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What drugs should all IHD patients be on?
Aspirin, Statin, BB and ACEI
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When could CCBs be used for IHD?
If BBs are not tolerated
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Do Nitrates have a mortality benefit for IHD?
No, symptomatic relief only
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Some patients are not on all four IHD drugs, which one is often not tolerated or CI and has to be eliminated?
ACEI
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What benefit do CCBs have for IHD?
Angina pain relief
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Aspirin dose for IHD:
81-325 mg/day
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MOA of aspirin:
Antiplatelet drug - Inhibits formation of thromboxane A2 by irreversible inhibition of COX1
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BBs reduce mortality by what amount?
23%
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How long should patients remain on BBs?
3 years minimum
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BBs are proven to have what benefits?
- Reduced mortality
- Reduced frequency of symptoms
- Improved exercise tolerance
- Reduce chest pain
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What is the MOA for BBs in the treatment of IHD?
Decrease O2 demand, Contractility, HR, Wall tension and Renin
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B1 selective BBs:
- Atenolol (Tenormin)
- Bisoprolol (Zebeta)
- Metoprolol tartrate (Lopressor)
- Metoprolol succinate (Toprol XL)
- Nebivolol (Bystolic)
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Metoprolol tartrate
Lopressor
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Metoprolol succinate
Toprol XL
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Should you start low and titrate up or start at a target dose with BBs?
Start low and titrate up
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ACEIs should be used in all patients with IHD who also have what conditions?
- Diabetes
- CKD
- HTN
- LV systolic dysfunction (EF < 40%)
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ACEIs for IHD:
- Captopril (Capoten)
- Enalapril (Vasotec)
- Lisinopril (Prinivil)
- Ramipril (Altace)
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ARBs for IHD:
- Trandolapril (Mavik)
- Candesartan (Atacand)
- Valsartan (Diovan)
- Losartan (Cozaar)
- Irbesartan (Avapro)
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What should you monitor ACEI and ARB use with?
Electrolytes, Scr, BUN, ↑K+
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Captopril is dosed how often?
2x day
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What are the pleiotropic effects of Statins:
- Anti-inflammatory
- Antiplatelet
- Antioxidant
- ↑ NO
- Plaque stabilizing
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