CVS Flashcards
Aspirin - Main Indications
1)
- ACS: Angina
- Acute ischaemic stroke
2) Long-term secondary prevention of thrombotic arterial events in patients with :
- Cardivascular
- Cerebovascular
- Peripheral arterial disease
Historically, used to control mild-to-moderate pain and fever
Aspirin - MOA
- Thrombotic events occur when platelet-rich thrombus forms in atheromatous arteries and occludes circulation.
- Aspirin irreversibly inhibits cyclooxygenase (COX) to reduce production of the pro-aggregator factor thromboxane from arachidonic acid, reducing platelet aggregation and the risk of arterial occlusion.
- Effect of aspirin occurs at low dose and lasts for lifetime of the platelet.
Aspirin - Side Effects
GI irritation: - Peptic ulceration + Haemorrhage Hypersensitivity reactions: - Bronchospasm Regular high-dose - tinnitus Life-threatening in overdose: -hyperventilation, hearing changes, metabolic acidosis, confusion, convulsions , CVS collapse, reps arrest
Aspirin - Contraindications
Should not be given:
- Children under 16 years (risk of Reye’s syndrome)
- People with aspirin hypersensitivity
- 3rd trimester of pregnancy
Aspirin - Caution
- Peptic ulceration
- Gout (may trigger attack)
- Elderly
Aspirin - Key interactions
Acts synergistically with antiplatelets and anticoagulants
Aspirin - Monitoring
Enquire about side effects
Aspirin - Patient Education
To minimise GI irritation taken after food.
Enteric-coated may help further but not useful in medical emergencies due to slower absorption
Clopidogrel - Class of drug and Other examples
Anti-platelet drugs , ADP-receptor antagonists
E.g : Ticagrelor, Prasugrel
Clopidogrel - Main Indications
1) ACS usually in combination with aspirin
2) Prevent occlusion of coronary artery stents - with aspirin
3) Long-term secondary prevention of thrombotic arterial events in patients with :
- Cardiovascular
- Cerebrovascular
- Peripheral arterial disease - alone or with aspirin
Clopidogrel - MOA
- Prevent platelet aggregation and reduce risk of arterial occlusion by binding irreversibly to adenosine diphosphate (ADP) receptor .
- Synergistic with aspirin
Clopidogrel - Side effects
- Bleeding
- GI upset - dyspepsia, abdominal pain & diarrhoea
- Can cause thrombocytopenia
Clopidogrel - Contraindications
- Active bleeding
Clopidogrel - Caution
- Must be stopped 7 days before elective surgery
- Renal and haptic impairment
Clopidogrel - Key interactions
- Clopidogrel is pro-drug that requires metabolism by hepatic cytochrome P450 enzymes to its active form to have an anti-platelet effect..
- -> Efficacy maybe reduced by CYP inhibitors by inhibiting activation.
- Antiplatelets and anticoagulants - increase risk of bleeding
Clopidogrel - Monitoring
Clinical monitoring for adverse effect
Clopidogrel - Patient Education
- Can be given with or without food
- Purpose of the treatment is to reduce risk of heart attacks or strokes
- Usually taken for 12 months
- stop if there is any active bleeding
Statins - Main indications
1) Primary prevention of CVS events: to prevent CVS in people over 40 years with QRISK tool of >10%
2) Secondary prevention CVS events: 1st line along with lifestyle changes, to prevent CVS disease
3) Primary hyperlipidaemia: 1st line
Statins - Examples
Simvastatin
Atorvastatin
Pravastatin
Rosuvastatin
Statins - MOA
Reduce serum cholesterol levels by:
- Inhibit 3-hydroxy-3-methyl-glutaryl coenzyme A (HMG CoA) reductase - enzyme involved in making cholesterol
- Decrease cholesterol production by the liver and increase clearance lof LDL from blood.
- Also reduce triglycerides and slightly increase HDL
- These effects slow the atherosclerotic process.
Statins - Side effects
- Headache
- GI disturbances
- Aches to serious myopathy; or rarely rhabdomyolysis
- rise in liver enzymes ; drug-induced hepatitis
Statins - Contraindications
None
Statins - Caution
- Hepatic impairment
- Renal impairment
- Pregnant (cholesterol essential in foetal development)
- Breastfeeding
Statins - Key interactions
Metabolism of statins reduced by cytochrome P450 inhibitors:
- amiodarone
- diltiazem
- macrolides
- protease inhibitors
These lead to accumulation of the statin in the body which can increase risk of adverse effects.
Amlodipine