135: CAD Pharmacology

Question 1

Valsartan, Losartan, Irbesartan, and Candesartan are which type of drug?

Answer 1

Angiotensin receptors blockers (ARBs);

They block the effects of angiotensin II on the AT1 receptor

Question 2

Give some examples of direct-acting thrombin inhibitors

Answer 2

Bivalirudin, lepirudin, argatroban, dabigatran

Dabigatran can be taken orally, usually used for outpatients

Question 3

Which anticoagulants might be used for a patient with CAD?

Answer 3

Any of the following

• Unfractionated heparin
• LMWH
• Fondaparinux
• Direct-acting thrombin inhibitors
• Warfarin
• Factor Xa inhibitors

Question 4

List some relevant aldosterone receptor antagonists

(aka Mineralcorticoid Receptor Antagonists, aka MRAs)

Answer 4

Spironolactone

Eplerenone

Question 5

What kind of drugs end in -pril?

Answer 5

ACE inhibitors

Lisinopril

Ramipril

Perindopril

Question 6

Which ARB is best for diabtics with renal dysfunction?

Answer 6

Losartan

Irbesartan

Question 7

Which ARB is best for patients with heart failure?

Answer 7

Valsartan, candesartan

Note: Valsartan is used in patients with heart failure and LV systolic dysfunction after heart attack (MI);
Valasartan = Valentine = hearts

Question 8

Abciximab, eptifibatide, and tirofiban belong to which drug class?

What is their mechanism of action?

Answer 8

Antiplatelet agent (intravenous)

Gp IIb/IIIa inhibitors

(use in patients undergoind angioplasty and stenting, and to stabilize patients with NSTEMI awaiting intervention)

Question 9

Lisinopril, ramipril, and perindopril are examples of what kind of drug?

Answer 9

ACE inhibitors

Question 10

In which patients are ARBs useful?

Answer 10

• Heart failure (valasartan, candesartan)
• LV systolic dysfunction post-MI (valasartan)
• Renal dysfunction in diabetics (lorsartan, irbesartan)
• Hypertension (all)

Question 11

Clopidogrel, prasugrel, and ticagrelor belong to which drug class?

What is their mechanism of action?

Answer 11

Antiplatelet agent (oral)

ADP receptor blockers

(Use flowwign stenting of a coronary artery)

Question 12

What is the mechanism of action of ACE inhibitors?

What are the effects?

Answer 12

Inhibit Angiotensin Converting Enzyme (ACE)

• Decreased production of Angiotensin II
  
  • Prevent LV hypertrophy, fibrosis, remodeling
  • Decreased retention of Na+, H2O
• Increased bradykinin (decreased degradation)
  
  • Vasodilation
    
    • Decreased platelet aggregation
    • Decreased ischemia
  • Cough (side effect(

Question 13

What kind of drugs end in -xaban?

Answer 13

Oral Factor Xa inhibitors

• Rivaroxaban
• Apixaban
• Edoxaban
• Betrixaban

Question 14

Which direct-acting thrombin inhibitor would be prescribed for outpatients?

Why?

Answer 14

Dabigatran

It can be taken orally

Question 15

Why are antithrombin drugs used in treating coronary artery disease?

Answer 15

The final common pathway of most coronary artery events involves activation of clotting pathways and platelets.

Thus, anticoagulants and anti-platelet agents are recommended

Question 16

In which patients can ACE inhibitors be used?

Answer 16

• Hypertension
• Heart failure
• Renal protection
• Following MI (especially if LV systolic dysfunction_
• CAD (chronic, stable)

Question 17

Give some examples of oral factor Xa inhibitors

Answer 17

-xaban

Rivaroxaban

Apixaban

Edoxaban

Betrixaban

Question 18

Which ARB is best for patients with hypertension?

Answer 18

All of the -sartans would work

Question 19

What kind of drugs end in -sartan?

Answer 19

Angiotensin Receptor Blockers (ARBs)

Valsartan

Losartan

Irbesartan

Candesartan

Question 20

What is the mechanism of action of angiotensin receptor blockers?

What are the effects?

Answer 20

Inhibit the binding fo angiotensin II to its AT1 receptor. This inhibits the actions of angiotension II on vasculature, kidney, and heart

• Inhibit vasoconstriction
• Prevent cell growth (prevent remodeling)
• Inhibit Na+/H2O Retention
• Inhibit sympathetic activation

Question 21

Give an example of a direct renin inhibitor

Answer 21

Aliskiren

Question 22

What are the effects fo aldosterone receptor antagonists?

Answer 22

Decrease blood pressure

Inhibit Na+ retention (K+ sparing)

Decrease myocardial fibrosis

Question 23

Which patients would benefit from valsartan?

Answer 23

Valsartan is used in patients with heart failure and LV systolic dysfunction after heart attack (MI)

(Valasartan = Valentine = hearts)