Aldactone) |
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Term
| Beta blockers indications |
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Definition
| Hypertension,AMI(within24hoursofhospital admission and at discharge), angina pectoris (stable), arrhythmias |
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Term
| Beta blockers contraindications |
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Definition
| Allergy,cardiogenicshock,severeheartfailure, bradycardia, second- or third-degree heart block |
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Term
| has SEs Bradycardia, AV nodal block, hypotension, dizziness, bronchospasm, fatigue, depressed mood |
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Definition
Beta blockers
Bisoprolol (Zabeta), Carvedilol (Coreg), Motoprolol succinate (Toprol XL), Nebivolol (Bystolic) |
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Term
| Beta blocker agents for HF |
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Definition
| Bisoprolol (Zabeta), Carvedilol (Coreg), Motoprolol succinate (Toprol XL), Nebivolol (Bystolic) |
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Term
| Funny Channel inhibitor agent |
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Definition
|
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Term
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Definition
| It works only by delaying conduction of sodium and potassium across what is called the IF channel, or the funny channel. Only works at SA node (useful for sinus rhythm but not aberrant conductin pathways) |
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Term
| ADEs HF, Symptomatic Bradycardia, Asymptomatic Bradycardia, Atrial Fibrillaiton, Phosphenes |
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Definition
| Ivabradine, funny channel inhibitor, IF channel |
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Term
| Ivabradine place in therapy |
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Definition
| • Resting HR > 70 bpm despite max tolerated β- blockade |
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Term
| Ivabradine contraindicaxtion |
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Definition
Contraindications
• Acute decompensated heart failure
• BP<90/50mmHg
• SSS, SA block, or 3o AV block
• Strong CYP3A4 inhibitors |
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Term
|
Definition
| Isosorbide Dinitrate/Hydralazine, Nitroglycerin (component of Isosorbide Dinitrate/Hydralazine), Nitroprusside, Nesiritide |
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Term
| Isosorbide Dinitrate/ Hydralazine MOA |
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Definition
• Direct vasodilatory combination
• Isosorbide relaxes venules > arterioles • Hydralazine relaxes arterioles |
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Term
| Isosorbide Dinitrate/Hydralazine place in therapy |
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Definition
| • Mortality benefit only in African-American HFrEF |
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Term
has SEs
• Hypotension, headache, weakness
• Chest pain |
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Definition
| Isosorbide Dinitrate/Hydralazine |
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Term
| Nitroglycerin MOA and Indication |
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Definition
(component of isosorbide dinitrate/hydralazine)
• Venodilator
• Reduce preload and ventricular stretch
• Rapid relief of pulmonary congestion
• Ideal for HF with HTN, ACS, or significant mitral regurgitation |
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Term
Has SEs of
• Postural hypotension
• Tachycardia
• Headache
• Tachyphylaxis develops within 24 hours
• DDI - Sildenafil (Viagra, Revatio), Tadalafil (Cialis), Vardenafil (Levitra) (PDEI)- Hypotension |
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Definition
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Term
| Nitroprusside MOA and monitoring |
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Definition
• Mixed arterial/venodilator
• Reduce preload and afterload
• Invasive arterial monitoring typically required |
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Term
Has SEs
• Excessive hypotension, especially HFpEF due to volume sensitivity
• Thiocyanate/cyanide toxicity |
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Definition
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Term
|
Definition
• RecombinantBNP
• Increases cAMP-veno and arteriolar vasodilitation
• Naturesis |
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Term
has SEs
• Hypotension, headache, nausea
• Renal toxicity and death
• Injection site extravasation |
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Definition
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Term
| Loop diuretic for HF agents |
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Definition
| furosemide(Lasix®) (most common),bumetanide (Bumex®), torsemide (Demadex®), ethacrynic acid (Edecrin®)(no sulfonamide) |
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Term
|
Definition
| • Inhibit Na/K/2Cl symporter on thick ascending limb of the loop of Henle |
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Term
has adverse effects of
• Hypokalemia, hypomagnesemia
• Cramping
• Hypotension
• Hearing decrements |
|
Definition
Loop diuretics
furosemide(Lasix®),bumetanide (Bumex®), torsemide (Demadex®), ethacrynic acid (Edecrin®) |
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Term
|
Definition
| Dopamine, Dobutamine, Milrinone |
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Term
|
Definition
• Mixed alpha and beta agonist
• Dopamine-arterial dilator, especially kidney
• β1-inotropy, arrhythmogenicity
• α-vasoconstriction |
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Term
Has SE
• Tachyarrhythmias
• Hypertension
• Extravasation necrosis |
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Definition
|
|
Term
|
Definition
• Beta agonist
• β1-inotropy, arrhythmogenicity
• β2 -peripheral vasodilation |
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Term
Has SEs
• Tachyarrhythmias
• Hypertension
• Hypotension
• Angina |
|
Definition
|
|
Term
|
Definition
• Phosphodiesterase-3i nhibitor
• Increase intracellular Ca++
• Vasodilation
• Inotropy |
|
|
Term
has SEs
• Arrhythmias
• Hypotension
• Headache |
|
Definition
|
|
Term
|
Definition
1. 3Na+/2K+ ATPase pump inhibitor
• Competes for K+ binding site • Intracellular Na+ increases
2. 3Na+/Ca2+exchanger
• Removes excess Na+
• Intracellular Ca2+ increases
Tn-C
3. Sarcoplasmicreticulum
• High Ca2+ activates troponin-C • Increases cardiac contractility
[image] |
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Term
Has Adverse effects
Digestive (most common)
Nausea, vomiting, anorexia, diarrhea
Neurologic
Headache, fatigue, disorientation, delirium, confusion
Visual
Blurred vision, altered color perception, greenish-yellow halo
Cardiac
Bradyarrhythmia, heart block, ventricular dysrhythmias |
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Definition
|
|
Term
|
Definition
• Symptomatic HF despite GDMT guideline-directed medical therapy
• No mortality benefit
• Lowers rehospitalization only
• Concurrent atrial fibrillation |
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Term
|
Definition
• Human relaxin-2, vascular hormone
• Responsible for many of the hemodynamic adaptions during pregnancy
• Promotes angiogenesis at ischemic sites
• Anti-inflammatory and antifibrotic properties
• t1/2 < 10 min
• Reduces SVR and PCWP
[image] |
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Term
| Omecamtiv Mecarbil MOA, effects |
|
Definition
• Cardiac myosin activator
• Increases entry rate of myosin into the tightly- bound, force-producing state with actin
• No increase in myocardial oxygen demand
• Increased systole/decreased diastolic may impact on coronary perfusion
• Benign troponin leak
[image] |
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Term
| SGLT-2 Inhibitor MOA diagram |
|
Definition
|
|
Term
|
Definition
• S = sodium and other dietary restrictions
• C = care in the community
• A = activity
• L = Lasix and other medications
• E = every day weight and symptom monitoring
• S = smoking cessation |
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