4.3 AI summary

Chronic Coronary Disease (CCD) is caused by ________ leading to an imbalance in myocardial oxygen supply and demand.

obstructive atherosclerotic plaque

The hallmark symptom of CCD is ________.

angina (chest pain)

The term once used for CCD was ________.

chronic stable angina

Angina in CCD is typically precipitated by ________ or exposure to ________.

exercise, cold air

Unstable angina differs from CCD in that symptoms occur ________ and are ________.

at rest, severe and sudden

PCI stands for ________.

percutaneous coronary intervention

CABG stands for ________.

coronary artery bypass graft

Diagnosis of CCD can be done non-invasively through ________ or pharmacologic stress testing.

exercise cardiac stress testing

A more invasive diagnostic test for CCD is ________.

coronary angiography

The validated tool for assessing angina impact on quality of life is the ________.

Seattle Angina Questionnaire

One major goal of CCD therapy is to prevent ________.

major adverse cardiac events (MACE)

Another goal of therapy is to improve ________ to relieve symptoms.

oxygen supply and demand balance

Lifestyle modification is a cornerstone of therapy because ________% of MI risk is linked to modifiable risk factors.

90

The ideal salt intake goal for CCD patients is less than ________ mg/day.

1500

Men should limit alcohol to ________ drinks/day and women to ________.

2, 1

Recommended exercise for CCD includes ________ minutes/week of moderate intensity.

150

All CCD patients should receive annual ________ and ________ vaccinations.

influenza, COVID

High-intensity statins should achieve at least ________% LDL reduction.

50

Examples of high-intensity statins are ________ mg Atorvastatin or ________ mg Rosuvastatin.

40-80, 20-40

ACE inhibitors are indicated for CCD patients with ________, ________, LVEF <40%, or CKD.

hypertension, diabetes

All CCD patients not on oral anticoagulants should receive ________ mg aspirin daily.

81

If allergic to aspirin, ________ can be used instead.

clopidogrel

Dual antiplatelet therapy (DAPT) consists of ________ plus a ________ inhibitor.

aspirin, P2Y12

Examples of P2Y12 inhibitors include ________, ________, and ________.

clopidogrel, prasugrel, ticagrelor

Patients on oral anticoagulants should generally not receive ________ unless post-PCI.

aspirin

Rivaroxaban at a dose of ________ mg BID can be considered for select low-bleeding-risk CCD patients.

2.5

All CCD patients should have access to short-acting ________ for acute angina relief.

nitroglycerin

Nitroglycerin acts by relaxing ________ and increasing blood flow.

vascular smooth muscle

Patients should take nitroglycerin while ________ to avoid dizziness.

sitting down

Maximum nitroglycerin doses allowed before calling 911 is ________ doses within 15 minutes.

3

Nitrates are contraindicated with ________ inhibitors.

PDE-5

Beta blockers reduce myocardial oxygen demand by lowering ________, ________, and ________.

heart rate, contractility, afterload

Preferred DHP calcium channel blockers for CCD are ________ and ________.

amlodipine, felodipine

Non-DHP CCBs like ________ and ________ are options when beta blockers are not tolerated.

verapamil, diltiazem

Long-acting nitrates must include a nitrate-free interval of ________ hours per day.

10-14

Ranolazine decreases angina by reducing ________ and ________.

ventricular wall tension, late sodium currents

NSAIDs should be avoided in CCD due to increased risk of ________ and ________.

hypertension, bleeding

SGLT2 inhibitors and GLP-1 agonists are beneficial in CCD patients with ________ or ________.

diabetes, heart failure

If angina persists despite therapy, consider ________ or ________ as elective procedures.

PCI, CABG

The pharmacist's role includes monitoring for efficacy using tools like ________ or the ________ method.

Seattle Angina Questionnaire, PQRST

Which of the following best defines chronic coronary disease (CCD)?

A. Sudden arterial spasm without plaque involvement

B. Obstruction by an atherosclerotic plaque causing ischemia

C. Myocardial necrosis due to complete thrombus occlusion

D. Transient vasodilation with reversible ischemia

B. Obstruction by an atherosclerotic plaque causing ischemia

Which of the following symptoms best characterizes stable angina in CCD?

A. Sharp pain at rest

B. Sudden tearing pain

C. Pressure or tightness induced by exertion

D. Pain worsened by inspiration

C. Pressure or tightness induced by exertion

Which of the following drugs provides mortality benefit in CCD through MACE prevention?

A. Nitroglycerin

B. Statins

C. Ranolazine

D. Verapamil

B. Statins

In patients with CCD and diabetes, which drug class should be prioritized to reduce MACE risk?

A. Beta blockers

B. ACE inhibitors

C. Nitrates

D. Calcium channel blockers

B. ACE inhibitors

For a patient allergic to aspirin, the appropriate antiplatelet alternative is:

A. Warfarin

B. Clopidogrel

C. Prasugrel

D. Rivaroxaban

B. Clopidogrel

How long should dual antiplatelet therapy (DAPT) typically continue after ACS in CCD patients?

A. 3 months

B. 6 months

C. 12 months

D. Indefinitely

C. 12 months

Ranolazine reduces anginal symptoms primarily by:

A. Increasing nitric oxide production

B. Decreasing myocardial wall tension

C. Enhancing β-adrenergic activity

D. Blocking calcium channels

B. Decreasing myocardial wall tension

Which combination should be avoided due to risk of severe hypotension?

A. Nitrates and PDE-5 inhibitors

B. Statins and ACE inhibitors

C. Beta blockers and CCBs

D. ACE inhibitors and aspirin

A. Nitrates and PDE-5 inhibitors

For CCD patients with hypertension and diabetes, which combination is most appropriate initially?

A. Aspirin + Verapamil

B. Lisinopril + Atorvastatin

C. Ranolazine + Amlodipine

D. Nitroglycerin + Rivaroxaban

B. Lisinopril + Atorvastatin