Angina

Question 1

How is aspirin used for angina?

Answer 1

Reduction in adverse events–MI, CVA, death

Used with stable angina, unstable angina, acute MI, and prophylaxis

Question 2

Thienopyridine antiplatelet agents used with angina?

Answer 2

Ticlopidine
Clopidogrel
Prasugrel

Question 3

What is the mechanism of action of ticlopidine?

Answer 3

Inhibits platelet aggregation by ADP–reduces blood viscosity by decreasing plasma fibrinogen and increasing RBC deformability–aspirin alternative

Question 4

What are the side effects of ticlopidine?

Answer 4

Neutropenia

Rarely TTP

Question 5

What is the mechanism of action of Clopidogrel?

Answer 5

Selectively and irreversibly inhibits ADP binding to P2Y12–blocks ADP-dependent activation of glycoprotein IIb/IIIa complex

Question 6

What are the uses of clopidogrel?

Answer 6

Great antithrombotic

Standard of care with stent

Question 7

What are the side effects of clopidogrel?

Answer 7

bleeding

No surgical or dental procedures if pt taking this

Question 8

What is the mechanism of action of prasugrel?

Answer 8

Irreversibly binds P2Y12 receptor–G protein coupled chemoreceptor for ADP

Question 9

What is prasugrel used for?

Answer 9

Reduce thrombotic events in those with percutaneous coronary intervention

Question 10

What are the side effects of prasugrel?

Answer 10

Massive bleeding risk

Question 11

Adenosine-like anti platelet agent used as antithrobic?

Answer 11

Ticagrelor

Question 12

What is the mechanism of action of ticagrelor?

Answer 12

Reversibly blocks ADP receptors

Question 13

Pyrimido-pyrimidine antiplatelet agent used for PVD and for stress test of heart?

Answer 13

Dipyradimole

Question 14

What is the mechanism of action of dipyradimole?

Answer 14

Increases platelet intracellular cAMP
inhibits phosphodiesterase 5
activated adenylate cyclase
inhibits uptake of adenosine from vascular endothelium and RBCs

Question 15

What are the side effects of dipyradimole?

Answer 15

Vasodilation of coronary arteries can enhance exercise-induced ischemia–because it elevates extracellular adenosine levels

Question 16

Quinoline antiplatelet agent used in tx of claudication with PVD?

Answer 16

Cilostazol

Question 17

What is the mechanism of action of Cilostazol?

Answer 17

Inhibits cellular phosphodiesterase and so raises intracellular cAMP

Question 18

The use of Cilostazol is contraindicated with

Answer 18

Heart failure

Question 19

How do ACEi help with angina and CAD

Answer 19

Reduce the incidence of future CAD events in pts at risk for or had vascular disease

Question 20

What B-blockers are used to prevent MIs, sudden cardiac death and increase survival post-MI?

Answer 20

Metoprolol
Bisoprolol
Atenolol

Question 21

Vasodilators used for acute episodes of angina and long-acting formulation available for those already on other drugs and still can’t control angina?

Answer 21

Isosorbide ditrate
Isosorbide
Mononitrate

Question 22

What is the mechanism of action of the vasodilators used for angina? Isosorbide ditrate, Isosorbide, Mononitrate?

Answer 22

Endothelium independent vasodilator

Inhibits platelet aggregation and leukocyte-endothelial interactions–anti-inflammatory

Question 23

What are the side effects of Isosorbide ditrate, Isosorbide, Mononitrate?

Answer 23

Tolerance with chronic use
HA
Hypotension
Activation of Bezold-Jarisch reflex–causes bradycardia

Decrease preload

Question 24

Ca++ channel blocker used for angina and Raynauds, 1st generation dihydropyridine?

Answer 24

Nifedipine

Question 25

Ca++ channel blockers that are 1st line agent for coronary vasospasm also used for angina and Raynauds, 2nd generation dihydropyridines?

Answer 25

Amlodipine
Felodipine
Isradipine

Question 26

Ca++ channel blockers used for HTN, anti-antignal effects–decrease myocardial O2 demand, and SVT, non dihydropyridines?

Answer 26

Verapamil

Diltiazem