Therapeutics of ischaemic heart disease Flashcards
1
Q
what should be used for stable angina
A
- beta blocker or a calcium channel blocker
- if not tolerated, contraindicated or ineffective:
- use a long acting nitrate or
- ivabradine or
- nicorandil or
- ranolazine - if symptoms not controlled, combine
2
Q
give examples of beta blockers
A
atenolol, bisoprolol, propranolol
3
Q
give examples of calcium channel blockers
A
- used as an alternative to beta blockers
- duhydropyridines- amlodipine
- can be used with beta blocker
- lower blood pressure - non dihydropyridines- verapamil
- lower blood pressure and heart rate
- don’t prescribe verapamil and beta blocker
- don’t prescribe if liver dysfunction
4
Q
give examples of secondary prevention of stable angina
A
- stop smoking
- lifestyle
5
Q
describe the treatment of STEMI
A
- stabilise patient
- pain relief
- restore blood flow through artery
- secondary prevention
6
Q
what is percutaneous coronary intervention
A
- local anaesthetic- lidocaine
- groin/wrist - insert catheter and feed round to the heart
- inject dye
- x ray- looking at flow/narrowings
7
Q
describe what pharmacotherapy involves
A
- antiplatelets
- aspirin and clopidogrel/prasugrel/ticagrelor - reduces risk of thrombus formation post atheroma rupture
- so reduces risk of CV events - reduces risk of in stent thrombosis
8
Q
what is ticagrelor
A
- cyclopentyl-triazolo-pyrimidine
- direct reversible oral P2Y12 inhibitor
- quick on/off set of action
- adverse effects: bleeding, dyspnoea
9
Q
what is rivaroxaban used for
A
- post ACS
2. combination with aspirin +/- clopidogrel
10
Q
what could be used in the prevention of thromboembolism
A
- heparins- low molecular weight heparins
- unfractionated heparin - glycoprotein IIb/IIIa inhibitors
- eptifibatide
- tirofiban
- abciximab - cangrelor
11
Q
describe the treatment of an NSTEMI
A
- pain relief
- dual antiplatelet
- antithrombotic
- risk stratify for coronary intervention
12
Q
describe the use of clopidogrel and PPIs
A
- co prescribed due to risk of GI symptoms
- clopidogrel is a prodrug activated by CYP2C19 isoenzyme
- some PPIs may inhibit isoenzyme
- reduced efficacy- increased risk of events/stent thrombosis
- assess need for PPI
13
Q
what is pharmacotherapy used for
A
- secondary prevention in all patients
- modify risk factors
14
Q
when are angiotensin II antagonists used
A
- do not inhibit breakdown of bradykinin- therefore no cough
- used if intolerant of ACE inhibitor
- not superior to ACE inhibitor
- monitoring as ACE inhibitors - check license
15
Q
what is used in lipid lowering therapy
A
statins
- ezetimibe, PCSK9 inhibitors, bempedoic acid
