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Pharmacology > Anti-anginal & anti-thrombotic > Flashcards

Anti-anginal & anti-thrombotic Flashcards

1
Q

Clinical features of CSA

A

Symptom reversibility
Repetitive attacks
Occurs over months to years

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2
Q

Nitrate MOA

A

Relaxation of vascular SM vasodilation

Venous dilation > arterial –> reduced preload –> reduced O2 consumption

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3
Q

two types of nitrates

A

NTG

isosorbide monoitrate

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4
Q

NGT uses / onset / duration of action

A

angina
onset: 1-3 mins (SL) 30 mins (patch) 60 mins (extended release)
lasts 25 mins (SL) 10-12 hours (patch) 4-8 hours (ER)

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5
Q

which natural products interact with hypotensives?

A 
coleus
hawthorne
l-citrulline
NAC
*all major interactions
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6
Q

why should combination with sildenafil be avoided with hypotensives?

A

unsafe hypotension

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7
Q

are nitrates more specific to arterial or venous blood vessels

A

venous

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8
Q

isosorbide mononitrate indications and onset

A

angina pectoris

30-45 mins

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9
Q

beta blockers role in therapy

A

prophylactic
blunts cardiac stimulation
prevents reflex tachycardia**
decreases HR, contractility and BP

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10
Q

beta blocker MOA

A

blocks beta adrenergic receptors

can be selective or non-selective to the heart

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11
Q

BB side effects

A

bradycardia, heart block, HA, fatigue, exercise intolerance, hypotension, erectile dysfunction

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12
Q

avoid use of BB with ______

A

intrinsic sympathomimetic activity (ISA aka partial agonist)

  • Pindolol
  • Acebutolol
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13
Q

BB 1-3 where are they found?

A

beta-1: heart
beta-2: lung mostly, but also heart
beta-3: adipose tissue, and heart

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14
Q

T/F at high doses, selective beta blockers become non-selective

A

true

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15
Q

why do you need to taper off BB’s gradually?

A

abrupt discontinuation can lead to reflex tachycardia

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16
Q

what are the cardioselective B1 competitive antagonist BB

A

Metoprolol, Atenolol

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17
Q

indications for metoprolol

A

MI, CHF, angina, HTN

all same for Atenolol except CHF

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18
Q

avoid metoprolol in ppl with

A

heart block or severe bradycardia

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19
Q

onset / duration of metoprolol

A

1 hr

3-6 hours (IR), 24 hrs (ER)

20
Q

Atenolol onset, duration of action

A

<1 hour
12-24 hours
metabolism: limited hepatic

21
Q

interactions with atenolol

A

apple (major)

22
Q

what BB has a higher concern of mortality, except for mortality benefit in silent ischemia

A

atenolol

23
Q

what is the non-selective B-1 & B-2 Beta blocker

A

propranolol

24
Q

indications for propranolol

A

MI (treat and prevent), HTN, angina, migraine prophylaxis, supraventricular arrhythmias

25
Q

avoid propranolol in ppl with ____ and ____

A

heart block and severe brachycardia

26
Q

onset and duration of propranolol

A

1-2 hours

6-12 hrs (IR) 24-27 (ER)

27
Q

propranolol interacts with what natural products

A

indian snakeroot

st john’s wort

28
Q

what is the nonselective BB with alpha-1 adrenergic blockade activity

A

Carvedilol

29
Q

what natural product interacts with carvedilol

A

grapefruit –> increases bioavailability

30
Q

which beta blockers are more likely to interact with beta-agonists used in asthma

A

nonselective

31
Q

which beta blocker covers both beta and alpha receptors

A

carvedilol

32
Q

calcium channel blockers role in therapy

A

prophylactic tx
decrease BP
dilates coronary blood vessels
dilates peripheral blood vessels

33
Q

CCB MOA

A

blocks calcium influx leading to relaxation of cardiac and SMs

34
Q

side effects of CCB

A

tachycardia**
edema**
(HA, fatigue, exercise intolerance, hypotension)

35
Q

CCB agents differ based on their selectivity towards which type of receptors

A

DHP (dihydropyridine), predominately found in periphery

36
Q

CCBs are a 2nd line tx in angina but a 1st line tx in what

A

variant angina

37
Q

DHP CCB Amlodipine indications

A

HTN, chronic stable angina, variant angina, disorder of cardiovascular system

38
Q

amlodipine interacts with

A

lots of different drugs! esp. statins
cholea
grapefruit
st john’s wort

39
Q

nonDHP CCB Diltiazem (Benzothiazepine CCB) indications

A

atrial arrhyythmias, HTN, SVT, angina

40
Q

avoid Diltiazem with what conditions

A

hypotension, LVEF <30%, AV block, sick-sinus syndrome, certain arrhythmias

41
Q

how do the MOA’s differ between DHP and non-DHP CCBs?

A

DHPs are working at periphery
non-DHP working at heart
non-DHP has higher rate of hospitalization due to heart failure

42
Q

why are CCBs more likely to have drug interactions with other therapeutic moieties

A

bc they inhibit CYPs which makes them susceptible to drug interactions

43
Q

Clopidogrel belongs to which drug category

A

Anti-platelet

44
Q

MOA of clopidogrel

A

irreversibly blocks P2Y component of ADP receptors on platelet surface
prevents activation of GPIIb/IIIa receptor complex
reduces platelet aggregration

45
Q

do drug interactions affecting CYP enzymes tend to increase or decrease the effectiveness of P2Y inhibitors (ex Clopidogrel)

A

it depends, you cannot make a generalization about it

46
Q

what is INR

A

international normalized ratio of prothrombin time, we target between 2 and 3

Pharmacology (6 decks)

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