Angina

Question 1

Aspirin

Class

Answer 1

NSAID

Question 2

Asprin

MOA

Answer 2

Irreversible inhibition of platelet COX

Question 3

Asprin

Uses

Answer 3

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

Question 4

Asprin

Misc

Answer 4

Low-doses;

Causes asthma in those allergic

Question 5

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

Answer 5

Ticlopidine (not used much anymore)
Clopidogrel
Prasugrel

Question 6

Ticlopidine

Class

Answer 6

Thienopyridine derivative

Question 7

Ticlopidine

MOA

Answer 7

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

Question 8

Ticlopidine

Uses

Answer 8

Aspirin alternative that’s not used much anymore

Question 9

Ticlopidine

Impt SE

Answer 9

Neutropenia

TTP (rarely)

Question 10

Clopidogrel

Class

Answer 10

Thienopyridine derivative

Question 11

Clopidogrel

MOA

Answer 11

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

Question 12

Clopidogrel

Uses

Answer 12

Great antithrombic

Question 13

Clopidogrel

Impt SE

Answer 13

Bleeding

Question 14

Clopidogrel

Misc

Answer 14

No surgical or dental procedures if pt taking this

Question 15

Prasugrel

Class

Answer 15

Thienopyridine derivative

Question 16

Prasugrel

MOA

Answer 16

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

Question 17

Prasugrel

Uses

Answer 17

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

Question 18

Prasugrel

Impt SE

Answer 18

Massive bleeding risk

Question 19

Dipyradimole

Class

Answer 19

Pyrimido-Pryrimidine Derivative

Question 20

Dipyradimole

MOA

Answer 20

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

Question 21

Dipyramidimole

Uses

Answer 21

Dec peripheral vasc dz (adjunct);

Stress test of heart

Question 22

Dipyramidimole

Impt SE

Answer 22

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

Question 23

ACE-I for Angina

MOA

Answer 23

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

Question 24

ACE-I

Uses

Answer 24

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

Question 25

ACE-I | Impt SE

Answer 25

Dry Cough Angioedema Decreased Renal Function Hypotension

Question 26

ACE-I | Misc & Contraindications

Answer 26

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

Question 27

Metoprolol, Propranolol, Bisoprolol | Class

Answer 27

Beta Blockers

Question 28

Metoprolol, Propranolol, Bisoprolol | MOA

Answer 28

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)

Question 29

Metoprolol, Propranolol, Bisoprolol | Uses

Answer 29

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

Question 30

Metoprolol, Propranolol, Bisoprolol | Impt SE

Answer 30

Fatigue Worsening claudication Impotence

Question 31

Metoprolol, Propranolol, Bisoprolol | Other SE

Answer 31

Decreased exercise tolerance Lethargy Insomnia

Question 32

Metoprolol, Propranolol, Bisoprolol | Contraindications

Answer 32

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

Question 33

Nitrates | Class

Answer 33

Vasodilator

Question 34

Nitrates | MOA

Answer 34

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

Question 35

Nitrates | Uses

Answer 35

For acute episodes; | Long-acting are for those already on other drugs and still can't cntrl angina

Question 36

Nitrates | Impt SE

Answer 36

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

Question 37

Nitrates | Other SE

Answer 37

Increases Preload

Question 38

Nitrates | Contraindications

Answer 38

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

Question 39

CCBs - Dihydropyridines used for angina | NAF

Answer 39

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

Question 40

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

Answer 40

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)

Question 41

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

Answer 41

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

Question 42

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

Answer 42

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)

Question 43

Other SEs of all the CCBs (Dihydro + Nondihydro) | Nefedipine, Amlodipine, Felodipine + Verapamil, Diltiazem

Answer 43

Constipation (Most common) HA; Flushing

Question 44

Contraindications of all the CCBs (Dihydro + Nondihydro) (Nefedipine, Amlodipine, Felodipine + Verapamil, Diltiazem)

Answer 44

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

Question 45

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

Answer 45

Verapamil (phenylakamine type) | Diltiazem (benzothiazepine type)

Question 46

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

Answer 46

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

Question 47

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

Answer 47

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

Question 48

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

Answer 48

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