Drugs for Angina Pectoris 3 Flashcards
Plavix (clopidogrel) is an **
anitplatelet drug
Plavix (clopidogrel) inhibits
ADP-induced platelet aggregation via the glycoprotein IIb/IIIa complex
Plavix (clopidogrel) reduces
CV events in established CVD patients—75 mg daily
give Plavix (clopidogrel) to pts with
Acute Coronary Syndrome (ACS), unstable angina, and NSTEMI patients—300 mg loading dose and then 75 mg daily with 75-325 mg of ASA
ASA and Plavix for
unstable angina or a new stent—combo for 9 months for unstable angina and 12 months after a stent
Prasugrel (Effient) is a
second generation clopidogrel; decreases clots after angioplasty; increased risk of stroke and fatal bleed; drugs for GERD lessen the protection of clopidogrel from forming clots
few other platelet inhibitors
Dipyridamole—Persantine; The following inhibit group IIb/IIIa, a molecule necessary for platelet aggregation; used for acute coronary syndromes - Abciximab (ReoPro), Eptifibatide (Integrillin), Tirofiban (Aggrastat)
Revascularization Therapy -
stent in coronary artery or bypass coronary artery by pass graft surgery
Revascularization Therapy
Coronary artery bypass graft surgery (CABG); Percutaneous transluminal coronary angioplasty (PTCA); Stent Placement
Percutaneous transluminal coronary angioplasty (PTCA)
putting catheter w/ balloon to open vessel and to put in stent; stent doesn’t cure anything
statin are drugs to
lower cholesterol level
“statin sisters”
lovastatin (Mevacor, Altocor) (1987); simvastatin (Zocor) (sold OTC in UK as Zocor Heart Pro); atorvastatin (Lipitor); fluvastatin (Lescol) (least potent); pravastatin (Pravachol); rosuvastatin (Crestor)
LDLs **
(low density lipoproteins: less than 100 (2.85mmol/L) mg/dL (depending on your risk of cardiovascular disease)
Diabetics and CAD patients ** —goal is
70 mg/dL (2.2 mmol/L)
HDLs **
( high density lipoproteins) greater than 40 mg/dL (but ladies, bump ‘em up even more—greater than 60 mg/dL is ideal); are cardioprotective
increase HDLs by
red wine, dark chocolate, high fiber, and exercise
LDL is the most **
atherogenic of the cholesterol bunch and puts fat right smack dab into all of the arterial walls; therefore, statins decrease circulating LDL-cholesterol and reduce atherosclerosis
atherogenic
hardening of the vessels
statins decrease
CAD, PVD, CVD risk and increase survival rates
What else do the statins do?
Potent anti-inflammatory agents
Inhibit the enzyme HMG-CoA reductase
in the liver and blocks the first step in the liver’s cholesterol-synthesis pathway, causing the amount of cholesterol in the membranes of the liver cells to plummet
The cells respond by producing
more surface receptors for LDL cholesterol which remove it (LDL-C) from the blood
other drugs to lower cholesterol
Niacin (vitamin B3) and Ezetimibe (Zetia)
Niacin (vitamin B3) sometimes given with
benydril
Niacin (vitamin B3) and HDLs
can give the HDLs a major boost—by as much as 20%-25%
To minimize niacin’s flushing and itching side effects
use ER or slow-release form; start low and titrate up every few weeks; take at bedtime with a small, low-calorie snack; or, take an aspirin ½ hour before the niacin dose
Advicor =
Niacin + atorvastatin
Ezetimibe (Zetia)—
blocks channels in GI tract for cholesterol reabsorption; reduces TC by 15-18% when used alone; has additive effects when used with statins (and can reduce the statin dose)
Zetia + Zocor (simvastatin) =
Vytorin*
Adding Zetia to a moderate dose statin
decreases the risk for rhabdomyolysis and other c/o muscle aches and pains
Bile-acid resin—
colesevelam (Welchol)(10-20% ↓)
