Angina Flashcards
What is the class for Aspirin (Unit IV)
NSAID
What is the mechanism for Aspirin (Unit IV)
Irreversible inhibition of platelet COX
What are the therapeutics for Aspirin (Unit IV)
Reduction in adverse events (MI, CVA, death); for those w/stable angina, unstable angina, acute MI, prophylaxis
What are the miscellaneous for Aspirin (Unit IV)
Low-doses; if you’re allergic, you’ll get asthma
What is the class for Ticlopidine (Ticlid)
Thienopyridine derivitive
What is the mechanism for Ticlopidine (Ticlid)
Inhibits platelet aggregation by ADP; reduces blood viscosity by decreasing plasma fibrinogen and increasing RBC deformability
What are the therapeutics for Ticlopidine (Ticlid)
Aspirin alternative
What are the important side effects for Ticlopidine (Ticlid)
Neutropenia and, rarely, TTP
What are the miscellaneous for Ticlopidine (Ticlid)
Not really used anymore
What is the class for Clopidogrel (Plavix)
Thienopyridine derivitive
What is the mechanism for Clopidogrel (Plavix)
Selectively and irreversibly inhibits ADP binding to P2Y12 (blocks ADP-dependent activation of glycoprotein IIb/IIIa complex)
What are the therapeutics for Clopidogrel (Plavix)
Great antithrombotic
What are the important side effects for Clopidogrel (Plavix)
Bleeding
What are the miscellaneous for Clopidogrel (Plavix)
No surgical or dental procedures if patient taking this
What is the class for Prasugrel (Effient)
Thienopyridine derivitive
What is the mechanism for Prasugrel (Effient)
Irreversibly binds P2Y12 receptor (G protein-coupled chemoreceptor for ADP)
What are the therapeutics for Prasugrel (Effient)
Reduce thrombotic events in those w/percutaneous coronary intervention (e.g., stent)
What are the important side effects for Prasugrel (Effient)
Massive bleeding risk
What is the class for Dipyradimole (Persantine)
Pyrimido-pyrimidine derivitive
What is the mechanism for Dipyradimole (Persantine)
Increases platelet intracellular cAMP (inhibits phosphodiesterase 5, activates adenylate cyclase, inhibits uptake of adenosine from vascular endothelium and RBCs)
What are the therapeutics for Dipyradimole (Persantine)
Decrease peripheral vascular disease (as an adjunct); stress test of heart
What are the important side effects for Dipyradimole (Persantine)
Vasodilation of coronary arteries can enhance exercise-induced ischemia (because it elevates extracellular adenosine levels)
What is the class for ACE inhibitors
ACE inhibitor
What is the mechanism for ACE inhibitors
Blocks endothelial ACE from converting angiotensin I to angiotensin II (potent vasoconstrictor); as a side effect, also prevents breakdown of bradykinin (potent vasodilator)
What are the therapeutics for ACE inhibitors
Often used as an add-on antihypertensive for anyone with chronic kidney disease/proteinuria, CHF, left ventricular hypertrophy, or post-MI (prevents left ventricular remodeling); reduces incidence of future CAD events, may reduce risk of diabetes
What are the important side effects for ACE inhibitors
Dry cough, angioedema, decreased renal function, hypotension
What are the miscellaneous for ACE inhibitors
Short-acting; contraindicated in pregnancy, renal artery stenosis, hyperkalemia, and prior angioedema (no ARB allowed, either); caution in renal failure
What is the class for Metoprolol, propranolol, bisoprolol
?-blocker
What is the mechanism for Metoprolol, propranolol, bisoprolol
Decrease contractility, HR (reduced myocardial O2 demand); class II antiarrhythmics (inhibit sympathetic influence on cardiac electrical activity, increase AP duration and effective refractory period in AV node)
What are the therapeutics for Metoprolol, propranolol, bisoprolol
Prevent MIs, prevent sudden cardiac death, increase survival post-MI (if patients suddenly stop, really bad!)
What are the important side effects for Metoprolol, propranolol, bisoprolol
Fatigue, worsening claudication, impotence (so men don’t take)
What are the other side effects for Metoprolol, propranolol, bisoprolol
Decreased exercise tolerance, lethargy, insomnia,
What are the miscellaneous for Metoprolol, propranolol, bisoprolol
Contraindicated in severe bradycardia, high degree AV block, sick sinus syndrome, unstable LV failure; relative contraindication is asthma, severe depression, peripheral vascular disease
What is the class for Nitrates
Vasodilator
What is the mechanism for Nitrates
Endothelium independent vasodilator; endothelial effects (inhibits platelet aggregation, inhibits leukocyte-endothelial interactions (anti-inflammatory))
What are the therapeutics for Nitrates
For acute episodes; long-acting formulations are for those already on other drugs and still can’t control angina
What are the important side effects for Nitrates
Tolerance w/chronic use (need nitrate free periods of 8-12 hours), headaches, hypotension, activation of Bezold-Jarisch reflex (causes bradycardia)
What are the other side effects for Nitrates
Increase preload
What are the miscellaneous for Nitrates
Contraindicated in hypertrophic cardiomyopathy, severe aortic stenosis, significant hypotension, use of phosphodiesterase inhibitors
What is the class for Nefedipine (Procardia)
Calcium channel blockers (dihydropyridines, 1st generation)
What is the mechanism for Nefedipine (Procardia)
Interact with L-type voltage gated plasma membrane Ca channel –> decreased calcium entry into vascular smooth muscle cell, preventing contraction; causes dilation of epicardial coronary arteries, arteriolar resistance arteries; less heart-specific activity, but more than 1st generation
What are the therapeutics for Nefedipine (Procardia)
Hypertension, Raynauds, angina (3rd choice drug)
What are the important side effects for Nefedipine (Procardia)
Leg edema, heart failure, AV nodal blockade, reflex tachycardia (lipophilic agents gain entry to brain and depress vasomotor center, rapidly dropping BP; this causes more reflex sympathetic activation (leading to adverse CV effects); long-acting agents are less lipophilic, and will cause less sympathetic activation and initial fall in BP)
What are the other side effects for Nefedipine (Procardia)
Constipation (most common), headache, flushing
What are the miscellaneous for Nefedipine (Procardia)
Contraindicated in overt decompensated heart failure, bradycardia, sinus node dysfunction, high-degree AV block
What is the class for Amlodipine (Norvasc)
Calcium channel blockers (dihydropyridines, 2nd generation)
What is the mechanism for Amlodipine (Norvasc)
Interact with L-type voltage gated plasma membrane Ca channel –> decreased calcium entry into vascular smooth muscle cell, preventing contraction; causes dilation of epicardial coronary arteries, arteriolar resistance arteries; less heart-specific activity
What are the therapeutics for Amlodipine (Norvasc)
Hypertension, Raynauds, angina (3rd choice drug)
What are the important side effects for Amlodipine (Norvasc)
Leg edema (less than 1st generation), heart failure, AV nodal blockade, reflex tachycardia (lipophilic agents gain entry to brain and depress vasomotor center, rapidly dropping BP; this causes more reflex sympathetic activation (leading to adverse CV effects); long-acting agents are less lipophilic, and will cause less sympathetic activation and initial fall in BP)
What are the other side effects for Amlodipine (Norvasc)
Constipation (most common), headache, flushing
What are the miscellaneous for Amlodipine (Norvasc)
Contraindicated in overt decompensated heart failure, bradycardia, sinus node dysfunction, high-degree AV block
What is the class for Felodipine (Plendil)
Calcium channel blockers (dihydropyridines, 2nd generation)
What is the mechanism for Felodipine (Plendil)
Interact with L-type voltage gated plasma membrane Ca channel –> decreased calcium entry into vascular smooth muscle cell, preventing contraction; causes dilation of epicardial coronary arteries, arteriolar resistance arteries; less heart-specific activity
What are the therapeutics for Felodipine (Plendil)
Hypertension, Raynauds
What are the important side effects for Felodipine (Plendil)
Leg edema (less than 1st generation), heart failure, AV nodal blockade, reflex tachycardia (lipophilic agents gain entry to brain and depress vasomotor center, rapidly dropping BP; this causes more reflex sympathetic activation (leading to adverse CV effects); long-acting agents are less lipophilic, and will cause less sympathetic activation and initial fall in BP)
What are the other side effects for Felodipine (Plendil)
Constipation (most common), headache, flushing
What are the miscellaneous for Felodipine (Plendil)
Contraindicated in overt decompensated heart failure, bradycardia, sinus node dysfunction, high-degree AV block
What is the class for Isradipine (Dynacirc)
Calcium channel blockers (dihydropyridines, 2nd generation)
What is the mechanism for Isradipine (Dynacirc)
Interact with L-type voltage gated plasma membrane Ca channel –> decreased calcium entry into vascular smooth muscle cell, preventing contraction; causes dilation of epicardial coronary arteries, arteriolar resistance arteries; less heart-specific activity
What are the therapeutics for Isradipine (Dynacirc)
Hypertension, Raynauds
What are the important side effects for Isradipine (Dynacirc)
Leg edema (less than 1st generation), heart failure, AV nodal blockade, reflex tachycardia (lipophilic agents gain entry to brain and depress vasomotor center, rapidly dropping BP; this causes more reflex sympathetic activation (leading to adverse CV effects); long-acting agents are less lipophilic, and will cause less sympathetic activation and initial fall in BP)
What are the other side effects for Isradipine (Dynacirc)
Constipation (most common), headache, flushing
What are the miscellaneous for Isradipine (Dynacirc)
Contraindicated in overt decompensated heart failure, bradycardia, sinus node dysfunction, high-degree AV block
What is the class for Verapamil (Calan)
Calcium channel blockers (nondihydropyridines, phenylalkamine type)
What is the mechanism for Verapamil (Calan)
Interact with L-type voltage gated plasma membrane Ca channel –> decreased calcium entry into vascular smooth muscle cell, preventing contraction; causes decreased contractility, firing rate of aberrant pacemaker sites, and conduction velocity; prolongs repolarization in SA node and AV node (–> decreases HR); less vasodilation
What are the therapeutics for Verapamil (Calan)
Hypertension, anti-anginal (chronotropic effects –> decreased myocardial oxygen demand), SVT (class IV anti-arrhythymic)
What are the important side effects for Verapamil (Calan)
Leg edema, bradycardia, AV nodal blockade, hypotension, worsening heart failure
What are the other side effects for Verapamil (Calan)
Constipation (most common), headache, flushing
What are the miscellaneous for Verapamil (Calan)
Contraindicated in overt decompensated heart failure, bradycardia, sinus node dysfunction, high-degree AV block
What is the class for Diltiazem (Cardizem)
Calcium channel blockers (nondihydropyridines, benzothiazepine type)
What is the mechanism for Diltiazem (Cardizem)
Interact with L-type voltage gated plasma membrane Ca channel –> decreased calcium entry into vascular smooth muscle cell, preventing contraction; causes decreased contractility, firing rate of aberrant pacemaker sites, and conduction velocity; prolongs repolarization in SA node and AV node (–> decreases HR); less vasodilation
What are the therapeutics for Diltiazem (Cardizem)
Hypertension, anti-anginal (chronotropic effects –> decreased myocardial oxygen demand), SVT (class IV anti-arrhythymic)
What are the important side effects for Diltiazem (Cardizem)
Leg edema, bradycardia, AV nodal blockade, hypotension, worsening heart failure
What are the other side effects for Diltiazem (Cardizem)
Constipation (most common), headache, flushing
What are the miscellaneous for Diltiazem (Cardizem)
Contraindicated in overt decompensated heart failure, bradycardia, sinus node dysfunction, high-degree AV block
