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Cardio Exam 2 > Part 2 of Pharmacology for CAD and Stroke > Flashcards

Part 2 of Pharmacology for CAD and Stroke Flashcards

1
Q

ADP Receptor Blockers are also known as?

A

Thienopyridines

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2
Q

ADP is a

A

potent initiator of platelet aggregation via P2Y12 and P2Y1

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3
Q

P2Y12 and P2Y1 receptors

A

Have to both be stimulated in order for platelet activation to occur
So for drugs, all you have to do is block one to block platelet activation

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4
Q

Thienopyridines Examples

A

Prasugrel

Clopidgrel

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5
Q

Thienopyridines are

A

Prodrugs
Metabolites bind to P2Y12 for irreversible blockage
Short half lives by long lasting effects

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6
Q

Thienopyridines Use

A

During ACS esp with angioplasty and stenting

Secondary prevention of MI and atheroembolic stroke

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7
Q

Thienopyridines Important Considerations

A

Metabolism is required fo activity
Inhibition is irreversible
Nature of metabolizing enzyme is key for efficacy

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8
Q

Clopidegrel requires

A

2C19

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9
Q

Prasegrel requires

A

3A4

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10
Q

Slow metabolizers should use:

A

Prasegrel

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11
Q

Reversible ADP Receptor Antagonists is otherwise known as

A

A non-thienopyridine

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12
Q

Example of Non-thienopyridine

A

Ticagrelor

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13
Q

Ticagrelor is

A

NOT a pro-drug
Metabolized by 3A4
BID

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14
Q

Ticagrelor MOA

A

Reversible blockade of P2Y12 receptor with quick recovery after stopping the drug

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15
Q

Thrombin receptor antagonists otherwise known as:

A

Protease-activated receptor 1

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16
Q

Example of a Thrombin Receptor Antagonists

A

Vorapaxar (Zontivity)

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17
Q

Thrombin background

A

Causes platelet activation and aggregation through PAR 1/4

Most potent activator

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18
Q

PAR1 is

A

high affinity receptor (more sensitive)

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19
Q

Vorapaxar MOA

A

PAR1 has it’s ligand on it so thrombin comes in to activate it and then Vorapaxar binds the domain where the ligand would normally bind
Making it inactive

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20
Q

Aspirin blocks

A

formation of TXA2

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21
Q

Prasugrel and Clopidogrel block

A

ADP receptor

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22
Q

Vorapaxar Use

A

MI and PAD

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23
Q

Glycoprotein IIb/IIIa

A

Platelet surface protein
Receptor for fibrinogen and vWF
When activated it anchors platelets to each other via fibrinogen and to the surface via vWF

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24
Q

What activated Glycoprotein IIb/IIIa?

A

Thrombin, TXA2, ADP, Collagen

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25
So why are glycoprotein IIb/IIIa inhibitors good?
Because the activators of the glycoprotein can still interact with their receptor but that won't matter if the glycoprotein is inhibited
26
Glycoprotein IIb/IIIa inhibitors MOA
inhibit interaction of glycoprotein IIb/IIIa with fibrinogen and vWF to impair platelet aggregation
27
Glycoprotein IIb/IIIa inhibitors Examples
Abciximab Eptifibatide Tirofiban
28
Abciximab MOA
Binds to inactivated platelets to prevent coagulation
29
Eptifibatide and Tirofiban MOA
Requires activated platelets and GP IIb/IIIa to bind and inhibit
30
Abciximab Use
With angioplasty for coronary thromboses | With aspirin and heparin to prevent restenosis and MIs
31
Eptifibatide and Tirofiban Use
UA, ACS, MI | Angioplastic coronary interventions
32
***Absolute Contraindications for Glycoprotein IIb/IIIa inhibitors and Fibrinolytics
``` Active internal bleed Intracranial bleed Intracranial tumor/aneurysm Aortic dissection Head/facial trauma (3 months) Prior ischemic stroke (3 months) ```
33
****Relative Contraindications for Glycoprotein IIb/IIIa inhibitors and Fibrinolytics
``` Severe HTN not controlled by Rx Dementia Current use of warfarin Bleeding diathesis Active peptic ulcer Prior ischemic stroke (more than 3 month) Major surgery (3 wks) Prior interal bleed (2-4 wks) Traumatic or prolong CPR (more than 10 mins) ```
34
Plasminogen -->
via tissue plasminogen activator makes plasmin which goes to enhance fibrinolysis (degradation of fibrin)
35
Fibrinolytic agents examples
Alteplase Reteplace Tenecteplase
36
Alteplase (Activase)
Shorter half-life
37
Reteplase (Retavase) | Tenecteplase (TNKase)
Longer half life
38
FIbrinolytic agent Use
acute MI and thromboembolic stroke
39
Statins MOA
Blocks HMG-CoA reductase (conversion to mevalonic acid so no cholesterol)
40
Beneficial effects of Statins
Lipid | Pleiotropic effects
41
Main adverse effects of Statins
Myopathy Cognitive effects Hepatotoxicity Hyperglycemia
42
MOA of ACEi
Inhibit angiotensin converting enzyme which converts AngI to AngII so no renin production and Ang1-7 and bradykinin will be produced
43
Main adverse effects of ACEi
Cough | Angioedema
44
Pure anti-anginal agent example
Ranolazine (Ranexa)
45
Ranolazine Use
Chronic angina | Combo with amlodipine, BB, or nitrate
46
Ranolazine MOA
Not because of reduction of BP, HR or workload Inhibit FA oxidation --> ATP is formed from glucose --> improved oxygen consumption OR inhibit late sodium current and decrease calcium overload during ischemic attack
47
Ranolazine + CYP
3A4 metabolized
48
Main adverse effevts of Ranolazine
Constipation | Prolongation of QT interval
49
CAUTION with Ranolazine
With diltiazem and verapamil bc of 3A4 inhibition
50
Define stroke
Disease affecting blood vessels that supply blood to the brain
51
Two types of stroke
Hemorrhagic (damage of vessels and bleeding) | Ischemic (blockage of a blood vessel by clot/mass
52
Define Thrombus
Forms in a brain artery
53
Define Embolus
Wandering clot | Formed away form the brain and comes and blocks the blood flow
54
Ischemic and TE Stroke Therapeutic goals
Reduce neurologic injury Decrease morality and long-term disability Prevent complication secondary to immobility and dysfunction Prevent stroke recurrence
55
Acute Stroke Treatment
Fibrinolytics | Anti-platelets
56
Fibrinolytics agents
Alteplase Reteplase Tenecteplase Help restore perfusion
57
Antiplatelet agents
Aspirin | Reduces aggregative activity of platelets
58
Secondary prevention treatment
Anti-platelets | Anti-coagulants
59
Anti-platelets
Used for atheroembolic stroke where platelets are a mjaor component of the thrombus
60
Anticoagulants
Used for cardio/TE stroke where clotting factors are primary components of thrombus
61
ACEi and Thiazides
BP Lowering agents Beneficial independent of HTN Reduce the risk of stroke recurrence Not used in the first 7 days of acute stroke period
62
ARBs
Alternative to ACEi | Cross BBB and may have more beneficial effects
63
Statins
Reduce risk of stroke in pts with CAD and elevated lipids in ALL ischemic stroke pts Beneficial effect: lipid lower and pleiotropic effects

Cardio Exam 2 (10 decks)

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