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58 Cards in this Set
- Front
- Back
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What are treatment goals when treating someone with PVD and/or CAD?
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bp < 130/80
cholesterol LDL < 100 (unless high-risk, then want less than70 Total Cholesterol < 200 TG <150 |
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What 7 things should you consider when treating CAD?
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1. ACEI/ARB
2. Anticoagulation (if high risk for MI or CVA; use warfarin) 3. Antiplatelet (ASA or Plavix) 4. Beta Blocker 5. CCB 6. Lifestyle changes 7. Statin |
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What 6 things are important when treating PVD?
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1. treat other diseases
2. alter modifiable risk factors 3. ACEI (if HTN) 4. Statin (if dyslipidemia) 5. glycemic control (if DM) 6. Antiplatelet (ASA or Plavix to prevent CV event) |
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What non-Rx treatment options are there for CAD/PVD?
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1. increase omega 3 fatty acids (1+gram per day)
2. increase fruits, veggies, whole grains, and fiber in diet 3. supplement: vit C, E, beta carotene 4. discontinue sat. and trans fat 5. increase exercise (30-60 min 3+ days a week) |
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What are the important molecules to look for when starting omega 3 fatty acid therapy?
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DHA
EPA |
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What 4 drugs are available for antiplatelet therapy for CAD/PVD?
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1. aspirin
2. aggrenox 3. plavix 4. ticlid |
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What is the first line antiplatelet treatment for CAD/PVD without CI or high-risk?
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aspirin (low-dose)
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What do you use for antiplatelet treatment in a patient who is either allergic to aspirin or is considered "high-risk"
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Plavix
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If a patient is pregnant and needs antiplatelet therapy for CAD/PVD, what do you give her?
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Plavix
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What is the MOA of aspirin?
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irreversible inhibits prostaglandin COX in platelets which prevents TXA2 formation and prevents platelet aggregation.
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What properties does aspirin have when dosed at less than 100mg?
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antiplatelet
analgesiac antipyretic |
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What properties does aspirin have when dosed at higher than 100mg?
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anti-inflammatory
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What pregnancy category (ies) does aspirin fall in?
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C;C;D
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What are common ADEs associated with aspirin therapy?
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1. Indigestion
2. stomach ulcer/bleeding |
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What is aggrenox?
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an antiplatelet drug that is ASA combined with dipyridamole ER
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What are significant ADEs associated with Aggrenox?
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1. increased GI side effects
2. increased bleed risk 3. headache 4. indigestion |
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Aggrenox has an ADE that is observed LESS frequently than it is observed in aspirin therapies. What is it, and why is this so?
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decreased risk of stomach ulcers with aggrenox because lower aspirin is in the combination drug than pure aspirin.
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What are CI for Aggrenox?
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1. CAD
2. Hypersensitivity to NSAIDS (aspirin allergy) |
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MOA of dipyridamole (Aggrenox)
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1. inhibits uptake of adenosine into platelets, RBCs, and endothelial cells which increases extracellular adenosine which then acts on A2 receptors on platelets to increase levels of cAMP
2. increased cAMP inhibits platelet aggregation. 3. inhibits PDE- which increases the release of cGMP produced by NO |
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What pregnancy category does Aggrenox fall into?
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D
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Clopidogrel (Plavix) is indicated for use in patients who:
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1. have CI to aspirin (NSAIDS)
2. are considered "high-risk" |
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Does Plavix have more/less therapeutic benefit than aspirin?
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more; but is much more expensive.
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What is the MOA of Plavix?
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inhibits ADP analogue binding to ADP platelet receptor--prevents activation of GPIIb/IIIa receptor complex, so there is IRREVERSIBLE platelet inhibition.
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what pregnancy category is plavix in?
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B
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Ticlodipine (Ticlid)- reason not prescribed often
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increased ADEs and prolongs bleeding time and has not been shown to be superior to other tx options.
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MOA of Ticlodipine (Ticlid)?
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inhibits ADP analogue binding to platelet receptor, so have irreversible platelet inhibition
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Common ADEs associated with Ticlodipine (Ticlid)?
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1. Rash: must monitor to see if it becomes macular/papular in nature
2. Dyspepsia 3. Gas 4. NV |
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What are more severe (rare) ADEs associated with Ticlodipine (Ticlid)?
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1. neutropenia
2. aplastic anemia 3. hepatotoxicity 4. blood dyscrasias 5. chronic diarrhea 6. GI ulcer |
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When should you take Ticlodipine (Ticlid)?
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with food
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When is the peak response of Ticlodipine (Ticlid)?
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2-5 days.
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What drugs can be prescribed to treat intermittent claudication?
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1. Cilostazol (Pletal)
2. Pentoxigylline (Trental, Pentoxil) |
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MOA of Cilostazol (Pletal)
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1. inhibit PDE III and decrease cAMP degradation- leads to increased cAMP in platelets and blood vessels.
2. reversibly inhibits platelet aggregation 3. vasodilation (not in renal arteries) -- leads to increased HR and contractility (to compensate for vasodilation) |
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Pregnancy category of Cilostazol (Pletal)
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C
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ADEs of Cilostazol (Pletal)
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1. palpitations/tachycardia
2. peripheral edema 3. HEADACHE 4. GI: indigestion/diarrhea/abdominal -pain 5. myalgia 5. dizziness |
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Rare ADEs associated with Cilostazol (Pletal)
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1. CHF
2. A Fib 3. MI |
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CI of using Cilostazol (Pletal)?
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HF- of ANY degree
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When should you take Cilostazol (Pletal)?
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30 minutes before or 2 hours after a FATTY meal-- leads to increased optimal absorption
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Cilostazol (Pletal) works as a vasodilator. What arteries are the exception, and are NOT affected?
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renal arteries
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What is the last line medication for intermittent claudication tx?
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Pentoxifylline (Trental, Pentoxil)
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What is the first line medication for intermittent claudication tx?
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Cilostazol (Pletal)
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What is the MOA of Pentoxyfylline (Trental, Pentoxil)?
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1. alters RBC flexibility
2. decreases platelet adhesion 3. decreases blood viscosity 4. decreases conc. of fibrinogen |
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What are the CI of using Pentoxifylline?
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use NSAIDS- will increase bleed risk with both medications being taken together
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ADEs that are commonly associated with Pentoxifylline?
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1. Indigestion
2. headache |
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Rare ADE associated with Pentoxifylline?
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Arrhythmias
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The ER formulation of Pentoxifylline requires how many doses/day and when should you take it?
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TID; with food (so with each meal)
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What is the 1st line treatment of CAD without CI?
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aspirin AND statin AND anti-HTN
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What anti-HTN is most frequently used in combination with CAD treatment?
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ACEI. Then ARB
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Is BB considered superior to ACEI/ARB treatment? When should you use a BB?
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no
use as add-on treatment or if patient has CI or is intolerant to ACEI/ARB therapy. |
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What is the treatment of CAD for a patient who also has a significant risk of embolism?
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coumadin + aspirin
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What is the treatment of CAD for a patient after an MI with LV thrombosis?
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Coumadin
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If you have to use a BB, what type should you use?
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one without intrinsic sympathomimetic activity.
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Which BB should you NOT use?
WHY |
Pindolol
Acebutolol *PIN da Ass*- don't use because they have increased intrinsic sympathomimetic activity. |
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If you are treating CAD in a patient with HF, what BB should you use?
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carvedilol, metoprolol ER, or bisoprolol
*my heart was full, the carver was mighty busy*- beta blockers to use for CAD in HF (heart was full= HF; carver = carvedilol; mighty= metoprolol ER; busy= bisoprolol. |
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what is third line treatment for a atient with CAD?
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CCB
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When should you use CCB?
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1. if ACEI/ARB, BB is NOT indicated
2. patient has angina |
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if you have to use a CCB for treatment of CAD, which type should you use?
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DHP CCB
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What are two examples of appropriate CCB to use for third-line treatment of CAD?
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felodipine
amlodipine "it dipines on if the others dont work"- use "dipines" after ACEI/ARB and BB have failed and/or are not indicated for use. |
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First line treatment for BP regulation in a patient with CAD?
Second line? Third? |
1. ACEI/ARB
2. BB without intrinsic sympathomimetric activity 3. DHP CCB |
