Anti-Anginals & Hyperlipidemia Flashcards
resins are ineffective for (2)
familial hypercholesterolemia
hypertriglyceridemia
resin MOA
binds bile acids, decreasing # of bile acids
this increases expression of hepatic LDL receptor
more uptake of LDL to make bile acids —> decreased LDL
Resins are effective when?
whenever LDL is elevated
Resin adverse effects?
Constipation & bloating
Steatorrhea
hyperprothrombinemia due to Vit K malabsorption
Niacin MOA (2)
inhibits VLDL secretion –> lower VLDL & LDL
inhibits hepatic cholesterologenesis
Niacin effects (3)
decrease VLDL
decrease LDL
increased HDL
Niacin side effects (4)
vasodilation/heat
GI discomfort
impairs glucose tolerance
rare hepatotoxicity
Statin MOA
inhibits HmG-CoA reductase, disrupting cholesterol synthesis & increasing the number of LDL receptors
Statin effects (5+)
decrease LDL decrease plasma TGs Increase HDL decrease C-reactive protein increase plaque stability enhance endothelial NO production, decrease lipoprotein oxidation, decrease platelet aggregation
statin side effects (4)
Increased aminotransferase levels
Liver damage
Increased creatinine kinase
Rhabdomyolysis
Statin contraindications (2)
Pregnancy
Active liver disease
Fibrates MOA (3)
PPAR-a ligand (nuclear receptor)
Upregulates LPL & other genes involved in fatty acid oxidation –> increased catabolism of VLDL
inhibits hepatic cholesterologenesis
Fibrates effects (3)
decreased VLDL
decreased triglycerides
decrease overall cholesterol
Fibrates unique adverse effects (5)
Increased liver enzymes Increased incidence of gallstones Inhibits statin metabolism Potent anticoagulant action of warfarin May increase LDL
Ezetimibe MOA
selectively blocks intestinal absorption of cholesterols
ezetimibe effects (2)
moderate decrease in LDL
synergistic with a statin
nitrate/nitrite MOA
NO –> cGMP –> myosin light chain dephosphorylation –> vasodilation
effects of nitrates (3)
decrease myocardial oxygen requirement
decrease preload
decrease afterload
how do vessels dilate with nitrates
large veins dilate more than arterioles
nitrate adverse effects for anti-angina (5)
reflex tachycardia orthostatic hypotension throbbing headaches fast tolerance cyanide
how do you minimize reflex tachy. w/ nitrates for angina?
combine with CCBs or B-blockers
most effective drug combo for angina
B-blockers & a Vasodilator
nifedipine effects in angina (4)
increases HR
coronary vasodilation
increased myocardial O2 supply
decreased afterload
verapamil/diltiazem effects in angina (2)
decreased myocardial contractility
bradycardia
Nifedipine adverse effects (2)
reflex tachycardia
increased cardiac workload
verapamil/diltiazem adverse effect
cardiac depression leading to further problems
treatments for Prinzmetal’s angina (2)
nitrates
CCBs
B-blockers effects in angina (2)
decreased sympathetic activation
decreased cardiac workload & O2 demand
B-blockers effect on the kidneys
decreased renin
why are B-blockers harmful in variant angina?
slowing HR prolongs the ejection time and increases the myocardial O2 demand
Ranolazine MOA (2)
partial fatty-acid oxidation inhibitor: decreases O2 consumption in ischemic tissue
Also inhibits late inward sodium current- decreased contractility
Ranolazine effects (2)
decreases left ventricular wall stiffness
improves coronary circulation
the preferred drug for angina & CHF?
nitrates
the preferred drugs for angina + asthma/diabetes? (2)
CCBs and nitrates
