cardio 2 Flashcards
Drug Tx for angina?
to restore balance b/w myocardial O2 supply/demand
MOA of nitrates?
available as
dilate vascular smooth muscle
decrease cardiac pre/afterload.
paste/sublingual/transderma/oral/spray
no more than 3 sprays in 15 mins. call ambulance after first 5 mins
ADR of nitrates?
reflex tachycardia from drop in BP dizzy orthostatic hypotension headache** burn under tongue
What are the platelet aggregator inhibitors?
aspirin
clopidogrel (plavix)
Reopro
MOA of aspirin?
block thromboxane A2 synthesis from AA in platelet.
single dose followed by daily of 81 mg
MOA of clopidogrel (plavix)?
side effect is
inhibit ADP induced platelet aggregation. comparable to medium dose aspirin.
bleeding
MOA of anticoagulants?
heparin
incativate factors involved in normal coagulation
preventing conversion of prothrombin to thrombin. which induces fibrin
MOA of lmw heparin?
decrease affinity to bind plasma proteins.
indication for anti-coagulants.
DVT/PE/MI/after surgery
every 12 hours
bleeding.
MOA of warfarin?
interfere with liver synthesis of vitamin K dependent clotting factors.
watch for INR
use of warfarin?
prophylaxis DVT/PE prevent stroke in fib acute MI mechanical heart valved.
Tx for warfarin skin necrosis?
drug withdrawal vit K heparin fresh frozen plasma protein C
lots of drugs make unstable plaque stable … whats one?
Lipitor
shelflife for nitrate?
6 mo closed
3 open. away from sunlight
MOA of Reopro?
inhibit binding of fibrin and vWF to glycoprotein 2b/3a
prevents restenosis after angioplasty
long standing HTN?
rough lining of artery, causing it to get sticky and possible clottingg factor.
explain formation of thrombus?
prothrombin turns to thrombin which cause platelets to firm by attracting fibrin (think of a scar)
anticoagulants block thrombin/production of clotting factors by liver to prevent this.
wafarin has a lot of interactions with
drugs and food (broccoli)
MOA for Pradaxa?
antidote for it?
Clot buster
Thrombin inhibitor through competitive inhibition. for stroke in a fib and DVT.
no antidote. ppl can bleed to death. especially with fall.
Dosing of Pradaxa?
what to note
32-38 days for THR. 10-14 for TKA. within 12-24 hr window.
pt can bleed. no interaction with vitamin K foods.
MOA for thrombolytics?
clot buster.
convert plasminogen to plasma to break down fibrin clots.
after CVA.. unless it happened overnight.
Dosing for Thrombolytics
3-4.5 hrs after stroke,
wishing 12 hours of MI
Contraindications of thrombolytics?
head trauma, ulcer, bleeding issue, uncontrolled HTN
preggo, Glucose <50/
MOA of statins?
competitive inhibitor of HMG CoA reductase. synthesizes cholesterol reduced LDL.
liver is target organ
lowers cholesterol
ADR of statins?
gas/cramps/headache/nausea
new onset diabetes
peripheral neuropathy
tendon rupture
what cant you have with statins?
grapefruit juice
what are other effects of statins?
protect brain from stroke increase NO inhibit action of cytokine prevent thrombus increase bone formation (ww)
Muscle pain due to statins treated with
Vitamin D
Muscle ache or weakness w/o elevated Creatine Kinase?
Myalgia very common with statins
Muscle symptoms with elevated CK?
myositis
muscle symptoms with CK elevation greater than 10x upper limit. brown urine
Rhabdomyolysis.
rare
Risk factor for muscle pain with statin?
large dose taken with med that inhibit statin metabolism >70 y./o female impaired liver/renal skinny alcohol untreated hypothyroid.
Prevent muscle injury with statin
low dose monitor CK level switch statin withdraw. measure grip strength
Zetia MOA?
reduce cholesterol absorption through small intestine.
combine with simvastatin= Vytorin. more beneficial.
Goals for pharmacotherapy in CHF?
remove salt+water (loop diuretic) improve contractility (+inotropic) decrease pre/afterload (vasodilator) dec after load and retain salt/water (ACE 1 ARB) antagonize aldosterone.
MOA of Digoxin?
Block Na/K pump. enhancing Na/Ca2+ pump increasing force of contraction w/o decreasing BP or HR.
helps L ventricle pump more effectively (CHF)
parasympathetic action at SA node.
also for arrhythmia
ADR of Digoxin?
arrhythmia
CNS effects
nausea/vomit/diarrhea
digitalis toxicity* result in bradycardia, halo vision.
What are some agents for CHF?
Diuretics-increase excretion Betablockers-dec contractility ACE 1 + ARB-v renin release Vasodilators Spironolactone-bind to aldosterone Beta activation-vasodilation relieve edema.
What cant happen during ERP? when does it? what doe anti-arrhythmias do?
AP
can during relative refractory .
increase duration of effective refractory period. (widen AP)
What are dysarrhythmic drugs?
class 1: Sodium blockers
2: beta blockers
3: true anti arrhythmia prolong repo.
4: calcium channel blockers
5: digoxin
Therapeutic concerns with anti-arrhythmics?
widely used but don’t work very well.
Exercise and anti-arrhythmia:
meds not effective with exercise.
some negative inotropic effects (performance or BP_
don’t stop exercise abruptly.
Alpha blockers do what?
dilate arteries and reduces BP
