Angina Flashcards

1
Q

Discuss apporpriate non-pharmacologic measures for a patient with angina.

A

-smoking cessation -increase physical activity and weight control -plasma glucose control -immunizations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

List the goals for pharmacologic therapy in chronic stable angina.

A

-Prevent progression to USA, MI or death (through anti-platelet therapy and cholesterol control) -provide effective relief of anginal symptoms (using beta blockers, calcium channel blockers, and nitrates) -Modify risk factors for CAD (blood pressure control, smoking)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What should you monitor when using a beta blocker for chronic stable angina relief?

A

heart rate-don’t start one on pt with t increase the dose with HR at goal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What should you monitor when using a calcium channel blocker for chronic stable angina relief?

A

blood pressure-can cause orthostatic hypotension HR-can cause reflex tachycardia watch for pitting edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the hard indications for use of a beta blocker for treatment of chronic stable angina?

A

-6 months post MI (ideally 3 years) -Ejection Fraction is <40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When should you initiate therapy with calcium channel blockers for chronic stable angina?

A

*Use non-DHP to replace beta blocker or if a beta blocker isn’t desirable. -don’t start if the HR is /= 2+ pitting edema or if patient has othostatic hypotension.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When should you initiate therapy with a long acting nitrate for chronic stable angina?

A

-add to a beta blocker or non-DHP to improve symtom control -useful over DHP in patients with cautions for use -Use with DHP if a pt can’t tolerate beta blocker or non-DHP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When should you initiate therapy with a short acting nitrate for chronic stable angina?

A

use to terminate acute attacks or to prophylaxis INFREQUENT stress or effort attacks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How would you initiate therapy with nitrates for chronic stable angina based on patient-specific information?

A

To alleviate pain, consider a beta blocker first, then add or substitute a CCB as needed, and then add or substitute a long-acting nitrate as needed.

Nitrates (short-acting and long-acting)

LA nitrates can be used for long term prophylaxis, are generally added to BB or non-dyhidropyridines to control anginal pain, are useful over DHP in patients with cautions for use, and can be combined with dyhidropyridines if patient can’t tolerate beta blockers or non-dyhidropyridines.
SA nitrates are used to terminate acute anginal attacks, prevent effort- or stress-induced attacks, and to prophylax infrequent stress or effort attacks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How would you initiate therapy with beta-blockers for chronic stable angina based on patient-specific information?

A

To alleviate pain, consider a beta blocker first, then add or substitute a CCB as needed, and then add or substitute a long-acting nitrate as needed.

Beta Blocker

Avoid use of beta blockers with intrinsic sympathomimetic agents, which will negate the “exercise-induced” benefits of beta blockers.
Try beta blockers first for patients with hard indications and no contraindications (use beta blockers for 6 months, preferably 3 years, post MI; use beta blockers for systolic HF [EF
For patients with cautions for use and NO hard indications, try something else first. Do NOT start a beta blocker if HR < 55.
Do NOT increase the dose with HR at a goal level of 55-60
Cautions: type I DM, asthma, decompensated HF, moderate to severe PAD.
Contraindications: bradycardia (HR<50), 2nd degree heart block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How would you initiate therapy with calcium channel blockers for chronic stable angina based on patient-specific information?

A

To alleviate pain, consider a beta blocker first, then add or substitute a CCB as needed, and then add or substitute a long-acting nitrate as needed.

Calcium Channel Blocker

For dihydropyridines, add to beta blocker if HR <= goal or combine with LA nitrates in patients who can’t take beta blockers or non-DHP.
Use non-dihydropyridines if HR > goal and a beta blocker is not recommended for use (no hard indications with cautions) or contraindicated.
Non-DHP contraindications include left ventricular dysfunction (EF<40%), bradycardia (HR<50 bpm), and AV block (2nd or 3rd).
Use non-DHP to replace a beta blocker or if a beta blocker is undesirable but do NOT use if HR<55 or increase the dose if HR is at goal. Use DHP in addition to a beta blocker when HR is at goal but do NOT start with >= 2+ pitting edema or with orthostatic hypotension.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly