Treatment of Cardiovascular Disorders Flashcards
Angina Pectoris, its types and what is it
Angina pectoris can be chest pain or a discomfort feeling in the chest. Usually it is retrosternally and lasts 15 minutes. Goes away with rest and nitroglycerin.
It has 2 types: it is stable when there is no change in frequency, precipitation and durtion. If these factors change or if there are new sysmptoms associated with angina then it is called unstable
Are all statins similar
No there’s different potency statins on the market, the best one to use will be the one that is potent and one that can be tolerated well with the patient and has minimal side effects
What are some of the other medication that has been introduced to treat CV diseases other than statins
PCSK9 inhibitors:
- PCSK9 binds to LDL receptors and facilitate its degradation.
- This medication inhibits this function so the LDL receptors on the cells are increased allowing more fat metabolism
- These are monoclonal antibodies: alirocumab and evalocumab
What are the drugs that lower LDL and how do they achieve this function
- Statins: LDL lowering, modest HDL raising and triglycerides loweing effects
- PCSK9 inhibitors: LDL lowering
- Niacin: LDL lowering, raises HDL and lowers triglycerides, does everything that we would want it to do.
- Fibrates: HDL raising, TG lowering, modest LDL benefits
- Bile Acid resins: modest LDL lowering, can be given in addition to statins
- Absorption inhibitors: LDL lowering
Why arent other drugs used to treat CV diseases according to the guidelines
Studies have shown that over long term medications other than statins may not be benefical even though their short term benefits are higher than statins for example Niacin appears to be more beneficial than a statin
Side effects of these medications
- Statins: Myalgias are most common, can cause hepatotoxicity by elevated LFTs, memory impairement and can raise blood sugar
- PCSK9 inhibitors: Nasopharyngitis, injection site reactions like arthus reactions and joint pains
- Fibrates: myopathy, especially in patients with reduced creatinine clearence in combination with statins
- Niacin: flushing and hepatotoxicity
What does the guidelines suggest about using statins and for who
People with diabetes, obese, high LDL, known atherosclerosis disease should be using statins as a preventive measure.
Statins in general should be used as a preventive measure in general especially in high risk populations
What is the relationship between diabetes and atherosclerosis
Insulin resistance can lead to a pro inflammatory state in the body hence there is a higher correlation of CV diseases with insulin and obesity
Who shouldnt be on beta blockers
People with asthma or those who have heart block
What are the drugs that are used in addition to statins and beta blockers to reduce the risk of CV disease
Antiplatelet therapy involves the use of aspirin, clopidogrel, prasugrel and ticagrelor
What other drugs can be used
ACE inhibitors/ARBS
What drugs can only be used when the patients are having chest pain
Nitrates. Some examples are nitroglycerin, isosorbide dinitrate and nonitrate They do not have a proven CAD mortality benefit. Headache is a common side effect
Fibrinolytics
These are used when
- There is an acute ST elevation observed in the EKG
- Evidence of MI
- Acute ischemic stroke
Examples are alteplase, reteplase, tenecteplase and streptokinase. These work by converting pro enzyme plasmogen into plasmin so they relieve a thrombin cloth. They have a risk of intracranial bleeding and a high risk of failure rate
Anticoagulents
Heparin is used as it is an anti clothing factor. Those at high risk for embolism can use this therapy. In order to use this therapy responsibly the platelet count have to be monitored closely as it can drop dangerously (heparin induced thrombocytopenia).
Low molecular weight heparin can be given, they have a longer half life
Angioplasty (or balloon angioplasty)
A balloon catheter is passed along the blocked artery, the balloon is inflated to widen the lumen of the artery and then the balloon is deflated and withdrawn
CABG
Coronory Artery Bypass grafting
- Think of heart failure as progression
Stage A: Diabetes, obesity but these patients do not have CHF
On the other hand of this you have patients who need cardiac transplant or even hispice as you cannot provide treatment to all patients.
This is all we need to know from this slide
Mortality proving medication for CHF
