2 CAD Flashcards
(42 cards)
P2Y12 Inhbitors
- clopidogrel
- prasugrel
- ticagrelor
___ and ___ are both prodrugs
clopidogrel, prasugrel
P2Y12i
clopidogrel
- class: ___
- ___ dependent conversion to active
- Potency: ___
- Time to peak inhibition: ___ - ___ hrs (300 mg), ___ - ___ hrs (600 mg)
- Time required for effect dissipation: ___ days
- thienopyridine
- CYP
- (+)
- 4-5, 2-3
- 5
P2Y12i
prasugrel
- class: ___
- “less” ___ dependent conversion to active
- Potency: ___
- Time to peak inhibition: ___ - ___ hrs
- Time required for effect dissipation: ___ days
- thienopyridine
- CYP
- ++
- 2-4
- 7
P2Y12i
ticagrelor
- class: ___
- ___ acting
- Potency: ___
- Time to peak inhibition: ___ - ___ hrs
- Time required for effect dissipation: ___ days
- cyclopentyl-triazolepyrimidine
- direct
- ++
- 2-4
- 5
AE P2Y12 Inhibitors
clopidogrel
- bleeding, diarrhea, rash
- ~1% increase in major bleeding when added to ___
prasugrel
- bleeding, diarrhea, rash
- 0.6% increase in major bleeding, 0.5% increase in life threatening bleeding (vs ___ )
ticagrelor
- bleeding, ___ , heart block, dyspnea
- ASA
- clopidogrel
- bradycardia
E
1) CCD: no history of stent implantation
AKA: ___ prevention - stable angina/stable ischemic heart disease, post-ACS or revascularization
SAPT (single-antiplatelet therapy) - all pts with a history of CCD should receive ___ ___ mg for life
- if CI or significant intolerance, do ___ mg
DAPT (dual antiplatelet therapy)
- certain high risk patients may receive both ___ and ___
secondary
ASA 81
clopidogrel 75
ASA, P2Y12i
T or F: all patients with CAD should receive ASA 81 mg for life
True
unless they are allergic for obv reasons
Intracoronary Artery Stents
Bare metal stents: uncommonly used
Drug eluting stents
1st generation: ___ and ___
2nd generation: ___ and ___
3rd generation (biosorbable polymer): ___ , ___ , and ___
- sirolimus, paclitaxel
- everolimus, zotarolimus
- biolimus, sirolimus, everolimus
2) CCD: Elective PCI + Drug Eluting Stent
Before procedure: ___ and ___ loading dose
After procedure:
- Low bleeding risk: DAPT: min ___ months, SAPT: ___
- High bleeding risk: DAPT: ___ - ___ months, SAPT: ___ for 12 months, SAPT: ___ indefinitely
New recommendations do not distinguish between choice of P2Y12i
- clopidogrel ___ mg daily, prasugrel ___ mg daily, ticagrelor ___ mg BID
ASA, P2Y12i
- 6, indefinitely
- 1-3, P2Y12, ASA
loading doses:
ASA - 325 mg
clopidogrel - 300-600 mg
3) SIHD: CABG
DAPT: ___ ___ mg/day + ___ ___ mg/day
SAPT: __ indefinitely
- ___ may be reasonable for 12 months
controversy regarding need for DAPT
ASA 81, clopidogrel 75
ASA
- clopidogrel
A
T or F: if a patient is on ticagrelor, ASA dose MUST BE > 100
F; less than 100
RAS (ACEi; ARBs)
___ plaque, improved ___ function, inhibition of ___ cell growth, decreased ___ migration.
- do not improve symptomatic ___
- decrease ___ events in high risk patients; should be considered in all patients with CCD (especially in patients with LVEF < ___ %, HTN, DM, or CKD)
stabilize, ET, VSM, macrophage
- ischemia
- CV, 40%
Colchicine
LoDoCo = low dose colchicine 0.5 mg
reduces ___, likely via reduction in ___ and ___
- indicated for reducing the risks of MI, stroke, coronary revascularization, and CV death
- reserved for patients with elevated ___ > 2
- ___ and ___ substrate: caution with strong inhibitors
- CI in severe ___ and ___ disease
inflammation, IL-1B, IL-18
hsCRP
CYP3A, P-gp
renal, hepatic
PCOL to Prevent/Reduce Ischemia/Angina
___ myocardial oxygen supply
- dilation of coronary arteries (reduce ___ ), collateral blood flow, prolong diastole
___ myocardial oxygen demand
- ___ , contractility, intramyocardial wall tension (afterload and preload)
increase, vasospasm
decrease
HR
Nitrates
___ HR
___ myocardial contractility
LV Wall Tension
- ___ systolic pressue
- ___ LV Volume
increase
N/A
decrease
super decrease
beta-blockers
___ HR
___ myocardial contractility
LV Wall Tension
- ___ systolic pressue
- ___ LV Volume
- super decrease
- decrease
- decrease
- increase
nifedipine (DHP)
___ HR
___ or ___ myocardial contractility
LV Wall Tension
- ___ systolic pressue
- ___ or ___ LV Volume
- increase
- N/A or decrease
- super decrease
- N/A or decrease
verapamil
___ HR
___ myocardial contractility
LV Wall Tension
- ___ systolic pressue
- ___ or ___ LV Volume
- super decrease
- decrease
- decrease
- N/A or decrease
diltiazem
___ HR
___ or ___ myocardial contractility
LV Wall Tension
- ___ systolic pressue
- ___ or ___ LV Volume
- decrease
- N/A or decrease
- decrease
- N/A or decrease
ranolazine
___ HR
___ myocardial contractility
LV Wall Tension
- ___ systolic pressue
- ___ LV Volume
N/A
N/A
N/A
N/A
PCOL to relieve ACUTE ischemia and angina - Organic Nitrates
MOA: activation of ___
Activity:
- marked veno ___ (decreased ___ )
- less ___ diation, coronary and peripheral
- inhibition of platelet ___ (minor)
guanylate cyclase
- venodilation, preload
- arteriole
- aggregation
Nitrates - Clinical effects
Increased myocardial O2 Supply
- ET dependent ___
- dilates epicardial ___ and coronary collateral vessels
Decreased myocardial O2 demand
- venous ___ causes reduced ___ and decreased LV volume
- vasodilation
- arteries
- vasodilation, preload
