A-25. Drugs used for treatment of angina pectoris. Pharmacotherapy of ischemic heart disease. Flashcards
Please review nitrates, beta blockers, and calcium channel blockers for treatment of angina pectoris
Please review nitrates, beta blockers, and calcium channel blockers for treatment of angina pectoris
Drug classes for treatment of stable coronary heart disease
- beta-blockers
- thrombocyte aggregator inhibitors
- antihyperlipidemic treatment
- ACE inhibitor or ARBs
- Nitroglycerine
- Calcium channel blocker
- Cytoprotective drugs
Antiplatelet treatment drugs
- ) Thrombin inhibitor
- Dabigatran - ) P2Y12 inhibitor
- Ticlopidine
- Clopidogrel
- Prasugrel
- Ticagrelor - ) COX-1 inhibitor
- Aspirin - ) GPIIb/IIIA antagonist
- abciximab
- eptifibatide
- tirofiban
Do COX2 inhibitors and Acetaminophen have antiplatelet activity
No
For using of Clopidogrel, which patients are at higher risk o f subsequent cardiovascular event
CYP2C19 loss of function allele
Four things that change lipid profile
- ) lifestyle changes i.e. exercise
- ) Diet (omega-3 are not effective for preventing future heart and stroke in patients who had previous heart attack)
- ) Estrogen
- ) Drugs
- ACE inhibitors- amelioration o fendothelial dysfunction
- Drugs decreasing the lipid levels of the blood
Which are the major antihyperlipidemic drugs? Which is used most typically in ischemic heart disease
Statins- most often used Fibrates- most often used Ezetimibe- used also PCSK9- used also Resin Niacin
Statin sides effects?
Rhabdomyolysis, myopathy
Statin intolerance
myalgia and increased CK biomarkers
What to change in statin intolerance
- other statin
- dose reduction
- lose dose statin in combo with ezetimbe
- discontinuation of statins ((ezetimibe, PCSK9)
What do Nitrates do in ischemic heart disease
They increase venular dilation decreasing preload on heart and dilate the coronaries
What do ACE inhibitors do in IHD
They increase venular and arterolar dilation which decreases preload and afterload
What do CCB do in IHD
They increase arteriolar dilation decreasing afterload on the heart and dilate the coronaries
What do Beta blockers do in IHD
They decrease O2 demand, cardiac work, wall tension, and pain
What to give for pain and sympathetic tone increased in IHD
oxygen, pain reliever (iv opiods), tranquilizer (benzodiazapines)
Which drug shifts cardiac metabolism to glucose oxidation from fatty acid oxidation
Trimetazidine
Why is it important to shift to glucose oxidation iwth trimetazidine?
Delays uncoupling of mitochondrial respiratory chain. This…
-Inhibits the production of reactive free radicals
-Maintains ATP production
Delays the onset of Anaerobe glycolysis which decreases intracellular acidosis
Kinetics of trimetazidine
- fast oral absorptions
- half life- 4-5 hours
- excretion in the kidneys
New antianginal agent similar in structure to nitrates
Molsidomine that leads to SIN-1 then 2 to form NO
Which cytoprotective drug inhibits late sodium channels in myocardial cells
Ranolazine
MOA of Ranolazine
- ) Inhibits late sodium channels in myocardial cells. This decreases intracellular Na, thereby activating Na/Ca transporter and decreases intracellular Ca overload
- ) Decreases fatty acid oxidation in the myocardium
- ) Decreases cardiac work, cytoprotective
Which new drug is used in both stabile effort angina and heart failure
Ivabradin
MOA of Ivabradin
decreases activity of sinus node by reducing the pacemaker If current
This decreases the heart rate without modifying the electric conduction parameters and contractile force
Contraindication of Ivabradin
sick sinus syndrome
Vitamins used to treat IHD
Omega 3, EPA, DHA—> decrease serum triglyceride levels and the formation of atherosclerotic plaques
Coenzyme Q10 (ubiquinon —> antioxidant, ATP production (in heart failure)
B6 and B12, folic acid—> decrease serum homocysteine level
