Fcm - Pharmacology Of Atherosclerosis

Front 1

Cholesterol guide lines for LDL

Back 1

LDL
<100 Optimal
101-129 Near Optimal
130-159 Borderline High
160-189 High
>190 Very High

Front 2

Cholesterol guide lines for HDL

Back 2

>40 Optimal
>60 High

Front 3

Cholesterol guide lines for total cholesterol

Back 3

<200 Optimal
200-239 Borderline High
>240 High

Front 4

Atherogenesis

Back 4

Disease of large arteries. It affects arteries in most of the vascular beds, but is most aggressive in the coronary, carotid, cerebral, iliac, renal, popliteal arteries and the thoracic and abdominal aorta. It is a systemic disease.

Vascular disease includes atherosclerosis and essential hypertension, and has reached epidemic proportions. 40% of all cause mortality is due to vascular disease.

Front 5

Nitric oxide

Back 5

Nature's atheroprotective molecule. NO production is stimulated by statins, ACE inhibitors, calcium channel blockers, and organic nitrates.

NO stimulates guanylyl cyclase, which inceases cGMP which, in turn, increases calcium sequestration into the SR and thus promotes vasodilation.

Front 6

Atherosclerotic syndromes

Back 6

Acute MI and angina pectoris

Front 7

Acute myocardial infarction

Back 7

The interruption of blood supply to part of the heart, causing some heart cells to die.

The overriding concept in acute MI is managing tissue ischemia. Myocardial energenics require that O2 supply always meet or exceed O2 consumption. When this is not met, ischemia results and contractility in the ischemic myocardium falls and the myocytes become increasingly at risk for developing life-threatening cardiac arrhythmias. The primary strategy is to restore myocardial energetics toward normal.

Front 8

Angina pectoris

Back 8

Severe chest pain brought on by myocardial ischemia.

Front 9

Variant angina

Back 9

Severe chest pain brought on by myocardial ischemia.. Coronary flow is reduced below O2 demand. Also called Prinzmetal's angina.

Front 10

Stable angina

Back 10

Severe chest pain brought on by myocardial ischemia. O2 demand is elevated above coronary flow. Also called effort angina.

Front 11

How is late stent thrombosis reduced?

Back 11

Long term aspirin and clopidogrel therapy.

Front 12

Sirolimus

Back 12

Macrolide antibiotic immunosuppressant which, when applied locally, has strong antiproliferative actions and inhibits cell cycle progression in vascular cells.

When coated on stents, sirolimus is slowly released over the first few weeks of stent placement, and impressively reduces restenosis after stent placement.

Front 13

Thrombolysis

Back 13

The breakdown (lysis) of blood clots by pharmacological means.

t-PA (tissue plasminogen factor; Alteplase, Reteplase) activates inactive tissue plasminogen to active plasmin, which lyses the thrombus from within.

Streptokinase is streptococcal protein complexed with proactivator plasminogen, which also activates inactive tissue plasminogen.

Front 14

Angioplasty (PCTA)

Back 14

Patients presenting with stable or unstable (but not variant) angina are frequently referred for catheter based stent placement (PCTA) for long term relief.

Anticoagulation with heparin is required and anti-platelet therapy (aspirin and IIB/IIIA inhibitors) is added and maintained if stents are used.

Front 15

Bypass surgery (CABG)

Back 15

Patients presenting with stable or unstable (but not variant) angina are frequently referred for CABG for long term relief.

Front 16

Peripheral vascular disease

Back 16

Includes all diseases caused by the obstruction of large arteries in the arms and legs. PVD can result from atherosclerosis, inflammatory processes leading to stenosis, an embolism or thrombus formation. It causes either acute or chronic ischemia (lack of blood supply), typically of the legs.

Front 17

Treatments for acute MI

Back 17

Aspirin, nitroglycerin, nasal oxygen, morphine, beta-blocker, and ACE inhibitor

POSSIBLY - thrombolysis or drug eluting stents

Front 18

Treatments for CAD

Back 18

Aspirin, ADP inhibitors, GP IIB/IIIA inhibitors

Front 19

Treatments for variant angina

Back 19

Organic nitrates and calcium channel blockers

Front 20

Treatments for effort angina

Back 20

Beta-blockers, nitrates, and calcium channel blockers

Front 21

Treatments for unstable angina

Back 21

Anti-platelet drugs, anticoagulation drugs, vasodilator therapy, and beta-blockers

More frequently, patients presenting with stable and unstable (but not variant) angina are referred for catheter-based (PTCA) stent placement or surgical (CABG) revascularization for long-term relief.