Lecture 2 Flashcards
psy12 inhibitors
clopidogrel, prasgurel, ticagrelor
why do we use multiple antiplatelet agents together
They have different MOA in aggregation cascade
Which p2y12 inhibitors are prodrugs? What enzyme activates them?
clopidogrel and prasgurel
they are dependent on cytochrome P450 to be activated
P2y12 adverse effects
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
clopidogrel generic name
plavix
CCD menaing
chronic coronary disease
CABG? PCI?
coronary artery bypass graft, percutaneous coronary intervention
CCD with no history of stent also known as
stable angina/stable ischemic heart disease, post ACS or revascularization
WHich patients are gonna be on life long 81 mg ASA
patients with hx of CCD (stable angina, stable ischemic heart disease, post MI or have had a stent)
if contraindication to lifelong ASA, what to give patient?
clopidogrel 75 mg/day
DAPT meaning and use
Certain high risk patients may receive DAPT, dual antiplatelet therapy.
ASA+PSY12 inhibitor
types of stents
Bare metal stents (uncommonly used)
drug eluting stents
treating CCD in patients with elective PCI +drug eluting stents
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
drugs to be used in patient undergoing CABG
DAPT for 12 months
SAPT- indefinitely
important thing to remember if patient is on aspirin and ticagrelor
Dose of aspirin must be below 100 mg
are ACEs and ARBs beneficial in patients with CCD
yes
when to use ACE or ARBS in CCD patients
Will almost always be used in CCD patients, especially in pts with decreased heart function, HTN, DM and CKD
How does colchicine work
decreases inflammation via decrease in IL-1B and IL-18
statin use in CCD patients
almost always high intensity
(rosuvastatin 20-40 mg rosuvastatin
40-80 mg atprvastatin)
show the myocardial schemia pxygen supply/demand chart leading to angina
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)
what do most drugs do to lower ischemia and angina
reduce myocardial O2 demand, reduce HR, reduce contractility, reduce afterload and pre load
How do nitrates reduce angina and ischemia
increase HR
no effect on myocardial conrractility
decrease systolic pressure
GREATLY reduce LV volume
how do B blockers reduce angina and ischemia
Greatly reduce HR
reduce myocardial conrractility
reduce systolic pressure
increase LV volume
how does nifedipine reduce angina and ischemia
Increase HR
little effect on myocardial contractility
GREATLY reduce systolic pressure
little effect on LV volume
