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Drugs: From molecule to man > ELM13: Acute coronary syndromes > Flashcards

ELM13: Acute coronary syndromes Flashcards

1
Q

What are ACS?

A

Disorders with chest pain that radiates
Not relived by rest
Caused by coronary artery thrombosis Involve cardiac ischaemia

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2
Q

What are the three main categories of ACS?

A

Unstable angina
NSTEMI
STEMI

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3
Q

What is the pain treatment for ACS?

A

Opiods

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4
Q

What is the treatment to reduce cardiac workload and improve blood supply in ACS?

A

Beta blocker
GTN

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5
Q

What is the treatment to prevent further thrombosis in ACS?

A

Aspirin
Ticagrelor
Heparins

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6
Q

What are the treatments for reperfusion in ACS?

A

PCI
CABG
Thrombolysis

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7
Q

What is haemostasis?

A

Preventing blood loss after vessel damage
Coagulation platelet aggregation and vasoconstriction

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8
Q

What is thombosis?

A

Pathological
DVT
Embolism
Stroke
Heart attack

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9
Q

What is a thrombus?

A

A pathogenic blood clot attached to cell wall
Traps platelets and blood cells

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10
Q

What has a major role in venous thrombosis?

A

Coagulation

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11
Q

What has a major role in arterial thrombosis?

A

Platelet aggregation

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12
Q

What is an embolus?

A

Complication of a thrombus
Part or whole detaches from wall and travels through vessels
Causes blockage

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13
Q

What is the main aim of drugs treating thrombus?

A

Inhibit formation without preventing haemostasis

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14
Q

What are the three main targets of modifying the thrombosis process?

A

Modify coagulation
Modify platelet aggregation
Modify clot thrombus breakdown

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15
Q

What are heparins in relation to thrombosis?

A

Modify coagulation to prevent thrombosis

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16
Q

Where are heparins found?

A

Liver
Lungs
Mast cells

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17
Q

What is the role of heparins?

A

Inhibit action of thrombin and factors Xa and IXA
Increases rate of formation of antithrombin III thrombin complex

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18
Q

What is required for heparins to work?

A

Antithrombin III
Factor IIA

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19
Q

What are some other actions of heparins?

A

Reduce platelet aggregation
Reduces platelet numbers
Influences lipid metabolism

20
Q

What are some clinical uses of heparins?

A

Venous thrombosis and embolism
After heart attack or stroke
Reduce DVT risk after orthopaedic surgery

21
Q

What is thrombin?

A

Proteolytic enzyme
Converts fibrinogen to fibrin

22
Q

How is actin thrombin formed?

A

Cleavage of prothrombin by factor Xa

23
Q

What is fondaparinux?

A

Synthetic sulphated mucopentasaccharide
Similar action to LMW heparins with less side effects

24
Q

What are some issues with heparins?

A

Not absorbed orally
Allergic reactions
Individualised dose
Haemorrhage risk

25
Q

How is warfarin administered?

A

Orally

26
Q

What is warfarin usually used for?

A

Venous thrombo embolism
Stroke prevention

27
Q

How does warfarin work?

A

Similar structure to vitamin K
Antagonises its role in some clotting factors

28
Q

What are some problems with warfarin?

A

Slow onset
Activity influenced by vitamin K
Exists as R S isomers
Haemorrhage risk
Teratogenic

29
Q

What drug is a direct inhibitor of thrombin?

A

Dabigatran

30
Q

What drug is an inhibitor of factor Xa?

A

Rivaroxaban

31
Q

What are the benefits of using newer drugs like dabigatran and rivaroxaban as treatment?

A

Don’t need monitoring ‘Easier to use

32
Q

What are platelets?

A

Derived from megakaryocytes
Fragments of cytoplasm with no nucleus

33
Q

What are some stimuli of platelet aggregation and activation?

A

ADP
TxA2
Thrombin

34
Q

What is the role of TxA2 in platelet aggregation and adhesion?

A
  1. Synthesised from arachidonic acid by cyclo-oxygenase
  2. Activated platelets synthesise TxA2
  3. Released from platelets and increases levels of IIb and IIa receptors
35
Q

What is the process of inhibition of aggregation?

A

Endothelium releases prostacyclin

36
Q

What is the first mechanism of antiplatelet drugs using aspirin?

A
  1. Irreversibly blocks platelet COX enzyme
  2. Reduces TxA2 synthesis
37
Q

W
hat are some unwanted side effects of aspirin?

A

Extended bleeding time
Indigestion
Allergy
Asthma attacks
Reyes

38
Q

What is the second mechanism of antiplatelet drugs?

A

Modulating expression of glycoprotein IIb/a receptors

39
Q

What is an example of a drug using the second mechanism?

A

Clopidogrel Inhibits glycoprotein IIa/b expression on platelets
Blocks ADP receptor irreversibly

40
Q

What was the PLATO trial?

A

Compared clopidogrel with ticagrelor
Ticagrelor superior

41
Q

What are some unwanted side effects of clopidogrel and ticagrelor?

A

Extended bleeding time GI tract problems
Headaches
Gout T
Breathless ness T

42
Q

What is the third mechanism of antiplatelet drugs?

A

Raise cAMP levels

43
Q

What is an example of a drug using the third mechanism?

A

Dipyridamole
Phosphodiester inhibitor that prevents cAMP breakdown in platelets

44
Q

What are some side effects of dipyridamole?

A

GI tract problems
Headaches
Muscle pain
Flushing

45
Q

What are some treatments causing reperfusion?

A

PCI
CABG
Thrombolysis

46
Q

What are some properties of PCI?

A

Rapid
Safe
Specialist centre

47
Q

What are some properties of thrombolysis?

A

Very rapid
Risky
Little equipment

Drugs: From molecule to man (21 decks)

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