Ischemic Heart Disease Pharm Flashcards
Unstable Angina
1) oxygen
2) ASA: anti-platlet
3) Heparin/Enoxaparin: anti-thrombotic, prevents fibrin formation of clotting cascade
4) Nitro: dilates coronary arteries, increase blood flow to heart
5) IV beta-blockers: reduce myocardial O2 demand, slows down the heart, decreases contractility, decrease HR
Others:
-Clopidogrel (Plavix): alt to ASA, platelet inhibitor
Glycoprotein IIb/IIIa inhibitors: unstable angina w/ active CP alt to all above, typically given in cath lab to prevent clotting of stent placement. Inhibit platelet aggregation
Stable Angina
1) Nitrates: vasodilator, reduce filling pressure, improve perfusion. AE: HA, lightheaded, syncope. Acute: sublingual Prevention: long acting forms (oral patch/paste) constant low level of NTG
2) ASA: anti-platelet. AE: GI bleeding. Reduces MI risk and mortality, all pts w/ angina should take
3) Beta Blockers: decrease HR and contractility, reduce myocardial demand. AE: bradycardia, hypotension, syncope, fatigue, dizzy, HA. shouldn’t take in pts w/ HR <60 and respiratory disease
4) CaCB: block Ca channels in arteries and cardiac muscle, reduce Ca entry thru cell membrane, decrease HR and contractility, reduce coronary arterial spasm, peripheral arterial vasodilation. AE: bradycardia, constipation, edema, HA
Acute MI
1) Same as unstable angina: O2, ASA, Heparin, IV Nitro, Beta-Blockers, Morphine
2) Cath Lab: primary angioplasty w/ stent placement to immediately remove clot
3) TPA if cath lab not available, thrombolytic therapy, dissolves the clot, converts plasminogen to plasmin. Indicated: ST elevation in 2 or more ECG leads, New LBBB in pt w/ typical MI sxs. CI: Gi hemorrhage, prolonged CPR, intracranial neoplasm or aneurysm, previous hemorrhagic stroke, preg, recent trauma/surgery, poorly controlled HTN, active peptic ulcer, previous stroke, known bleeding disorder, hepatic insufficiency, hemorrhagic retinopathy. Most effective in 1t mins to hrs after MI, give w/ ASA
