132 Cardio Drugs

Question 1

Platelet aggregation drugs:

1. ADP Receptor antagonists: Ticlopidine, clopidogrel, ticagrelor, prasugrel, elinogrel, cangrelor
2. heparin
3. Thromboxane inhibitors: aspirin
4. thromboxane synthetase inhibitors
5. thromboxane receptor antagonist
6. GP2b/3a antagonists: abciximab, eptifibatide, tirofiban
7. Par-1 Antagonists: vorapaxar

Answer 1

Question 2

P2Y12 inhibitor properties

Answer 2

Question 3

Fibrinolytics

Answer 3

Fibrinolytic agents are a class of drugs known as plasminogen activators, which convert plasminogen into plasmin. Plasmin enzymatically cleaves the fibrin strands, which bind the platelets and red blood cells together within the thrombus, leading to clot dissolution. A naturally occurring serine protease, t-PA is endogenously secreted by the vascular endothelium and helps maintain, along with other hematologic components, a balance between hemostasis and fibrinolysis

Streptokinase, Alteplase, Tenecteplase

Question 4

ABCDE Treatment of chronic stable angina

+ current therapies for chronic angina

Answer 4

A = Aspirin, other antiplatelet, and antianginal therapy

B = Beta-blocker and Blood pressure

C = Cigarette smoking and Cholesterol

D = Diet and Diabetes

E = Education

Question 5

Hemodynamic Effects of
Anti-Anginal Drugs

Answer 5

Question 6

Beta blockers:

relative B1 specific: (4)

Nonspecific: (3)

Mixed alpha-beta inhibition: (1)

Answer 6

§Block cardiac beta receptors leading to slowing of heart rate, reduction of blood pressure, and reduction of myocardial contractility

§Relative B1 specific—nebivolol, metoprolol, atenolol, esmolol

§Nonspecific—propranolol, nadolol, carvedilol

§Mixed alpha-beta inhibition—carvedilol

§Clinical uses—these agents treat angina, arrhythmias, blood pressure, and heart failure

Question 7

Nitrates (mechanism)

Answer 7

• §Mechanism of action—reduce preload, afterload, coronary vasodilation
• §Increase in cyclic GMP leads to relaxation of vascular smooth muscle
• §Preparations
  
  • –Sublingual—onset in 1 minute; lasts 5-15 minutes
  • –Oral—isosorbide dinitrate short acting (several hours)
  • –Oral—isosorbide mononitrate (short acting and once daily preparations)
  • –Transdermal—patch worn for 12-24 hours; ointment lasts 6 hours
  • –Intravenous

Question 8

Calcium channel antagonists

Answer 8

• §Block calcium channels in vascular smooth muscle, leading to coronary vasodilation, peripheral vasodilation, decreased myocardial contractility, and decreased heart rate.
• §Useful for angina, hypertension, and supraventricular tachycardias
• §Types of CCBs:
  
  • –Dihydropyridines—amlodipine, nifedipine, nicardipine, felodipine, isradipine
  • –Diltiazem
  • –Verapamil

Question 9

Main side effects/limits of:

Beta Blockers

Nitrates

Calcium antagonists

Answer 9

Question 10

Ranolazine

Answer 10

Question 11

Renin–angiotensin system

Answer 11

Question 12

Angiotensin Converting Enzyme (ACE) Inhibitors

Answer 12

• §Available ACE inhibitors: captopril, enalapril, benazepril, ramipril, quinapril, perindopril, trandolapril
• §Mechanism of action: block conversion of AII from AI and block degration of bradykinin
• §Clinical uses: hypertension, congestive heart failure, prevention of atherosclerotic complications, and prevention of renal deterioration
• §Most common side effects: cough, skin reactions, angioedema, renal dysfunction

Question 13

Angiotensin receptor blockers (ARB)

Answer 13

• §Members of the class: losartan, valsartan, irbesartan, candesartan, eprosartan, telmisartan, olmesartan, azilsartan
• §Mechanism of action: blockade of the AT-1 receptor for angiotensin II
• §Clinical uses: hypertension, heart failure, (?) progression of CAD
• §Side effects—very infrequent; well tolerated class of drugs

Question 14

Four Anticoagulant Choices

Answer 14