SIHD Flashcards
what is ischemia
restriction in blood supply
Printzmetals angina is what kind of ischemia?
supply ischemia
chronic stable angina is what kind of ischemia
demand ischemia
unstable angina is what kind of ischemia?
supply ischemia
what two things lead to ischemia?
decreased coronary blood flow and increased oxygen consumption
what things cause increased oxygen consumption?
increased HR, preload, afterload, and contractility
what is preload?
volume of blood in ventricles at the end of diastole
what is afterload?
pressure left ventricle must overcome to eject blood during contraction
if we decrease contractility we decrease what
oxygen consumption
if we decrease HR we decrease/inc what?
decrease O2 consumption and increase coronary perfusion
if we decrease preload what happens
decrease o2 consumption, increase in myocardial perfusion
how do we decrease preload?
venodilation
how do we decrease afterload?
arterial dilation
what happens if we decrease afterload?
decrease in o2 consumption
BP and A1c goals
<130/80
<7%
ASA mechanism of action
irreversible inhibition of COX1 and blocking TXA2 synthesis
what does COX-1 do
increase platelet aggregation and vasoconstriction
what does COX-2 and prostacyclin do
inhibit aggregation and has vasodilation
P2Y12 inhibitors MOA
inhibit ADP induced platelet aggregation with no effect on TXA2, inhibits adenyl cyclase
ASA adverse effects
GI bleed, brain bleed
clopidogrel adverse effects
bleeding, diarrhea, rash
prasugrel side effects
bleeding, diarrhea, rash
ticagrelor side effects
bleeding, bradycardia, heart block, dyspnea
elective PCI pts antiplatelet therapy
ASA indefinitely
low risk bleeding: clopidogrel 6 months
high risk bleeding: DAPT 1-3 months, P2y12 till 12 months
CABG pts antiplatelet therapy
DAPT 12 months
which drug must ASA dose be below 100 mg
ticagrelor
how does colchicine reduce inflammation
reduction in IL-1b and IL-18
nitrates effect on O2 demand
increase HR, decrease preload and afterload
beta blockers effect on O2 demand
decrease HR, decrease contractility, decrease afterload, increase preload (LV volume)
DHP effect on O2 demand
increase HR, decrease contractility, decrease preload and afterload
non DHP effect on O2 demand
decrease HR, decrease contractility, decrease preload and afterload
nitrates MOA
nitric oxide releasers / donors, activators of guanyl cyclase
ionotropy is what
contractility
chronotropy is what
heart rate
beta blockers moa
competitive reversible inhibition of beta stimulation by catecholamines
beta blockers side effects
bradycardia, sinus arrest, AV block, fatigue, depression, broonchoconstruction
DHPS have much more ___ selectivity than non DHP
vascular
verapamil brands
isoptin, calan
diltiazem brands
cardizem, dilacor, tiamate
nifedipine brands
procardia, adalat
DHP side effects
hypotension, flushing, headache, dizziness
peripheral edema
reflex adrenergic
non DHP side effects
hyptension, flushing, headache, dizziness
constipation
av block, bradycardia
ranolazine MOA
inhibit late inward Na current to decrease Ca influx
what drugs to not use with ranolazine
-onazole, non DHP, carbemazepine
ranolazine adverse effects
constipation, nausea, dizziness, headache
