therap 2 1: 3 CAD Flash Cards

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Title: therap 2 1: 3 CAD
Description: birtcher
Number of Cards: 87
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Author: sophie.ly
Created: 2012-02-02
Tags: 2012
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    • Question
    • Answer
    • Side 3
    • ischemic heart disease is the same as ______ heart disease
    • coronary

      ischemic heart disease is the same as ______ heart disease
    • what are 3 common manifestations of CAD?
    • 1. chronic stable angina
      2. coronary arter vasospasm (variant or prinzmetal's angina)
      3. acute coronary syndrome (unstable angina, non ST elevation MI, ST elevation MI)
    • Matching:

      a. happens over yrs
      b. happens over min

      1. fibrous plaque
      2. unstable angina
      3. occlusive atherosclerotic plaque forms
      4. stroke
      5. critical leg ischemia
      6. coronary death
      7. fatty streak
    • a 1. fibrous plaque formation
      b 2. unstable angina
      a 3. occlusive atherosclerotic plaque forms
      b 4. stroke
      b 5. critical leg ischemia
      b 6. coronary death
      a 7. fatty streak forms

      a. happens over yrs
      b. happens over min
    • matching:

      a. PAD
      b. CAD

      1. MI
      2. ischemic stroke
      3. transient ischemic attack
      4. necrosis
      5. unstable angina
      6. stable angina
      7. gangrene
      8. rest pain
      9. intermittent claudication
    • b 1. MI
      a 2. ischemic stroke
      a 3. transient ischemic attack
      a 4. necrosis
      b 5. unstable angina
      b 6. stable angina
      a 7. gangrene
      a 8. rest pain
      a 9. intermittent claudication
    • T/F If a person has CAD is it common to to have plaque elsewhere
    • True

      If a person has CAD is it common to to have plaque elsewhere
    • CAD initially presents in
      1. women as _____
      2. men as _____
      3. incidence (inc/dec) w/ age
      4. incidence (inc/dec) w/ less RFs
    • CAD initially presents in
      1. women as ANGINA
      2. men as MI
      3. incidence INC w/ age
      4. incidence DEC w/ less RFs
    • exertional angina may occur when it occludes #% of the coronary artery

      a. 15%
      b. 50%
      c. 75%
      d. 90%
    • c. 75%

      exertional angina may occur when it occludes #% of the coronary artery
    • T/F a person w/ chronic stable angina only experiences flare up Sx 2x/yr or less
    • trick question, technically true.

      a person w/ chronic stable angina doesn't experience Sx despite the blockage
    • Which are synonymous w/ acute coronary syndrome (ACS)?

      a. stable angina
      b. unstable angina
      c. acute MI
      d. prinzmetal's angina
      e. all the above
      f. 2 of the above
    • f. 2 of the above (b & c)

      ACS = unstable angina = acute MI
    • which determines

      a. O2 demand
      b. O2 supply

      1. HR
      2. coronary blood flow
      3. arterial pO2
      4. myocardial contractility
      5. ventricular wall tension
      6. diastolic filling time
    • a. O2 demand
      b. O2 supply

      a 1. HR
      b 2. coronary blood flow
      b 3. arterial pO2
      a 4 . myocardial contractility
      a 5. ventricular wall tension
      b 6. diastolic filling time
    • how do you dec O2 demand?

      1. inc/dec HR
      2. inc/dec contractility
      3. inc/dec wall tension
      4. inc/dec preload
      5. inc/dec afterload
    • dec O2 demand

      1. DEC HR
      2. DEC contractility
      3. DEC wall tension
      4. DEC preload
      5. DEC afterload
    • how do you inc O2 supply?

      1. inc/dec coronary blood flow?
      2. inc/dec diastolic filling time
      3. inc/dec HR
    • 1. INC coronary blood flow?
      2. INC diastolic filling time
      3. DEC HR
    • what condition needs to be treated when trying to inc O2 supply?
    • anemia

      needs to be treated when trying to inc O2 supply
    • name 7 modifiable RFs of CAD
    • 1. tobacco cessation & avoidance of 2nd hand smoke
      2. physical activity
      3. heart healthy diet
      4. wt mgmt
      5. BP mgmt
      6. lipid mgmt
      7. DM mgmt
    • matching

      a. angina
      b. chronic stable angina

      1. imbalance b/t O2 demand & supply
      2. no changes in Sx over previous 2 mo
      3. inc demand for O2 or dec O2 supply
      4. lack O2 due to inadequate perfusion
    • a. angina
      b. chronic stable angina

      a 1. imbalance b/t O2 demand & supply
      b 2. no changes in Sx over previous 2 mo
      b 3. inc demand for O2 or dec O2 supply
      a 4. lack O2 due to inadequate perfusion
    • what are the differential Dx of angina? (5)
    • 1. duration of pain (5-15min)
      2. quality (visceral, pressure)
      3. provocation (spontaneous or w/ effort or emotion)
      4. relief (NTG +/- rest)
      5. location (substernal, radiates)
    • 1. name the 3 criteria for chronic stable angina

      2. T/F all 3 of the criteria MUST be met for typical chronic stable angina
    • 1. 3 criteria for chronic stable angina
      typical
      a. substernal chest discomfort w/ characteristic quality & duration
      b. provoked by exertion or emotional stress
      c. relieved by rest or NTG

      True 2. all 3 of the criteria MUST be met for typical chronic stable angina.
      atypical: 2/3 criteria
    • 1. who experiences atypical chronic stable angina?
      2. what types of Sx do they experience?
    • 1. women, elderly, DM
      2. fatigue, dysnpea, SOB
    • What are the classifications for the Canadian CV society? give examples of each class.


      KNOW HOW TO DO THIS!!!
    • 1. class 1: no Sx w/ usual phys activity (occur w/ prolonged exercise)
      2. class 2: Sx slightly limit usual activities (walking > 2 blocks or climbing > 1 flight stairs)
      3. class 3: Sx limit usual activities (occur w/ walking 1-2 blocks or 1 flight of stairs)
      4. class 4: Sx @ rest or w/ min activity
    • T/F There is a direct correlation b/t angina class & severity of CAD determined by angiography
    • false

      NO correlation b/t angina class & severity of CAD determined by angiography
    • name signs of angina in the PE. (8)
    • 1. often normal
      2. arterial bruits
      3. retinal vascular abnormalities
      4. S4
      5. loud S3 or S4 (during acute episode)
      5. diaphoresis (during acute episode)
      6. rales (during acute episode)
      7. transient murmur (during acute episode)
      8. ST segment changes (depression/elevation)
    • 1. ST depression indicates ____
      2. ST elevation indicates _____ or _____



      KNOW THIS!!!
    • 1. ST depression indicates ISCHEMIA
      2. ST elevation indicates ACUTE INFARCTION or TRANSIENT CORONARY ARTERY SPASM
    • T/F exercise stress tests are perfectly safe for all PTs.

      If false, what can they do?
    • false

      PTs that can't walk can't perform exercise stress tests, so they can do a pharmacological/chemical stress test.
    • sometimes exercise stress tests give false results, esp for men/women
    • sometimes exercise stress tests give false results, esp for WOMEN
    • 1. what chemicals (2) are used in the chem stress test?
      2. what must you avoid before taking a chem stress test? (5)
      3. what can you administer to counter the SE of the chems mentioned in #1?
    • 1. adenosine & dipyridamole
      2. theophylline , caffeine, decaffeinated products, chocolate, food (several hrs everything else 24 hrs)
      3. aminophylline IV

      1. what chemicals (2) are used in the chem stress test?
      2. what must you avoid before taking a chem stress test? (5)
      3. what can you administer to counter the SE of the chems mentioned in #1?
    • what is the gold std for Dxing CAD?
    • cardiac catheterization & angiography

      what is the gold std for Dxing CAD?
    • what does the PT receive before catetherization & angiography? (2)
    • ASA & IV heparin bolus

      receive before catetherization & angiography
    • 1. who is at risk of contrast induced acute kidney injury (AKI)? (3)
      2. what do you measure prior to the procedure?
      3. what steps are done to protect the kidneys?
    • 1. elderly, compromised renal fx PTs, DMs
      2. SCr 1-2 wks before procedure
      3. stop drugs that could damage kidney (NSAIDs, metformin) & give adequate hydration before & after contrast media is administered
      4.
    • if a PT's CrCL < 60ml/min, should you give more/less contrast media?
    • if a PT's CrCL < 60ml/min, should you give LESS contrast media?
    • If a PT is taking metformin and needs to be given contrast media, what should be done to decrease his risk of AKI?
    • stop taking metformin the day OF the procedure & 48 hrs after


      If a PT is taking metformin and needs to be given contrast media, what should be done to decrease his risk of AKI?
    • 1. what controversial drug (& dose) can be given to prevent the kidneys from AKI?

      2. what other drug is used to prevent AKI? how should you counsel the PT to take it?
    • 1. n-acetylcysteine 600mg PO BID day before & day of contrast

      2. mucomyst 10% or 20% INHALATION soln. mix w/ small amt of juice/soda immediately before taking to improve taste


      1. what controversial drug (& dose) can be given to prevent the kidneys from AKI?

      2. what other drug is used to prevent AKI? how should you counsel the PT to take it?
    • Rx: Mucomyst 600mg PO BID x 4 doses.
      Stock: Mucomyst 10% inhalation soln

      1. how much do you dispense?
      2. how much will the PT take for each dose?
      3. what else should you mention to the PT?
    • Rx: Mucomyst 600mg PO BID x 4 doses.
      Stock: Mucomyst 10% inhalation soln

      1. how much do you dispense?
      600mg/dose x 4 doses/day x 100ml/10g x 1g/1000mg = 24ml/day

      2. how much will the PT take for each dose?
      24ml/4 doses= 6 ml/dose

      3. what else should you mention to the PT?
      take w/ small amt of juice/soda. show PT how to use syringe
    • what types of revascularization procedures exist?
    • 1. percutaneous coronary intervention (PCI) in cath lab
      2. coronary artery bypass grafting (CAB, CABG) open heart surgery
    • T/F after revascularization procedures it is possible to D/C angina meds
    • true reduce or D/C

      after revascularization procedures it is possible to D/C angina meds
    • matching: advantages

      a. PCI
      b. CAB
      c. both

      1. less invasive
      2. relieves Sx
      3. improved survival in DMs
      4. lower initial cost
      5. achieve complete revascularization
      6. shorter hosp stay
      7. easily repeated
    • advantages

      a 1. less invasive
      c 2. relieves Sx
      b 3. improved survival in DMs
      a 4. lower initial cost
      b 5. achieve complete revascularization
      a 6. shorter hosp stay
      a 7. easily repeated

      a. PCI
      b. CAB
      c. both
    • matching disadvantages:

      a. PCI
      b. CAB
      c. both

      1. cost
      2. invasive
      3. incomplete revascularization
      4. can only use on limited PTs
      5. risks due to repeat procedures due to graft closures
      6. restenosis
      7. morbidity & mortality of major surgery
    • disadvantages

      a. PCI
      b. CAB
      c. both

      b 1. cost
      b 2. invasive
      a 3. incomplete revascularization
      a 4. can only use on limited PTs
      b 5. risks due to repeat procedures due to graft closures
      a 6. restenosis
      b 7. morbidity & mortality of major surgery
    • 1. PCI = ???

      2. what do you pre TX PCI w/?

      3. what do you post TX PCI w/?
    • 1. angioplasty +/- stent

      2. ASA + heparain IV bolus +/- clopidogrel (sometimes + glycoprotein IIb/IIIa inhibitor)

      3. ASA 81mg indefinitely
      a. if they had a bare metal stent w/ non ACS clopidogrel at least 1 mo up to 1 yr min of 2 wks if PT is at inc bleeding risk
      b. DES w/ non ACS: clopidogrel x at least 1 yr
      c. PTs should be counseled on how impt compliance w/ dual therapy is (mainstay for preventing stent thrombosis bc premature D/C can lead to MI &/or death)
    • what is the dosing on antiplatelet TX prior to PCI?

      1. chronic daily ASA already
      2. no daily ASA
    • 1. 81-325mg ASA before PCI + clopidogrel 600mg w/ stent placement (depends on institution, may due after)

      2. nonenteric ASA 325mg prior to PCI
    • glycoprotein IIb/IIIa inhibitors:

      1. MOA
      2. examples
      3. indication
    • glycoprotein IIb/IIIa inhibitors:

      1. MOA: inhibit platelet aggregation by blocking effects of fibrinogen at platelet glycoPRO IIb/IIIa Rcs --> dec ischemic complications
      2. examples: eptifibatide (integrilin), abciximab (reopro), tirofiban (aggrastat)
      3. indication: PTS IS NOT @ high risk for bleeding complications
    • 1. what type of drugs are on drug eluting stents?
      2. examps?
    • 1. anti rejection meds
      2. taxus (paclitaxel), cyper (sirolimus), endeavor (zatarolimus), xience, promus (everolimus)
    • is it safer to use lower/regular ASA w/ clopidogrel if you're concerned ab bleeding complications?
    • LOWER

      safer to use lower strength ASA w/ clopidogrel if you're concerned ab bleeding complications?
    • 1. it's best to avoid invasive surgeries after stent placement for at least 1 yr, but if it's ABSOLUTELY necessary the min amt of time to wait is ___ after bare metal stent implantation

      2. if the procedure MUST be done, D/C ___ --> continue ___ if possible & restart ___ after the procedure ASAP
    • 1. 1 mo
      2. D/C clopidogrel, cont ASA, restart clopidogrel ASAP

      it's best to avoid invasive surgeries after stent placement for at least 1 yr, but if it's ABSOLUTELY necessary the min amt of time to wait is ___ after bare metal stent implantation

      2. if the procedure MUST be done, D/C ___ --> continue ___ if possible & restart ___ after the procedure ASAP
    • T/F clopidogrel genetic testing is recommended for PTs at high risk of poor clinical outcomes bc they are predisposed to inadequate platelet inhibition by plavix
    • false it's not recommended

      T/F clopidogrel genetic testing is recommended for PTs at high risk of poor clinical outcomes bc they are predisposed to inadequate platelet inhibition by plavix
    • T/F platelet fx testing is recommended for PTs w/ high platelet reactivity
    • false not recommended

      platelet fx testing is recommended for PTs w/ high platelet reactivity
    • what are the TX goals for chronic stable angina? (3)
    • 1. relieve acute Sx of myocardial ischemia
      2. prevent Sx of myocardial ischemia
      3. improve long term survival by prevening unstable angina, AMI, death
    • 1. PPIs are recommended for PTs at high/low risk of GI bleeding.
      2. name demographics of ppl that should take PPIs.
      3. which PPIs should be avoided w/ plavix?
    • 1. high risk of GI bleeding
      2. advanced age, warfarin, steroids, NSAIDs, H. pylori inf
      3. omeprazole, esomeprazole, cimetidine
    • 1. what DFs do short acting nitrates come in?
      2. MOA
      3. indication
    • 1. tabs & sprays
      2a. dec myocardial O2 demand by systemic venodilation --> dec preload & ventricular wall stress
      2b. dec myocardial O2 demand by arterial venodilation
      --> dec afterload
      2c. inc O2 supply by dilating coronary arteries & relieving vasospasm
      3. effort induced angina

      1. what DFs do short acting nitrates come in?
      2. MOA
      3. indication
    • 1. if a PT experiences chest pains whenever she sweeps the kitchen (~20min), what kind of short acting nitrate should she take?

      2. what if she experiences chest pains while gardening for over 1 hr?
    • 1. SL NTG
      2. SL isosorbide dinitrate

      1. if a PT experiences chest pains whenever she sweeps the kitchen (~20min), what kind of short acting nitrate should she take?

      2. what if she experiences chest pains while gardening for over 1 hr?
    • what do PTs need to know ab SL nitrates?



      KNOW THIS!!!
    • 1. when chest pain occurs stop what you're doing & sit down
      2. place tab/spray under tongue
      3. if no pain relief after 5 min or pain worsens call 911

      *make sure PT knows this & can repeat it to you*

      4. store in original container
      5. keep bottle w/ you at all times
      6. replace SL tabs often
      7. fill Rx for 100 w/ 4x25
      8. C/I w/ ED drugs (sildenafil, vardenafil, tadalafil)
    • if after # tab(s) you're still experiencing chest pain after # min call 911!


      KNOW THIS!!!!
    • 1 tab, 5 min

      if after # tab(s) you're still experiencing chest pain after # min call 911!
    • what is the min amt of time someone can take ____ w/ if they just took a SL NTG?

      1. tadalafil
      2. sildenafil
      3. vardenafil
    • 48 hrs 1. tadalafil
      24 hrs 2. sildenafil
      24 hrs 3. vardenafil

      what is the min amt of time someone can take ____ w/ if they just took a SL NTG?
    • 1. which SL nitrate is better for dry mouth?
      2. expires sooner
      3. req's priming (how often must you prime?)

      a. SL tab
      b. SL spray
    • 1. b
      2. a
      3. b (initial use & at least 1x q 6wks if unused)
    • what is the order of drugs to prevent ischemia Sx? (3)
    • 1. B blockers
      2. CCBs
      3. long acting nitrates
    • matching MOA

      a. long acting nitrates
      b. B blockers
      c. CCBs

      1. dec HR
      2. systemic venodilation
      3. dec O2 demand by vasodilating systemic arterioles --> dec afterload
      4. dec BP
      5. dilate coronary arteries
      6. systemic venodilation --> dec afterload
      7. dec contractility
    • b c 1. dec HR
      a 2. systemic venodilation --> dec preload
      a c 3. dec O2 demand by vasodilating arterioles --> dec afterload
      b 4. dec BP
      a 5. dilate coronary arteries & relieving vasospasm
      a 6. systemic venodilation --> dec afterload
      b c 7. dec contractility

      a. long acting nitrates
      b. B blockers
      c. CCBs
    • 1. what is the resting HR goal for PTs w/ CAD on B blockers?
      2. max HR while exercising
      3. how much is max HR should go over during exercise?


      KNOW THIS!!!
    • 1. 50 - 60 bpm
      2. < 100 bpm
      3. 10% or < 20 bpm
    • T/F acebutolol & pindolol are intrinsic sympathomimetics that should be used w/ B blockers.
    • false AVOID intrinsic sympathomimetic activity

      acebutolol & pindolol are intrinsic sympathomimetics that should NOT be used.
      - partial beta agonist effects negate decrease in HR
    • T/F non cardioselective B blockers dec the SE assoc'd w/ B blockers?
    • false cardioselective

      dec the SE assoc'd w/ B blockers
    • how long must you taper B blockers for when D/Cing?
    • over 2+ days or several wks to avoid rebound angina, MI, arrhythmias or rebound HTN
    • B blockers C/I?
    • 1. 2nd or 3rd degree AV block w/o pacemaker; decompensated HF; HR <50 bpm, SBP < 90mmHg
    • beta # selectively diminishes at high/low dose.
    • 1; 15 min
    • matching SE

      a. long acting nitrates
      b. B blockers
      c. CCBs

      1. HA
      2. hallucinations
      3. depression
      4. myocardial depression
      5. flushing
      6. hypotension
      7. heart block
      8. bradycardia
      9. mask hypoglycemia Sx
      10. edema
      11. syncope
      12. impotence
      13. contact dermatitis
      14. palpitations
    • SE

      a. long acting nitrates
      b. B blockers
      c. CCBs

      a c 1. HA
      b 2. hallucinations
      b 3. depression
      c 4. myocardial depression
      a c 5. flushing
      a b c 6. hypotension
      c 7. heart block
      b 8. bradycardia
      b 9. mask hypoglycemia Sx
      c 10. edema
      a 11. syncope
      b 12. impotence
      a 13. contact dermatitis
      c 14. palpitations
    • a. DHP
      b. non DHP

      a 1. vasodilation
      b 2. slow HR
      a 3. HA
      b 4. can be used w/ B blocker
      a 5. amlodipine
      b 6. verapamil
      b 7. diltiazem
      a 8. nicardipine
    • a. DHP
      b. non DHP

      a 1. vasodilation
      b 2. slow HR
      a 3. HA
      b 4. can be used w/ B blocker
      a 5. amlodipine
      b 6. verapamil
      b 7. diltiazem
      a 8. nicardipine
    • if nifedipine is used in angina PTs, short/long acting should be used bc otherwise it would inc/dec the HR too quickly, which is why w/ the short/long acting nifedipine you should also have a ________ on board
    • LONG acting; INC HR; LONG acting; B blocker

      if nifedipine is used in angina PTs, short/long acting should be used bc otherwise it would inc/dec the HR too quickly, which is why w/ the short/long acting nifedipine you should also have a ________ on board
    • what are some C/I for verapamil & diltiazem? (4)
    • 1. hypotension
      2. 2nd or 3rd degree AV block w/o pacemaker
      3. bradycardia
      4. L ventricular systolic dysfx (low EF)
    • 1. what DFs do long acting nitrates come in?

      2. are long acting nitrates appropriate for acute angina?

      3. what are some C/I for long acting nitrates?

      4. examps
    • 1. transdermal & PO
      2. no, but short acting are
      3. ED drugs (sildenafil, vardenafil, tadalafil)
      4. PO: isosorbide dinitrate, isosorbide mononitrate, NTG. transdermal: patches, ointments
    • what are some conditions that you should avoid nitrate with? (4)
    • 1. SBP <90 or >/= 30 below baseline
      2. severe bradycardia (<50bpm)
      3. tachycardia (>100bpm)
      4. R ventricular infarction
    • 1. T/F using nitrates more often will make you more tolerant to them

      2. if this is true, what can you do?
    • 1. true

      dec response in presence of continuously or freqly administered nitrates

      2. want daily nitrate free interval 10-12 hrs
    • matching: consider

      a. long acting nitrates
      b. B blockers
      c. DHP CCB
      d. non DHP CCB

      1. sinus bradycardia
      2. sinus tachycardia
      3. reactive COPD/asthma
      4. severe pre existing HA
      5. hyperthyroidism

      avoid:


      1. sinus bradycardia
      2. sinus tachycardia
      3. reactive COPD/asthma
      4. severe pre existing HA
    • consider:

      a c1. sinus bradycardia
      b d2. sinus tachycardia
      a b c 3. reactive COPD/asthma (selective B blocker, CCB, nitrate)
      b 4. severe pre existing HA
      b 5. hyperthyroidism


      avoid:


      b d 1. sinus bradycardia
      a c 2. sinus tachycardia
      b 3. reactive COPD/asthma (non selective B blocker)
      a c 4. severe pre existing HA
    • ranolazine (ranexa)

      1. availability
      2. dosing
      3. SE
    • 1. ER 500mg tab
      2. 500mg PO BID inc to 1000mg PO BID PRN based on clinical Sx; max 500mg BID if taking diltiazem/verapamil/grapefruit juice/products/moderate CYP3A4 inhibitors (erythromycin, fluconazole)

      swallow whole, dont crush, break or chew

      3. QT prolongation, constipation, dizziness, HA, nausea
    • drug interaxns of ranolazine (ranexa)

      1. inc/dec dose if coadministered w/ cyclosporine/sirolimus/tacrolimus, digoxin, lovastatin, antipsychotics, TCAs

      2. limit simvastatin to #mg

      3. cyclosporine may inc/dec ranolazine lvls, so titrate ranolazine dose based on that response

      4. may be less effective in men/women

      5. PTs should report _____ or _____ bc it could be a sign of QT int problem
    • drug interaxns of ranolazine (ranexa)

      1. DEC dose if coadministered w/ cyclosporine/sirolimus/tacrolimus, digoxin, lovastatin, antipsychotics, TCAs

      2. limit simvastatin to 20mg

      3. cyclosporine may INC ranolazine lvls, so titrate ranolazine dose based on that response

      4. may be less effective in WOMEN

      5. PTs should report PALPITATIONS or FAINTING SPELLS bc it could be a sign of QT int problem
    • 1. if angina occurs < 1x/wk use

      2. if angina occurs > 1x/wk use

      a. chronic therapy
      b. nitrate SL PRN
    • b 1. if angina occurs < 1x/wk use

      a 2. if angina occurs > 1x/wk use

      a. chronic therapy
      b. nitrate SL PRN
    • secondary TX for CAD & ohter atherosclerotic vascular dz

      A
      B
      C
      D
      E
      F
    • A -- antianginal, antiplatelet, ACE-I, +/- aldosterone inh
      B -- B blocker, BP
      C -- chol, cigs
      D -- diet, DM, depression
      E -- education, exercise
      F -- fish oil, flu vaccine
    • what dose of ASA do you use in ALL CAD PTs unless C/I

      a. 81
      b. 162
      c. 325
      d. 650
      e. 2 of the above
    • dose of ASA you use in ALL CAD PTs unless C/I

      e. 2 of the above (a & b)
    • 1. if a PT has an ASA allergy, what should they get instead?

      2. what is an acceptable daily antiplatelet TX for chronic stable CAD

      3. post ischemic stroke or TIA

      4. PAD
    • 1. clopidogrel

      2. ASA 75-162 + plavix 75

      3. ASA 75-325mg QD or plavix 75 QD or ER dipyridamole + ASA (25mg/200mg BID)

      4. ASA 75-325mg QD or clopidogrel 75 QD
    • if a PT is intolerant of ACE-I what can they get instead?
    • ARB