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Therapeutics > Lecture 2 > Flashcards

Lecture 2 Flashcards

1
Q

psy12 inhibitors

A

clopidogrel, prasgurel, ticagrelor

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2
Q

why do we use multiple antiplatelet agents together

A

They have different MOA in aggregation cascade

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3
Q

Which p2y12 inhibitors are prodrugs? What enzyme activates them?

A

clopidogrel and prasgurel
they are dependent on cytochrome P450 to be activated

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4
Q

P2y12 adverse effects

A

Bleeding, diarrhea, rash for all

clopidogrel- 1% increase in major bleeding when added to ASA
prasgurel- 0.6% increase in major bleeding, 0.5% increase in life threatening bleeding

ticagrelor- bleeding, bradycardia, heartblock, dyspnea

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5
Q

clopidogrel generic name

A

plavix

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6
Q

CCD menaing

A

chronic coronary disease

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7
Q

CABG? PCI?

A

coronary artery bypass graft, percutaneous coronary intervention

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8
Q

CCD with no history of stent also known as

A

stable angina/stable ischemic heart disease, post ACS or revascularization

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9
Q

WHich patients are gonna be on life long 81 mg ASA

A

patients with hx of CCD (stable angina, stable ischemic heart disease, post MI or have had a stent)

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10
Q

if contraindication to lifelong ASA, what to give patient?

A

clopidogrel 75 mg/day

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11
Q

DAPT meaning and use

A

Certain high risk patients may receive DAPT, dual antiplatelet therapy.

ASA+PSY12 inhibitor

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12
Q

types of stents

A

Bare metal stents (uncommonly used)
drug eluting stents

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13
Q

treating CCD in patients with elective PCI +drug eluting stents

A

Before procedure they get a single high dose of aspirin (325)
also a P2Y12 loading dose

after procedure if low risk of bleeding
DAPT for 6 months minimum
SAPT indefinitely

after procedure high risk of bleeding
DAPT- 1-3 months may be reasonable
SAPT- P2Y12 inhibitors until 12 months
SAPT- indefinitely

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14
Q

drugs to be used in patient undergoing CABG

A

DAPT for 12 months
SAPT- indefinitely

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15
Q

important thing to remember if patient is on aspirin and ticagrelor

A

Dose of aspirin must be below 100 mg

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16
Q

are ACEs and ARBs beneficial in patients with CCD

A

yes

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17
Q

when to use ACE or ARBS in CCD patients

A

Will almost always be used in CCD patients, especially in pts with decreased heart function, HTN, DM and CKD

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18
Q

How does colchicine work

A

decreases inflammation via decrease in IL-1B and IL-18

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19
Q

statin use in CCD patients

A

almost always high intensity
(rosuvastatin 20-40 mg rosuvastatin
40-80 mg atprvastatin)

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20
Q

show the myocardial schemia pxygen supply/demand chart leading to angina

A

fixed stenosis vasospasm thrombus–> decreased coronary blood flow–> ischemia (leads to angina

also

Increased HR contraction afterload and pre load—> increased O2 consumption—-> ischemia (Angina)

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21
Q

what do most drugs do to lower ischemia and angina

A

reduce myocardial O2 demand, reduce HR, reduce contractility, reduce afterload and pre load

22
Q

How do nitrates reduce angina and ischemia

A

increase HR
no effect on myocardial conrractility
decrease systolic pressure
GREATLY reduce LV volume

23
Q

how do B blockers reduce angina and ischemia

A

Greatly reduce HR
reduce myocardial conrractility
reduce systolic pressure
increase LV volume

24
Q

how does nifedipine reduce angina and ischemia

A

Increase HR
little effect on myocardial contractility
GREATLY reduce systolic pressure
little effect on LV volume

25
Q

how does verapamil reduce angina and ischemia

A

GREATLY reduce HR
reduce myocardial contractility
reduce systolic pressure
little effect on LV volume

26
Q

How does diltiazem reduce angina and ischemia

A

reduce HR
little effect on myocardial contractility and LV volume
reduce sysotlic pressure

27
Q

3 types of organic nitrates

A

ISMN
ISDN
NTG

28
Q

MOA of nitrates

A

nitric acid donors/releasers activate guanylyl cyclase

29
Q

activity of orgnic nitrates

A

marked vasodilation (decreased pre load)
less arteriole dilation (coronary and peripheral)
inhibition of platelet aggregation

30
Q

where is NO produced

A

Endothelial cells

31
Q

clinical effects of nitrates

A

increased myocardial O2 supply
decreased O2 demand

32
Q

instructions for NTG once patient experiences chest pain

A

has patient been previously prescribed NTG? if yes, take 1 NTG dose

if no, is chest discomfort/ pain unimproved or worsening 5 minutes after start?

If no, notify physician, If yes call 911 immeditely

call 911 if chest pain has not been relieed after 1st dose

33
Q

patient education points for tablet NTG

A

keep in original container (no plastic container)
no sfaety cap
place under togue, do not swallow
cotton plug out
no storage in bathroom/humid environments
need for rx refills 6 months

34
Q

Patient education for spray NTG

A

spray under tongue, do not inhale
DO not shake
3 year refills

35
Q

adverse effects of NTG

A

headaches, hypotension, dizziness, lightheadedness, facial flushing, reflex tachycardia

36
Q

What type of painkillers to use for NTG

A

tylenol, not NSAIDS

37
Q

LEgally, what do we have to make sure is not being taken with NTG

A

PDE 5 inhibitors (sildenafil, tadalafil)
could lead to hypotension leading to death

38
Q

Duration of time to avoid PDE 5 Inhibitors with nitrates

A

avanafil- 12 hrs
sildenafil and vardenafil- 24 hrs
Tadalafil- 48 hrs

39
Q

pcol therapy to prevent recurring angina/ischemia

A

B blocker
CCB
Nitrates

40
Q

how do B blockers work

A

B blockers block catecholamines from being able to cause chronotropy/inotropy

41
Q

desired effects of B blockers on myocardial O2 demand

A

decreased HR
decreased contractility
decreased BP

42
Q

undesired effects of B blockers on myocardial O2 demand

A

reducing HR leads to increased diastolic filling time, leading to increased pre load

43
Q

B1 selective drugs

A

Atenolol
Metoprolol

44
Q

B non selective drugs

A

Propanolol
carvedilol

45
Q

ISA B drugs

A

Pindolol
acebutolol

46
Q

lipid soluble B blokcers

A

Propanolol
carvedilol

47
Q

Water soluble B blockers

A

atenolol
bisoprolol

48
Q

B blocker adverse effects

A

Cardiac- sinus bradycardia, sinus arrest, AV block, reduced LVEF

others- bronchoconstriction, fatigue, depression

49
Q

Goal HR on B blockers

A

Initiate at lowest dose
goal HR- 50-60
exercise- less than 100

50
Q
A

Therapeutics (38 decks)

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