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Cardiology > Pharm Ischemic Heart Disease > Flashcards

Pharm Ischemic Heart Disease Flashcards

1
Q

Nitrates

  • examples
  • indications
  • MOA
A

Examples:

  • Nitroglycerin (Nitrostat, Nitroquick)
  • Isosorbide dinitrate (Isordil)
  • Isosorbide mononitratae (Imdur)
  • Transdermal patch (NitroDur)

Indications:

  • acute angina
  • chronic angina
  • CHF

MOA:

  • nitrates decrease the O2 demand of the heart by:
    1. decreasing arteriolar and venous tone (systemic and coronary)
    2. decrease preload
    3. decrease afterload
    4. incrase O2 supply to the heart
    4. decrease BP
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2
Q

Short Acting Nitrates

  • when do you use these?
  • how are they taken?
A
  • used fro immediate relief of acute anginal sx.
  • sublingual nitro tablets or spray, repeat in 3-5min if needed x3. Not great advice for everyone, requires a lot of patient education. Best advice is to take one and call 911.
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3
Q

Nitroglycerin

  • SE
  • CI
A 
SE: 
-HA
-Dizziness
-Hypotension
-Flushing
**Passing out.
CI: 
-Hypotension
-Aortic Stenosis
-Severe volume depletion
-acute RV infarction (rely on high preload during this time) 
-Hypertrophic cardiomyopathy 
-Recent meds for ED (Viagra, Levitra, Cialis)
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4
Q

Long acting nitrates

  • first line monotherapy? Why or why not?
  • how long does the blood need to be free of free nitrates/day?
  • examples
A
  • Not used as first line, usually used as and add on to other anti-angina drugs. This is because over time tolerance is developed to this medication and it no longer works, so we save this for last.
  • The blood needs to be free of free nitrates for 8-10hrs/day.

Examples:

  • Isosorbide dinitrate(Isordil)
  • Isosorbide mononitrate (Imdur)***
  • Transdermal patch (NitroDur)
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5
Q

Beta Blockers

  • examples
  • Indications
  • SE
  • MOA
A

Examples:

  • Metoprolol (Lopressor, Toprol)
  • Bisoprolol (Zebeta)
  • Atenolol (Tenormin)
  • Carvedilol (Coreg)

Indications:

  • HTN
  • Tachycardia
  • CHF
  • Ischemic Heart disease
  • -NSTEMI (non-elevated ST elevation MI)
  • -STEMI
  • -Unstable/Chronic Angina

SE:

  • Bradycardia
  • Lethargy
  • GI disturbance
  • CHF
  • Decreased BP
  • Depression

MOA:

  • negative inotrope and chronotrope
  • decreases HR, force of contraction, AV conduction rate.
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6
Q

What is first line therapy for treatment of chronic angina?

A

-beta blocker

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7
Q

What is the only anti-anginal agent proven to prolong life in patients with CAD post MI?

A
  • beta blockers!!!

* most common: Metoprolol (Lopressor)

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8
Q

Beta Blockers

  • CI
  • caution
A
  • severe bronchospasm
  • bradyarrhythmias
  • decompensated heart failure (in midst of acute exacerbation)
  • may worsent with Prinzmetals angina d/t leaving alpha 1 receptors unopposed. (normally, alpha and beta try to balance one another out, if you block the betas the alphas party b/c the betas are gone, this makes angina worse)

Cautions:

  • mask hypoglycemia sx (tachycarida, sweating, confusion)
  • abrupt withdrawl (3 days)
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9
Q

Calcium Channel Blockers

  • examples
  • indications
  • MOA
A 
examples: 
Dihydropyridines:
-Amlodipine (Norvasc) 
-Nifedipine (Adalat, Procardia) 
Nondihydropyridines:
-Diltiazem (Cardizem) 
-Verapamil

Indications:

  • HTN
  • Tachycardia
  • Chronic Angina
  • Coronary vasospaasm
  • Peripheral vasospasm

MOA:

  • Calcium channel blockers decrease myocardial O2 demand by:
    1. decrease preload
    2. decrease heart rate (verapamil, diltiazem)
    3. decrease blood pressure
    4. decrease contractility (Verapamil, diltiazem)
    5. increase O2 supply
    6. cause coronary artery vasodilation
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10
Q

Which of the Ca2+ channel blocker medication is only approved for use in CHF? WHY?

A

-Dihydropyridines; Amlodipine (Norvasc)

Why:
-it does not have the negative inotropic(contractility) or chronotropic(rate) effects that the other calcium channel blockers have.

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11
Q

SE of Calcium CHannel Blockers

A
  • HA
  • Edema
  • Constipation
  • Hypotension
  • Dizziness
  • Bradycardia (nondihydropyridines; cardizem & verapamil)
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12
Q
  • CI to nondihydropyridines (verapamil, cardizem)

- CI for all calcium channel blockers

A
  • systolic CHF d/t lower EF
  • AV block or bradycardia.

CI All Ca2+:

  • pt w/ peripheral edema or hx of hypotension
  • multiple drug interactions* caution* (cleared through the liver, CYP enzymes)
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13
Q

Define each of the following:

  • Antiplatelet
  • Fibrinolytic
  • Anticoagulants
A

Antiplatelets: drugs interfere either with platelet adhesion and/or aggregation. (prevent initial clot formation)

Fibrinolytic: degrade fibrinogen/fibrin (eliminate formed clots)

Anticoagulants: inhibit clotting mechanism ( prevent progression of thrombosis)

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14
Q

Antiplatelets

  • examples
  • MOA
  • absorption peak
A

Examples: Antiplatelet

  • Aspirin
  • Clopidogrel (Plavix)
  • Prasugrel (Effient)
  • Ticagrelor (Brilinta)
  • Abiciximab (Reopro)
  • EPtifibatide (Integrelin)
  • last two are IV, used in setting of MI

MOA:

  • inhibits cyclooxygenase that then inhibits the synthesis of thromboxane A2, a potent stimulator of platelet aggregation.
  • irreversible platelet inhibitor

Absorption peak is 1Hr

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15
Q

Dosing Recommendations of Aspirin

  • primary prevention of CVA/MI
  • Secondary prevention of CVA/MI (already had one)
  • Acute coronary syndrome (in the midst of having an MI)
A

Primary prevention: 81mg/day

Secondary: 325mg/day acutely(several months)

Acute syndrome: 325mg chewed x1

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16
Q

SE of Aspirin

A

-GI bleeding
(H2 Blockers or proton pump inhibitors may decrease gastritis and GI bleeding, also administer with food to decrease GI disturbnace)

  • tinnitus at high doses
  • resistance (dont metabolize and has no effect on platelet aggregation)
  • allergy
17
Q

How many days pre-op should you stop taking aspirin?

A

-4days

18
Q

P2Y12 Antagonists

  • examples
  • MOA
  • indications
A

Examples: Antiplatelet

  • Clopidogrel (Plavix)
  • Prasugrel (Effient)
  • Ticagrelor (Brilinta)

MOA:

  • inhibits the binding of fibrinogen to activated platelets by blocking P2Y12 receptor site, as a result the GP IIb/IIIa receptor is not activated. (which is the binding site for fibrinogen, von Willebrand factor)
  • resulting in the blockage of platelet aggregation and prevention of thrombosis
19
Q

P2Y12 Antagonists

  • Indications
  • do these require loading dose?
A

Indications:

  • unstable angina
  • NSTEMI/STEMI
  • post intracoronary stent placement
  • post stroke
  • PVD
  • no indication for primary prevention of MI/CVA unless the patient is allergic to aspirin

-yes, these drugs require a loading dose. Plavix has the slowest time to detection in the blood of all three medications

20
Q

P2Y12

  • SE
  • not recommended in whom?
  • reversible?
A

SE:

  • bleeding**
  • SOB w/ Ticagrelor

Not recommended in LOP. Greater than 75 or weigh less than 132lbs.

-No antidote for the reversal of the medication in the event of significant bleeding.

21
Q

GPIIB/IIIA Antagonist

  • examples
  • Route of administration
  • Indications
A

examples: Platelet Antagonists
- Abiciximab (Reopro)
- EPtifibatide (Integrelin)

Route: IV

Indication:
acute coronary syndrome, percutananeous coronary intervention

22
Q

GPIIB/IIIA Antagonist

  • onset of action
  • reversible?
  • SE
A

Onset: immediate

-yes Reversible, platelet function is restored to normal 4-8hrs after discontinuation of infusion

SE:

  • bleeding
  • thrombocytopenia (reversible once discontinuation of med_
  • allergy
23
Q

Anticoagulants:

  • examples
  • indications
A

Enoxaparin (Lovenox) (LMWH)
Heparin (UFH)
Bivalirudin (Angiomax)

  • indications:
  • acute MI situations only.
24
Q

Heparin

  • MOA
  • what lab do we base our medication adjustments on?
  • CI
  • Adverse Effects
A

anticoagulant
MOA:
-activation of anti-clotting factors (especially ATIII)
-indirect thrombin inhibitor

-Base med adjustments on the PTT

CI:
-anaphylaxis and recent major surgery

Adverse effects:
-bleeding, hypersensitivity rxn, transaminitis, heparin induced thrombocytopenia (HIT)

25
Q

Enoxaparin (Lovenox)

  • MOA
  • route of admin
A

Anticoagulant

MOA:

  • inhibits Xa and ATIII
  • indirect inhibitor of thrombin

Route:
used in MI, IV dose followed by SQ dose.

26
Q

Bivalirudin (Angiomax)

  • MOA
  • Route of administration
  • SE
  • CI
A

MOA:
-direct thrombin inhibitor (IIa), immediate onset of action.

-IV infusion only

  • SE: bleeding
  • CI: Allergy or recent major surgery or trauma
27
Q

Fibrinolytics

  • aka
  • examples
  • MOA
  • Indications
A

aka: Thrombolytics

exampleS:

  • tPA: Alteplase (Activase); Reteplase (Retavase); Tenecteplase (TNKase)
  • Streptokinase (Streptase)
  • Urokinase (Abbokinase)

MOA:
-convert plasminogen into plasmin to break down fibrin strands.

Indications :

  • MI
  • Stroke
  • MASSIVE PE
  • Limb threatening ischemia
28
Q

Fibrinolytics

  • SE
  • CI
A

SE:

  • life threatening bleeding (LTB)
  • check with hospital to use a checklist prior to administration.

CI:
ABSOLUTE:
-previous intracranial bleeding at any time
-CVA in last 3 mo
-Close head or facial trauma last 3 mo
-uncontrolled HTN greater than 180SBP and 100DBP

Relative:
-Current anticoagulant use
-invasive surgical procedure in last 2 wks
-pregnancy
known bleeding diathesis (predisposition)

Cardiology (12 decks)

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