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
how does verapamil reduce angina and ischemia
GREATLY reduce HR reduce myocardial contractility reduce systolic pressure little effect on LV volume
26
How does diltiazem reduce angina and ischemia
reduce HR little effect on myocardial contractility and LV volume reduce sysotlic pressure
27
3 types of organic nitrates
ISMN ISDN NTG
28
MOA of nitrates
nitric acid donors/releasers activate guanylyl cyclase
29
activity of orgnic nitrates
marked vasodilation (decreased pre load) less arteriole dilation (coronary and peripheral) inhibition of platelet aggregation
30
where is NO produced
Endothelial cells
31
clinical effects of nitrates
increased myocardial O2 supply decreased O2 demand
32
instructions for NTG once patient experiences chest pain
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
patient education points for tablet NTG
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
Patient education for spray NTG
spray under tongue, do not inhale DO not shake 3 year refills
35
adverse effects of NTG
headaches, hypotension, dizziness, lightheadedness, facial flushing, reflex tachycardia
36
What type of painkillers to use for NTG
tylenol, not NSAIDS
37
LEgally, what do we have to make sure is not being taken with NTG
PDE 5 inhibitors (sildenafil, tadalafil) could lead to hypotension leading to death
38
Duration of time to avoid PDE 5 Inhibitors with nitrates
avanafil- 12 hrs sildenafil and vardenafil- 24 hrs Tadalafil- 48 hrs
39
pcol therapy to prevent recurring angina/ischemia
B blocker CCB Nitrates
40
how do B blockers work
B blockers block catecholamines from being able to cause chronotropy/inotropy
41
desired effects of B blockers on myocardial O2 demand
decreased HR decreased contractility decreased BP
42
undesired effects of B blockers on myocardial O2 demand
reducing HR leads to increased diastolic filling time, leading to increased pre load
43
B1 selective drugs
Atenolol Metoprolol
44
B non selective drugs
Propanolol carvedilol
45
ISA B drugs
Pindolol acebutolol
46
lipid soluble B blokcers
Propanolol carvedilol
47
Water soluble B blockers
atenolol bisoprolol
48
B blocker adverse effects
Cardiac- sinus bradycardia, sinus arrest, AV block, reduced LVEF others- bronchoconstriction, fatigue, depression
49
Goal HR on B blockers
Initiate at lowest dose goal HR- 50-60 exercise- less than 100
50