PHARM-- antianginals Flashcards
patients with NSTEMI are not candidates for __
fibrinolytics
4 general effects of fibrinolytic therapy
- sx resolution
- get hemodynamic stability
- reduce biomarker
- resolve ST elevation
block NE release to decrease cardiac work and myocardial oxygen consumption
BB
decreases HR, contractility, SBP; cardioprotective; antiarrhythmic properties
beta blocker
which beta blocker targets Alpha, B1, B2
carvedilol
which BB Targets B1 but at higher dose can target B2
metroprolol
these are indications for what class?
- For 3 yrs in all w/ normal LV function after ACS
- all who have LV dysfunction (EF < 40%) w/ HF or prior MI
- Chronic therapy in all other ppl w/ SIHD or other vasc. dz
beta blocker
which class has C/I of
- High degree heart block
- Sick sinus syndrome
- Severe asthma/COPD (caution)
- Vasospastic angina
BB
which class has the ADR of
- Hypotension, brady
- 1st deg. Heart block
- Bronchospasms
- Glucose intolerance (non-vasodilating BB)
- Impotence
- Feeling cold
Beta blocker
you should titrate your BB to HR of ____ at rest, ____ during exercise
- at rest: 55-60 bpm
- w/ exercise: < 100 bpm
which BB is preferred in pts w/ DM
Carvedilol
which type of CCB is preferred in Afib, a flutter
non DHP
which type of CCB is preferred if on BB already
DHP
which type of CCB is preferred in HFrEF
DHP
which type of CCB is a potent arterial vasodilator w/ variable to no inotropic effects
DHP- CCB
which type of CCB is a moderate vasodilator w/ significant SA and AV conduction inhibition, negative chronotropic and ** inotropic** effects
non-DHP
block transmembrane Ca currents in vascular smooth muscle to cause arterial vasodilation
CCB
effect of ____
* Direct vasodilation of epicardial arterials to ↑ O2 supply
* ↓ myocardial O2 demand by reducing systemic vascular resistance & systolic pressure
* No effect on exercise; no tolerance issues
CCB
which type of CCB does this extra thing:
↓ myocardial O2 demand *by decreasing HR and contractility *
non-DHP
Drug of choice for reducing sx w/ vasospastic angina
CCB
these are ADR seen in which type of CCBs
increased angina, gingival hyperplasia
DHP
these are ADR seen in which type of CCBs
bradycardia, AV block, sinus node dysfunction
Non-DHP
these are common ADR of what class
Hypotension, worsening HF, peripheral edema, constipation, HA, flushing, dizzy
CCBs
increased cGMP levels cause less intracellular Ca release to produce vascular smooth muscle relaxation
nitrates
increased cGMP levels cause less intracellular Ca release to produce vascular smooth muscle relaxation
nitrates
First line for Immediate relief of angina
short acting nitrates
- ↑ myocardial supply by direct vasodilation of large epicardial arterials & reduces vasospasms
- ↓ myocardial demand by venous dilation (decrease preload) and arterial dilation (decreases afterload & BP)
- Improve exercise tolerance and time to onset of angina
nitrates
C/I inclues using erectile dysfunction meds (sildenafil, vardenafil, tadalafil)
nitrates
ADR of
- Hypotension, HA
- Flushing
-
Reflex tachy.
* tolerance - Methemoglobinemia
- Syncope, Dizziness, palpitations
nitrates
how do you manage nitrate tolerance
nitrate free interval each day (12 for patch, 8-12 for tabs)
which med should not be stopped abruptly, d/t rebound tachy
nitrates
blocks late Na+ channel to stop late sodium entry into myocardial cell which decreases Ca entry (Na-Ca exchanger) to decrease wall tension (myocardial oxygen demand)
ranolazine
has no effect on HR and BP; prolongs exercise duration and time to angina
ranolazine
used in combo w/ BB, CCB, LA nitrates for refractory angina & NOT to be used in acute anginal episodes
NOT a sole indicator
ranolazine
has these C/I
- Severe renal impairment (CrCl < 30ml/min)
- Liver cirrhosis
- Use of clarithromycin, antiretroviral meds, azole antifungals
ranolazine
use caution when giving this medication in Existing QT prolongation or with meds that also do it (Class Ia or III antiarrhythmics except amiodarone)
ranolazine
has these ADR
- Dose dependent QT prolongation
- Dizziness
- HA
- Nausea
- Constipation
- asthenia
ranolazine
thrombolytic made from recombinant DNA
altepase (rTPA)
dissolves stable fibrin rich clots by activating plasminogen to plasmin
rTPA, RPA, TNK
The most fibrin specific of the three; used in STEMI but not pulmonary embolisms
tenecteplase (TNK)
which two fibrinolytics is from the mutant of human wild-type
RPA & TNK
3 scenerios of using fibrinolytics in STEMI
- STEMI w/in 12hrs of ischemia/sx onset
- w/in 12-24 hrs + sx of ongoing ischemia
- Time to hospital for PCI >120 mins
rank the antianginals in order of 1st line through 4th line
- Beta blockers
- CCB
- Nitrates
- ranolazine
Avoid IV NTG in patients w/ ____
right ventricular infarcts
