Drugs to treat ACS/Stable Angina Flashcards
what is stable angina
occlusion of coronary arteries resulting from the formation of atherosclerotic plaque
what are the determinants of myocardial oxygen demand
HR
Contractility
Preload
Afterload
What are the four categories of drugs used to treat stable angina
Nitrates
Calcium channel blockers
Beta Blockers
Ranolazine
What drugs belong to the nitrate class
Nitroglycerine
Isosorbide dinitrate
Isosorbide mononitrate
describe the pharmacokinetics of nitrates
extensive first pass metabolism, prefer non oral routes
isosorbide mononitrate has higher bioavailability
Describe the mechanism of action of Nitrates
increase NO -> venous dilation -> decrease O2 demand
Describe the development of tolerance of nitrates
depletes thiol compounds and increases superoxide radicals
reflex activation of sympathetics
Which subclass of nitrates is used to relieve symptoms
short acting
Long acting - prevent attacks
What are some adverse effects of nitrates
Headache
Orthostatic hypotension
Increased sympathetic discharge
Increased renal Na and H20 reabsorption
what drug class must be not used with nitrated
ED drugs
–Sildenafil (afil drugs)
both increase cGMP
what are the non-cardioactive calcium channel blockers
Amlodipine
Nifedipine
Nicardipine
what are the cardioactive calcium channel blockers
diltiazem
verapamil
what is the mechanism of Calcium channel blockers
dilation of peripheral arterioles
Decreased cardiac contractility*
reduced heart rate *
*only cardioactive
What are the major adverse effects of calcium channel blockers
- cardiac depression
- bradyarrhythmias, atrioventricular block
- hypotension
- short acting dihydropyridine - reflex sympathetics
- nifedipine - induce MI in people with HTN
what are the minor adverse effects of calcium channel blockers
Flushing, headache, anorexia, dizziness
Peripheral edema
Constipation
what beta blockers are used to treat stable angina
propranolol
nadolol
metoprolol
atenolol
What is the mechanism of action in beta blockers
decreased myocardial oxygen demand
what is the mechanism of action in ranolazine
Inhibits late Na current in cardiomyocytes
normalizes repolarization of cardiac myocytes and reduces mechanical dysfunction
What is the clinical use of ranolazine
- stable angina refractory to other medication
- decreases angina episodes and improves exercise tolerance in patients taking nitrates, amlodipine, or atenolol
What are the first line and second line drugs used to treat vasospastic angina
CCBs - Diltiazem or Amlodipine
-if refractory, long acting nitrates
When are antiplatelet drugs indicated for prevention
arterial (white) thrombi
When are anticoagulants indicated for prevention
venous (red) thrombi
when are thrombolytics indicated
obliterate existing thrombi
What is the mechanism of action of ASA (aspirin)
started soon after acute coronary events
secondary prevention of coronary events with low dose aspirin
What are adverse effects of aspirin
GI bleeds
Aspirin hypersensitivity
What are the three P2Y12 (ADP) receptor blockers
Clopidogrel
Prasugrel
ticagrelor
What is the mechanism of P2Y12 (ADP) inhibitors
decreases cAMP production
Describe clopidogrel resistance
non-functional CYP2C19
50% chinese, 34% AA, 25% caucasian, 19% mexican americans
what is the clinical use of P2Y12 receptor blockers
started after coronary events
used with aspirin
What are adverse reactions to P2Y12 receptor blockers
major and minor bleeding risk
what three drugs are Glycoprotein IIB/IIIA inhibitors
Abciximab
Eptifibatide
Tirofiban
What is the clinical use of GPIIB/IIIA inhibitors
declined over the past years
used during PCI in high risk patients
What are the adverse effects of GPIIB/IIIA inhibitors
bleeding (especially in CKI)
thrombocytopenia (especially with abciximab)
What are the three TPA drugs
Alteplase
Reteplase
Tenecteplase
what substance is produced by bacteria that binds to plasminogen to activate it
streptokinase
What is the clinical use of thrombolytics
Often in STEMI within 12 hours of onset of symptoms
What are adverse effects of thrombolytics
Bleeding Allergic Reactions (streptokinase)
