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Ripley Rotation
Ischemic Heart Disease
14
Pharmacology
Post-Graduate
04/18/2011

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Cards

Term
Unalterable risk factors
Definition
gender; age; family history or genetic composition; environmental influences such as climate, air pollution, trace metal composition of drinking water; and to some extent, diabetes mellitus
Term
Risk factors that can be altered
Definition
smoking, hypertension, hyperlipidemia, obesity, sedentary lifestyle, hyperuricemia, psychosocial factors such as stress and type A behavior patterns, and the use of certain drugs that may be detrimental, including progestins, corticosteroids, and cyclosporine.
Term
cigarette smoke
Definition
elevated heart rate and blood pressure from nicotine
he negative inotropic effect of carboxyhemoglobin
increased platelet adhesiveness and promotion of aggregation resulting in thrombotic tendencies because of nicotine and carboxyhemoglobin; (d) lowered threshold for ventricular fibrillation during ischemia as a consequence of carboxyhemoglobin; and (e) impaired endothelial function owing to smoking
Term
Blood pressure goals
Definition
<130/80 mm Hg for patients with stable angina, unstable angina, non–ST-segment myocardial infarction, ST-segment myocardial infarction and <120/80 mm Hg in patients with left ventricular dysfunction
Term
ABCDE
Definition
A – anticoagulation, ACE-I/ARBs, anti-anginals.
B – beta blockers, blood pressure.
C – cholesterol management, cigarette smoking, cardiac re-vascularization.
D – diabetes, diet.
E – education, exercise
Term
Risk Factors for IHD
Definition
• Age (NCEP says males over 45, females over 55. JNC says males over 55, females over 65).
• Family History (CHD in 1st degree male before 55 or female before 65).
• Current cigarette smoking.
• Hypertension (over 140/90 or on HTN medication).
• Dyslipidemia (low HDL, high TC and LDL).
• Diabetes Mellitus – considered to have “equivalent risk” as someone who already has IHD.
• Microalbuminuria.
• Physical inactivity.
• Type A personality – controversial, but clotting factors are elevated in these people.
• Alcohol ingestion is not a risk factor for development of CAD, moderate amounts decrease CAD.
Term
TIMI risk score
Definition
This is a seven-point risk score for ACS pts to predict the risk of death, re-infarction or severe ischemia.
•Age > 65 years.
•More than three coronary risk factors.
•Prior angiographic coronary obstruction.
•ST-segment deviation.
•More than 2 angina events within 24 hours.
•Use of aspirin within 7 days.
•Elevated cardiac markers.

• 0-2 = low risk
• 3-4 = intermediate risk
• 5-7 = high risk
Term
Aspirin MOA
Definition
Aspirin affects platelet aggregation by irreversibly inhibiting prostaglandin cyclooxygenase. This effect lasts for the life of the platelet and prevents the formation of the platelet aggregating factor thromboxane A2. Nonacetylated salicylates do not inhibit this enzyme and have no effect on platelet aggregation. At somewhat higher doses, aspirin reversibly inhibits the formation of prostaglandin I2 (prostacyclin), which is an arterial vasodilator and inhibits platelet aggregation.
Term
Plavix MOA
Definition
Clopidogrel must be metabolized by CYP-450 enzymes to produce the active metabolite that inhibits platelet aggregation. The active metabolite of clopidogrel selectively inhibits the binding of ADP to its platelet P2Y12 receptor and the subsequent ADP-mediated activation of the glycoprotein IIb/IIIa complex, thereby inhibiting platelet aggregation. This action is irreversible. Consequently, platelets exposed to clopidogrel's active metabolite are affected for the remainder of their lifespan (approximately 7 to 10 days). Platelet aggregation induced by agonists other than ADP is also inhibited by blocking the amplification of platelet activation by released ADP
Term
Prasugrel MOA
Definition
Prasugrel is a thienopyridine class inhibitor of platelet activation and aggregation through the irreversible binding of its active metabolite to the P2Y12 class of adenosine diphosphate receptors on platelets
Term
Coronary risk factors
Definition
• Hypertension
• Hyperlipidemia
• Diabetes
• Smoking
• Family History
Term
Goals of therapy
Definition
The short-term goals of therapy for ischemic heart disease are to reduce or prevent the symptoms of angina that limit exercise capability and impair quality of life. Long-term goals of therapy are to prevent CHD events such as myocardial infarction, arrhythmias, and heart failure and to extend the patient's life.
Term
Use of anti-platelet therapy in patient's at risk of IHD
Definition
Those with a 10-year risk greater or equal to 10%.
•Aspirin – 75-162.5mg QD.
oRole of ASA in women is controversial. Irreversible platelet inhibitor.
o81mg almost completely inhibits Thromboxane A2 synthetase. Platelet half-life 7-10 days.
•clopidogrel (Plavix) – 75mg QD
oThienopyridine that irreversibly inhibits ADP induced platelet aggregation.
o For those intolerant to ASA.
Term
Ranexa MOA
Definition
intracellular sodium leading to reduced calcium overload, decreasing wall tension and contractile dysfunction
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