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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
Q

Cilostazol

Drug class

A

Quinoline antiplatelet agent

26
Q

Cilostazol

Mechanism

A

Inhibits cellular phosphodiesterase & so raises intracellular cAMP

–> inhibits platelet aggregation

27
Q

Cilostazol

Uses

A

Treatment for claudication with peripheral vascular disease

28
Q

Cilostazol

Side effects

A

Vasodilation

Contraindicated in heart failure

29
Q

Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Zestril), Ramipril (Altace), Quinapril (Accupril), Fosinopril (Monopril)

Drug class

A

ACE inhibitor

30
Q

Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Zestril), Ramipril (Altace), Quinapril (Accupril), Fosinopril (Monopril)

Mechanism

A

Blocks endothelial ACE from converting angiotensin I to angiotensin II (potent vasoconstrictor); as a side effect, also prevents breakdown of bradykinin (potent vasodilator)

31
Q

Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Zestril), Ramipril (Altace), Quinapril (Accupril), Fosinopril (Monopril)

Uses

A

Reduces incidence of future CAD events in patients at risk for or had vascular disease

32
Q

Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Zestril), Ramipril (Altace), Quinapril (Accupril), Fosinopril (Monopril)

Side effects

A

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
Q

Metoprolol (Lopressor), Bisoprolol (Zebeta), Atenolol (Tenormin)

Drug class

A

β1-selective blocker

34
Q

Metoprolol (Lopressor), Bisoprolol (Zebeta), Atenolol (Tenormin)

Mechanism

A

Decrease contractility and HR (reduced myocardial O2 demand)

35
Q

Metoprolol (Lopressor), Bisoprolol (Zebeta), Atenolol (Tenormin)

Uses

A

Prevent MIs, prevent sudden cardiac death, increase survival post-MI (if patients suddenly stop, really bad!)

36
Q

Metoprolol (Lopressor), Bisoprolol (Zebeta), Atenolol (Tenormin)

Side effects

A

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
Q

Isosorbide dinitrate (Isordil), Isosorbide mononitrate (Imdur)

Drug class

A

Vasodilator

38
Q

Isosorbide dinitrate (Isordil), Isosorbide mononitrate (Imdur)

Mechanism

A

Endothelium independent vasodilator; endothelial effects (inhibits platelet aggregation, inhibits leukocyte-endothelial interactions (anti-inflammatory))

39
Q

Isosorbide dinitrate (Isordil), Isosorbide mononitrate (Imdur)

Uses

A

For acute episodes; long-acting formulations are for those already on other drugs and still can’t control angina

40
Q

Isosorbide dinitrate (Isordil), Isosorbide mononitrate (Imdur)

Side effects

A

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
Q

Nifedipine

Drug class

A

Calcium channel blocker - 1st generation dihydropyridine

42
Q

Nifedipine

Mechanism

A

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
Q

Nifedipine

Uses

A

Angina (3rd choice drug); Raynaud’s

44
Q

Nifedipine

Side effects

A

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
Q

Amlodipine (Norvasc), Felodipine (Plendil), Isradipine (Dynacirc)

Drug class

A

Calcium channel blocker - 2nd generation dihydropyridine

46
Q

Amlodipine (Norvasc), Felodipine (Plendil), Isradipine (Dynacirc)

Mechanism

A

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
Q

Amlodipine (Norvasc), Felodipine (Plendil), Isradipine (Dynacirc)

Uses

A

1st line agent for coronary vasospasm; angina (3rd choice drug); Raynaud’s

48
Q

Amlodipine (Norvasc), Felodipine (Plendil), Isradipine (Dynacirc)

Side effects

A

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
Q

Verapamil (Calan); Diltiazem (Cardizem)

Drug class

A

Calcium channel blockers - non-dihydropyridine

50
Q

Verapamil (Calan); Diltiazem (Cardizem)

Mechanism

A

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
Q

Verapamil (Calan); Diltiazem (Cardizem)

Uses

A

Hypertension, anti-anginal (chronotropic effects –> decreased myocardial oxygen demand), SVT (class IV anti-arrhythymic)

52
Q

Verapamil (Calan); Diltiazem (Cardizem)

Side effects

A

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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