Coronary Heart Disease and Stroke Drugs

Question 1

What are Nitrovasodilators?

Answer 1

Used to treat angina. E.g: Glyceryl Trinitrate (GTN).

Fast Acting.

Question 2

How do NVs work?

Answer 2

They produce Nitric Oxide. This causes the muscles to relax and the vessels dilate.

Question 3

Side effects of Nitrates?

Answer 3

Throbbing headache from cerebral vasodilation. Dizziness from lowered BP

Question 4

What are statins?

Answer 4

Lipid-lowering drugs (cholesterol)

Question 5

Side effects of statins?

Answer 5

GI upset
Abnormal liver tests
Muscle problems

Question 6

Fibrinolytic Agents? (FAs)

Answer 6

Used to treat stroke

Question 7

What do FAs do?

Answer 7

Activate plasminogen to form Plasmin - plasmin is the clot buster, it breaks down fibrin in a clot to dissolve the clot.

Question 8

Give the name of a Fibrinolytic agent…

Answer 8

Alteplase/Streptokinase
Given IV
Short -acting

Question 9

What is a problem with Alteplase?

Answer 9

Effective only if given within the first 3 hours of the stroke. But the ischaemic event must be confirmed before giving the drug.

Question 10

Anti-platelet drugs?

Answer 10

Used to treat stroke.

Question 11

What do anti-platelet drugs do?

Answer 11

Reduce platelet adhesion and activate aggregation to dissolve clot.

Question 12

Aspirin action for stroke…

Answer 12

Inhibits COX1 and prevents thromboxane formation.

Question 13

Dipyridamole?

Answer 13

Anti-platelet drug used to treat stroke. Inhibits thromboxane synthase and prevents thromboxane formation. Often used in conjunction with aspirin.

Question 14

Which anti-platelet drug antagonises actions of ADP and ADP receptors?

Answer 14

Clopidogrel

Question 15

What is Abciximab?

Answer 15

An anti-platelet drug which prevents linking of platelets to fibres.

Question 16

After a stroke/TIA how quickly does aspirin have to be given?

Answer 16

Within the first 24 hours (300mg)

Question 17

What is Heparin?

Answer 17

An anti-coat drug. Iv administration. Activates body’s own anti-clotting molecule - Antithrombin III. This then blocks the formation of fibrinogen to fibrin - the final stage in clot formation.

Question 18

Which ant-coagulant acts on the liver to inhibit the enzyme Vitamin K reductase?

Answer 18

Warfarin.

Question 19

How long does Warfarin take to act?

Answer 19

Days. Dose must be monitored via INR.

Question 20

How do you reverse anticoagulation urgently?

Answer 20

Give clotting factors.

Question 21

Side effects of anticoagulants?

Answer 21

should not be given to patients who are at risk of bleeding e.g GI ulcers, spinal puncture, recent trauma, TB and pregnancy. Can cause bleeding gums, nausea, GI upset and diarrhoea. Warfarin has been associated with alopecia and dermatitis.

Question 22

How do statins work?

Answer 22

Inhibit the enzyme HMG-CoA. This reduces the amount of cholesterol produced by the liver.

Question 23

Examples of statins?

Answer 23

Simvastatin, Atorvastatin, Pravastatin etc etc