SM 132 CAD Pharmacology Flashcards
What factors influence Oxygen demand?
Heart Rate, Contractility, Wall Tension
What pathway are Nitrates associated with?
Nitrates activate the cGMP pathway to cause vasorelaxation
What are Nitrates primarily used for?
Short term relief of acute chest pain
How do Nitrates work?
Nitrates cause VENOdilation, reducing myocardial wall tension and therefore reducing oxygen requirements
What are Direct Renin Inhibitors?
Block the first step in the activation of the renin-angiotensin pathway to treat congestive heart failure
What does platelet activation result in?
Expression of GP IIbIIIa receptor and a change in shapde
What are the low molecular weight heparins?
Enoxaparin and Dalteparin
Inhibit Factor Xa > Factor II
What factors can activate platelets?
Shear stress, ADP, Epinepthrine, Collagen, Thrombin
Which Beta Blocker has a long half life?
Nadolol
What is required for GP IIbIIIa expression, and what role does it mediate?
Platelet activation is required for GP IIbIIIa expression
GP IIbIIIa mediates binding to Fibrinogen
How do Aldosterone receptor antagonists work?
Block the interaction of Aldosterone with its receptor, leading to lower blood pressure and lower sodium retention
What class of drugs does Ticagrelor belong to?
Ticagrelor is a Triazolopyrimidine
NOT a Thienopyridine like Clopidogrel and Prasugrel
How do Thienopyridines work?
Inhibit P2Y12 ADP receptor mediated activation of platelets to reduce clot formation
Name an example of an Aldosterone receptor antagonist?
Spironolactone
What effect does increasing dose have on a Beta Blocker?
Higher doses of a Beta Blocker are less specific to Beta1 or Beta2 receptors
Why is Reocclusion a risk with fibrinolytic reperfusion?
Fibrinolytic reperfusion does nothing to address the causes of clot formation, and only breaks an existing clot, so another could reform later
What are the side effects of Beta Blockers?
Sedation and Asthma
What are Beta Blockers primarily used for?
Reduce mortality and reinfarction after MI
What are the advantages of Fibrinolytic reperfusion over surgical approaches?
Universally available
Ease of use
Rapid administration
What are the GP IIbIIIa inhibitors?
Abciximab, Tirofibin, Eptifibatide
Prevent platelet aggregation
How do Calcium Channel Blockers work?
Block Calcium channels in the vascular smooth muscle and myocardium resulting in improved myocardial blood flow and lower blood pressure
Which Beta Blocker is nonspecific?
Propranolol; blocks both Beta1 and Beta2 receptors
When are plasminogen activators used?
Rapid dissolution of a clot during STEMI
What factors influence Oxygen supply?
Coronary Blood Flow is set by Diastolic Time, Collateral supply, and the Aortic Diastole - LVEDP gradient
How do ARB works?
Angiotensin Receptor Blockers prevent binding of Angiotensin II to the AT1 receptor, effecting the vasculature, heart, kidney, and muscle
Useful for Heart Failure, Left Ventricular Systolic Dysfunction, Hypertension
How does Ticagrelor work?
Inhibits platelet activation via ADP receptor pathway
How do plasminogen activators work?
They cleave Plasminogen into Plasmin and degrade the fibrin strands holding a thrombus together
What are the plasminogen activators?
Streptokinase, Alteplase, and Tenecteplase
What functions does ACE have other than the conversion of Angiotensin?
ACE inactivates Bradykinin and Enkephalins
ACE inhibitors potentiate Bradykinin and cause cough
How do Beta Blockers work?
Beta Blockers lower HR and improve Diastolic Filling Time, lowering BP and preventing exercise induced increases in myocardial contractility
What are the main side effects of Nitrates?
Headache and dizziness; rapid development of tolerance
What gradient determines coronary perfusion?
The gradient between Aortic Diastolic Pressure and LVED determines the coronary perfusion
How does Ranolazine work?
Ranolazine reduces the late inward Na current in ischemic myocardium, thereby lowering intracellular Na and restricting Na/Ca exchange, ultimately lowering contractility
What is the most common side effect of Verapamil and Diltiazem?
Bradycarida and heart failure
How do Triazolopyrimidines compare to Trhienopyridines?
Triazolopyrimidines are reversible, active drugs with rapid onset
Thienopyridines are irreversible, prodrugs with slow onset
Triazolopyrimidines include Ticagrelor
Thienopyridines include Clopidogrel and Prasugrel
Both Triazolopyrimidines and Thienopyridines effect P2Y12 receptors
When is Warfarin the anticoagulative of choice?
OVAHP
Outpatient setting Venous Thromboembolitic Disease Heart Valves Atrial Fibrillation Prior Emboli
What are the side effects of ARB?
Minimal
What can Beta Blockers not improve?
Beta Blockers cannot improve Oxygen supply, only decrease Oxygen demand
What is the suffix of ACE inhibitors?
-pril
How do ACE inhibitors work?
ACE Inhibitors prevent the formation of Angiotensin II from Angiotensin I
Used for Hypertension, Heart Failure, MI
What drugs fall in the Thienopyridine class?
Clopidogrel and Prasugrel
NOT Ticagrelor
Name an example of a DIrect Renin Inhibitor?
Aliskiren
What are the disadvantages of Fibrinolytic reperfusion over surgical approaches?
Hemorrhage/stroke risk
Reocclusion
Contraindications
~50-60% optimal flow restoration
Why is Tenecteplase the best fibrinolytic agent?
Dosed as a single bolus, high fibrin specificity to a specific clot, directly activates Plasminogen and is not antigenic
Why might a fibrinolytic reperfusion agent like Streptokinase cause ICH?
Intracranial hemorrhage can arise after an agent like Streptokinase is administered because healthy clots are broken as well, potentially leading to ICH
What is the suffix of ARB drugs?
-artan
How do Dihydropyridine and Non-dihydropyridine agents differ in their effects on heart rate?
Both are Calcium channel blockers
Dihydropyridines increase HR while Non-dihydropyridines decrease HR
What are the side effects of ACE Inhibitors?
Nonproductive cough
How does the GP IIbIIIa receptor affect platelet function?
Activation of the receptor allows platelets to tightly bind eachother, with Fibrinogen acting as the connection between two platelets
What are the effects and outcomes of Calcium antagonists?
Calcium antagonists inhibit vasoconstriction and enhance ventricular relaxation
Decrease Oxygen demand and increase Oxygen supply
How do small molecule GP IIbIIIa inhibitors compare to peptide inhibitors?
Small molecule inhibitors have a shorter half life and need continuous IV infusion
How does the dose of aspirin determine it’s effects?
Low dose aspirin inhibits Thromboxane A2 synthesis, opposing clots
High dose aspirin inhibits Prostacyclin synthesis, promoting clots
What are the Dihydropyridines?
Calcium Channel Blockers FANN
Felodipine
Amlodipine
Nifedipine
Nicardipine
All are arterial vasodilators
What are GP IIbIIIa inhibitors used for?
Angioplasty and stenting
Which Beta Blocker has anti alpha-adrenergic effects?
Carvedilol
What are the effects and outcomes of Nitrates?
Nitrates cause vasodilation and decrease preload
Decrease Oxygen demand and improve Oxygen supply
What are the side effects of Dihidropyridines?
Pedal edema
What are the effects and outcomes of Beta Blockers?
Beta Blockers treat chronic angina by decreasing HR, contractility, and BP
Decrease Oxygen demand
