Atherosclerosis

Question 1

preventative pharmacological management is and include

Answer 1

Primarily to minimise the formation of plaques. Anti platelets, lipid lowering drugs (statins), unfractionated (standard heparin), and warfarin

Question 2

Use of aspirin in CAD is as a

Answer 2

Preventative measure against stroke and AMI in patients with high risk factors

Question 3

Dose of aspirin

Answer 3

Typically 75-150mg/day

Question 4

How does aspirin work

Answer 4

Work by inhibiting platelet aggregation through stopping cyclo-oxygenase (COX) enzyme thus reducing the synthesis of thromboxane A2 (platelet stickiness and vasoconstriction)

Question 5

Common AEs of aspirin

Answer 5

Bleeding, GI irritation (at higher doses), allergy response (asthma, rhinitis)

Question 6

Lipid lowering drugs (statins) used in:

Answer 6

Use of these in hypercholesterolaemia (dyslipidaemia) aim to prevent AMI and stroke

Question 7

E.g. of lipid lowering drugs

Answer 7

Atorvastatin, Fluvastatin, simvastatin, pravastatin

Question 8

What do statins do

Answer 8

Inhibit 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, an enzyme responsible for total cholesterol syntheses and thus reduces total cholesterol

Question 9

Common AEs of statins

Answer 9

Include GI irritation, headaches, increased BGL, liver function abnormalities, rhabdomyolysis (0.1% affected), increased skeletal muscle destruction, altered cognition, risk of multiple sclerosis

Question 10

Clinically increasing statin levels in the blood can cause…

Answer 10

Myopathy and antibiotics (erythromycin) can increase the risk of rhabdomyolysis

Question 11

Unfractionated (standard) heparin is

Answer 11

Short-term treatment low molecular weight heparins (LMWHs)

Question 12

E.g. of unfractionated heparin

Answer 12

Enoxaparin

Question 13

How is unfractionated heparin administered

Answer 13

Subcut

Question 14

Low dose of unfractionated heparin is

Answer 14

For prevention

Question 15

High dose of unfractionated heparin is

Answer 15

For treatment

Question 16

Warfarin (oral) is

Answer 16

Long-term antithrombotic

Question 17

What does warfarin do

Answer 17

Inhibits synthesis of clotting factors which reduce the chance of further clots

Question 18

Restorative pharmacological management for atherosclerosis include

Answer 18

Thrombolytic agents used to treat acute vascular occlusions including DVT, pulmonary embolism, ischemic stroke and MI

Question 19

Thrombolytic agents end in

Answer 19

-ase

Question 20

E.g. of thrombolytic agents

Answer 20

Alteplase, Streptokinase, Urokinase

Question 21

How do thrombolytic agents work

Answer 21

Work by converting plasminogen to plasmin, a proteolytic enzyme that breaks the cross-links (structural integrity) between fibrin molecules which dissolves the thrombus/embolus (‘clot busting’)

Question 22

AEs of thrombolytic agents

Answer 22

Haemorrhage and allergic reactions

Question 23

Clinical considerations for thrombolytic agents

Answer 23

Avoid IM injections and other invasive procedures (insertion of NG tube, intubation, etc) during IV therapy.
If severe bleeding occurs, stop infusion.

Question 24

Contraindications for thrombolytic agents

Answer 24

Active internal bleeding
Neurosurgery within past six months
Recent (less than one month) major surgery or trauma
Intracranial neoplasm
Intracranial aneurysm