Coronary heart disease

Characterized by atherosclerosis in coronary arteries and can be asymptomatic.

• Coronary artery disease

• Acute coronary syndrome

Includes the diagnoses of angina pectoris (stable and unstable),

Myocardial Infarction (STEMI) (MI) and silent myocardial ischemia(non-

STEMI).

• ACS

• CAD

• CVD

• CHD

Symptoms of ischemia and ST- segment elevation at least two

contiguous leads to:

• STEMI

• NSTEMI

The use of nitric oxide donors, like all nitroglycerin preparations,

isosorbide mononitrate and isosorbide dinitrate, is an absolute

contraindication to the use of _____ inhibitors because of the risk of

synergistic effects on vasodilation that cause hypotension and

hemodynamic collapse.

• PDE5

• ACE

• B-1

If a patient treated with PDE5 inhibitors suffers chest pain, nitrates

should not be administered in: .

• 24 hr: sildenafil, vardenafil

• 48 h tadalafil

• 48 h sildenafil, vardenafil

• 24 hr: tadalafil

MAO: converted to nitric oxide -> ⬆ cGMP -> dephosphorylation of the myosin light chain -> ⬆ Ca ions -> relaxation of the smooth muscle cells and vasodilation.

• Nitroglycerin

• Isosorbide dinitrate

• Metroprolol

• Aliskerin

Side effects: ⬆ intracranial pressure, Vertigo; Nausea and vomiting (possibly with colic and even bloody diarrhea); Syncope (especially in the upright posture); Air hunger and dyspnea, later followed by reduced ventilatory effort; Diaphoresis, with the skin either flushed or cold and clammy; Heart block and bradycardia; Paralysis; Coma; Seizures; Death.

• Nitrates

• Beta blockers

• Ca blocker

Nitroglycerin interacts with PDE5 inhibitors and cause:

• Methemoglobinemia

• Hypotension

• Severity of adverse effects

Nitroglycerin & Isosorbide dinitrate interacts with Acetaminophen and cause:

• Hypotension

• Severe adverse effects

• Methemoglobinemia

Sublingual ______ is the standard initial treatment for stress stable angina.

• Isorsobide dinitrate

• Nitroglycerin

• Metoprolol

• Carvedilol