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Pharmacology > Unit 4-Angina/Coronary Artery Disease > Flashcards

Unit 4-Angina/Coronary Artery Disease Flashcards

1
Q

Aspirin

Drug class

A

NSAID - Antiplatelet agent

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2
Q

Aspirin

Mechanism

A

Irreversible inhibition of COX (thus no TxA2 synthesis), so blocks platelet aggregation

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3
Q

Aspirin

Uses

A

Reduction in adverse events (MI, CVA, death); for those w/stable angina, unstable angina, acute MI, prophylaxis

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4
Q

Aspirin

Side effects

A

Low-doses; if you’re allergic, you’ll get asthma

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5
Q

Ticlopidine

Drug class

A

Thienopyridine antiplatelet agent

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6
Q

Ticlopidine

Mechanism

A

Inhibits platelet aggregation by ADP;

reduces blood viscosity by decreasing plasma fibrinogen and increasing RBC deformability

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7
Q

Ticlopidine

Uses

A

Aspirin alternative

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8
Q

Ticlopidine

Side effects

A

Neutropenia and, rarely, TTP

Not really used anymore

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9
Q

Clopidogrel

Drug class

A

Thienopyridine antiplatelet agent

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10
Q

Clopidogrel

Mechanism

A

Selectively and irreversibly inhibits ADP binding to P2Y12 (blocks ADP-dependent activation of glycoprotein IIb/IIIa complex)

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11
Q

Clopidogrel

Uses

A

Great antithrombotic; standard of care w/ stent

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12
Q

Clopidogrel

Side effects

A

Bleeding

No surgical or dental procedures if patient taking this

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13
Q

Prasugrel

Drug class

A

Thienopyridine antiplatelet agent

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14
Q

Prasugrel

Mechanism

A

Irreversibly binds P2Y12 receptor (G protein-coupled chemoreceptor for ADP)

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15
Q

Prasugrel

Uses

A

Reduce thrombotic events in those w/percutaneous coronary intervention (e.g., stent)

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16
Q

Prasugrel

Side effects

A

Massive bleeding risk

Drug is limited to patients under 75 in age, greater than 60 Kg in weight, and no history of stroke or TIA.

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17
Q

Ticagrelor

Drug class

A

Adenosine-like antiplatelet agent

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18
Q

Ticagrelor

Mechanism

A

Reversibly blocks ADP receptors

Does not require hepatic activation

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19
Q

Ticagrelor

Uses

A

Great antithrombic

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20
Q

Ticagrelor

Side effects

A

Bleeding

Requires bid dosing

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21
Q

Dipyridamole

Drug class

A

Pyrimido-pyrimidine antiplatelet agent

22
Q

Dipyridamole

Mechanism

A

Increases platelet intracellular cAMP (inhibits phosphodiesterase 5, activates adenylate cyclase, inhibits uptake of adenosine from vascular endothelium and RBCs)

23
Q

Dipyridamole

Uses

A

Decrease peripheral vascular disease (as an adjunct); stress test of heart

24
Q

Dipyridamole

Side effects

A

Vasodilation of coronary arteries can enhance exercise-induced ischemia (because it elevates extracellular adenosine levels)

25
Cilostazol Drug class
Quinoline antiplatelet agent
26
Cilostazol Mechanism
Inhibits cellular phosphodiesterase & so raises intracellular cAMP --\> inhibits platelet aggregation
27
Cilostazol Uses
Treatment for claudication with peripheral vascular disease
28
Cilostazol Side effects
Vasodilation Contraindicated in heart failure
29
Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Zestril), Ramipril (Altace), Quinapril (Accupril), Fosinopril (Monopril) Drug class
ACE inhibitor
30
Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Zestril), Ramipril (Altace), Quinapril (Accupril), Fosinopril (Monopril) Mechanism
Blocks endothelial ACE from converting angiotensin I to angiotensin II (potent vasoconstrictor); as a side effect, also prevents breakdown of bradykinin (potent vasodilator)
31
Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Zestril), Ramipril (Altace), Quinapril (Accupril), Fosinopril (Monopril) Uses
Reduces incidence of future CAD events in patients at risk for or had vascular disease
32
Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Zestril), Ramipril (Altace), Quinapril (Accupril), Fosinopril (Monopril) Side effects
Dry cough, angioedema, hyperkalemia, hypotension Short-acting; contraindicated in pregnancy, renal artery stenosis, hyperkalemia, and prior angioedema (no ARB allowed, either); caution in renal failure
33
Metoprolol (Lopressor), Bisoprolol (Zebeta), Atenolol (Tenormin) Drug class
β1-selective blocker
34
Metoprolol (Lopressor), Bisoprolol (Zebeta), Atenolol (Tenormin) Mechanism
Decrease contractility and HR (reduced myocardial O2 demand)
35
Metoprolol (Lopressor), Bisoprolol (Zebeta), Atenolol (Tenormin) Uses
Prevent MIs, prevent sudden cardiac death, increase survival post-MI (if patients suddenly stop, really bad!)
36
Metoprolol (Lopressor), Bisoprolol (Zebeta), Atenolol (Tenormin) Side effects
Fatigue, worsening claudication, impotence (so men don't take) Decreased exercise tolerance, lethargy, insomnia Contraindicated in severe bradycardia, high degree AV block, sick sinus syndrome, unstable LV failure; relative contraindication is asthma, severe depression, peripheral vascular disease
37
Isosorbide dinitrate (Isordil), Isosorbide mononitrate (Imdur) Drug class
Vasodilator
38
Isosorbide dinitrate (Isordil), Isosorbide mononitrate (Imdur) Mechanism
Endothelium independent vasodilator; endothelial effects (inhibits platelet aggregation, inhibits leukocyte-endothelial interactions (anti-inflammatory))
39
Isosorbide dinitrate (Isordil), Isosorbide mononitrate (Imdur) Uses
For acute episodes; long-acting formulations are for those already on other drugs and still can't control angina
40
Isosorbide dinitrate (Isordil), Isosorbide mononitrate (Imdur) Side effects
Tolerance w/chronic use (need nitrate free periods of 8-12 hours), headaches, hypotension, activation of Bezold-Jarisch reflex (causes bradycardia) Contraindicated in hypertrophic cardiomyopathy, severe aortic stenosis, significant hypotension, use of phosphodiesterase inhibitors
41
Nifedipine Drug class
Calcium channel blocker - 1st generation dihydropyridine
42
Nifedipine Mechanism
Interact with L-type voltage gated plasma membrane Ca channel --\> decreased calcium entry into vascular smooth muscle cell, preventing contraction; causes dilation of epicardial coronary arteries, arteriolar resistance arteries
43
Nifedipine Uses
Angina (3rd choice drug); Raynaud's
44
Nifedipine Side effects
Leg edema, heart failure, AV nodal blockade, reflex tachycardia Constipation (most common), headache, flushing Contraindicated in overt decompensated heart failure, bradycardia, sinus node dysfunction, high-degree AV block
45
Amlodipine (Norvasc), Felodipine (Plendil), Isradipine (Dynacirc) Drug class
Calcium channel blocker - 2nd generation dihydropyridine
46
Amlodipine (Norvasc), Felodipine (Plendil), Isradipine (Dynacirc) Mechanism
Interact with L-type voltage gated plasma membrane Ca channel --\> decreased calcium entry into vascular smooth muscle cell, preventing contraction; causes dilation of epicardial coronary arteries, arteriolar resistance arteries; less heart-specific activity
47
Amlodipine (Norvasc), Felodipine (Plendil), Isradipine (Dynacirc) Uses
1st line agent for coronary vasospasm; angina (3rd choice drug); Raynaud's
48
Amlodipine (Norvasc), Felodipine (Plendil), Isradipine (Dynacirc) Side effects
Leg edema (less than 1st generation), heart failure, AV nodal blockade, reflex tachycardia Constipation (most common), headache, flushing Contraindicated in overt decompensated heart failure, bradycardia, sinus node dysfunction, high-degree AV block
49
Verapamil (Calan); Diltiazem (Cardizem) Drug class
Calcium channel blockers - non-dihydropyridine
50
Verapamil (Calan); Diltiazem (Cardizem) Mechanism
Interact with L-type voltage gated plasma membrane Ca channel --\> decreased calcium entry into vascular smooth muscle cell, preventing contraction; causes decreased contractility, firing rate of aberrant pacemaker sites, and conduction velocity; prolongs repolarization in SA node and AV node (--\> decreases HR); less vasodilation
51
Verapamil (Calan); Diltiazem (Cardizem) Uses
Hypertension, anti-anginal (chronotropic effects --\> decreased myocardial oxygen demand), SVT (class IV anti-arrhythymic)
52
Verapamil (Calan); Diltiazem (Cardizem) Side effects
Leg edema, bradycardia, AV nodal blockade, hypotension, worsening heart failure Constipation (most common), headache, flushing Contraindicated in overt decompensated heart failure, bradycardia, sinus node dysfunction, high-degree AV block

Pharmacology (26 decks)

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