Ischemic Heart Disease (SIHD) and Treatment Quiz
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Questions and Answers

Which drug is indicated for acute coronary syndromes (ACS) in combination with aspirin or in patients with recent myocardial infarction (MI), stroke, or peripheral arterial disease (PAD)?

  • Durlaza
  • Aspirin
  • Rivaroxaban
  • Clopidogrel (correct)

    • Which drug is a prodrug and its effectiveness depends on the conversion to an active metabolite, mainly by CYP450 2C19?

  • Aspirin
  • Rivaroxaban
  • Clopidogrel (correct)
  • Durlaza

    • Which drug is used with low-dose rivaroxaban to reduce the risk of major cardiovascular events such as MI and stroke?

  • Durlaza
  • Rivaroxaban
  • Clopidogrel
  • Aspirin (correct)

    • Which drug should not be used when rapid onset is needed, for example, in acute coronary syndrome (ACS) or pre-percutaneous coronary intervention (PCI)?

    <p>Durlaza</p> Signup and view all the answers

    Which drug is indicated for those at risk of developing aspirin-associated gastric ulcers?

    <p>Durlaza</p> Signup and view all the answers

    Which drug is used in single antiplatelet therapy (SAPT) for stable ischemic heart disease (SIHD) when there is a contraindication to aspirin?

    <p>Clopidogrel</p> Signup and view all the answers

    Which drug is the only P2Y12 inhibitor recommended in SIHD for dual antiplatelet therapy (DAPT)?

    <p>Clopidogrel</p> Signup and view all the answers

    What is the classic symptom of stable angina?

    <p>Chest pain relieved by rest or nitroglycerin</p> Signup and view all the answers

    What is the medical emergency associated with unstable angina?

    <p>Acute coronary syndrome</p> Signup and view all the answers

    What can lead to misdiagnosis of stable angina in certain patient groups?

    <p>Absence of classic symptoms</p> Signup and view all the answers

    What is the term for chest pain caused by vasospasm of the coronary arteries?

    <p>Prinzmetal's angina</p> Signup and view all the answers

    What is the main cause of decreased myocardial oxygen supply in stable ischemic heart disease?

    <p>Plaque build-up in the coronary arteries</p> Signup and view all the answers

    What type of angina can occur at rest and be caused by illicit drug use, particularly cocaine?

    <p>Prinzmetal's angina</p> Signup and view all the answers

    What is the term for chest pain that does not vary with position or respiration?

    <p>Typical of stable angina</p> Signup and view all the answers

    Which type of nitrates is recommended for all patients for fast relief of angina?

    <p>Short-acting nitrates</p> Signup and view all the answers

    What is the main side effect associated with long-acting nitrates?

    <p>Tachyphylaxis</p> Signup and view all the answers

    Which condition is a contraindication for short-acting nitrates?

    <p>Severe anemia</p> Signup and view all the answers

    What is the recommended monitoring for long-acting nitrates?

    <p>Blood pressure</p> Signup and view all the answers

    Which formulation of nitroglycerin requires a nitrate-free interval to prevent tolerance?

    <p>Nitroglycerin transdermal patch</p> Signup and view all the answers

    What is the main warning associated with nitroglycerin TL spray?

    <p>Hypotension</p> Signup and view all the answers

    Which type of nitrates can aggravate angina caused by hypertrophic cardiomyopathy?

    <p>Nitroglycerin TL spray</p> Signup and view all the answers

    What is the main side effect associated with nitroglycerin SL powder?

    <p>Syncope</p> Signup and view all the answers

    Which type of nitrates does not develop tolerance with SL/TL products?

    <p>Nitroglycerin SL tablet</p> Signup and view all the answers

    Which factor does not contribute to the risk of Ischemic Heart Disease (SIHD)?

    <p>Regular exercise</p> Signup and view all the answers

    What is the recommended antiplatelet for SIHD treatment?

    <p>Aspirin</p> Signup and view all the answers

    What is the purpose of a cardiac stress test in the context of SIHD?

    <p>To assess the likelihood of CAD and diagnose SIHD</p> Signup and view all the answers

    What is the goal of SIHD treatment?

    <p>To improve function, prevent future cardiovascular events, and reduce the risk of cardiovascular death</p> Signup and view all the answers

    Which combination is FDA-approved for reducing the risk of cardiovascular events in patients with CAD?

    <p>Low-dose rivaroxaban (Xarelto) and aspirin</p> Signup and view all the answers

    What is the purpose of antianginal treatment for SIHD?

    <p>To decrease myocardial oxygen demand or increase myocardial oxygen supply</p> Signup and view all the answers

    What is recommended for patients with SIHD to manage hypertension, heart failure, and diabetes?

    <p>High-intensity statin and aggressive management</p> Signup and view all the answers

    Unstable angina is not a type of acute coronary syndrome (ACS)

    <p>False</p> Signup and view all the answers

    Prinzmetal's angina can only occur during physical exertion

    <p>False</p> Signup and view all the answers

    Chest pain caused by vasospasm of the coronary arteries is known as stable angina

    <p>False</p> Signup and view all the answers

    Myocardial oxygen supply is often decreased due to plaque buildup in the outer walls of the coronary arteries in stable ischemic heart disease (SIHD)

    <p>False</p> Signup and view all the answers

    Long-acting nitrates are more effective than beta-blockers and calcium channel blockers in silent ischemia.

    <p>False</p> Signup and view all the answers

    Clopidogrel is a direct-acting P2Y12 inhibitor.

    <p>False</p> Signup and view all the answers

    Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is recommended for all patients with stable ischemic heart disease (SIHD).

    <p>False</p> Signup and view all the answers

    Aspirin should be used indefinitely in SIHD unless contraindicated.

    <p>True</p> Signup and view all the answers

    Yosprala and Durlaza should be used when rapid onset is needed, for example, in acute coronary syndrome (ACS) or pre-percutaneous coronary intervention (PCI).

    <p>False</p> Signup and view all the answers

    Prinzmetal's (variant) angina is preferred for treatment with beta-blockers.

    <p>False</p> Signup and view all the answers

    Omeprazole and esomeprazole are safe to use in combination with clopidogrel.

    <p>False</p> Signup and view all the answers

    Clopidogrel is contraindicated in patients with active serious bleeding.

    <p>True</p> Signup and view all the answers

    Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is reserved for those who have had placement of a drug-eluting stent for at least one month.

    <p>False</p> Signup and view all the answers

    Clopidogrel is the only P2Y12 inhibitor recommended in SIHD.

    <p>True</p> Signup and view all the answers

    Yosprala is indicated for those at risk of developing aspirin-associated gastric ulcers.

    <p>True</p> Signup and view all the answers

    Aspirin should be used indefinitely in SIHD when there is a contraindication to aspirin.

    <p>False</p> Signup and view all the answers

    Long-acting nitrates can be used without a nitrate-free interval to prevent tolerance

    <p>False</p> Signup and view all the answers

    Ranolazine (Ranexa) can be used in combination with beta-blockers without risk of excessive bradycardia

    <p>False</p> Signup and view all the answers

    Short-acting nitrates have the potential to aggravate angina caused by hypertrophic cardiomyopathy

    <p>True</p> Signup and view all the answers

    Nitrates do not develop tolerance with SL/TL products

    <p>False</p> Signup and view all the answers

    Isosorbide dinitrate should be dosed three times daily for a 14-hour nitrate-free interval

    <p>True</p> Signup and view all the answers

    Isosorbide mononitrate should be dosed twice daily, 7 hours apart

    <p>False</p> Signup and view all the answers

    Nitroglycerin ER capsules should be taken with a 18-hour nitrate-free interval

    <p>False</p> Signup and view all the answers

    Isosorbide dinitrate is recommended for use in combination with hydralazine

    <p>True</p> Signup and view all the answers

    Nitrates are recommended for all patients for fast relief of angina

    <p>False</p> Signup and view all the answers

    Nitrates have little to no clinical effects on heart rate or blood pressure

    <p>False</p> Signup and view all the answers

    Nitroglycerin transdermal patch should be worn for 12-14 hours with a nitrate-free interval of 10-12 hours

    <p>True</p> Signup and view all the answers

    Nitrates are contraindicated in patients with liver cirrhosis and use of strong CYP3A4 inhibitors or inducers

    <p>True</p> Signup and view all the answers

    Coronary artery disease causes widening of arteries and increased blood flow to the heart

    <p>False</p> Signup and view all the answers

    Myocardial oxygen demand decreases when the heart is working harder

    <p>False</p> Signup and view all the answers

    Annual influenza vaccine and pneumococcal vaccines are not recommended for patients with SIHD

    <p>False</p> Signup and view all the answers

    Low-dose rivaroxaban (Xarelto) in combination with aspirin is not FDA-approved for reducing the risk of cardiovascular events in patients with CAD

    <p>False</p> Signup and view all the answers

    Antiplatelet and antianginal drug regimens are not used together for SIHD treatment

    <p>False</p> Signup and view all the answers

    Aspirin is not the recommended antiplatelet for SIHD treatment

    <p>False</p> Signup and view all the answers

    Non-drug treatments for SIHD include heart-healthy diet, exercise, and smoking cessation

    <p>True</p> Signup and view all the answers

    A high-intensity statin is not recommended for patients with SIHD

    <p>False</p> Signup and view all the answers

    Antiplatelet treatment decreases myocardial oxygen demand or increases myocardial oxygen supply

    <p>False</p> Signup and view all the answers

    Patients with SIHD should not have hypertension, heart failure, and diabetes aggressively managed

    <p>False</p> Signup and view all the answers

    Cardiac stress test is not performed to assess the likelihood of CAD and diagnose SIHD

    <p>False</p> Signup and view all the answers

    Risk factors for SIHD do not include physical inactivity

    <p>False</p> Signup and view all the answers

    What is the classic symptom of stable angina?

    <p>Chest pain, described as 'squeezing,' 'grip-like,' 'heavy' or 'suffocating', typically not varying with position or respiration.</p> Signup and view all the answers

    What type of angina can occur at rest and be caused by illicit drug use, particularly cocaine?

    <p>Prinzmetal's (variant or vasospastic) angina.</p> Signup and view all the answers

    What is the term for chest pain that does not vary with position or respiration?

    <p>Stable angina.</p> Signup and view all the answers

    What is the term for chest pain caused by vasospasm of the coronary arteries?

    <p>Prinzmetal's (variant or vasospastic) angina.</p> Signup and view all the answers

    Which enzyme is responsible for the conversion of clopidogrel to its active metabolite, and what genetic variation can affect this conversion?

    <p>CYP450 2C19; Poor metabolizers of CYP2C19 exhibit higher cardiovascular events than patients with normal CYP2C19 function.</p> Signup and view all the answers

    What is the duration of dual antiplatelet therapy (DAPT) with aspirin and clopidogrel for patients with a drug-eluting stent, according to the text?

    <p>DAPT for at least six months.</p> Signup and view all the answers

    What is the main drug interaction to avoid when using clopidogrel, and what are the potential consequences of this interaction?

    <p>Omeprazole and esomeprazole; Premature discontinuation (risk of thrombosis).</p> Signup and view all the answers

    What is the recommended daily dose of aspirin in a dual antiplatelet therapy (DAPT) regimen?

    <p>81 mg daily.</p> Signup and view all the answers

    What is the preferred type of beta-blockers for use in stable ischemic heart disease (SIHD), and why are beta-blockers without intrinsic sympathomimetic activity (ISA) preferred?

    <p>Beta-blockers without ISA; Provide mortality reduction and symptom improvement.</p> Signup and view all the answers

    What is the clinical benefit of calcium channel blockers in the treatment of stable ischemic heart disease?

    <p>Increase myocardial oxygen supply: all CCBs blood flow through coronary arteries.</p> Signup and view all the answers

    What is the main risk associated with the use of long-acting nitrates?

    <p>Excessive hypotension.</p> Signup and view all the answers

    What is the indication for Yosprala, and when should it not be used?

    <p>Indicated for those at risk of developing aspirin-associated gastric ulcers; Yosprala should not be used when rapid onset is needed (e.g., ACS, pre-PCI).</p> Signup and view all the answers

    What type of angina is preferred for treatment with calcium channel blockers?

    <p>Prinzmetal's (variant) angina.</p> Signup and view all the answers

    What is the main warning associated with clopidogrel, and what is the recommended action regarding CYP2C19 genotype testing?

    <p>Premature discontinuation (risk of thrombosis); Tests to check CYP2C19 genotype can be used as an aid in determining a therapeutic strategy.</p> Signup and view all the answers

    What are the potential adverse effects that should be monitored in patients taking aspirin or clopidogrel?

    <p>Symptoms of bleeding, Hgb/Hct as necessary.</p> Signup and view all the answers

    What is the recommended duration of dual antiplatelet therapy (DAPT) for patients with a bare metal stent, according to the text?

    <p>DAPT for at least one month.</p> Signup and view all the answers

    What are the risk factors for SIHD?

    <p>Hypertension, smoking, dyslipidemia, diabetes, obesity, and physical inactivity</p> Signup and view all the answers

    What is the recommended antiplatelet for SIHD?

    <p>Aspirin</p> Signup and view all the answers

    What is the alternative to aspirin for antiplatelet treatment in SIHD?

    <p>Clopidogrel (Plavix)</p> Signup and view all the answers

    What non-drug treatments are recommended for SIHD?

    <p>Heart-healthy diet, exercise, smoking cessation, and alcohol limitation</p> Signup and view all the answers

    What is the FDA-approved combination for reducing the risk of cardiovascular events in patients with CAD?

    <p>Low-dose rivaroxaban (Xarelto) in combination with aspirin</p> Signup and view all the answers

    What is the goal of SIHD treatment?

    <p>To improve function, prevent future cardiovascular events, and reduce the risk of cardiovascular death</p> Signup and view all the answers

    What type of treatment decreases myocardial oxygen demand or increases myocardial oxygen supply in SIHD?

    <p>Antianginal treatment</p> Signup and view all the answers

    What is the recommended statin intensity for patients with SIHD?

    <p>High-intensity statin</p> Signup and view all the answers

    What vaccines are recommended for patients with SIHD?

    <p>Annual influenza vaccine and pneumococcal vaccines</p> Signup and view all the answers

    What is the only P2Y12 inhibitor recommended for SIHD dual antiplatelet therapy (DAPT)?

    <p>Clopidogrel</p> Signup and view all the answers

    What is the only P2Y12 inhibitor recommended for SIHD single antiplatelet therapy (SAPT) when there is a contraindication to aspirin?

    <p>Clopidogrel</p> Signup and view all the answers

    What drug is used with low-dose rivaroxaban to reduce the risk of major cardiovascular events in CAD?

    <p>Aspirin</p> Signup and view all the answers

    What is the purpose of long-acting nitrates in stable ischemic heart disease (SIHD) treatment?

    <p>To be used when beta-blockers are contraindicated or as add-on therapy, if continued symptoms; a nitrate-free interval is required to prevent tolerance</p> Signup and view all the answers

    What is the main contraindication for nitroglycerin SL tablet (Nitrostat)?

    <p>Hypersensitivity to organic nitrates, do not use with PDE-5 inhibitors or riociguat</p> Signup and view all the answers

    What is the recommended monitoring for nitroglycerin SL powder (GoNitro)?

    <p>Blood pressure (BP), heart rate (HR), chest pain</p> Signup and view all the answers

    What is the safety concern associated with nitroglycerin TL spray (NitroMist, Nitrolingual)?

    <p>Hypotension, headache, tachyphylaxis, can aggravate angina caused by hypertrophic cardiomyopathy</p> Signup and view all the answers

    What is the purpose of nitrate-free interval in long-acting nitrates?

    <p>To prevent tolerance</p> Signup and view all the answers

    What is the recommended dosing schedule for nitroglycerin ointment 2% (Nitro-Bid)?

    <p>BID, 6 hours apart with a 10-12 hour nitrate-free interval</p> Signup and view all the answers

    When are long-acting nitrates used?

    <p>When beta-blockers are contraindicated or as add-on therapy, if continued symptoms</p> Signup and view all the answers

    What is the recommended monitoring for nitroglycerin SL tablet (Nitrostat)?

    <p>ECG, potassium (K), renal function</p> Signup and view all the answers

    What is the main safety concern associated with nitroglycerin SL powder (GoNitro)?

    <p>Dizziness, headache, constipation, nausea</p> Signup and view all the answers

    What is the main warning associated with long-acting nitrates?

    <p>Nitrate tolerance does not develop with SL/TL products</p> Signup and view all the answers

    What is the main contraindication for nitroglycerin TL spray (NitroMist, Nitrolingual)?

    <p>Intracranial pressure, severe anemia, circulatory failure and shock (SL powder only)</p> Signup and view all the answers

    What are the recommended conditions for which short-acting nitrates should not be used?

    <p>Intracranial pressure, severe anemia, circulatory failure and shock</p> Signup and view all the answers

    Study Notes

    Ischemic Heart Disease (SIHD) and its Treatment

    • Coronary artery disease (CAD) causes narrowing of arteries and reduced blood flow to the heart
    • Myocardial oxygen demand increases when the heart is working harder due to increased heart rate, contractility, or left ventricular wall tension
    • Risk factors for SIHD include hypertension, smoking, dyslipidemia, diabetes, obesity, and physical inactivity
    • Cardiac stress test is performed to assess the likelihood of CAD and diagnose SIHD
    • Treatment goals for SIHD are to improve function, prevent future cardiovascular events, and reduce the risk of cardiovascular death
    • Antiplatelet and antianginal drug regimens are used together for SIHD treatment
    • Aspirin is the recommended antiplatelet; clopidogrel (Plavix) is used as an alternative
    • Non-drug treatments for SIHD include heart-healthy diet, exercise, smoking cessation, and alcohol limitation
    • Low-dose rivaroxaban (Xarelto) in combination with aspirin is FDA-approved for reducing the risk of cardiovascular events in patients with CAD
    • Antianginal treatment decreases myocardial oxygen demand or increases myocardial oxygen supply
    • Patients with SIHD should be treated with a high-intensity statin and have hypertension, heart failure, and diabetes aggressively managed
    • Annual influenza vaccine and pneumococcal vaccines are recommended for patients with SIHD

    Ischemic Heart Disease (SIHD) and its Treatment

    • Coronary artery disease (CAD) causes narrowing of arteries and reduced blood flow to the heart
    • Myocardial oxygen demand increases when the heart is working harder due to increased heart rate, contractility, or left ventricular wall tension
    • Risk factors for SIHD include hypertension, smoking, dyslipidemia, diabetes, obesity, and physical inactivity
    • Cardiac stress test is performed to assess the likelihood of CAD and diagnose SIHD
    • Treatment goals for SIHD are to improve function, prevent future cardiovascular events, and reduce the risk of cardiovascular death
    • Antiplatelet and antianginal drug regimens are used together for SIHD treatment
    • Aspirin is the recommended antiplatelet; clopidogrel (Plavix) is used as an alternative
    • Non-drug treatments for SIHD include heart-healthy diet, exercise, smoking cessation, and alcohol limitation
    • Low-dose rivaroxaban (Xarelto) in combination with aspirin is FDA-approved for reducing the risk of cardiovascular events in patients with CAD
    • Antianginal treatment decreases myocardial oxygen demand or increases myocardial oxygen supply
    • Patients with SIHD should be treated with a high-intensity statin and have hypertension, heart failure, and diabetes aggressively managed
    • Annual influenza vaccine and pneumococcal vaccines are recommended for patients with SIHD

    Ischemic Heart Disease (SIHD) and its Treatment

    • Coronary artery disease (CAD) causes narrowing of arteries and reduced blood flow to the heart
    • Myocardial oxygen demand increases when the heart is working harder due to increased heart rate, contractility, or left ventricular wall tension
    • Risk factors for SIHD include hypertension, smoking, dyslipidemia, diabetes, obesity, and physical inactivity
    • Cardiac stress test is performed to assess the likelihood of CAD and diagnose SIHD
    • Treatment goals for SIHD are to improve function, prevent future cardiovascular events, and reduce the risk of cardiovascular death
    • Antiplatelet and antianginal drug regimens are used together for SIHD treatment
    • Aspirin is the recommended antiplatelet; clopidogrel (Plavix) is used as an alternative
    • Non-drug treatments for SIHD include heart-healthy diet, exercise, smoking cessation, and alcohol limitation
    • Low-dose rivaroxaban (Xarelto) in combination with aspirin is FDA-approved for reducing the risk of cardiovascular events in patients with CAD
    • Antianginal treatment decreases myocardial oxygen demand or increases myocardial oxygen supply
    • Patients with SIHD should be treated with a high-intensity statin and have hypertension, heart failure, and diabetes aggressively managed
    • Annual influenza vaccine and pneumococcal vaccines are recommended for patients with SIHD

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    Test your knowledge of Ischemic Heart Disease (SIHD) and its Treatment with this quiz. Explore the risk factors, diagnostic methods, and treatment options, including drug regimens and non-drug interventions, to improve patient outcomes and reduce cardiovascular risks.

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