Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology > CHF/CAD > Flashcards

CHF/CAD Flashcards

1
Q

Name 6 example chronic coronary syndrome

A

1 .Stable angina (chest pain on exertion relieved by rest) and or dyspnoea - suspected CAD

  1. New onset HF or LV dysfunction and suspected CAD
  2. asymptomatic and symptomatic pts with stabilised symptoms <1 year after ACS or pts with recent revascularisation
  3. Asymptomatic and symptomatic >1 year after initial diagnosis or revascularisation
  4. Angina or suspected vasospastic or micro vascular disease
  5. Asymptomatic subjects in whom CAD is detected at screening
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Name 2 examples Acute coronary syndromes

A

Unstable angina
STEMI
Cardiac emergency!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pathophysiology stable angina?

A

Atheroma in 1/more coronary arteries, angina experienced when plaque >50% vessel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Name 3 treatment options chronic stable angina

A

1 nitrates
2 beta blockers or CCBS
3 aspirin or clopidogrel (anti platelet)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Name 4 treatments Acute unstable angina or nstemi

A

1 nitrates IV
2 beta blockers
3 aspirin AND clopidogrel
4 heparin (anticoag)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Name 6 treatment component of Acute MI stemi

A

1 nitrates
2 beta blockers: carvedilol, bisoprolol, metoprolol
3 aspirin plus clopidogrel second and lifelong
4 heparin eg clexane third
5 alteplase/streptokinase (thrombolytic) first
6 +/- ACE-I as soon as hemodynamicalle stable.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is given for Acute immediate pain relief of stable angina?

A

AKA Acute prophylaxis
Short acting nitrate: nitroglycerin
Sublingual or spray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is prescribed for definitive long term prophylaxis of stable angina?

A

First line: Beta blockers OR non-dihydropyridine CCB eg verapamil, diltiazem

If first line C/I, poorly tolerated, insufficient: long acting nitrate formulations eg, isosorbide mononitrate ISM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Name 3 examples long acting nitrate formula

A

1 erythrityl tetranitrate
2 pentaerythritol tetranitrate
3 isosorbide mononitrate ISM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Name 3 examples short acting nitrates

A

1 nitroglycerin
2 isosorbide dinitrate
3 glyceryl trinitrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Moa nitrates? (4)

A

Metabolised by smooth muscle cells to produce No!
This activates guanylyl cyclase
Increased cGMP (second messenger)!
Dephosphorylation myosin light chain and sequestration Ca in sr
Thereby relaxing smooth muscle !

Relatively selective for venous smooth muscle. Venodilation reduce cardiacpreload!
Therefore decreased venous return, ventricular filling, ventricular chamber diameter, ventricular wall tension, cardiac work
Decreased oxygen demand!

Decreased LVEDP: increased coronary blood flow!

Mild reduction centennial tone; decreased of terload and so oxygen demand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Name adverse effects nitrates ( 3 )

A
  • Hypotension and reflex tachycardia, angina
  • headache and flushing (vasodilation)
  • tolerance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Name a drug interaction with nitrates

A

Interact with pde-5 inhibitors, potentially fatal eg sildenafil (erectile dysfunction)!
Life threatening hypotension.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which CCB preferred for stable angina?

A

Non-dihydropyridines: diltiazem or verapamil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Name 4 functions/actions aspirin

A
  • Analgesic
  • antipyretic
  • anti-inflammatory
  • anti-platelet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Aspirin moa?

A
  • Block synthesis thromboxane a2 from arachidonic acid in platelets by acetylating and so inhibiting enzyme cyclooxygenase (cox) 1! (Selective and irreversible)
  • thromboxane a2 stimulate PLC and so increase calcium levels and cause platelet aggregation

• block synthesis prostacyclin from endothelium which inhibit platelet aggregation

17
Q

Aspirin AE? (2)

A

• Git ulceration and haemorrhage (inhibit PGE2 biosynthesis in stomach causing less mucous secretion, more acid, vasoconstriction submucosal microvessels, decreased git motility aka constipation )!
. Bleeding tendency (inhibit platelet TXA2)

18
Q

Clopidogrel moa?

A

Adenosine diphosphate inhibitor (irreversible inhibit platelet adenosine p2y12 r)

19
Q

Name 3 ways unstable angina can present

A
  • rest angina > 20 min
  • new onset angina, recent (2 months) onset of moderate to severe angina
  • crescendo angina , ie previous angina which progressively increases in severity and intensity, and at lower threshold, over short period time
20
Q

How diagnose acute mi? (6)

A

Increased cardiac biomarker, troponin, with at least 1 of following;
• symptoms ischaemia (chest pain)
• New significant st-t wave changes or left bundle branch block on 12 lead ECG
• pathological q waves
• imaging: new loss viable myocardium or regional wall motion abnormality
• intracoronary thrombus detected on angiography or autopsy

21
Q

Name 4 injectable anticoagulants for acute phase unstable angina/ nstemi

A
  • Fondaparinux: selective factor 10a inhibitors
  • unfractioned heparin UFH!
  • lmwh eg enoxaparin!
  • bivalirudin: bind directly to thrombin so inhibit thrombin Induced conversion of fibrinogen to fibrin; used during PCI
22
Q

Unfractioned heparin UFH moa?

A

Activate antithrombin 3!, which limit blood clotting by inactivate thrombin and factor 10a
(Monitor appt after admin)

23
Q

Lmwh moa?

A

Similar to UFH but
Only increase action of antithrombin 3 on factor 10a!, not its action on thrombin
Longer acting and more predictable

24
Q

Name 2 examples lmwh

A
  • Enoxaparin

* dalteparin

25
Q

When is oral anticoagulation following acute phase of unstable angina or nstemi indicated?

A

If concomitant conditions eg afib, mechanical heart valves, venous thromboembolism,

26
Q

Name 2 types oral anticoagulation following acute phase of unstable angina or nstemi

A
  • Vitamin K antagonist: warfarin

* non vitamin K antagonists noac: rivaroxaban, apixaban

27
Q

Warfarin moa?

A
  • Block reduction vitamin K epoxide, necessary for action as cofactor in synthesis of clotting factors: 2,7,9,10
  • delayed onset of action
28
Q

Antidote warfarin? (2)

A

• vitamin K

. FFP

29
Q

Antidote heparin?

A

Protamine sulphate

30
Q

Important pharmacokinetic detail of UFH?

A

Zero order kinetics

31
Q

Fibrinolytic therapy indication for stemi?

A

Within 12 hours of symptom onset if primary PCI (percutaneous coronary intervention) can’t be performed within 120 minutes from stemi diagnosis and no contraindications

32
Q

Name 4 fibrinolytic drugs

A

• Alteplase: tissue-type plasminogen activators
. Streptokinase: activate plasminogen to plasmin
• anistrepelase:liberate streptokinase- prodrug
• urokinase: unlicensed for mi.

33
Q

Which physiological agent breaks down fibrin clots?

A

Plasmin

34
Q

Name 5 contraindications streptokinase

A 
(Fibrinolytic)
• active gi bleed/ pud
• trauma
• recent surgery
• Head injury/stroke, cerebrovascular disease
• pregnancy
35
Q

Chronic prophylaxis vasospastic angina?

A

Ccb:diltiazem

36
Q

Name 2 indications aspirin and clopidogrel

A
  • Secondary prevention cv events caused by IHD

* acute coronary syndrome dapt,

37
Q

Indication fibrinolytic?

A

Eg streptokinase, alteplase.

Embolic stroke, stemi, nstemi

38
Q

Name 3 adverse effects fibrinolytic

A

Eg streptokinase
• hypotension
• antigenic
• risk cerebral haemorrhage

Pharmacology (34 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions