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靠北CV吳老師藥理 - Coggle Diagram

- - - - mevastatin
      - lovastatin
      - simvastatin
    - - pravastatin
      - fluvastatin
    - - chol下降→vldl下降→ldl下降
      - 因vldl下降→tg下降
      - ldl receptor增加→ldl回收增加→chol下降下降下降
    - - Hepatotoxicity
      - Myopathy and 橫紋肌溶解症 (rhabdomyolysis): creatine phosphokinase (CPK) 上昇
    - - warfarin
      - erytromycin, azole antifungal, grapefruit juice
      - gemfibrozil
  - - - 跟statin很像，只是LDL receptor沒降，作用小
    - - colesevelam
        
        less GI intolerance
      - colestipol
      - cholestyramine
        
        配果汁、陰離子
  - - - β-sitosterol
      - ezetimib
        
        liver dysfunction不要用
  - - - inhibits lipolysis
      - Niacin inhibits VLDL secretion, in turn decreasing production of LDL
      - thrombosis ↓
    - - flushing (due to cutaneous vasodilation and sensation of warmth) and dyspepsia
      - Pruritus
      - liver toxicity
  - - - Gemfibrozil
        
        不可與statin一起 (myopathy and rhabdomyolysis
      - fenofibrate
        
        prodrug
    - - ligand for PPAR-α, upregulate LPL
    - - gastrointestinal (GI) disturbances
      - gallstones (increase biliary cholesterol excretion)
      - Myositis
  - - - PCSK9把LDL receptor degrade掉
- - - - MOA
        
        inhibit TXA2 formation
      - last for 7-10 days
      - t recurrent MI, 作用weak
    - - PDE inhibitor
        
        Dipyridamole
        
        MOA
        
        coronary vasodilator via the increase of cytosolic cGMP
        
        treat angina pectoris, usually given in combination with aspirin
        
        side effect
        
        headache, hypotension
        
        Cilostazol
        
        MOA
        
        increase cAMP
        
        treat intermittent claudication
    - - ADP receptor antagonists (Selectively and irreversibly blocks ADP
        不可逆！！
        
        ticlopidine
        
        side effect
        
        neutropenia
        
        thrombotic thrombocytopenia purpura (TTP)
        
        clopedogrel and prasugrel
        
        less toxicity than ticlopidine
        
        Routinely used in stent
        
        secondary prevention of stroke and peripheral vascular diseases
      - GP IIb/IIIa antagonists
        
        abciximab
        
        t acute coronary syndrome
        
        IV, 24-48 hrs
        
        side effect
        
        bleeding, especially used with anticoagulants
        
        tirofiban and eptifibatide
        
        mimic arginineglycine-aspartate (RGD) seq. of fibrinogen
  - - - Unfractionated heparin (UFH)
        
        2a9a10a
        
        monitoring of the activated partial thromboplastin time (aPTT or PTT )
      - LMW heparin (Enoxaparin and dalteparin)
        
        10a
      - fondaparinux
        
        10a
      - t deep vein thrombosis (DVT) and pulmonary embolism
      - side effect
        
        Bleeding (be treated with protamine sulfate
        
        Thrombocytopenia
        
        IM of heparin causes hematoma formation
    - - MOA
        
        抑制Vit K reductase作用
      - prevent acute DVT or pulmonary embolism following an initial course of heparin
        prevent VT in pts’ undergoing orthopedic or gynecological surgery and systemic embolization in pts’ with AMI, prosthetic heart valves, or chronic atrial fibrillation
      - side effect
        
        Minor bleeding → oral ad. of vitamin K
        Severe bleeding → IV inj. of vitamin K or fresh frozen plasma (FFP)
      - 不能
        
        吃菠菜
        
        給孕婦
  - - - Hirudin
      - lepirudin
        
        t heparin-induced thrombocytopenia; HIT
      - bivalirudin
        
        percutaneous coronary angioplasty
      - Argatroban
        
        only at the thrombin active site
        
        t HIT
      - Dabigartran etexilate (PRADAXA®)
        
        prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation
        
        enoxaparin for thromboprophylaxis in orthopedic surgery
        
        oral
    - - Rivaroxaban
        
        is approved for treatment and prevention of DVT and PE and for the prevention of stroke in nonvalvular atrial fibrillation
      - apixaban
        
        stroke prevention in nonvalvular atrial fibrillation