SIHD and ACS NAPLEX test
questions and answers 2024
What is angina? What is the pathophysiology?
chest pain, caused by an imbalance between myocardial oxygen
demand and myocardial oxygen supply by the blood, oxygen
demand is increased when HR/BP/contractility increases
What is stable angina?
predictable chest pain brought on by exertion and relieved by rest
or nitroglycerin, typically caused by atherosclerosis
What is Prinzmetal's angina?
angina at rest due to coronary artery spasm
How is SIHD diagnosed?
cardiac stress test with patient walking on treadmill and monitoring
ECG/chest pain
How do we perform a cardiac stress test in a patient that cannot
walk on a treadmill?
Administer medications to increase heart rate, adenosine,
dipyrimadole, dobutamine or regadenoson
What is the ABCDE treatment model for SIHD (hint - each letter
corresponds to 2 things)?
antiplatelet and antianginal drugs, beta blockers and blood
pressure, cholesterol and cigarettes, diet and diabetes, exercise
and education
What are the anti-anginal drug classes?
Beta blocker, CCB, nitrates, ranolazine (BBs are first line)
What are the antiplatelet drug classes?
Aspirin, Plavix/clopidogrel (aspirin preferred)
What is the mechanism of action of aspirin?
, Irreversible COX 1 and 2 blocker leading to reduced prostaglandins
and thromboxane A2 production and inhibiting platelet aggregation
What is the mechanism of action of clopidogrel?
Prodrug converted to active form by CYP2C19 that irreversibly
inhibits P2Y12 platelet activation and aggregation
What is the dosing of aspirin for SIHD?
71-162mg daily (almost always 81mg due to availability of dosage
form)
What is the dosing of clopidogrel for SIHD?
75mg daily
What are some safety/AE/monitoring considerations for aspirin?
contraindicated in Salicylate allergic patients and children with viral
infections (Reye's), Warning for bleeding and tinnitus, non-enteric
formulation (chewable) preferred in ACS (enteric formulation can be
chewed to achieve the same effect)
What are some safety/AE/monitoring considerations for clopidogrel?
Second line so aspirin in SIHD, BBW o check for CYP2C19 genotype
prior to initiation to verify effectiveness of conversion to active
metabolite, contraindicated in patients with serious bleeding,
warning for bleed risk, not recommended to use with omeprazole or
esomeprazole, can cause thrombotic thrombocytopenic purpura
How do we determine the dose of beta blockers for patients with
SIHD?
Start low and titrate to HR of 55-60 BPM
When do we use CCBs as anti-anginal treatment?
Patient contraindicated for beta blocker, Add on to BB if symptoms
persist, CCBs preferred for prinzmetal's angina (vasospastic angina)
Which type of CCBs should we use when adding to BB therapy?
DHP (amlodipine, nifedipine, nicardipine)
Note: Never give anyone nifedipine IR on the exam, it's basically
never recommended. say OK
OK
questions and answers 2024
What is angina? What is the pathophysiology?
chest pain, caused by an imbalance between myocardial oxygen
demand and myocardial oxygen supply by the blood, oxygen
demand is increased when HR/BP/contractility increases
What is stable angina?
predictable chest pain brought on by exertion and relieved by rest
or nitroglycerin, typically caused by atherosclerosis
What is Prinzmetal's angina?
angina at rest due to coronary artery spasm
How is SIHD diagnosed?
cardiac stress test with patient walking on treadmill and monitoring
ECG/chest pain
How do we perform a cardiac stress test in a patient that cannot
walk on a treadmill?
Administer medications to increase heart rate, adenosine,
dipyrimadole, dobutamine or regadenoson
What is the ABCDE treatment model for SIHD (hint - each letter
corresponds to 2 things)?
antiplatelet and antianginal drugs, beta blockers and blood
pressure, cholesterol and cigarettes, diet and diabetes, exercise
and education
What are the anti-anginal drug classes?
Beta blocker, CCB, nitrates, ranolazine (BBs are first line)
What are the antiplatelet drug classes?
Aspirin, Plavix/clopidogrel (aspirin preferred)
What is the mechanism of action of aspirin?
, Irreversible COX 1 and 2 blocker leading to reduced prostaglandins
and thromboxane A2 production and inhibiting platelet aggregation
What is the mechanism of action of clopidogrel?
Prodrug converted to active form by CYP2C19 that irreversibly
inhibits P2Y12 platelet activation and aggregation
What is the dosing of aspirin for SIHD?
71-162mg daily (almost always 81mg due to availability of dosage
form)
What is the dosing of clopidogrel for SIHD?
75mg daily
What are some safety/AE/monitoring considerations for aspirin?
contraindicated in Salicylate allergic patients and children with viral
infections (Reye's), Warning for bleeding and tinnitus, non-enteric
formulation (chewable) preferred in ACS (enteric formulation can be
chewed to achieve the same effect)
What are some safety/AE/monitoring considerations for clopidogrel?
Second line so aspirin in SIHD, BBW o check for CYP2C19 genotype
prior to initiation to verify effectiveness of conversion to active
metabolite, contraindicated in patients with serious bleeding,
warning for bleed risk, not recommended to use with omeprazole or
esomeprazole, can cause thrombotic thrombocytopenic purpura
How do we determine the dose of beta blockers for patients with
SIHD?
Start low and titrate to HR of 55-60 BPM
When do we use CCBs as anti-anginal treatment?
Patient contraindicated for beta blocker, Add on to BB if symptoms
persist, CCBs preferred for prinzmetal's angina (vasospastic angina)
Which type of CCBs should we use when adding to BB therapy?
DHP (amlodipine, nifedipine, nicardipine)
Note: Never give anyone nifedipine IR on the exam, it's basically
never recommended. say OK
OK
