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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?
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

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?



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
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



inhibit platelet activation

what is a the MOA of dipyridamole
inhibits phophodiesterase and therefore increases cAMP...


what is the prototype indirect thrombin inhibitor



binds to thrombin III and causes a config change that results in more efficient inactivation of thrombin

what anticoagulant drug might cause thrombocytopenia
what drug might cause osteoporosis with long term use
low molecular weight heparin called enoxaparin
what is the prototype direct thrombin inhibitor


hirudin, bivalrudin, argotrban

inhibits thrombin

what is a prototype anti coag vitamin k blocking agent
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
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
prototype dihydropyridine
nifedipine, amlodipine
nifedipine mechanism

what kind of drug

block ca channel in vsm cells leading to vasodialation

dihydropyridine ca channel blocker

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


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
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