L9. Myocardial infraction Flashcards
nitroglycerin
- symptomatic
- nitrate
- indication: effort angina, variant angina, acute coronary syndrome
- increases production of nitric oxide which increases cGMP levels which causes vasodilation –> vasodilation brings more blood flow to the heart which increases oxygen supply to the heart + reduces BP
- toxicity: orthostatic hypotension, tachycardia, headache
nifedipine, verapamil, diltiazem
- symptomatic
- Ca2+ channel blockers
- indication: effort angina, variant angina
- block calcium channels to adjust the contractility of the blood vessels
- vasodilator
- reduces cardiac work
- Ca2+ cannot turn into calmodium which blocks muscle contraction
- toxicity: orthostatic hypotension, AV blockage, edema
propranolol
- symptomatic
- beta blocker
- indication: effort angina, acute coronary syndrome
- reduces BP and cardiac work by reducing force and rate of contraction
- toxicity: orthostatic hypotension, tachycardia, headache
lovastatin
- prophylactic
- prevents plaque formation (atherosclerosis)
- lipid-lowering drug
- statin
- inhibits HMG-Co-A reductase that blocks de novo synthesis of cholesterol
- may damage skeletal muscle or liver, interferes with myelination of infants
cholestyramine
- prophylactic
- prevents plaque formation (atherosclerosis)
- lipid-lowering drug
- resin
- non-absorbable macromolecules that bind to cholesterol and prevent reabsorption from gut
- side effects: unpleasant taste, upsets GI, interferes with vitamin/drug absorption
vitamin B3 (nicotinic acid)
- prophylactic
- prevents plaque formation (atherosclerosis)
- lipid-lowering drug
- niacin
- action not well understood, but it decreases secretion of VLDL in the liver
- side effects: occasional flush with itching,
rarely causes glucose intolerance
gemfibrozil
- prophylactic
- prevents plaque formation (atherosclerosis)
- lipid-lowering drug
- fibrates
- activates peroxisome proliferator-activated receptor-alpha (PPARa) which increases lipoprotein lipase synthesis
- side effects: nausea, skin rash, occasional increased risk of gallstones
warfarin
- prophylactic
- prevents plaque formation (atherosclerosis)
- anti-coagulant
- blocks reactivation of vitamin K epoxide, vitamin K antagonist binds coagulation factors II, VII, IX and X
- side effects: teratogenic, bleeding – side effect monitored via prothrombin time test
contraindicated during pregnancy
heparin
prophylactic
- prevents plaque formation (atherosclerosis)
- anti-coagulant
- HMW: binds coagulation factor Xa and antithrombin III (effect must be monitored, used in hospitals)
- LMW: inhibits factor Xa, but has less effect on antithrombin III (predictable response, doesn’t have to be monitored)
streptokinase
prophylactic
- prevents plaque formation (atherosclerosis)
- fibrinolytic
- bacterial culture
- converts plasminogen to plasmin, an enzyme that break down fibrin dissolving blood clots
- plasmin breaks down thrombi
- cost effective
- to treat pulmonary embolism and myocardial infraction
- side effects: allergic response or bleeding
tissue plasminogen activators
prophylactic
- prevents plaque formation (atherosclerosis)
- fibrinolytic
- expensive
- activation of plasminogen bound to fibrin to plasmin
- side effects: bleeding
aspirin and ibuprofen
prophylactic
- prevents plaque formation (atherosclerosis)
- anti-platelet
- inhibits platelet cyclooxygenase, blocking the synthesis of thromboxane A2
- indications: transient ischemic attacks and myocardial infarction
side effects: Bleeding, GI ulceration (aspirin)
people often take Aspirin as prophylactic drugs, they can reduce the chance of a 2nd heart attack
ticlopidine and clopidogrel
prophylactic
- prevents plaque formation (atherosclerosis)
- anti-platelet
- mechanism: Alternative to aspirin (when allergic), inhibits platelet response by blocking the ability of secreted ADP to bind to adenosine receptors
- indications: transient ischemic attacks and myocardial infarctions
side effects: bleeding, skin Rashes
