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Year 3 > Anti-platelets and drugs for ischaemic heart disease > Flashcards

Anti-platelets and drugs for ischaemic heart disease Flashcards

1
Q

MOA: Irreversibly inhibits COX-1 enzyme to reduce production of the pro-aggregetory thromboxane from arachidonic acid

A

Aspirin

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2
Q

Indication: for the treatment of ACS and acute ischemic stroke, where rapid inhibition of platelet aggregation can prevent or limit arterial thrombosis and reduce subsequent mortality

A

Aspirin

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3
Q

The most common adverse effect of this drug is GI upset. More serious effects include peptic ulceration and haemorrhage, and hypersensitivity reactions including bronchospasm. In regular, high-dose therapy, it can cause tinnitus

A

Aspirin

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4
Q

This drug is contraindicated in children under the age of 16, and in the third trimester of pregnancy. Avoid in people with peptic ulcers or gout

A

Aspirin

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5
Q

MOA: Adenosine diphosphate (ADP) receptor antagonists/P2Y12 receptor antagonists. These drugs prevent platelet aggregation and reduce the risk of arterial occlusion by binding irreversibly to ADP receptors (P2Y12 subtype) on the surface of platelets, inhibiting their action.
(3 drugs)

A

Clopidogrel
Ticagrelor
Prasugrel

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6
Q

Indications: For treatment of ACS, usually in combination with Aspirin. For prevention of coronary artery stent occlusion, usually in combination with aspirin. For secondary prevention of major adverse cardiovascular events in people with IHD, cerebrovascular disease, or PVD, alone or in combination with aspirin.

A

ADP receptor antagonists: Clopidogrel, Ticragrelor, Prasugrel

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7
Q

The most important adverse effects of this drug class include bleeding, which can be serious. GI upset is common, including dyspepsia, abdominal pain, and diarrhea. Thrombocytopaenia possible.

A

ADP receptor antagonists: Clopidogrel, Ticragrelor, Prasugrel

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8
Q

Clopidogrel and Prasugrel act on the ADP receptor irreversibly, so their effects last for the lifetime of platelets. Therefore, these drugs should be stopped ___ days before elective surgery and invasive procedures

A

7

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9
Q

Drug class/MOA of abciximab?

A

Glycoprotein 2b/3a inhibitor

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10
Q

MOA: This drug is a very powerful antiplatelet, blocking the final common pathway of platelet aggregation. It binds to fibrinogen and inhibits 2b/3a glycoproteins, inhibiting platelet aggregation

A

Abciximab

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11
Q

Indication: This antiplatelet drug can be used if there is a lot of visible thrombus during PCI procedures, however is DOUBLES THE MAJOR BLEEDING RISK

A

Abciximab

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12
Q

Chest pain that occurs only on exertion is also known as

A

Stable angina

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13
Q

Cardiac-sounding chest pain AT REST or rapidly progressive exertional chest pain
+/- ECG changes
Troponin negative

A

Unstable angina

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14
Q

Cardiac-sounding chest pain AT REST
+/- ECG changes
TROPONIN POSITIVE

A

Myocardial infarction

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15
Q

Medical interventions to prevent IHD from recurring and/or progressing

A

Secondary prevention

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15
Q

Medical interventions to prevent IHD from recurring and/or progressing

A

Secondary prevention

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15
Q

Medical interventions to prevent IHD from recurring and/or progressing

A

Secondary prevention

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15
Q

Medical interventions to prevent IHD from recurring and/or progressing

A

Secondary prevention

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15
Q

Medical interventions to prevent IHD from recurring and/or progressing. This type of prevention involves the detection and medical treatment of conditions that may cause disease (eg HTN, hyperlipidemia, DM)

A

Secondary prevention

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16
Q

This type of prevention addresses the social determinants of dz, eg lack of exercise, poor diet

A

Primary prevention

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17
Q

This type of prevention reduces the burden of long-term disease by drug tx and/or medical/surgical interventions

A

Tertiary prevention

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18
Q

Medical management of chronic, stable angina
1. Anti-platelet (eg _______)
2. Anti-anginal agent (eg ___________ regularly, plus ______ prn)
3. Anti-hypertensive agent (eg ________)
4. Lipid-lowering agent (eg _________)

A
  1. Aspirin
  2. Bisoprolol regularly, plus GTN spray prn
  3. Ramipril
  4. Atorvostatin
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19
Q

Second-line anti-platelet agents used in the treatment of chronic stable angina (after aspirin)

A

Clopidogrel, Prasugrel, Ticagrelor

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20
Q

Anti-platelet agents used in the treatment of chronic, stable angina

A

First line: Aspirin
Second line: Clopidogrel, Prasugrel, Ticagrelor

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21
Q

Anti-anginal agents used in the treatment of chronic, stable angina

A

First line: Bisoprolol regularly plus GTN spray regularly
Second line: Diltiazem, Amlodipine, Isosorbide mononitrate

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22
Q

Anti-hypertensive agents used in the treatment of chronic, stable angina

A

First line: Ramipril
Second line: Losartan, Candesartan, Amlodipine

23
Q

Lipid-lowering agents used in the treatment of chronic, stable angina

A

First line: Atrovostatin
Second line: Simvistatin

24
Q

Which drugs specifically dilate the coronary arterioles?

A

Diltiazem, also nitrates

25
Q

This drug class reduces the heart rate and force of contraction, and so reduce myocardial O2 demand

A

Beta blockers

26
Q

The MOA of these drugs is to deliver NO to tissue
Dilates veins +++
Dilates arterioles ++
Reduces preload & afterload (this reducing cardiac workload)
Coronary artery/arteriole dilation

A

Nitrates

27
Q

Which fast-acting drug can be used as a spray in acute angina attacks, or as prophylaxis to prevent angina during exercise?

A

Glyceryl trinitrate spray

28
Q

What type of slow-release drug is used to prevent attacks of angina?

A

Isosorbide mononitrate

29
Q

Common side effects of this drug class are due to vasodilation: Headache, hypotension, dizziness, syncope.
NB: Can also develop tolerance with continuous use

A

Nitrates

30
Q

Of the three main CCB’s, which drug has the strongest effect on reducing afterload?

A

Amlodipine, as it has the strongest effect on vasodilation

31
Q

Of the three CCB’s, which two drugs have the strongest effect on reducing cardiac energy demand (ie reducing cardiac contractility and heart rate)?

A

Verapamil (strongest effect on the heart) and Diltiazem

32
Q

Of the three CCB’s, which tends to be used most for angina?

A

Diltiazem

33
Q

What are the 5 drugs prescribed on admission to manage unstable angina?

  1. Antiplatelet
  2. Second anti-platelet
  3. Anti-anginal
  4. Fast-acting anti-anginal
  5. Anti-thrombotic
A
  1. Aspirin
  2. Clopidogrel
  3. Bisoprolol
  4. GTN infusion/spray
  5. Enoxaparin
34
Q

Which four investigations should be done within the first three days after admission for unstable angina?

A

Serial ECG’s (Look for recurrent ischaemia)
Repeat troponins (?Progression to MI)
Echocardiogram (check LV function, ?regional abnormality)
Coronary angiogram (?revascularization - PCI/CABG)

34
Q

Which four investigations should be done within the first three days after admission for unstable angina?

A

Serial ECG’s (Look for recurrent ischaemia)
Repeat troponins (?Progression to MI)
Echocardiogram (check LV function, ?regional abnormality)
Coronary angiogram (?revascularization - PCI/CABG)

34
Q

Which four investigations should be done within the first three days after admission for unstable angina?

A

Serial ECG’s (Look for recurrent ischaemia)
Repeat troponins (?Progression to MI)
Echocardiogram (check LV function, ?regional abnormality)
Coronary angiogram (?revascularization - PCI/CABG)

34
Q

Which four investigations should be done within the first three days after admission for unstable angina?

A

Serial ECG’s (Look for recurrent ischaemia)
Repeat troponins (?Progression to MI)
Echocardiogram (check LV function, ?regional abnormality)
Coronary angiogram (?revascularization - PCI/CABG)

34
Q

Which four investigations should be done within the first three days after admission for unstable angina?

A

Serial ECG’s (Look for recurrent ischaemia)
Repeat troponins (?Progression to MI)
Echocardiogram (check LV function, ?regional abnormality)
Coronary angiogram (?revascularization - PCI/CABG)

35
Q

Which drug is typically given with aspirin following coronary stendting to reduce stent thrombosis?

A

Clopidogrel

36
Q

Which drug is a potent anti-platelet, given to high risk patient in order reduce risk of stent thrombosis and recurrent MI?

A

Prasugrel

37
Q

How long is Clopidogrel given for a patient with stable IHD, following elective PCI?

A

6 months (along with aspirin for life)

38
Q

How long is Clopidogrel given for a patient with either unstable angina or that has had an NSTEMI?

A

12 months (along with aspirin for life)

39
Q

Which anticoagulant drug activates anti-thrombin III?

A

Heparin

40
Q

____________ inactivates clotting factors, particularly factors IIa (thrombin), and Xa, providing a natural break to the clotting process.

A

Antithrombin

41
Q

Indication: These drugs are used for prevention of DVTs and PEs (collectively known as venous thromboembolism) in hospital inpatients. They can also be given alongside anti-platelet drugs in ACS to reduce clot progression

A

LMWH (Heparin) or Fondapairnux

42
Q

Fondaparinux is a synthetic pentasaccharide that mimics the sequence of the binding site of heparin to antithrombin and is very specific for factor _____

A

Xa

43
Q

How are the LMWH’s (Enoxaparin, Tinzaparin, Dalteparin, and Fondaparinux) administered?

A

Subcutaneous injection

44
Q

What patients require unfractionated Heparin?

A

Patients with chronic kidney disease (eg dialysis, bypass machines)

45
Q

Important adverse effects of this drug class include hemorrhage, bruising (particularly at injection site), occasionally hyperkalemia. Rarely, low platelet count

A

Low molecular weight heparins

46
Q

Contraindication for Enoxaparin or Fondaparinux?

A

The contraindication for all LMWH’s is Severe renal impairment: eGFR <30

47
Q

Which drug is routinely given during angiography via radial artery route during PCI procedures?

A

Unfractionated heparin

48
Q

The treatment of choice for an MI is primary PCI (reperfusion therapy), provided that the patient can access the service within ____ hours from the time of the emergency call

A

2 hours

49
Q

What medical backup should be provided if a patient with a suspected MI cannot be transferred to a PCI centre in under two hours?

A

Thrombolysis- Alteplase or Tenecteplase

50
Q

Indication for Alteplase or Tenecteplase?

A

Thrombolysis for STEMI when patient cannot access PPCI in < 2 hours. Less reliable than PCI< only achieves partial reflow

51
Q

Adverse effects of Alteplase and Tenecteplase?

A

Major bleeds, requiring transfusion
1-2% intracranial bleeds

52
Q

Mnemonic for secondary prevention, post-MI?

A

“AAB DAP STAT”
Ace-inhibitor
(Aldosterone antagonist such as Spironolactone, as it has good prognosis for heart failure)
Beta blocker
DAPT- ASA & Prasugrel
Statin- Atorvostatin

53
Q

Which two drug classes have a beneficial effect on LV remodelling after MI?

A

Beta blockers and Ace-inhibitors

54
Q

Name the three components of post-MI community care

A
  1. GP practice
  2. Cardiac rehabilitation
  3. COmmunity HF team
55
Q

MOA: Fibrinolytic

A

Alteplase, Tenectaplase

Year 3 (23 decks)

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