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Pharmacology > Drugs used To Treat Coronary Artery Disease > Flashcards

Drugs used To Treat Coronary Artery Disease Flashcards

1
Q

Nitroglycerin is converted to which compound?

A

Nitric oxide

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2
Q

Nitric oxide activated which compound?

A

Guanylate Cyclase

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3
Q

Nitroglycerin increases the amounts of which compound?

A

CGMP

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4
Q

Nitroglycerin induces the dephosphorylation of?

A

Myosin light chain of the smooth muscle fiber

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5
Q

Nitroglycerin leads to…

A

Smooth muscle relaxation and vasodilation

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6
Q

What is the target of nitroglycerin?

A

Atrial natriuretic peptide receptor

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7
Q

Which is the key enzyme involved in the metabolism of nitroglycerin?

A

Cytochrome P450

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8
Q

What are some important adverse effects of nitroglycerin?

A

Syncope ( especially when standing), dyspnea, diaphoresis with the skin either flushed or cold and clammy, bradycardia, heart block, death

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9
Q

What are some important drug interactions to know about nitroglycerin?

A

Increases the severity or risk of hypotension when taken with verdanafil, sildenafil, tadalafil

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10
Q

When nitroglycerin is taken with acetaminophen what is the adverse interaction?

A

Increases the risk or severity of methemglobinemia

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11
Q

The risk or severity of adverse effects of nitroglycerin is increased when the drug is combined with…

A

Aliskerin

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12
Q

What is the standard treatment for stress stable angina?

A

Sublingual nitroglycerin

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13
Q

In what position should a person be in when angina occurs?

A

Should be in a sitting position because standing up will lead to syncope and allying down increases the venous return and hence the workload on the heart

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14
Q

Sublingual 5mg of isosorbide dinitrate helps to cut of attacks of what condition and for how long?

A

Angina and an hour (approximately)

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15
Q

What is the onset of anti angina action of isosorbide dinitrate and why is it slower than nitroglycerin?

A

Anti angina onset is (3-4) minutes and the reason why it is slower is because dinitrate needs to be converted by the liver to mono nitrate first

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16
Q

The oral formulation of isosorbide dinitrate is used for…

A

Angina prophylaxis

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17
Q

How do beta blockers work?

A

By decreasing the heart rate, contráctility , AV conduction, and ectopic activity. They can also improve perfuming in areas that have ischemia by prolonging diastole and increasing vascular resistance to areas without ischemia

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18
Q

Which are the beta blockers that commonly act on beta-1 receptors?

A

Metoprolol, bisoprolol, atenolol, Nevibolol

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19
Q

Carvediol is a…

A

Non selective beta-alpha 1 blocker

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20
Q

Nifedipine is a…

A

Calcium Chanel’s blocker drug

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21
Q

How do calcium channel blockers work?

A

By inhibiting the influx of calcium ions through the L-type calcium channels

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22
Q

Nifedipine, a calcium channel blocker can be used for the treatment of…

A

Vasospastic angina ( Prinzmetal), chronic stable angina, hypertension, Raynaud’s phenomenon

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23
Q

Dihydropyridine calcium channel blockers end with what suffix?

A

Dipine

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24
Q

Nifedipine can also be a first like agent for ?

A

left ventricular hypertrophy

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25
Q

Dihydropyridine acts on…

A

Vascular smooth muscle cells to cause relaxation

26
Q

Dihydropyridine calcium channel blockers can cause….

A

Dizziness

27
Q

What is an important adverse effect of nifedipine?

A

Severe drop in blood pressure is there is overdose

28
Q

What would happen if nifedipine is taken with warfarin?

A

the metabolism of R- warfarin can be decreased

29
Q

What happens when acetylsalicylic acid is taken with nifedipine?

A

there is an increased risk or severity of congestive heart failure and hypotension

30
Q

What happens when adenosine is taken with nifedipine?

A

The risk or severity of QTc prolongation is increased

31
Q

How does ivabradine work?

A

By inhibiting the funny channels in the heart in a concentration dependent manner without affecting any other cardiac ion channels ( including calcium and potassium)

32
Q

How does nicorandil work?

A

Via two mechanism:

  1. Activates and opens ATP depend and potassium channels
  2. Contains a nitrate moeity in its structure that makes it a good dilator of vascular smooth muscle
33
Q

How does trimetazidine work?

A

Metabolic agent that improves myocardial glucose utilization via the inhibition of long-chain 3-ketoacyl CoA thiolase which results in a reduction of fatty acid oxidation and a stimulation of glucose utilization

34
Q

How does Ranolozine work?

A

inhibits sodium and potassium ion channel currents

35
Q

The use of nitric oxide donors like all nitroglycerin preparations is an absolute contraindication to…

A

The use of PDE5 inhibitors because of the synergistic effects of hypotension and hemodynamic collapse

36
Q

Patients with established stable angina are considered high risk patients for cardiovascular events for whom treatment with…

A

Statins should be considered regardless of LDL levels

37
Q

In patients with CAD and hypertension, what would be the ideal blood pressure?

A

A reduction in systolic BP to less than 140 mmHg and a diastolic blood pressure of les than 90 mmHg

38
Q

Diabetes is a potent risk factor for what?

A

Cardiovascular complications
Increases the risk for progression of coronary artery disease.

Requires careful management that requires adequate control of HBA1c with a general objective of less than 7% and an individualized target of less than 6.5-6.9%

39
Q

What are the two pharmacological approaches in stable angina?

A

Relief of symptoms and the prevention of cardiovascular events

40
Q

What is the analgesic most commonly used for the treatment of pain?

A

opioids like morphine

41
Q

What is one important adverse effect of morphine?

A

diminished effects of oral anti platelet agents

42
Q

Hyperoxia (excessive supply of oxygen) may be harmful to patients who have…

A

uncomplicated MI

43
Q

Benzodiazepine should be considered in…

A

Anxious patients

44
Q

If someone is having chest pain and the healthcare team will take less than or 120 minutes to reperfuse the ischemic area of the heart what strategy will the healthcare team use?

A

PCI - percutaneous coronary intervention

45
Q

If a patient is having chest pain and the healthcare team knows it will take them more than 120 minutes to reperfuse the ischemic area, what strategy will they adopt?

A

Fibrinolysis and later reperfusion

46
Q

Patients undergoing PCI should receive what?

A

dual anti platelet therapy (DAPT), a combination of aspirin and a P2Y 12 inhibitor and a parenteral anticoagulant

47
Q

The aspiring given to patients who are undergoing PCI can be given in which way?

A

orally including chewing or via I.v to ensure complete inhibition of thromboxane A-2 dependent platelet aggregation

48
Q

In patients undergoing a PCI, what should be the oral dose of plain aspiring given?

A

150-300 mg

49
Q

In patients undergoing a PCI what is the preferred P2Y12 inhibitors?

A

Prasugrel (60mg loading dose and 10 mg maintenance dose once daily per o.s)

Ticagrelor (180 mg loading dose and 90mg maintenance dose twice daily)

50
Q

In patients undergoing PCI, what are the options for anticoagulants?

A

Unfractionated heparin (UFH) - first line

Enoxaparin
Bivalirudin

51
Q

Reperfusion therapy is indicated in all patients with symptoms of?

A

Ischemia of less than or equal to 12 hours of duration and persistent ST segment elevation

52
Q

If timely primary PCI cannot be performed after STEMI diagnosis, what should be done?

A

Fibrinolytic therapy is recommended within 12 hours of symptom onset in patients without contraindications

53
Q

True or False

Is a primary PCI strategy recommended over fibrinolysis within indicated time frames?

A

Yes

54
Q

In the absence of ST- segment elevation, a primary PCI strategy is indicated in patients with suspected ongoing what?

A

Ischemic symptoms suggestive of MI and at least one of the following criteria

  1. Hemodynamic instability or cardiogenic shock
  2. Recurrent or ongoing chest pain refractory to medical treatment
  3. Life-threatening arrthymias or cardiac arrest
  4. Mechanical complications of MI
  5. Acute heart failure
  6. Recurrent dynamic ST segment or T wave changes, particularly with intermittent ST- segment elevation
55
Q

If a patient is having a STEMI heart attack, and the healthcare team doesn’t think they will be able to perform the PCI in less than 120 minutes, what’s the next step in treatment?

A

Fibrinolytic therapy

56
Q

Which two medications can you use when initiating fibrinolytic therapy on a patient?

A

Tenecteplase and Alteplase

57
Q

When it comes to treating patients with tenecteplase, what is a recommendation?

A

To reduce the dose in half for patients older than 75 years of age

58
Q

The good thing about tenecteplase is that there is a…

A

Standard dose depending on the weight

59
Q

How do we give alteplase?

A

First as a single 15 mg I.v bolus
Then as a 0.75 mg/kg I.v over 30 minutes
lastly as a 0.5 mg/kg I.V over 60 minutes

60
Q

Instead of using aspirin, in fibrinolytic therapy we use…

A

Clopidrogel (antiplatelet medication)

61
Q

In fibrinolytic therapy what medication do we use that starts with the letter E?

A

Enoxaparin (anticoagulant)

Pharmacology (5 decks)

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