druggie drugs for angina/UA/NSTEMI/STEMI (week 4)

Question 1

list nitrates

Answer 1

nitroglycerin

isosorbide dinitrate
isosorbide mononitrate

Question 2

nitrates MOA

Answer 2

stimulates release of NO–> venodilation–> reduced venous return to heart and therefore decreases workload of the heart

vasodilatory effect on coronary vessels to increase perfusion

effect = decreased cardiac workload and decreased O2 demand

Question 3

indications for nitrates

Answer 3

SYMPTOMATIC treatment for acute ischemic episodes

may also be taken for short term prophylaxis

no evidence for improved survival or MI prevention

Question 4

contraindications for nitrates

Answer 4

preload dependent patients (i.e aortic stenosis, RV dysfunction, viagra users)

Question 5

list Beta blockers

Answer 5

metoprolol

Question 6

beta blocker MOA

Answer 6

beta receptor antagonists, blocking both inotropic and chronotropic effects

effect = decrease myocardial O2 demand by slowing HR and contractility

also increases coronary blood flow by increasing diastolic time through slower HR

Question 7

indications for beta blockers

Answer 7

CAD

Question 8

contraindications for beta blockers

Answer 8

obstructive airway disease
LV dysfunction
marked bradycardia or heart block
insulin treated diabetes patients

Question 9

side effects of beta blockers

Answer 9

sexual dysfunction and fatigue

Question 10

non-DHP calcium channel blockers examples

Answer 10

diltiazem and verapamil

Question 11

non-DHP calcium channel blocker MOA

Answer 11

antagonize voltage gated L-type calcium channels

in doing so, they decrease inotropy and slow HR

minor vasodilatory effect

Question 12

indications for non-DHP calcium channel blockers

Answer 12

reserved for those in whom ischemia persists despite beta blockers and nitrate therapies or for those who have contraindications to beta blockers

Question 13

contraindications for non-DHP calcium channel blockers

Answer 13

LV systolic dysfunction

Question 14

list lipid lowering agents

Answer 14

1. STATINS
2. niacin
3. fibric acid derivatives
4. bile acid binding agents
5. cholesterol intestinal absorption inhibitors

Question 15

MOA of statins

Answer 15

HMG-CoA reductase inhibitors

inhibit the rate limiting step/enzyme responsible for cholesterol biosynthesis

results in reduction in intracellular cholesterol

Question 16

MOA of bile acid binding agents

Answer 16

increase secretion of bile acids

Question 17

MOA of nicotinic acid

Answer 17

decrease VLDL secretion and LDL formation and increase HDL formation

Question 18

MOA of fibrates

Answer 18

decrease VLDL secretion and increase triglyceride removal

Question 19

anti-platelets examples

Answer 19

ASA

Question 20

MOA of antiplatelets

Answer 20

irreversible cyclooxygenase inhibition

inhibit platelet synthesis of THROMBOXANE A2, which is a potent mediator of platelet activation

has anti-thrombotic activities through the inhibition of platelet aggregation as well as anti-inflammatory properties

Question 21

indications for anti-platelets

Answer 21

CAD

Question 22

counterindications for antiplatelets

Answer 22

gastric bleeding
allergies

*should be continued indefinitely in all patients with CAD

Question 23

anti-thrombin agents

Answer 23

heparin (unfractionated and LMWHs)

Question 24

MOA of anti-thrombins

Answer 24

heparin

bind to and increase potency of ANTITHROMBIN III which inactivates clot-forming thrombin

inhibits COAGULATION FACTOR Xa which slows thrombin formation and therefore reduces further clot development

it is an ANTICOAGULANT

Question 25

indications for heparin/anti-thrombins

Answer 25

standard therapy for UA and NSTEMI decrease likelihood of progression from UA to NSTEMI adjunctive antithrombotic therapy after fibrinolytics or PCI in STEMI

Question 26

fibrinolytic drugs

Answer 26

alteplase tPA reteplase rPA tenecteplase TNK-tPA

Question 27

fibrinolytics MOA

Answer 27

stimulate the natural fibrinolytic system by transforming the inactive precursor PLASMINOGEN into the active protease PLASMIN which lyses fibrin clots accelerates the lysis of the occlusive coronary thrombus

Question 28

indications for fibrinolytics

Answer 28

in STEMI and ONLY for STEMI

Question 29

contraindications for fibrinolytics

Answer 29

``` underlying bleeding disorder active peptic ulcer disease recent stroke recovering from recent surgery pregnancy intracranial tumor suspected aortic dissection pericarditis ```

Question 30

nitroglycerin

Answer 30

a nitrate

Question 31

metoprolol

Answer 31

beta blocker

Question 32

diltiazem

Answer 32

non-DHP calcium channel blocker

Question 33

alteplase tPA

Answer 33

fibrinolytic

Question 34

heparin

Answer 34

anti-thrombin

Question 35

ASA

Answer 35

anti-platelet

Question 36

statins

Answer 36

lipid lowering agent

Question 37

niacin

Answer 37

lipid lowering agent

Question 38

verapamil

Answer 38

non-DHP calcium channel blocker

Question 39

reteplase rPA

Answer 39

fibrinolytic

Question 40

fibric acid derivatives

Answer 40

lipid lowering agent

Question 41

isosorbide dinitrate or mononitrate

Answer 41

nitrate

Question 42

tenecteplase TNK-tPA

Answer 42

fibrinolytic

Question 43

bile acid binding agents

Answer 43

lipid lowering agent