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Pharm 1 > Antianginal and antithrombotic drugs > Flashcards

Antianginal and antithrombotic drugs Flashcards

1
Q

What drug class is nitroglycerin (Nitrostat)

A

nitrate vasodilator

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2
Q

What are the indications of nitroglycerin (nitrostat)

A

all forms of angina, but does not work as well fro prinzmetal

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3
Q

What are the side effects of nitroglycerin (nitrostat)

A

Headache (from marked vasodilation), flushing of face and tongue tingling (SL), hypotension, rebound tachycardia

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4
Q

When is nitrate vasodilator use contraindicated?

A

When patient is using alcohol and Viagra: synergistic vasodilation > hypotension,

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5
Q

What drug class is isosorbide dinitrate (Isordil)?

A

Long acting nitrate vasodilator

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6
Q

What are the indications of isosorbide dinitrate (Isordil)?

A

angina, prophylaxis of angina

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7
Q

What are the side effects of isosorbide dinitrate (Isordil)?

A

Headache, hypotension, rebound tachycardia. (severe hypotension with concurrent viagra use like NTG)

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8
Q

What effect do beta-blockers have during acute MI

A

They reduce the infarct size

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9
Q

What are two good drug options for prinzmetal angina?

A

nitrates and calcium channel blockers

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10
Q

What are the 3 classes of drugs used to treat stable angina?

A

nitrates, beta blockers, and calcium channel blockers

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11
Q

What is the mechanism of action for nitrates?

A

nitrates relax smooth ms by converting to NO, which activates guanyl cyclase and increases intracellular cGMP > vasodilation

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12
Q

What are the two main classes of nitrate drugs?

A

nitroglycerin (NTG)/nitrostat and Isosorbide dinitrate/Isordil (long acting)

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13
Q

What do beta blockers do?

A

occupying beta receptors site, esp B-1 diminsh cardiac O2 demand, contractility and rate. Decrease sympathetic stimulation

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14
Q

What substance is used to reverse an beta-blocker overdose that caused bradycardia?

A

Glucagon- inc cAMP in myocardium bypasses the B-adrenergic second messenger system. Atropine and epinephrine can also be used.

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15
Q

what drug class is propranolol/inderal?

A

non-selective beta blocker

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16
Q

What are the indications for propranolol use?

A

Angina, post-MI, HTN, acute panic attacks, migraine HA.

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17
Q

What is the MOA for propanolol?

A

non-selectively blocks adrenergic stimulation which serves to decrease heart rate and O2 demand and decreases renin.

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18
Q

Side effects of propranolol/inderal

A

bronchocontriction, hypotension, bradycardia, fatigue, impotence. Abrupt discontinuation can result in rebound HTN and tachycardia> MI and stroke risk

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19
Q

Is it OK to abruptly stop use of propanolol?

A

NO, abrupt discontinuation can result in rebound HTN and tachycardia> MI and stroke risk

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20
Q

Name a selective beta blocker and what is selective for.

A

Atenolol/Tenormin, selective for B-1 receptor site.

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21
Q

what is atenolol indicated for

A

angina, hypertension, MI

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22
Q

What is the MOA of atenolol?

A

decreases heart rate and myocardial O2 demand by B1 adrenergic blockade.

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23
Q

Side effects of atenolol?

A

similar to propranolol: bronchoconstriction (possible B2 block), bradycardia, fatigue, impotence. Slightly less risk of bronchoconstriction.

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24
Q

how do calcium channel blockers work?

A

they inhibit the entrance of calcium into cardiac and smooth ms cells resulting in vasodilation of both coronary and systemic arterial beds. Decrease heart rate and O2 demand.

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25
Q

what is the antidote for bradycardia cause by a calcium channel blocker?

A

Calcium gluconate

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26
Q

Name a calcium channel blocker

A

Amlodopine/Norvasc

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27
Q

What are the indications for Amlodopine/Norvasc?

A

angina: esp prinzmetal/varient, HTN

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28
Q

what is the MOA of Amlodopine/Norvasc?

A

blocks the calcium influx>vasodilation of cardiac and peripheral arteries. Diminishes sympathetic induced coronary spasm.

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29
Q

Side effects of Amlodopine/Norvasc?

A

Flushing, HA, hypotension. (do not combine with beta-blockers- risk for hypotension and bradycardia)

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30
Q

what should you do if you have a patient presenting with unstable angina?

A

MONA: morphine, oxygen, nitrate, aspirin. Send to ER.

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31
Q

what is the standard analgesic of choice for unstable angina or MI?

A

morphine sulfate

32
Q

What does morphine sulfate do?

A

reduces pain and anxiety, peripheral vasodilation

33
Q

What is the antidote for morphine?

A

Naloxaone/narcan

34
Q

what is the MOA of morphine sulfate?

A

opiate receptor agonist

35
Q

Side effects of morphine sulfate?

A

potential for respiratory depression- monitor. Severe hypotension.

36
Q

name an anti-platelet agent

A

Aspirin (ASA)

37
Q

what class is Aspirin/ASA?

A

Salicylate with anti-inflammatory analgesic and anti-pyretic properties

38
Q

What is the indication for aspirin use?

A

reduce risk of MI in unstable angina or prior infarct, dec risk of TIA and stroke. Also taken for fever, aches and pains.

39
Q

what is aspirin’s MOA?

A

irreversibly inhibits COX 1 and 2, preventing the formation of thromboxane A2 and prostaglandins > diminished platelet aggregation.

40
Q

Side effects of Aspirin?

A

GI ulceration, bleeding, salicylism: with hyperventilation, tinnitus, dizziness, N/V. Increased risk of Reyes syndrome in children w/fever and viral conditions.

41
Q

what class of drug is clopidogrel/plavix?

A

platelet aggregation inhibitor

42
Q

What is the indication for clopidogrel/plavix?

A

reduces thrombotic events, dec incidence of MI and stroke

43
Q

MOA of clopidogrel?

A

antagonist of the adenosine diphosphate (ADP) receptor site on platelets. ADP receptor blockade results in dec platelet aggregation.

44
Q

side effect of clopidogrel/plavix?

A

bleeding, nausea, headaches, neutropenia. CI in pts with active bleeding. Anti-platelet activity is irreversible.

45
Q

What do glycoprotein IIB/IIIA inhibitors do?

A

prevent the binding of fibrinogen, thereby blocking platelet aggregation

46
Q

what class of drug is Abciximab/ReoPro?

A

glycoprotein IIB/IIIA inhibitor

47
Q

what are the indications for abciximab/ReoPro?

A

reduces risk of MI

48
Q

MOA for Abciximab/ReoPro?

A

inhibition of glycoprotein IIB/IIIA receptor site on platelets prevents binding of fibrinogen and von willebrand’s factor to activate platelets resulting in dec platelet aggregation

49
Q

how is abciximab/reopro administered?

A

IV administration only

50
Q

Side effects of abciximamb?

A

increased bleeding. CI in pts with active internal bleeding, hx of hemorrhage, head trauma or stroke in last 30 days.

51
Q

What does heparin do?

A

anticoagulant- ultimately prevents conversion of fibrinogen to fibrin. Does not actively lyse clots.

52
Q

What route is heparin given?

A

IV or SQ

53
Q

Indication for heparin?

A

anticoagulant for unstable angina, acute MI, atrial fibrillation and DVT

54
Q

What is the antidote for heparin?

A

Protamine sulfate

55
Q

what does low molecular weight heparin do?

A

replaced regular heparin, it acts by directly inactivating factor X (Xa) in the clotting cascade.

56
Q

What class is Enoxaparin/Lovenox?

A

low molecular weight heparin

57
Q

What is enoxaparin indicated for?

A

unstable angina, acute MI, prophylaxis and tx for DVT

58
Q

what is the MOA of enoxaparin

A

bind to and inactivates activated factor X (Xa)

59
Q

Side effects of enoxaparin

A

hemorrhage, caution in pts with liver disease, bleeding disorder or GI bleed. Discontinue if platelet count is under 100k/mm3

60
Q

What class is warfarin/coumadin?

A

oral anticoagulant

61
Q

what is warfarin/coumadin indicated for/.

A

prophylaxis and tx of DVT, PE, and thromboemolic events associated with atrial fib and cardiac valve replacement.

62
Q

MOA of warfarin/coumadin?

A

antagonizes vitamin K, interferes with synthesis of vitamin K dependent clotting factors (2, 7, 9, 10)

63
Q

Side effects of warfarin?

A

Bleeding, check PT and INR to maintain optimal blood levels

64
Q

What is the antidote for warfarin/coumadin?

A

vitamin K

65
Q

what category drugs is coumadin?

A

Category X- contraindicated in pregnancy.

66
Q

what class is rivaroxaban?

A

anticoagulant

67
Q

what is rivaroxaban indicated for?

A

prophylaxis of DVT which may lead to PE in those undergoing hip and knee replacement.

68
Q

what is the MOA of rivaroxaban/xarelto?

A

direct inhibition of factor Xa.

Given PO only!

69
Q

Side effects of rivaroxaban/xarelto?

A

bleeding.

70
Q

name a thrombolytic

A

Streptokinase

71
Q

what class is streptokinase

A

thrombolytic (“clot buster”)– only one that actively lyses clots

72
Q

what is streptokinase indicated for?

A

acute MI, acute ischemic stroke, acute DVT or PE.

73
Q

what the MOA of streptokinase?

A

activates plasminogen to plasmin> Plasmin digests fibrin and fibrinogen forming degradation products

74
Q

what is the origin of streptokinase? derived from…

A

isolated from streptococcus species-group C beta hemolytic strep. IV adminstration only!

75
Q

criteria for giving streptokinase?

A

the amount of time passes since MI or stroke…etc.

76
Q

side effects of streptokinase?

A

bleeding

77
Q

what is the antidote for streptokinase?

A

Aminocaproic acid (Amicar): plasmin inactivator and antifibrinolytic.

Pharm 1 (14 decks)

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