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RxPrep
Stable angina (Ch 29)
| Question | Answer |
|---|---|
| First-line drugs for stable angina symptom control? | Beta-blockers |
| Drugs for immediate relief of angina? | Sublingual nitroglycerin |
| If symptoms persist on one antianginal? | Add second agent from different class |
| When is ranolazine used? | Add-on therapy after other antianginals |
| Stable angina ALWAYS requires what preventive drug? | Antiplatelet (mainly Aspirin) |
| If aspirin contraindicated in stable angina, what do we use? | Plavix |
| Goal of antianginal therapy? | ↓ O2 demand or ↑ O2 supply |
| Which antianginals reduce HR and contractility? | Beta blockers |
| Which antianginals dilate coronary arteries? | CCBs and nitrates |
| Long-acting nitrates used for? | Prevention of angina |
| Key ADRs of nitrates? | headache, flushing, dizziness |
| How can we prevent nitrate tolerance? | have 10-12 hour nitrate free intervals |
| When to call 911 with nitroglycerin use? | If chest pain persists after first dose |
| Counseling on nitroglycerin patches? | Wear 12-14 hours, remove for 10-12 hours |
| Nitrates increase _______ and decrease ________ | Myocardial oxygen supply; preload |
| Beta blockers mechanism in angina? | ↓ HR, ↓ contractility → ↓ O2 demand |
| Preferred first-line for stable angina? | Beta blockers |
| Avoid beta blockers in? | Vasospastic angina |
| Non-DHP CCB effect in angina? | ↓ HR and contractility |
| DHP CCB effect in angina? | ↓ SVR (afterload) |
| Preferred CCB for vasospastic angina? | DHP CCBs |
| Should short acting nifedipine be used for angina or any other condition? | NO |
| Ranolazine is NOT used for? | Acute chest pain |
| What effect does ranolazine have on the heart? | Drops myocardial oxygen supply and drops oxygen consumption |
| What effects does ranolazine have on HR or BP? | Little to no effect |
| Major warning with ranolizine? | QT prolongation |
| CI of ranolizine? | Strong 3A4 inhibitors or inducers |
| Monitoring for ranolizine? | Potassium (hyperkalemia), ECG (qtc prolongation), renal function (can cause renal failure) (DONT USE IN CrCl < 30) |
| Ranolazine useful when? | Low BP or HR limits other drugs |
| Aspirin use in stable angina? | Secondary prevention |
| Common early sign of aspirin overdose? | Tinnitus |
| Clopidogrel used when? | Aspirin allergy |
| Clopidogrel boxed warning? | Poor metabolizers of 2C19, decreases efficacy |
| Clopidogrel major drug interaction? | Omeprazole, esomeprazole |
| Rare but serious ADR of plavix? | TTP (thrombotic thromocytopenic purpura) |
| MOA of plavix | P2Y12 inhibitor |
| Stop clopidogrel before surgery? | 5 days |
| Drug(s) of choice for vasospastic angina? | DHP CCBs |
Created by:
cdaughtry