Drugs Used in Acute Coronary Syndromes

Question 1

What are the four types of acute coronary syndromes?

Answer 1

1. Stable angina
2. Unstable angina
3. NSTEMI
4. STEMI

Question 2

Where do red thrombi form?

Answer 2

• Low pressure veins and in the heart

Question 3

Where do white thrombi form?

Answer 3

• High pressure arteries

Question 4

What is the pathologic association of red thrombi?

Answer 4

• Pain, swelling, embolism, and emobolic stroke

Question 5

What is the pathologic association of white thrombi?

Answer 5

• Local ischemia due to arterial occlusion (acute coronary syndromes)

Question 6

What drug classes are used in treating thromboembolic disorders?

Answer 6

• Antiplatelet drugs
• Anticoagulants
• Thrombolytics

Question 7

When are antiplatelet drugs used?

Answer 7

• Used to prevent clots from forming in arteries (white thrombi)

Question 8

When are anticoagulants used?

Answer 8

• Used to prevent clots from forming in the venous system (red thrombi)

Question 9

When are thrombolytics used?

Answer 9

• Used to re-establish blood flow through vessels once clots have formed

Question 10

What are the different types of antiplatelet drugs?

Answer 10

• Inhibitors of thromboxane A2 synthesis
• P2Y12 receptor blockers
• Platelet glycoprotein receptor blockers

Question 11

What drug inhibits thromboxane A2 synthesis?

Answer 11

• Aspirin

Question 12

What is the MOA of aspirin?

Answer 12

• Irreversible inhibition of COX to block TxA2 production

Question 13

What is the clinical use of aspirin?

Answer 13

• Start ASAP in acute coronary events

- Secondary prevention of coronary events with low dose aspirin

Question 14

What are some adverse effects of aspirin?

Answer 14

• GI bleeding

- Aspirin hypersensitivity

Question 15

What drugs are P2Y12 receptor blockers?

Answer 15

• Clopidogrel
• Prasugrel
• Ticagrelor

Question 16

What is the MOA of P2Y12 receptor blockers?

Answer 16

• By blocking these receptors, there will be an increase in adenylyl cyclase activity and cellular cAMP levels

Question 17

How does clopidogrel resistance occur?

Answer 17

• Metabolism of CYP2C19 isoenzyme

- Present in 50% chinese, 34% africans, 25% caucasians, 19% mexican americans

Question 18

What is the clinical use of P2Y12 receptor blockers?

Answer 18

• Started ASAP in acute coronary events
• Used alone in patients with aspirin hypersensitivity
• Secondary prevention in patients with history of acute coronary events

Question 19

What is an adverse effect of P2Y12 receptor blocker?

Answer 19

• Minor and major bleeding complications

Question 20

What drugs are glycoprotein IIB/IIIA inhibitors?

Answer 20

• Abciximab
• Eptifibatide
• Tirofiban

Question 21

What is the MOA of BP IIB/IIIA inhibitors?

Answer 21

• Prevent binding of ligands to GP IIb/IIIa receptor to inhibit platelet aggregation

Question 22

What is the clinical use of GP IIb/IIIa inhibitors?

Answer 22

• Use has declined in the last several of years

- Used during PCI in high-risk patients

Question 23

What are some adverse effects of GP IIb/IIIa inhibitors?

Answer 23

• Bleeding (esp in patients with chronic kidney disease)

- Thrombocytopenia

Question 24

What are the two types of thrombolytic drugs?

Answer 24

• Tissue type plasminogen activator drugs

- Streptokinase preparation

Question 25

What do thrombolytic drugs do?

Answer 25

• Induce fibrinolysis

- Activate endogenous fibrinolytic system by converting plasminogen into plasmin

Question 26

What drugs are tissue type plasminogen activator drugs?

Answer 26

• Alteplase
• Reteplase
• Tenecteplase

Question 27

What are the clinical uses of thrombolytic drugs?

Answer 27

• Used in STEMI and less often in NSTEMI within 12 hours following the onset of symptoms

Question 28

What are some adverse effects of thrombolytic drugs?

Answer 28

• Bleeding (esp with streptokinase)

- Allergic reactions