Antianginal

Question 1

Vasospastic angina Tx

Answer 1

Nitrates for vasospastic angina
Beta-blockers contraindicated
CEB’s useful

Question 2

ibuprofen

Answer 2

Class: NSAID
Indications: analgesic, antipyretic, anti-inflammatory, anti-gout, anti-dysmennorhea
P’dynamics: mech unclear; inhibits PG synthesis via COX
P’kinetics: F~80%, Hepatic metabolism; T1/2=~3h
Tox: contrindicated w/ allergy to ASA, renal compromise, ulcer, fluid retention in CHF
Interactions: warfarin, ASA, diuretics, antiHTN
considerations: geriatric toxicity

Question 3

TNG

Answer 3

Class: organic nitrates; antianginal; veno/vasodilator
Indications: angina
P’dynamics: nitrate receptor on vascular SM, NO crosses into SM cells, activates guanylate cyclase; cGMP causes SM relaxation
P’kinetics: well absorbed PO; high first pass; SL, transdermal, IV
Tox: hypotension, headache, flushing
Interactions: severe hypotension w/ sildenafil
considerations: remove patch before defibrillating; fresh TNG tablets

Question 4

isosorbide dinitrate

Answer 4

Class
Indications
P'dynamics
P'kinetics
Tox
Interactions
considerations

Question 5

ASA

Answer 5

Class: salicylate;
Indications: analgesic, anti-inflammatory, antiplatelet, antipyretic, MI prevention
P’dynamics: irreversibly inhibits COX-1; decreased TX-A2; inhibits COX2 in endothelium => reduced PGI2
P’kinetics: F~60% half life 3-4h, renal excretion
Tox: ulceration of GI, tinnitus
DDI: inhibits tubular secretion of methotrexate; potentiates warfarin
considerations: Avoid w/ nasal polyps, asthma

Question 6

clopidogrel

Answer 6

Class: ADP induced platelet aggregation inhibitor
Indications: antiplatelet agent; pri/2ndary TIA, stroke, MI prevention
P’dynamics: irreversibly blocks ADP receptors; prevents ADP mediated aggregation
P’kinetics: well absorbed, hepatic metabolism CYP3A; onset 1-2h, T.5=~8h
Tox: hemorrhage; bruising
Interactions: increased bleeding w/ ASA
considerations: risk benefit in each patient

Question 7

abciximab

Answer 7

Class: fab fragment monoclonal Ab. IIb/IIIA inhibitor
Indications: adjunct to PCI to prevent ischemic complications; MI
P’dynamics: noncompetitive GP IIa/IIIb receptor inhibitor; prevents vWF, fibrinogen etc binding on activated platelets
P’kinetics: T.5~30m;
Tox: contraindicated w/ aneurysm, av malformation, bleeding, stroke, surgery, etc.
Interactions: additive w/ ASA. clopidogrel, heparin, low dose tPA
considerations: cost

Question 8

tirofiban

Answer 8

Class: fab fragment monoclonal Ab. IIb/IIIA inhibitor
Indications: adjunct to PCI to prevent ischemic complications; MI
P’dynamics: noncompetitive GP IIa/IIIb receptor inhibitor; prevents vWF, fibrinogen etc binding on activated platelets
P’kinetics: T.5~30m;
Tox: contraindicated w/ aneurysm, av malformation, bleeding, stroke, surgery, etc.
Interactions: additive w/ ASA. clopidogrel, heparin, low dose tPA
considerations: cost

Question 9

eptifbatide

Answer 9

Class: fab fragment monoclonal Ab. IIb/IIIa inhibitor
Indications: adjunct to PCI to prevent ischemic complications; MI
P’dynamics: noncompetitive GP IIa/IIIb receptor inhibitor; prevents vWF, fibrinogen etc binding on activated platelets
P’kinetics: T.5~30m;
Tox: contraindicated w/ aneurysm, av malformation, bleeding, stroke, surgery, etc.
Interactions: additive w/ ASA. clopidogrel, heparin, low dose tPA
considerations: cost

Question 10

Unstable Angina Tx

Answer 10

platelet suppression