Ischemic heart disease

Question 1

Heparin

Answer 1

Class:
Anti-coagulant

MOA:
Complexes with antithrombin III

Clinical uses:
venous thrombosis, PE, MI, unstable angina

Toxicity:
bleeding, thrombocytopenia, osteoporosis

Note: monitor carefully if given with other anticoagulants

Question 2

Enoxaparin

Answer 2

Class:
Anti-coagulant, low MW heparin

Other drugs:
tinzaparin, dalteparin

MOA:
Complexes with antithrombin III

Clinical uses:
venous thrombosis, PE, MI, unstable angina

Toxicity:
bleeding, thrombocytopenia, osteoporosis

Note:
monitor carefully if given with other anticoagulants, longer duration of action than unfractionated heparin

Question 3

Clopidogrel

Answer 3

Class:
Anti-platelet

Other drugs:
Ticlopidine, prasugrel

MOA:
non-competitive P2Y12 receptor antagonist

Clinical uses:
venous thrombosis, PE, MI, unstable angina

toxicity:
bleeding and itching

Note:
DDIs with PPIs

Question 4

Abciximab

Answer 4

Class:
Anti-platelet

other drugs:
epitifibatide, tirofiban

MOA:
Glycoprotein IIb/IIIa antagonist

Clinical uses:
ACS, prevent restenosis during PCI, unstable angina

Toxicity:
bleeding, thrombocytopenia

Note:
DDIs with anticoagulants and thrombolytics

Question 5

Acetylsalicylic acid (Aspirin)

Answer 5

Class:
Anti-platelet inhibitor

MOA:
Non selective Irr. cyclooxygenase inhibitor

Clinical uses:
prevention and treatemnt of arterial thrombosis, anti-inflammatory

toxcity:
GI and nehpro-toxic, hypersensitivity reactions,

Note:
DDIs with NSAIDs, acetazolamide, corticosteroids, sprinolactone

Question 6

Alteplase

Answer 6

Class:
Thrombolytics

Other drugs:
Reteplase, tenecteplase

MOA:
Converts plasminogen to plasmin

Clinical uses:
Coronary artery thrombosis, PE, ischemic stroke

Toxicity:
bleeding, cerebral hemorrhage

Note: analog of endogenous tissue plasminogen activating factor (tPA)

Question 7

Streptokinase

Answer 7

Class:
Thrombolytics

other names:
urokinase, staphylokinase

MOA:
converts plasminogen to plasmin

Clinical uses:
coronary artery or deep vein thrombosis, PE, and ischemic stroke

toxicitiy:
bleeding, cerebral hemorrhage

Note:
isolated from strepcocci

Question 8

Nitroglycerin

Answer 8

Class:
Vasodilator

other names:
isosorbid dinitrate, nitroprusside

Toxicity:
tachycardia, hyptoension

Note:

sublinual: short duration
oral: long duration