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CPR Exam 1 > Drugs to treat ACS/Stable Angina > Flashcards

Drugs to treat ACS/Stable Angina Flashcards

1
Q

what is stable angina

A

occlusion of coronary arteries resulting from the formation of atherosclerotic plaque

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2
Q

what are the determinants of myocardial oxygen demand

A

HR
Contractility
Preload
Afterload

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3
Q

What are the four categories of drugs used to treat stable angina

A

Nitrates
Calcium channel blockers
Beta Blockers
Ranolazine

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4
Q

What drugs belong to the nitrate class

A

Nitroglycerine
Isosorbide dinitrate
Isosorbide mononitrate

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5
Q

describe the pharmacokinetics of nitrates

A

extensive first pass metabolism, prefer non oral routes

isosorbide mononitrate has higher bioavailability

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6
Q

Describe the mechanism of action of Nitrates

A

increase NO -> venous dilation -> decrease O2 demand

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7
Q

Describe the development of tolerance of nitrates

A

depletes thiol compounds and increases superoxide radicals

reflex activation of sympathetics

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8
Q

Which subclass of nitrates is used to relieve symptoms

A

short acting

Long acting - prevent attacks

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9
Q

What are some adverse effects of nitrates

A

Headache
Orthostatic hypotension
Increased sympathetic discharge
Increased renal Na and H20 reabsorption

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10
Q

what drug class must be not used with nitrated

A

ED drugs
–Sildenafil (afil drugs)

both increase cGMP

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11
Q

what are the non-cardioactive calcium channel blockers

A

Amlodipine
Nifedipine
Nicardipine

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12
Q

what are the cardioactive calcium channel blockers

A

diltiazem

verapamil

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13
Q

what is the mechanism of Calcium channel blockers

A

dilation of peripheral arterioles
Decreased cardiac contractility*
reduced heart rate *

*only cardioactive

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14
Q

What are the major adverse effects of calcium channel blockers

A
  • cardiac depression
  • bradyarrhythmias, atrioventricular block
  • hypotension
  • short acting dihydropyridine - reflex sympathetics
  • nifedipine - induce MI in people with HTN
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15
Q

what are the minor adverse effects of calcium channel blockers

A

Flushing, headache, anorexia, dizziness
Peripheral edema
Constipation

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16
Q

what beta blockers are used to treat stable angina

A

propranolol
nadolol
metoprolol
atenolol

17
Q

What is the mechanism of action in beta blockers

A

decreased myocardial oxygen demand

18
Q

what is the mechanism of action in ranolazine

A

Inhibits late Na current in cardiomyocytes

normalizes repolarization of cardiac myocytes and reduces mechanical dysfunction

19
Q

What is the clinical use of ranolazine

A
  • stable angina refractory to other medication

- decreases angina episodes and improves exercise tolerance in patients taking nitrates, amlodipine, or atenolol

20
Q

What are the first line and second line drugs used to treat vasospastic angina

A

CCBs - Diltiazem or Amlodipine

-if refractory, long acting nitrates

21
Q

When are antiplatelet drugs indicated for prevention

A

arterial (white) thrombi

22
Q

When are anticoagulants indicated for prevention

A

venous (red) thrombi

23
Q

when are thrombolytics indicated

A

obliterate existing thrombi

24
Q

What is the mechanism of action of ASA (aspirin)

A

started soon after acute coronary events

secondary prevention of coronary events with low dose aspirin

25
Q

What are adverse effects of aspirin

A

GI bleeds

Aspirin hypersensitivity

26
Q

What are the three P2Y12 (ADP) receptor blockers

A

Clopidogrel
Prasugrel
ticagrelor

27
Q

What is the mechanism of P2Y12 (ADP) inhibitors

A

decreases cAMP production

28
Q

Describe clopidogrel resistance

A

non-functional CYP2C19

50% chinese, 34% AA, 25% caucasian, 19% mexican americans

29
Q

what is the clinical use of P2Y12 receptor blockers

A

started after coronary events

used with aspirin

30
Q

What are adverse reactions to P2Y12 receptor blockers

A

major and minor bleeding risk

31
Q

what three drugs are Glycoprotein IIB/IIIA inhibitors

A

Abciximab
Eptifibatide
Tirofiban

32
Q

What is the clinical use of GPIIB/IIIA inhibitors

A

declined over the past years

used during PCI in high risk patients

33
Q

What are the adverse effects of GPIIB/IIIA inhibitors

A

bleeding (especially in CKI)

thrombocytopenia (especially with abciximab)

34
Q

What are the three TPA drugs

A

Alteplase
Reteplase
Tenecteplase

35
Q

what substance is produced by bacteria that binds to plasminogen to activate it

A

streptokinase

36
Q

What is the clinical use of thrombolytics

A

Often in STEMI within 12 hours of onset of symptoms

37
Q

What are adverse effects of thrombolytics

A 
Bleeding
Allergic Reactions (streptokinase)

CPR Exam 1 (19 decks)

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