Pharmacology for Ischemic Heart Disease

Question 1

Nitrates

Answer 1

decrease the O2 demand of the heart.
↓ Arteriolar and venous tone
↓ Preload
↓ Afterload (at higher doses)
Vasodilation
↑ O2 supply to the heart
↓ Blood pressure

Question 2

Long acting nitrates

Answer 2

Isosorbide dinitrate (Isordil)
Isosorbide mononitrate (Imdur)
Transdermal patch (NitroDur)

Question 3

Beta blockers are first line therapy for treatment of chronic angina

Answer 3

Metoprolol (Lopressor, Toprol), bisoprolol (Zebeta), atenolol (Tenormin), carvedilol (Coreg)

Question 4

Beta blocker contraindications

Answer 4

Severe bronchospasm
Bradyarrhythmias
Decompensated heart failure (in the midst of an acute exacerbation)
May worsen Prinzmetal’s (variant) angina due to leaving the alpha1 receptors unopposed

Question 5

Calcium Channel Blockers Indications

Answer 5

Hypertension
Tachycardia
Chronic angina
Coronary vasospasm
Peripheral vasospasm

Question 6

Calcium channel blockers

Answer 6

decrease myocardial O2 demand.
↓ preload
↓ heart rate (verapamil, diltiazem)
↓ blood pressure
↓ contractility (verapamil, diltiazem)
↑ oxygen supply
 Cause coronary and peripheral vasodilation

Question 7

Calcium channel blockers

Answer 7

Dihydropyridines:
*Amlodipine (Norvasc)
Nifedipine (Adalat, Procardia)

Nondihydropyridines:
Diltiazem (Cardizem)
Verapamil

Question 8

Contraindications to nondihydropyridines

Answer 8

Systolic CHF

AV block or bradycardia

Question 9

P2Y12 Antagonists

Answer 9

Inhibit the binding of fibrinogen to activated platelets by blocking the P2Y12 receptor site as a result the GP IIb/IIIa receptor is not activated

Question 10

P2Y12 Antagonists drugs

Answer 10

Clopidogrel (Plavix)
Prasugrel (Effient)- don’t give to little or old people
Ticagrelor (Brilenta)- SOB within first few days

Question 11

GPiib/IIIa antagonists

Answer 11

Abciximab (Reopro)

Eptifibatide (Integrelin)

Question 12

Anticoagulants

Answer 12

Enoxaparin (Lovenox) (Low molecular weight Heparin)
Heparin (Unfractionated Heparin)
Bivalirudin (Angiomax)

Question 13

Heparin MOA

Answer 13

activation of anticlotting factors (especially antithrombin III)

IV-rapid onset

Question 14

Enoxaparin (Lovenox)

Answer 14

Inhibits Xa and antithrombin III
Indirect thrombin inhibitor
Stronger inhibition of Xa than UFH
For use in MI patients: IV dose followed by a SQ dose