unstable angina

chest pain is an imbalance of what

myocardial oxygen demand (workload) and supply (blood flow)

Myocardial oxygen demand increases when there is ?

Increased HR, contractitiliy or left ventircular wall tension (due to increased preload and or afterload (svr))

stable angina; myocardial oxygen demand decrese be?

atherlosclerosis; CAD (coranry artery disease)- narrowing of arteries and reducded blood flow to the heart

chest pain caused by coranary artery vasopsasms is called

vasospastic angina (variant or Prinzmetal angina)

evaluation of stable angina

hx and physical; cbc, ck0mb, topronins, aptt, pt/inre, lipid panel, glucose, ecg (at rest and during chest pain), cardiac stress test/stress imgaing, cardiac catheterization

non drug treatment

<2.3g/day of sodium, no trans fat, waist circumferene <35 in females in <40 in males

150 min of mod-intensity aerobic activity

avoid nsaids chornically, 1 drink aoclohol

general treatment idealogy for stable agina

antiplatelet + antianginal

antiplatelet therapy in PAD

low dose rivaroxaban in combo with aspirin

antianginal moa

decrease myocardial oxygen demand or increase myocardial supply

prevention options

beta blockers, DHP or nonDHP ccbs, or long acting nitrates

what happens if one agent isnt enough to relieve angina

add on another class of med

ranolazine use

refractory angina (to two therapuetic classes)

immediate relief options

short aciting nitroglycin, (sl or translingual spray)

treatment approach acronym

A (antiplatelet and antianginal drugs)

B (bp)

C (cholesterol statins and cigarette cessation)

D (diet and diabetes)

E (exercise and education)

clopidogrel moa

prodrug inhibits p2y12 adp mediation platelet activation and aggregation

aspiring type for acs

chewable, non enteric coated

what drugs to avoid clopidogrel wtih

esmoperprazole and omeprazole

how much before sx does clopidogrel need d/c

5 days

beta blocker mechanism of benefit

reduced myocardial oxygen demand; decrease HR and contractility and lfet ventiruclar wall tension

CCB mechanism of benefit

reduce myocardial oxygen demand; non DHPs decrease HR and contractility; DHPS decrease SVR (Afterload). all increase myocardial oxygen supply; increase blood flow through coronary arteries

DHPs vs nonDHPs

DHPs + beta blockers preferred; avoid short acting DHPs (like IR nifedipine)

Nitrate mechanism of benefit

Reduce myocardail oxygen demand; decrease preload

Increases oxygen supply; increase blood flow through collateral arteries

ranolazine

aspruzyo sprinkle, ranexa

ranolazine moa

selectively inhibits the late phase Na current and decrease intracellular Ca

decreases myocardial oxygen demand by decreasein gventircular tension and oxygen consumption

ranolazine ci

liver cirrhosis, do not use wtih stron gCYP3A4 inhbitiors/inducers

ranolazine warnings/se

QT prolongation; ARF (crcl<30), dizziness, headache, constipation, nausea

ranolazine affect on hr/bp

none

Nitroglyerl SL tablets (nitrostat)

0.3, 0.4, 0.6mg

nitroglycerin TL spray (nitromist, nitrolingual)

0.4mg/spray

isosorbide mononitrate tablets

IR (10,20mg) BID, 7 hrs apart (8am and 3pm)

ER (30, 60, 120mg) once daily in the am

isosrbide dinitrate IR (siordil)

IR 5, 10, 20, 30, 40mg; BID or TID (goal 14 hr nitrate interval)

how long to wear trandermal patch

wear for 12-14 hrs, off for 10-12 hrs

nitroglycerin ointment 2%

BID; 6 hrs apart