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Pharm - Atherosclerosis
Meds
32
Health Care
Graduate
09/08/2016

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Term
Pathophys Coronary Artery Disease (CAD)
Definition
Also known as ischemic heart disease. Occurs due to lack of O2 to myocardium as a result of coronary artery narrowing (high cholesterol plaques). May present as angina or acute myocardial infarction (MI)
Term
Pathophys of CAD cont..
Definition
Decreased Oxygen Supply: decreased coronary blood flow, vessel caliber, perfusion pressure. Increased HR, ventricular wall tension.
Increased O2 Demand: Increased HR, contractility, ventricular wall tension, filling pressure (preload), resistance to ejection (afterload)
Term
Presentation of CV event
Definition
Angina (30 seconds - 30 minutes)
Burning/chest tightness/pressure
SOB
Pain w/radiation to the arms.
Precipitated by exercise, large meals, emotional stress.
Term
3 Types of Angina
Definition
Stable (exertional): most common. no pain at rest but increasing O2 demand mismatched w/decreased O2 supply, angina results. Rest and Nitro
Prinzmetal's (Variant): results from coronary spasm. Sx occur at rest and usually during night or morning. No chest pain w/exertion and not typically relieved by rest.
Unstable: chest pain w/minimal activity. Differing times of the day. preceeds a CV event such as MI.
Term
Treatments for Angina
Definition
Nitrates (direct vasodilators)
Beta Blockers (HR control/contractility)
Calcium Channel Blockers (contractility)
Aspirin (anti-platelet)
Surgery (angioplasty/stenting)
Term
Nitrates: MOA, drugs, and ADE's
Definition
MOA: dilation of systemic veins and arterioles = reduction of preload and afterload.
Nitroglycerin and Isosorbide dinitrate/mononitrate.
ADE's: reflex tachycardia, dizziness, ortho hypotension, weakness, headache.
Precaution: avoid heat modality w/vasodilators can cause syncope.
Term
Nitrate administration
Definition
Nitroglycerin sublingual, tablets, IV, topical, patch. More effective if taken at immediate onset of angina. Can be taken 5-10 mins before activity that may cause angina. Patches placed above elbow, preferred on chest to max effect. Drug free periods are important to avoid tolerance.
Term
Beta Blockers: MOA contraindications and nomenclature
Definition
MOA: reduce myocardial O2 demand via decreased contractility.
CI: asthmatics (non-specific BBs), bradycardia, hypotension and heart block
"lols"
Term
Calcium Channel Blockers: MOA and drugs
Definition
MOA: reduction of contractility and cardiac tone resulting in decreased O2 demand. smooth muscle vasodilation w/reduction in preload/afterload.
Nifedipine/Amlodipine = greater smooth muscle effects.
Verapamil/Diltiazem reduce contractility and slow conduction of nodal tissue.
Term
MONA-B
Definition
Morphine causes vasodilation/pain relief
Oxygen to stabilize O2 saturation
Nitrates cause vasodilation/pain relief
Aspirin to inhibit further platelet aggregation
Beta blocker to help decrease rates of re-infarction
Term
Clot Cascade
Definition
1 - endothelial cell damage
2 - platelets bind to damaged vessel
3 - release thromboxane ADP, fibrinogen, Ca++
4 - recruit other platelets
5 - glycoprotein receptors IIb /IIIa on cell surface conformational change
6 - these receptors allow binding CLOT
Term
Extrinsic vs Intrinsic clot systems
Definition
Extrinsic: measured by prothrombin time
Intrinsic: measured by activated partial thromboplastin time
Term
3 ways to prevent/treat clot
Definition
1) Inhibit platelet aggregation (antiplatelet agents) aspirin
2) Prevent extension of existing clot
(anticoagulants) heparin
3) Lyse the clot (thromolytic agents) streptokinase
Term
Antiplatelet Therapy
Definition
Aspirin - irreversible binding to COX1 and COX2, inhibiting platelet aggregation
ADE's: bleeding bruising, GI irritation
Clopidogrel (Plavix) - ADP receptor antagonist by irreversibly blocking
ADE's: bleeding bruising
Term
Anticoagulants: Heparinoids
Definition
Heparin: subQ to prevent DVT or IV
Enoxaparin (Lovenox)
Fondaparinux (Arixtra)
ADE's: bleeding, bruising, injection site pain
Term
Anticoagulants: Warfarin (Coumadin)
Definition
MOA: vitamin K antagonist, inhibiting vitamin k dependent clotting factors
ADE's: bleeding (major/minor);bruising
vitamin k tabs to reverse effects of warfarin
Term
Oral Factor Xa Inhibitors
Definition
Rivaroxaban (Xarelto)
Apixaban (Eliquis)
MOA: inhibits factor Xa and inhibits thrombin-induced platelet aggregation
ADE's: bleeding and bruising, duh
Term
Direct Thrombin Inhibitor
Definition
Dabigatran (Pradaxa)
MOA: inhibits free and fibrin-bound thrombin preventing thrombin-platelet aggregation
ADE's: bleeding and bruising
Term
PT Interventions w/antiplatelet/anticoagulants
Definition
Caution w/deep tissue work = bruising
Subjective info from patient about s/s of bleeding, and educate pts about bleeding. dark tarry stool, coughing up blood or coffee grounds, cuts not healing, blood in urine.
Careful changing dressings.
Term
Contraindications for Anticoagulant patients
Definition
Debridement
Rigorous manual techniques
Deep tissue massage
Chest percussions
Term
DVT and Pulmonary Embolism (PE)
Definition
low risk: minor surgery, full ambulatory
mod risk: undergoing general surgery, gynecologic surgery, on bed rest
high risk: major orthopedic surgery, spinal cord injury, major trauma, spinal cord injury
Term
DVT and Pulmonary Embolism (PE) Mgmt
Definition
Non-pharm: mobilization, external compression, filter devices, PROM for bed rest pts.
Meds: low molecular weight heparin, unfractionated heparin, warfarin (Coumadin), novel oral anticoagulants
Term
Management of Cholesterol
Definition
Statins
Bile Acid Resins
Ezetimibe
Fibric Acid derivatives/Fibrates
Nicotinic Acid
Term
Committal step in cholesterol synthesis
Definition
HMG-CoA conversion to MEVALONATE
Term
Statins (HMG-CoA Reductase Inhibitors)
Definition
First line therapy for cholesterol mgmt.
MOA: inhibits HMG-CoA reductase
ADE's: muscle pain, myopathy or rhabdomyolysis
Term
Statin drugs
Definition
Simvastatin (Zocor)
Atorvastatin (Lipitor)
Rosuvastatin (Crestor)
Provastatin (Pravachol)
Lovastatin (Mevacor)
Fluvastatin (Lescol)
Pitavastatin (Livalo)
Term
Bile Acid-Binding Resins
Definition
MOA: Bind bile salts secreted into duodenum preventing reuptake of bile salt-bound cholesterol
Cholestyramine (Questran)
Colesevelam (Welchol)
Colestipol (Colestid)
ADE's: GI Intolerance (abdominal pain, constipation, diarrhea, vomiting
Term
Fibrates
Definition
Have fibro in name. inhibit triglyceride synthesis. increase HDL.
GI upset common
Term
Nicotinic Acid
Definition
Niacin/Niaspan reduces free fatty acid metabolism from adpipocytes, reducing TG/LDL and total cholesterol
ADE's: flushing, GI upset, fatigue, increased uric acid
Term
Ezetimibe (Zetia)
Definition
Inhibits intestinal absorbtion leading to decreased LDL and TG
Term
PT Intervention concerns
Definition
Muscle pain and soreness
Concern for rhabdomyolysis when used w/statins AND other lipin-lowering meds.
Term
Intermittent Claudication
Definition
Pain with walking in calves, relieved with rest.
RF Mods: stop smoking, lower cholesterol, HTN control, diabetes control.
Meds:
Cilostazol (Pletal) vasodilate smooth muscle
Pentoxifylline (Trental): allows red/white cells squeeze through vessels, lowers fibrinogen and antiplatelet effects
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