Ischemic Heart Disease Study Guide
Terms
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a fixed atherosclerotic plaque will lead to
a. chronic stable angina
b. unstable angina
c. variant angina
d. printzmetal's angina - a. chronic stable angina
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unstable agina is also known as
a. stemi
b. nstemi -
b. nstemi
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a ruptured plaque with or without a thrombus that is non occlusive is
a. nstemi
b. stemi - nstemi
- if you have an nstemi you should administer anitcoagulants and antiplatelet drugs ... which ones
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thienopyridine or maybe glycoprotein IIb/IIIa inhibitors for anti platelet
and anticoagulants like heparin or lmw heparin -
a stemi is caused by
a. ruptured vulnerable plaque with occlusive thrombus
b. non occlusive plaque
c. spasm - a. ruptured vuln. plaque with occlusvie thrombus
- what drugs to give to a pt with a STEMI?
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strong anti platelet therapy and maybe anti coagulant
beta blocker to reduce recurrent mi risk
ace inhibitor or ARB preventing adverse remodeling
long term aspirin therapy reducing mi recurrence
dont forget to treat underlying risk factors, you might need statins or something
- what is variant angina caused by and whats another name for it?
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printzmetals
spasm
- what do u give to a pt with printzmetals angina
- vasodilator
- what type of vasodialator to give to a pt with variant agina?
- vasodialator esp calcium channel blocker
- whats the MOA of aspirin
- ihibits cox-1 which prevents platlets from making thrmoboxane thus decreasing aggregation tendancy ... irreversible
- what is the prototype drug of the thienopyridines and what are they used for?
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anti platelet
clopidigrel - what is the mechanism of clopidigrel
- block an adenosine receptor to prevent platelet activation
- what is the prototype drug for glycoprotein IIB/IIIA inhibitor
- abciximab
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what does abciximab do
what kinda drug is it -
inhibit platelet activation
glycoprotein IIb IIIa inhibitor - what is the mechanism of dipridamole
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inhibits phosphodiesterase and therefore increases cAMP
anti-platelet -
indirect thrombin inhibitors are
a. anti platelet
b. anti coagulants - a antiplatelet
- what type of drug is heparin
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anti coag
indirect thrombin inhibitor - what is the mechanism of thrombin
- binds to anti thrombin III and causes a configuration change that results in more efficient inactivation of thrombin
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if you want a longer lasting indirect thrombin inhibitor would you chose
lmw heparin or heparin - lmw heparin
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what is the major adverse side effect of heparin
lmw heparin - thrombocytopenia for both and osteoporosis with long term use for lmw heparin
- what are direct thrombin inhibitors used for? name some drugs
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anti coag
hirudin, bivalrudin, argatroban - what is a drug that is an anti coagulant that is a vit k blocking agent
- warfarin
- what is the mechanism of warfarin
- blocks vit k dependent production of clotting cascade proteins in the liver
- does warfarin work immediately or does it take a few days
- takes several days to work bc the factors that we do have have to be depleted
- name two fibrinolytic drugs
- streptokinase and tissue plasminogen activator
- what is the difference in selectivity of streptokinase and tissue plasminogen activator
- tpa is more selective for plasminogen bound to clot so less of a systemic effect
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name some nitroglycerin drugs
what do they do -
nitroglycerin, isosorbide, mononitrate
vasodialate by increasing NO in vascular endothelium leading to relaxation of vascular smooth muscle - dihyrdopyridines are used for what?
- vasodialation
- what are two prototype dihyrdropyridines?
- nifedipine and amlodipine
- what is the mechanism of nifedipine?
- block calcium channels in vsm cells leading to vasodialation
- what is the mechanism of amlodipine
- block ca channels in vsm cells leading to vasodialation
- what do dihydropyridines do to heart rate
- increase heart rate in reflex manner
- what does nifedipine do to heart rate
- increases it
- what does amlodipine do to heart rate
- increases the heart rate in a reflex manner
- what drugs are used to decrease myocardial demand?
- beta blockers and non-dihydropyridine calcium channel blockers
- what are two prototypical drugs of the beta blocker class
- propranolol and metprolol
- what is the mechanism of metoprolol
- block beta receptor on myocardium leading to decreased heart rate (pacemaker cells) and decreased contractility of myocytes
- what are two prototypical non-dihydropyridine calcium channel blockers
- verapamil and dilitazem
- would u use verapamil or ditiazem on a persone with lv dysfunction
- no they have a very neg inotropic effect