IHD pharm Flashcards
What is nitroglycerin used for?
Short acting nitrate used for immediate relief of anginal symptoms
What are the dosage forms of nitroglycerin?
0.3-0.6 mg SL repeat Q 3-5 min until relief of CP. Max dose: 3 doses w/in 15min
What are long acting nitrates used for?
Added to beta blockers or calcium channel blockers to control stable angina
What is the MOA of beta blockers?
antagonize effects of catecholamines on the heart. Non-selective act on both B1 and B2 receptors
What is the black box warning for metoprolol (Lopressor), atenolol?
severe angina exacerbation, MI, and ventricular arrhythmias in angina pts after abrupt discontinuation. taper gradually over 1-2 wks and re-initiate therapy if angina worsens
What should be monitored in diabetic patients prescribed carvedilol (Coreg)?
Monitor BP, HR Cr/BUN at baseline, glucose in diabetics
What are the side effects of beta-1 blockers?
Bradycardia, heart block, heart failure
What are the side effects of beta-2 blockers?
bronchospasm, worsening PVD, Raynaud’s phenomenon
What are side effects for both beta-1 and beta-2 blockers?
Fatigue, depression, nightmares, impotence. May mask hypoglycemia and worsen glycemic control in diabetics
What is the MOA of calcium channel blockers?
Prevent opening of voltage-gated calcium channels. Vasodilator effect on resistance vessels
When should you be cautious to prescribe a calcium channel blocker?
pt’s with peripheral edema or history of hypotension. Multiple drug interactions
What is the MOA of aspirin?
inhibits cyclo-oxygenase and thromboxane A2 synthesis
What is the MOA of Theinopyridines (clopidogrel)?
block binding of ADP to platelet receptor
What is the black box warning for clopidogrel (plavix)?
diminished effect in poor metabolizers (CYP450)
What are antiplatelet agents?
aspirin, clopidogrel (plavix), Prasugrel (Effient),
Ticagrelor (Brilinta)
Name the statins
Lovastatin, fluvastatin, pravastatin, simvastatin (zocor), atorvastatin (lipitor), and rosuvastatin (crestor)
What is important about the pharmokinetics of statins?
extensive first-pass metabolism by the liver. Greater than 95% of most of these drugs are bound to plasma proteins.
At what time of day should statins be taken?
taken orally at bedtime because of diurnal rhythm of cholesterol synthesis, except atorvastatin taken at any time because of its long half-life (14 hours).
What is the MOA of statins?
inhibit cholesterol synthesis in the liver, so they deplete the intracellular supply of cholesterol, which triggers an up-regulation of hepatic LDL receptors causing increased clearance of plasma LDL .
What are side effects of statins?
GI upset, HA, hepatotoxicity, Myopathy (increased creatine kinase) when combined with: Fibrates, Niacin, erythromycin, cyclosporine, verapamil, ketoconazole)
What needs to be routinely measured with statin therapy?
Liver transaminases and CK
What is the maximum dose of aspirin?
4 grams/day
