Antianginal and antithrombotic drugs Flashcards
What drug class is nitroglycerin (Nitrostat)
nitrate vasodilator
What are the indications of nitroglycerin (nitrostat)
all forms of angina, but does not work as well fro prinzmetal
What are the side effects of nitroglycerin (nitrostat)
Headache (from marked vasodilation), flushing of face and tongue tingling (SL), hypotension, rebound tachycardia
When is nitrate vasodilator use contraindicated?
When patient is using alcohol and Viagra: synergistic vasodilation > hypotension,
What drug class is isosorbide dinitrate (Isordil)?
Long acting nitrate vasodilator
What are the indications of isosorbide dinitrate (Isordil)?
angina, prophylaxis of angina
What are the side effects of isosorbide dinitrate (Isordil)?
Headache, hypotension, rebound tachycardia. (severe hypotension with concurrent viagra use like NTG)
What effect do beta-blockers have during acute MI
They reduce the infarct size
What are two good drug options for prinzmetal angina?
nitrates and calcium channel blockers
What are the 3 classes of drugs used to treat stable angina?
nitrates, beta blockers, and calcium channel blockers
What is the mechanism of action for nitrates?
nitrates relax smooth ms by converting to NO, which activates guanyl cyclase and increases intracellular cGMP > vasodilation
What are the two main classes of nitrate drugs?
nitroglycerin (NTG)/nitrostat and Isosorbide dinitrate/Isordil (long acting)
What do beta blockers do?
occupying beta receptors site, esp B-1 diminsh cardiac O2 demand, contractility and rate. Decrease sympathetic stimulation
What substance is used to reverse an beta-blocker overdose that caused bradycardia?
Glucagon- inc cAMP in myocardium bypasses the B-adrenergic second messenger system. Atropine and epinephrine can also be used.
what drug class is propranolol/inderal?
non-selective beta blocker
What are the indications for propranolol use?
Angina, post-MI, HTN, acute panic attacks, migraine HA.
What is the MOA for propanolol?
non-selectively blocks adrenergic stimulation which serves to decrease heart rate and O2 demand and decreases renin.
Side effects of propranolol/inderal
bronchocontriction, hypotension, bradycardia, fatigue, impotence. Abrupt discontinuation can result in rebound HTN and tachycardia> MI and stroke risk
Is it OK to abruptly stop use of propanolol?
NO, abrupt discontinuation can result in rebound HTN and tachycardia> MI and stroke risk
Name a selective beta blocker and what is selective for.
Atenolol/Tenormin, selective for B-1 receptor site.
what is atenolol indicated for
angina, hypertension, MI
What is the MOA of atenolol?
decreases heart rate and myocardial O2 demand by B1 adrenergic blockade.
Side effects of atenolol?
similar to propranolol: bronchoconstriction (possible B2 block), bradycardia, fatigue, impotence. Slightly less risk of bronchoconstriction.
how do calcium channel blockers work?
they inhibit the entrance of calcium into cardiac and smooth ms cells resulting in vasodilation of both coronary and systemic arterial beds. Decrease heart rate and O2 demand.
what is the antidote for bradycardia cause by a calcium channel blocker?
Calcium gluconate
Name a calcium channel blocker
Amlodopine/Norvasc
What are the indications for Amlodopine/Norvasc?
angina: esp prinzmetal/varient, HTN
what is the MOA of Amlodopine/Norvasc?
blocks the calcium influx>vasodilation of cardiac and peripheral arteries. Diminishes sympathetic induced coronary spasm.
Side effects of Amlodopine/Norvasc?
Flushing, HA, hypotension. (do not combine with beta-blockers- risk for hypotension and bradycardia)
what should you do if you have a patient presenting with unstable angina?
MONA: morphine, oxygen, nitrate, aspirin. Send to ER.
what is the standard analgesic of choice for unstable angina or MI?
morphine sulfate
What does morphine sulfate do?
reduces pain and anxiety, peripheral vasodilation
What is the antidote for morphine?
Naloxaone/narcan
what is the MOA of morphine sulfate?
opiate receptor agonist
Side effects of morphine sulfate?
potential for respiratory depression- monitor. Severe hypotension.
name an anti-platelet agent
Aspirin (ASA)
what class is Aspirin/ASA?
Salicylate with anti-inflammatory analgesic and anti-pyretic properties
What is the indication for aspirin use?
reduce risk of MI in unstable angina or prior infarct, dec risk of TIA and stroke. Also taken for fever, aches and pains.
what is aspirin’s MOA?
irreversibly inhibits COX 1 and 2, preventing the formation of thromboxane A2 and prostaglandins > diminished platelet aggregation.
Side effects of Aspirin?
GI ulceration, bleeding, salicylism: with hyperventilation, tinnitus, dizziness, N/V. Increased risk of Reyes syndrome in children w/fever and viral conditions.
what class of drug is clopidogrel/plavix?
platelet aggregation inhibitor
What is the indication for clopidogrel/plavix?
reduces thrombotic events, dec incidence of MI and stroke
MOA of clopidogrel?
antagonist of the adenosine diphosphate (ADP) receptor site on platelets. ADP receptor blockade results in dec platelet aggregation.
side effect of clopidogrel/plavix?
bleeding, nausea, headaches, neutropenia. CI in pts with active bleeding. Anti-platelet activity is irreversible.
What do glycoprotein IIB/IIIA inhibitors do?
prevent the binding of fibrinogen, thereby blocking platelet aggregation
what class of drug is Abciximab/ReoPro?
glycoprotein IIB/IIIA inhibitor
what are the indications for abciximab/ReoPro?
reduces risk of MI
MOA for Abciximab/ReoPro?
inhibition of glycoprotein IIB/IIIA receptor site on platelets prevents binding of fibrinogen and von willebrand’s factor to activate platelets resulting in dec platelet aggregation
how is abciximab/reopro administered?
IV administration only
Side effects of abciximamb?
increased bleeding. CI in pts with active internal bleeding, hx of hemorrhage, head trauma or stroke in last 30 days.
What does heparin do?
anticoagulant- ultimately prevents conversion of fibrinogen to fibrin. Does not actively lyse clots.
What route is heparin given?
IV or SQ
Indication for heparin?
anticoagulant for unstable angina, acute MI, atrial fibrillation and DVT
What is the antidote for heparin?
Protamine sulfate
what does low molecular weight heparin do?
replaced regular heparin, it acts by directly inactivating factor X (Xa) in the clotting cascade.
What class is Enoxaparin/Lovenox?
low molecular weight heparin
What is enoxaparin indicated for?
unstable angina, acute MI, prophylaxis and tx for DVT
what is the MOA of enoxaparin
bind to and inactivates activated factor X (Xa)
Side effects of enoxaparin
hemorrhage, caution in pts with liver disease, bleeding disorder or GI bleed. Discontinue if platelet count is under 100k/mm3
What class is warfarin/coumadin?
oral anticoagulant
what is warfarin/coumadin indicated for/.
prophylaxis and tx of DVT, PE, and thromboemolic events associated with atrial fib and cardiac valve replacement.
MOA of warfarin/coumadin?
antagonizes vitamin K, interferes with synthesis of vitamin K dependent clotting factors (2, 7, 9, 10)
Side effects of warfarin?
Bleeding, check PT and INR to maintain optimal blood levels
What is the antidote for warfarin/coumadin?
vitamin K
what category drugs is coumadin?
Category X- contraindicated in pregnancy.
what class is rivaroxaban?
anticoagulant
what is rivaroxaban indicated for?
prophylaxis of DVT which may lead to PE in those undergoing hip and knee replacement.
what is the MOA of rivaroxaban/xarelto?
direct inhibition of factor Xa.
Given PO only!
Side effects of rivaroxaban/xarelto?
bleeding.
name a thrombolytic
Streptokinase
what class is streptokinase
thrombolytic (“clot buster”)– only one that actively lyses clots
what is streptokinase indicated for?
acute MI, acute ischemic stroke, acute DVT or PE.
what the MOA of streptokinase?
activates plasminogen to plasmin> Plasmin digests fibrin and fibrinogen forming degradation products
what is the origin of streptokinase? derived from…
isolated from streptococcus species-group C beta hemolytic strep. IV adminstration only!
criteria for giving streptokinase?
the amount of time passes since MI or stroke…etc.
side effects of streptokinase?
bleeding
what is the antidote for streptokinase?
Aminocaproic acid (Amicar): plasmin inactivator and antifibrinolytic.
