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Flashcards in Pharm for ischemic heart disease Deck (52)
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1

Nitrates class?

- nitroglycerin (nitrostat, Nitroquick)
- isosorbide dinitrate (Isordil)
- isosorbide mononitrate (Imdur)
- transdermal patch (nitrodur)

2

Indications for Nitrates use?

- acute angina
- chronic angina
- CHF

3

MOA of nitrates?

- decrease O2 demand of heart
- decrease arteriolar and venous tone
- decrease preload and decrease afterload (at higher doses)
- cause vasodilation
- increases O2 to the heart
- decreases BP

4

In what diseases is preload increased?

- hypervolemia
- regurgitation of cardiac valves
- heart failure

5

In what diseases is afterload increased?

- HTN and vasoconstriction
(increased after load = increased cardiac workload)

6

What are short acting nitrates used for?
- dosage?

- immediate relief of anginal sxs
- sublingual nitro tablets or spray: 0.4 mg and repeat in 3-5 minutes if needed (up to 3)
- pain lasting more than 20 minutes should go to ED via EMS

7

What are the most common SEs from nitrates?

- HA
- dizziness (from lowering BP)
- Hypotension
- flushing

8

CIs to nitrates?

- hypotension
- aortic stenosis
- severe volume depletion
- acute RV infarction
- hypertrophic cardiomyopathy
- recent meds for ED: sildenafil (viagra), vardenafil (levitra), tadalafil (Cialis)

9

When are long acting nitrates used?

- added to B blockers or CCBs to control stable angina (not first line because you want to save nitrate for when angina can't be controlled by other meds, don't want to become tolerant)
- limited by development of tolerance
- need a nitrate free interval for 8-10 hours a day

10

Types of long acting nitrates?

- isosorbide dinitrate (Isordil)L 5-40 mg BID to TID
- Isosorbide mononitrate (Imdur - most common) 30-120 QD to BID
- transdermal patch (NitroDur): 0.1, 0.2, 0.4, 0.6 mg/hr (low dose for people with hypotension)

11

B blockers class?

- metoprolol (Lopressor, toprol)
- bisoprolol (zebeta)
- atenolol (tenormin)
- carvedilol (coreg)

12

Indications for B blockers use?

- HTN
- tachycardia
- CHF
- ischemic heart disease
NSTEMI
STEMI
unstable angina
chronic angina

13

B blockers are first line therapy for tx of what?

- tx of chronic angina

14

MOA of B blockers?

- blocks b receptors in heart causing a decrease in HR, decrease in force of contraction, decrease of AV conduction
- only antianginal agents that have been demonstrated to prolong life in pts with CAD post MI
- most commonly used is Metoprolol

15

B blocker CIs

- severe bronchospasm (asthmatics)
- bradyarrhythmias
- decompensated heart failure (in midst of acute exacerbation)
- may worsen Prinzmetal's (variant) angina due to leaving alpha 1 receptors unopposed

16

Caution in B blocker use

- they may mask sxs of hypoglycemia (tachycardia, diaphoresis) - so caution in diabetics
- abrupt withdrawal may precipitate tachycardia, HTN crisis, angina or MI so it must be tapered off slowly (especially high doses) to prevent these sxs

17

Drugs in CCB class?

Amlodipine (Norvasc)
Nifedipine (Adalat, Procardia)
DIltiazem (Cardizem)
Verapamil

18

Indications for CCB use?

- HTN
- tachycardia
- chronic angina
- coronary vasospasm
- peripheral vasospasm

19

MOA of CCBs?

- decrease O2 demand
- decrease preload
- decrease HR (verapamil and diltiazem)
- decrease BP
- decrease contractility (verapmil, diltiazem)
- increase O2 supply
- cause coronary vasodilation

20

2 different subclasses of CCBs?

- dihydropyridines:
Amlodipine (Norvasc) - can be used in HF
Nifedipine (Adalat, Procardia)
- Nondihydropyridines:
Diltiazem (Cardizem), and Verapamil
(have neg chronotropic rate and neg inatropic effect)>

21

Common SEs of CCBs?

- HA
- edema
- constipation
- hypotension
- dizziness
- bradycardia (nondihydropyridines)

22

CI for nondihydropyridines?

- systolic CHF: b/c low EF
- AV block or bradycardia

23

CI for all CCBs?

- caution when using in pt's with peripheral edema or hx of hypotension (elderly), multiple drug interactions - metabolized by the liver (use caution)

24

What are anti platelet drugs function?

- interfere either with platelet adhesion and/or aggregation
goal: prevent initial clot formation

25

Fxn of fibrinolytic agents?

- degrade fibrinogen/fibrin
goal: eliminate already formed clots

26

Fxn of anticoagulants?

- inhibit clotting mechanism, goal: prevent progression of thrombosis

27

What are the antiplatet agents?

- aspirin
- clopidogrel (plavix)
- prasugrel
- Ticagrelor

- acute situations IV:
Abiciximab and Eptifibatide

28

MOA of aspirin?

- inhibits cox: this then inhibits synthesis of thromboxane A2, a potent stimulator of platelt aggregation
- irreversible platelet inhibitor
- prevents form. of clots by inhibition of platelet plug
- rapid absorption with peak effects in 1 hr

29

Dosing recommendations of aspirin and indication?

- primary prevention of CVA/MI: 81 mg daily
- 2nd prevention of CVA/MI: depends on other meds. acutely 325 mg daily for MI and CVA
- acute coronary syndrome: 325 mg chewed x 1

30

Is ASA beneficial in unstable angina?

- study showed that aspirin lead to a 51% reduction in CV events