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Pharm > Angina > Flashcards

Angina Flashcards

1
Q

Aspirin

Class

A

NSAID

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2
Q

Asprin

MOA

A

Irreversible inhibition of platelet COX

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3
Q

Asprin

Uses

A

Reduction in adverse events (MI, CVA, Death);
For those with stable/unstable angina, acute MI;
Prophylaxis

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4
Q

Asprin

Misc

A

Low-doses;

Causes asthma in those allergic

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5
Q

What 3 Thienopyridine Derivatives are used to treat angina? (TCP)

A

Ticlopidine (not used much anymore)
Clopidogrel
Prasugrel

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6
Q

Ticlopidine

Class

A

Thienopyridine derivative

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7
Q

Ticlopidine

MOA

A

Inhibits plt aggregation by ADP; Reduces blood viscosity by decreasing plasma fibrinogen and inc RBC deformability

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8
Q

Ticlopidine

Uses

A

Aspirin alternative that’s not used much anymore

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9
Q

Ticlopidine

Impt SE

A

Neutropenia

TTP (rarely)

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10
Q

Clopidogrel

Class

A

Thienopyridine derivative

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11
Q

Clopidogrel

MOA

A

Selectively and irreversibly inhibits ADP binding to P2Y12 (blocks ADP-dependent activation of GP IIb/IIIa complex)

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12
Q

Clopidogrel

Uses

A

Great antithrombic

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13
Q

Clopidogrel

Impt SE

A

Bleeding

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14
Q

Clopidogrel

Misc

A

No surgical or dental procedures if pt taking this

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15
Q

Prasugrel

Class

A

Thienopyridine derivative

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16
Q

Prasugrel

MOA

A

Irreversibly bind P2Y12 receptor (G protein-coupled chemoreceptor for ADP)

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17
Q

Prasugrel

Uses

A

Reduce thrombotic events in those with percutaneous coronary intervention (stent)

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18
Q

Prasugrel

Impt SE

A

Massive bleeding risk

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19
Q

Dipyradimole

Class

A

Pyrimido-Pryrimidine Derivative

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20
Q

Dipyradimole

MOA

A

Inc plt intracellular cAMP (inhibits phosphodiesterase 5, activates adenylate cyclase, inhibits uptake of adenosine from vasc endothelium and RBCs)

21
Q

Dipyramidimole

Uses

A

Dec peripheral vasc dz (adjunct);

Stress test of heart

22
Q

Dipyramidimole

Impt SE

A

Vasodilation of coronary arteries can enhance exercise-induced ischemia (bc it elevates extracellular adenosine levels)

23
Q

ACE-I for Angina

MOA

A

Blocks endothelial ACE from converting Angio I to Angio II; also prevents breakdown of bradykinin (potent vasodilator)

24
Q

ACE-I

Uses

A

Often used as an add-on “anti-hypertensive” for anyone with CKD/Proteinuria, CHF, LVH, Post-MI to prevent LV remodeling;
Reduces incidence of future CAD events;
May reduce risk of DM

25
Q

ACE-I

Impt SE

A

Dry Cough
Angioedema
Decreased Renal Function
Hypotension

26
Q

ACE-I

Misc & Contraindications

A

Short-acting;
Contraind: Pregnancy, Renal artery stenosis, Hyperkalemia, Prior angioedema (no ARB either);
Caution in Renal Failure

27
Q

Metoprolol, Propranolol, Bisoprolol

Class

A

Beta Blockers

28
Q

Metoprolol, Propranolol, Bisoprolol

MOA

A

Decreases contractility and HR (dec myocardial O2 demand);
Class II Antiarrhythmic (inhibits sympathetic influence on cardiac electrical activity, inc AP duration and effective refractory period in AV node)

29
Q

Metoprolol, Propranolol, Bisoprolol

Uses

A

Prevent MIs;
Prevent sudden cardiac death;
Inc survival post-MI

30
Q

Metoprolol, Propranolol, Bisoprolol

Impt SE

A

Fatigue
Worsening claudication
Impotence

31
Q

Metoprolol, Propranolol, Bisoprolol

Other SE

A

Decreased exercise tolerance
Lethargy
Insomnia

32
Q

Metoprolol, Propranolol, Bisoprolol

Contraindications

A 
Severe bradycardia
High degree AV block
Sick Sinus Syndrome
Unstable LV failure
Relative contraindications:
-Asthma, severe depression, peripheral vasc dz
33
Q

Nitrates

Class

A

Vasodilator

34
Q

Nitrates

MOA

A

Endothelium independent vasodilator; Endothelial effects (inhibits plt aggregation, inhibits leukocyte-endothelial interactions [anti-inflam])

35
Q

Nitrates

Uses

A

For acute episodes;

Long-acting are for those already on other drugs and still can’t cntrl angina

36
Q

Nitrates

Impt SE

A

Tolerance with chronic use (need nitrate free periods of 8-12 hrs);
HA;
Hypotension;
Activation of Bezold-Jarisch reflex (bradycardia)

37
Q

Nitrates

Other SE

A

Increases Preload

38
Q

Nitrates

Contraindications

A

Cardiomyopathy;
Severe aortic stenosis;
Significant hypotension;
Use of PDE inhibitors

39
Q

CCBs - Dihydropyridines used for angina

NAF

A

Nefedipine (1st gen)
Amlodipine (2nd gen)
Felodipine (2nd gen)

40
Q

Dihydropyridines (CCBs)
MOA
(Nefedipine, Amlodipine, Felodipine)

A

Interact with L-type voltage gated plasma membrane Ca channel –> dec Ca entry into vasc smooth muscle cell, preventing contraction; Causes dilation of epicardial coronary arteries and arteriolar resistance arteries (less heart specific activity, more effect on BP compared to non-dihydros)

41
Q

Dihydropyridines (CCBs)
Uses
(Nefedipine, Amlodipine, Felodipine)

A

Nefedipine & Amlodipine
(HTN, Raynauds, Angina [3rd choice drugs])

Felodipine
(HTN, Raynauds)

42
Q

Dihydropyridines (CCBs)
Impt SE
(Nefedipine, Amlodipine, Felodipine)

A

Leg edema (more in Nefedipine);
HF;
AV Nodal blockade;
Reflex Tachycardia (long-acting agents are less lipophilic and will cause less sympathetic activation and less BP drop)

43
Q

Other SEs of all the CCBs (Dihydro + Nondihydro)

Nefedipine, Amlodipine, Felodipine + Verapamil, Diltiazem

A

Constipation (Most common)
HA;
Flushing

44
Q

Contraindications of all the CCBs
(Dihydro + Nondihydro)

(Nefedipine, Amlodipine, Felodipine + Verapamil, Diltiazem)

A

Decompensated HF;
Bradycardia;
Sinus Node dysfunction;
High degree AV Block

45
Q

Non-Hydropyridines (CCBs) used to treat Angina (VD)

A

Verapamil (phenylakamine type)

Diltiazem (benzothiazepine type)

46
Q

Non-Hydropyridines (CCBs)
MOA
(Verapamil, Diltiazem)

A

Interact with L-type voltage gated plasma membrane Ca channel –> decreased Ca entry into vasc smooth musc cell preventing contraction –> dec contraction, dec conduction velocity, and dec firing rate of aberrant pacemaker sites;
Prolongs repolarization in SA and AV nodes (dec HR); less vasodilation, more heart specific

47
Q

Non-dihydropyridines (CCBs)
Uses
(Verapamil, Diltiazem)

A

HTN;
Angina (chronotropic effects –> dec myocardial O2 demand);
SVT (Class IV antiarrhythmics)

48
Q

Non-dihydropryidines (CCBs)
Impt SEs
(Verapamil, Diltiazem)

A 
Leg edema;
Bradycardia;
AV nodal blockade;
Hypotension;
Worsening HF

Pharm (7 decks)

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