Angina drugs Flashcards
nitrate vasodilators
NTG
isosorbide dinirrate
CaCh Blockers
verapamil
diltiazem
DHPs
DHPs
Nifedipeine
amlodipine
felodipine
Beta blockers
atenolol
metoprolol
propranolol
antiplatelet agents
asiprin
clopidorgrel
reasugrel
IIa/IIIb inhibitors
IIa/IIIb inhibitors
abciximab
tirofibran
eptifibatide
anticoagulants
heparin
chronic coronary artery disease/stable angina
aspirin beta blockers nitragtes CaCh blockers ACE inhibitors Ranolazine
Acute coronary syndromes
aspirin
beta blockers
nitrates
acute w/no ST elevation
heparin + GPIIb-IIIa inhibitors +
ADP R blocker
or
bivalirudin + ADP R blocker
STEMI thrombolysis
thrombolytic agent
heparin
ADP R blocker
STEMI angioplasty
heparin + GPIIb-IIIa inhibitors +
ADP R blocker
or
bivalirudin + ADP R blocker
Post MI management
statin ACE inhibitor aldosterone receptor antagonist aspirin ADP R antagonist
typical angina
induced by exercise
alleviated by NTG
lasts no longer then 15min, 5-15 episodes/week
ST segment depression
unstable angina
if symptoms not relieved by 3 NTG tablets w/in 15min should call 911/get to ED asap
treatment of typical angina
beta blockers + aspirin (clopidogrel if aspirin not tollerated)
can also add long-acting nitrate
Nitrate for acute attacks
ACE inhib in diabetes or left ventricular dysfunction
long acting DHP when beta blocker contraindicated, not working, or causing intolerable side effects
unstable angina treatment
MONA beta blocker if beta blocker contrainidcated use verapamil or diltiazem aspirin + heparin PCI cbg thrombolytics
MONA
morphine
O2
NTG
ASA
Thrombolytics
alteplase
reteplase
tenecteplase
streptokinase
NO
increases cGMP
Isosorbide dinitrate
long acting vasodilator
adverse effects of vasodilators
headaches
facial flush
dizziness
orthostatic hypotension (worse w/ethanol)
nitrate limitations
tolerance
must have 8hr/day drug free
drug holidays
nitrates contraindications
in AMI avoid if RV infarction
patients on erectile dysfunction drugs dangerous fall in BP
Non DHPs
verapamil
diltiazem
primarily cardiac effects
DHPs
vasodilatory effects
Nifedipine
amlodipine
felodipine
CaCh blocker over all effects
cause neg inotropic effect, but concurrent drop in TPR can cause drop in BP activating barorecptor reflex increasing HR
non-DHPs actioin
drop rate of SA node depolarization and decrease AV nodal conduction
All CCBs
decrease coronary vascular resistance and increase coronary blood flow
CCB toxcity
excessive vasodilation-dizziness, hypotension, headache, flushing, nausea verapamil- constipation peripheral edema coughing wheezing pulmonary edema coronary steal
CCB contraindications
nonDHPs cannot be used w/beta blocker ->AV block
SA, AV nodal conduction defects
systolic pressure <90
clopidogrel
slectively inhibits ADPRs
irreversible long term inhibition of platelet aggregation
useful for unstable angina, prevention and Tx of TIA and stroke
stent replacement
abciximab
used during angioplasty
monoclonal Ab against GPIIb/IIIaR
other angioplasty drugs
tirofiban
eptifibatide
inhibit ligand binding to IIb/IIIa R
acute prophylaxis and Tx of single attacks
NTG
maintenance therapy of chronic stable angina
beta blockers, CCBs, or long duration nitrates or combo
vasospastic angina
CCB or nitrates
