Therapeutic Strategies in Ischemic Heart Disease
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- What is the mechanism of chronic stable angina?
- Fixed Atherosclerotic Plaque and supply/demand mismatch
- how do you treat the supply/demand mismatch in chronic stable angina?
- drugs that improve supply like beta blockers and calcium channel blockers and nitrates
- how do you reduce the risk of converting stable angina into unstable syndrome due to platelet activation phamacologically?
- aspirin and maybe thienopyridines
- is Nstemi stable or unstable?
- unstable
-
a ruptured vulnerable plaque is called what?
a. nstemi
b. stemi
c. variant angina - a. nstemi
- what type of anti-platelet therapy for nstemi... name some drugs
- aspirin, thienopyridine, glycoprotein IIb IIIa inhibitor
- in addition to anti-platelet therapy, for an nstemi you should add anticoagulants... which ones would you probably administer?
- Anti-coagulant (to block ongoing clot formation and propogation) - usually heparin or LMW heparin due to acute nature, rapidly titrateable therapy
-
a ruptured vulnerable plaque with occlusive thrombus is ...
a. chronic stable angina
b. stemi
c. nstemi
d. variant angina - b. STEMI
- what treatment do you do for STEMI
- opening of vessel by mechanical means or maybe by a fibrinolytic agent
- in addition to opening the vessel what other treatments should you give to a STEMI pt?
- anti platelet therapy and maybe anti coag to decrease more clot formation
- what is a beta blocker used for in a STEMI
- reduces recurrent mi risk
- what is a ACE inhibitor used for (or ARB) in treatment of a STEMI
- prevents adverse remodeling
- what long term therapy does a STEMI pt start?
- aspirin therapy reducing the risk of another MI
- why would you give statins to a STEMI pt?
- to treat underlying risk factors if needed
- what kind of angina is printzmetal's?
- variant angina / spasm
- what treatment do u give to pts iwth variant angina?
- vasodialators esp calcium channel blockers
-
what prototype drug is a cox inhibitor?
MOA -
aspirin
inhibs cox-1 which prevents platelets from making thromboxane, thus decreasing tendency to aggregate. as platelets dont have nuclei they ar eunable to make new cox-1... irreversible - what side effects of aspirin
- gastric upset, brusing bleeding allergies
- thienopyridine prototype drug
- clopidigrel
- what is the moa of clopidigrel
- block an adenosine receptor to prvent platelet aggregation
- when do u use clopidigrel
- in pts who are known to have CAD and esp those with prior event. may b given acutely ... not used just in case...
-
what is a prototype glycoprotein IIb/IIIa inhibitor
MOA -
abciximab
inhibit platelet activation - what is a the MOA of dipyridamole
-
inhibits phophodiesterase and therefore increases cAMP...
antiplatelet -
what is the prototype indirect thrombin inhibitor
MOA -
heparin
binds to thrombin III and causes a config change that results in more efficient inactivation of thrombin - what anticoagulant drug might cause thrombocytopenia
- heparin
- what drug might cause osteoporosis with long term use
- low molecular weight heparin called enoxaparin
-
what is the prototype direct thrombin inhibitor
moa -
hirudin, bivalrudin, argotrban
inhibits thrombin - what is a prototype anti coag vitamin k blocking agent
- warfarin
- what is the mechanism of warfarin
- blocks vit k dependent production of clotting cascade proteins in liver
- name two thrombolytic drugs
- streptokinase and tissue plasminogen activator
- what is the mechanism of streptokinase
-
activates plasminogen into plasmin leading to clot breakdown fibrinolytic
- tissue plasminogen activator moa
-
recombiant drug mimicking a naturally occuring compound in the body. activates plasminogen into plasmin leading to clot breakdown
- which fibrinolytic drug is selective for plasminogen bound to clots
- tissue plasminogen activator
- what does nitorglycerin do
- vasodialate
- what are some nitroglycerin drugs
- nitroglycerin, isosorbide, mononitrate
- mechanism of nitroglycerin
- increasing NO in vascular endothelium leading to relaxation of vascular smooth muscle
- dihydropyridine does what
- vasodialate
- prototype dihydropyridine
- nifedipine, amlodipine
-
nifedipine mechanism
what kind of drug -
block ca channel in vsm cells leading to vasodialation
dihydropyridine ca channel blocker -
amlodipine
mechanism
drug type -
block ca channel in vsm cells leading to vasodialation
dihydropyridine ca channel blocker - what two types of drugs are used to decrease myocardial oxygen demand
- beta blockers and non-dihydropyridine calcium channel blockers
- what are two prototypical drugs of the beta blocker class that are used to decrease myocardial oxygen demand
- propranolol and metoprolol
- what is the mechanism of action of metoprolol and propranolol. what are they used for
-
used to decrease myocardial o2 demand and ...
block beta receptor on myocardium leading to decreased heart rate and contractility -
what are two prototypical non-dihydropyridine calcium channel blockers
what are they used for
mechanism -
verapamil and diltiazem
decreasing myocardial o2 demand
block calcium channels more in heart to slow heart rate and decrease contractility
- would you use verapamil or diltiazem or propranolol in a pt with LV dysfunction in order to decrease myocardial o2 demand?
- do not use non-dyhydropyridines like verapamil or diltiazem in pts with lv dysfunction bc they have a more neg inotropic effect than beta blockers so use a beta blocker like propranolol
- hmm
- this is a flashcard