Week 2 - Clinical Pharmacology of Stable Angina and ACS Flashcards
What drugs are used first line in treatment?
beta blockers, CCB’s statins, vasodilators
What beta blockers are used and their mechanism?
bisoprolol, metaprolol, atenolol. can be selective or not selective. selective act on myocardial cells. slows down heart.
What is a danger with beta blockers?
only use cardio-selective on asthma patients - may constrict airways
What are calcium channel blockers?
can be rate limiting or vasodilating - prevent/prolong contraction of muscle.
are dihydropyridines (vasodilating) or non-dihydropyridines (rate limiting)
What are some examples of calcium channel blockers?
- dihydropyridines - amlodipine, felodipine, nifedipine.
- non-dihydropyridines - verapamil an diltiazem
What are some statins?
cholesterol lowering drugs.
- HMG CoA reductase inhibitors,
- Fibrates,
- PCSK-9 inhibitors
What is a vasodilator?
- nitrates. turn into NO and dilate everything they touch - non selectively.
- CCB’s also act as vasodilators
Which drugs are 2nd line?
- vasodilator,
- statins
- ivabridine,
- sodium channel inhibitor
What is ivabridine?
affects SA node only to reduce heart rate. only used in patients with sinus rhythm
What are the goals of treatment of NSTEMI and unstable angina?
drugs aim to increase o2 supply and decrease o2 demand
What are the goals of treatment in STEMI? How can this be done?
unblock the artery
emergency angioplasty, or thrombolysis if angioplasty not available after 2 hours
what is the initial management for NSTEMI or unstable angina patients?
MONA
- morphine, opiates, nitrates, aspirin
What 3 non-invasive treatments are used for treatment of NSTEMI and unstable angina?
anti-platelets and thrombolytics.
secondary disease prevention
What 3 invasive methods are used in treatment of acute coronary syndrome?
angiogram (xray), angioplasty, stenting
What causes an NSTEMI to progress to a STEMI?
platelet aggregation causes it to go from a subendocardial infarct to a transmural infarct (occludes entire vessel)
