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Cardiovascular system SA > Stable coronary heart disease - clinical pharmacology > Flashcards

Stable coronary heart disease - clinical pharmacology Flashcards

1
Q

What is the spectrum of ACS

A

Unstable angina
Non-ST elevation myocardial infarction (NSTEMI)
ST-elevation myocardial infarction (STEMI)
Sudden cardiac death

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2
Q

What is the goal of clinical pharmacology in ACS

A

Increase myocardial supply

Reduces myocardial demand

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3
Q

Through which mechanisms does drug therapy increase myocardial supply

A

through coronary vasodilation

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4
Q

Through which mechanism does drug therapy reduces myocardial demand

A

Decrease in heart rate,
Decrease blood pressure,
Decrease preload or myocardial contractility

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5
Q

When would thrombolysis treatment be administrated

A

If PCI is not available within 2 hours

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6
Q

How do Thrombolytic agents work

and what is the outcome

A

Serine proteases convert plasminogen to plasmin which lyses clot by breaking down the fibrinogen and fibrin contained in a clot

Resulting in bursting up of the clot but not dealing with the atheroma

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7
Q

What is the two categories of Thrombolytic agents

A

Fibrin-specific agents such as

Non–fibrin-specific agents

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8
Q

What are examples of fibrin specific agents

A

alteplase,
reteplase,
tenecteplase

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9
Q

What is an examples of a non fibrin specific agent

A

streptokinase

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10
Q

What further reduces mortality in combination with thrombolysis

A

aspirin

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11
Q

What are the possible contradictions to consider before performing thrombolysis

A

Prior intracranial hemorrhage (ICH)

Known structural cerebral vascular lesion

Known malignant intracranial neoplasm

Ischaemic stroke within 3 months

Suspected aortic dissection

Active bleeding or bleeding diathesis (excluding menses)

Significant closed-head trauma or facial trauma within 3 months

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12
Q

what is the ACS medical protocol treatments if no evidence of a STEMI

A 
Aspirin
Tigagrelor/Clopidogrel
Fondaparinux/LMW heparin
Intravenous nitrate
Analgesia
Beta Blockers
prasugrel
GIIbIIIa receptor blockers
Statins
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13
Q

What the management to reduce the risk of a STEMI

A 
PCI or CABG
Aspirin
Clopidogrel, prasugrel, ticagrelor, ticlopidine or cilostazol
Heparin (LMWH)
Fondaparinux
GIIb/IIIa receptor blockers
Statins
B blockers
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14
Q

What is the normal dosage of aspirin used

and why is this

A

75-150mg

Aspirin is just as effective at low dose than high, slow dose used to reduced adverse reaction of bleeding

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15
Q

How does aspirin work in the treatment of ACS

A

As a preventer
Inhibit platelet thromboxane A2
Preventing platelet aggrevation and vasoconstriction

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16
Q

What is examples of ADP receptor inhibitors

A

Clopidogrel

Prasugrel

17
Q

How does clopidogrel (ADP receptor) work in the treatment of ACS

A

As a preventer
Inhhibits GP IIb/IIIa pathway therefore preventing binding of fibrinogen, so platelets aren’t activated

(glycoprotein IIb/IIIa pathway receptor found on platelets)

18
Q

What is ADP receptor inhibitors used in combination with

A

Aspirin

19
Q

What is the disadvatages of clopidogrel

A

Adverse reaction of G bleeding
Interact and reduces affect of proton pump inhibitors
Can show resistance

20
Q

Why could some patients show a resistance to clopidogrel

A

Clopidogrel is a prodruf, therefore some patients may have low levels of CYP 2C19 hepatic enzymes, so isn’t metabolised

21
Q

what is the benefit of prasugrel over clopidogrel

A

More effective

More rapid and consistent inhibits ADP induced platelet aggravation

22
Q

How does Low molecular weight heparin work

A

preventing certain cofactors, namely thrombin and fibrin, from working correctly

23
Q

What is examples of LMWH

A

Enoxaparin
dalteparin
Tinzeparin
Fondaparinux - most effective

24
Q

Beta blockers is used post MI as secondary prevention how does this work in treating ACS

A

Inhibit sympathetic system, reducing myocardial oxygen consumption , lowers heart rate and reduces contracility

25
Q

Why should beta blockers not be administered to those patients of risk of developing cariogenic shock

A

Will take away sympathetic drive

26
Q

What paitents are at risk of developing cardiogenic shock

A 
>70 years 
HR> 110bpm 
Systolic BP < 120mmHG 
Those with symptoms of coronary vasoplasm 
Patients with cocaine use

Cardiovascular system SA (43 decks)

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