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Applied Pharmacology bs > Coronary Heart Disease and Stroke > Flashcards

Coronary Heart Disease and Stroke Flashcards

1
Q

What is cardiovascular disease?

A

disease of the heart & blood vessels

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2
Q

Most common manifestation of CVD is…

A

coronary heart disease also known as

  • coronary artery disease
  • ischaemic heart disease
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3
Q

What are the symptoms of angina pectoris

A
  • crushing pain in chest that may radiate to arm, jaw or shoulder
  • normally on the left side
  • usually on exertion
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4
Q

What are the pathophysiological problems in CHD?

A

narrowing of coronary arteries by atheroma (fatty gunge)

  • so not enough oxygen reaches the heart muscle
  • so oxygen DEMAND succeeds SUPPLY
  • so heart muscle is hypoxic
  • so heart cells DIE
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5
Q

What are the consequences of the heart working anaerobically?

A

cells don’t work well (less blood pumped);

  • may “misbehave” electrically (conduction problems & arrhythmias)
  • pain
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6
Q

When heart oxygen demand exceeds supply how can you help the demand and with what drugs?

A
  • Reduce heart rate - BETA BLOCKERS
  • Reduce heart filling/ contraction strength - NITROVASODILATORS
  • Reduced arterial resistance - BLOOD PRESSURE LOWERING DRUGS
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7
Q

When heart oxygen demand exceeds supply how can you help the supply and with what drugs?

A
  • open up heart arteries -
  • prevent atheroma formation - cholesterol lowering drugs. eg. STATINS
  • Decrease risk of clotting - ANTI-PLATELET DRUGS
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8
Q

What causes myocardial infarction?

A

coronary artery completely blocked, typically by blood clot on ruptured plaque

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9
Q

What 4 types of drugs are used to treat heart attack and why?

A
  • painkillers eg. morphine and diamorphine
  • anti-arrhythmia drugs - injured cells often misbehave
  • thrombolytic - clot busting drugs
  • anti-platelet drugs - as blood is less likely to form a clot again
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10
Q

What is the most common Nitrates (nitrovasodilators) used?

A

Glyceryl Trinitrate (GTN)

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11
Q

How is GTN (glyceryl trinitrate) administered?

A

Sublingual tablet, nasal spray, transdermal patch

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12
Q

What is the actions of nitrates?

A
  • Nitrates produce nitric oxide
  • this increases cGMP in muscle cells
  • muscle relaxes = vessels dilate
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13
Q

nitrovasodilators dilate..

A

both arteries and veins

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14
Q

What happens when you dilate systemic arteries ?

A
  • less risistence (reduced BP)

- Less work for the heart ( less oxygen demand)

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15
Q

What happens when you dilate large veins?

A
  • this is the biggest effect
  • more blood in venous system - less back to the heart
  • heart fills less - less work - less oxygen demand
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16
Q

What happens when you dilate cerebral arteries?

A

cerebral blood flow increased - throbbing or pounding headache

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17
Q

What are the side effects of nitrates?

A
  • throbbing headache

- dizziness especially on getting up - lowered BP

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18
Q

What are the cautions when taking nitrates?

A
  • Other BP-lowering drugs (BP can be too low!)

- Other drugs acting on NO pathway e.g. Sildenafil

19
Q

Statins have few side effects what are they?

A
  • GI upset (usually wears off)
  • abnormal liver tests (usually mild)
  • muscle problems (myopathy – rare but serious)
20
Q

What are statins used for?

A

Statins are a group of medicines that can help lower the level of low-density lipoprotein (LDL) cholesterol in the blood.

21
Q

What is the difference between a thromboembolic infarction and a intracranial haemorrhage?

A

A thromboembolic infarction is a BLOCKAGE that stops the blood of blood to an area of the brain.
A intracranial haemorrhage is DAMAGE/BLEED. Blood leaks into the brain.

22
Q

What are the risk of clot busters given to stroke patients?

A

risk of intracerebral bleeding

23
Q

Modern clot busting drugs are ‘recombinant tissue plasminogen activators’ or ‘r-tPAs’. What is the most common example of this?

A

Alteplase

24
Q

How are r-tPAs administered

A

IV injection by specialist nurses’

25
Q

Are r-tPAs short or long acting ?

A

short acting

26
Q

Must confirm ISCHAEMIC event before giving tPA but how is this done?

A

brain imaging (CT or MRI scan)

27
Q

How do antiplatelet drugs administer in stroke patients work?

A

inhibit platelet aggregation & thrombus formation by preventing GPIIa/IIIb receptor expression.

28
Q

How do anti-coagulants drugs administered in stroke patients work?

A
  • reduce activation of clotting cascade

- fibrin?

29
Q

Targets for modifying thrombosis process?

A

Modify coagulation
most successful in venous thrombosis
(lower pressure, slower flow)

Modify platelet aggregation
important in arterial thrombosis

Modify clot, thrombus breakdown
after prophylaxis fails

30
Q

How does aspirin work in preventing ischaemic stroke?

A

→ Inhibits cyclo-oxygenase (COX1).

→ Prevents thromboxane formation

31
Q

How does dipyridamole work in preventing ischaemic stroke?

A

→ Inhibits thromboxane synthase

→ Prevents thromboxane formation

32
Q

Which drug can be used in conjunction with aspirin in preventing ischaemic stroke?

A

dipyridamole

33
Q

What are the actions of clopidogrel in treating ischaemic stroke?

A

Clopidogrel (& similar agents) → antagonize actions of ADP at purinergic (ADP) receptors

34
Q

What are the actions of abciximab in ischaemic stroke?

A

Abciximab prevents linking of platelets to fibres

35
Q

What type of drug is abciximab?

A

anti-platelet

36
Q

What type of drug is dipyridamole?

A

anti- platelet

37
Q

What type of drug is alteplase?

A

Fibrinolytic Agents

38
Q

What type of drug is clopidogrel?

A

anti-platelet

39
Q

heparin is an anti-coagulant, how is it administered?

A

IV

40
Q

What are the actions of heparin?

A

activates (one of) body’s own anti-clotting molecules, antithrombin III.

41
Q

What type of drug is warfarin?

A

anti-coagulant

42
Q

What are the actions of warfarin?

A

acts on the liver to inhibit the enzyme Vitamin K reductase.
- action (gradually) diminishing concs. of clotting factors

 - eventually body not being able to make as much fibrin
43
Q

How can you reverse the actions of anticoagulation?

A
  • If not in hurry, can stop anticoagulant drugs & wait
  • Vitamin K to reverse warfarin action (still takes a while – why?)
  • URGENT: give clotting factors
44
Q

What are the long-Term Treatment of Ischaemic Stroke?

A

. Antiplatelet therapy:

Long-term anti-platelet therapy reduces substantially the incidence of further infarction.

Secondary Prevention
e.g. combined aspirin (75 mg day) and dipyridamole (200 mg 2x day)

Applied Pharmacology bs (10 decks)

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