Atherosclerosis Flashcards
preventative pharmacological management is and include
Primarily to minimise the formation of plaques. Anti platelets, lipid lowering drugs (statins), unfractionated (standard heparin), and warfarin
Use of aspirin in CAD is as a
Preventative measure against stroke and AMI in patients with high risk factors
Dose of aspirin
Typically 75-150mg/day
How does aspirin work
Work by inhibiting platelet aggregation through stopping cyclo-oxygenase (COX) enzyme thus reducing the synthesis of thromboxane A2 (platelet stickiness and vasoconstriction)
Common AEs of aspirin
Bleeding, GI irritation (at higher doses), allergy response (asthma, rhinitis)
Lipid lowering drugs (statins) used in:
Use of these in hypercholesterolaemia (dyslipidaemia) aim to prevent AMI and stroke
E.g. of lipid lowering drugs
Atorvastatin, Fluvastatin, simvastatin, pravastatin
What do statins do
Inhibit 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, an enzyme responsible for total cholesterol syntheses and thus reduces total cholesterol
Common AEs of statins
Include GI irritation, headaches, increased BGL, liver function abnormalities, rhabdomyolysis (0.1% affected), increased skeletal muscle destruction, altered cognition, risk of multiple sclerosis
Clinically increasing statin levels in the blood can cause…
Myopathy and antibiotics (erythromycin) can increase the risk of rhabdomyolysis
Unfractionated (standard) heparin is
Short-term treatment low molecular weight heparins (LMWHs)
E.g. of unfractionated heparin
Enoxaparin
How is unfractionated heparin administered
Subcut
Low dose of unfractionated heparin is
For prevention
High dose of unfractionated heparin is
For treatment
Warfarin (oral) is
Long-term antithrombotic
What does warfarin do
Inhibits synthesis of clotting factors which reduce the chance of further clots
Restorative pharmacological management for atherosclerosis include
Thrombolytic agents used to treat acute vascular occlusions including DVT, pulmonary embolism, ischemic stroke and MI
Thrombolytic agents end in
-ase
E.g. of thrombolytic agents
Alteplase, Streptokinase, Urokinase
How do thrombolytic agents work
Work by converting plasminogen to plasmin, a proteolytic enzyme that breaks the cross-links (structural integrity) between fibrin molecules which dissolves the thrombus/embolus (‘clot busting’)
AEs of thrombolytic agents
Haemorrhage and allergic reactions
Clinical considerations for thrombolytic agents
Avoid IM injections and other invasive procedures (insertion of NG tube, intubation, etc) during IV therapy.
If severe bleeding occurs, stop infusion.
Contraindications for thrombolytic agents
Active internal bleeding Neurosurgery within past six months Recent (less than one month) major surgery or trauma Intracranial neoplasm Intracranial aneurysm
