Please enable JavaScript.

Coggle requires JavaScript to display documents.

Stable Ischemic Heart Disease (SIHD), which abtianginal agents would be…

- - - - MOA
        
        irreversibly blocks COX-1 activity (~95%) for the life of the platelet (~10 d) thereby inhibiting thromboxane A2 production. This reduction in TA2 leads to reduced platelet activation and aggregation.
      - ADRs
      - Regimen
        
        per guidelines: 75-162 mg daily
      - Monitoring
        
        Monitor for signs and symptoms of drug reaction with eosinophilia and systemic symptoms (eg, fever, rash, lymphadenopathy, eosinophilia in association with other organ system involvement such as hepatitis, nephritis, hematological abnormalities, myocarditis, myositis; early symptoms of hypersensitivity reaction may occur without rash).
      - Duration
        
        forever 🙃
      - Contraindications
        
        Contraindications: Hypersensitivity to NSAIDs; patients with asthma, rhinitis, and nasal polyps; use in children or teenagers for viral infections, with or without fever.
        
        Precautions
        
        Hypoglycemia
        Salicylates may have a hypoglycemic action. They may also potentiate the effect of oral hypoglycemics, and the concomitant use of these agents is not recommended. However, if such use is necessary, reduced dosage of the hypoglycemic agent may be necessary. The hypoglycemic action of salicylates may also necessitate adjustment of the insulin dose of diabetics.
        
        Gout
        While salicylates in large doses have a uricosuric effect, smaller amounts may reduce urate excretion and increase serum uric acid. Therefore, avoid the use of salicylates in patients with gout.
        
        Alcohol warning
        Counsel patients who consume 3 or more alcoholic drinks every day about the bleeding risks involved with chronic, heavy alcohol use while taking aspirin.
        
        Coagulation abnormalities
        Even low doses of aspirin can inhibit platelet function, leading to an increase in bleeding time. This can adversely affect patients with inherited (hemophilia) or acquired (liver disease or vitamin K deficiency) bleeding disorders. Use aspirin with caution when anticoagulants are prescribed concurrently, because aspirin may depress platelet aggregation and increase bleeding time.
        
        GI adverse reactions
        GI adverse reactions include stomach pain, heartburn, nausea, vomiting, and gross GI bleeding. Although minor upper GI symptoms, such as dyspepsia, are common and can occur anytime during therapy, remain alert for signs of ulceration and bleeding, even in the absence of previous GI symptoms. Factors that increase the risk for GI bleeding in patients treated with NSAIDs include history of stomach ulcers or bleeding problems; concomitant use of oral corticosteroids, other NSAIDs, or anticoagulants;
        
        Peptic ulcer disease
        Use with caution in patients with erosive gastritis. Avoid use in patients with active peptic ulcer disease.
      - DDI/DFIs
        
        Substrate of CYP2C9 so strong inducers and inhibitors of 2C9
        
        Food may decrease the rate but not the extent of oral absorption. Benedictine liqueur, prunes, raisins, tea, and gherkins have a potential to cause salicylate accumulation. Fresh fruits containing vitamin C may displace drug from binding sites, resulting in increased urinary excretion of aspirin. Curry powder, paprika, licorice; may cause salicylate accumulation.
      - Special Populations
        
        Renal function impairment
        When using high dosages (eg, analgesic or anti-inflammatory uses), use with caution and monitor renal function or consider the use of an alternative analgesic/anti-inflammatory agent.Ref Low-dose aspirin (eg, 75 to 162 mg daily) may be safely used in patients with any degree of renal impairment.
        
        Hepatic function impairment
        Avoid aspirin in patients with severe hepatic insufficiency.
      - Education & Counseling
    - - Regimen
        
        75 mg/day for SIHD patients
  - - - PRN
    - - peripheral edema
      - Headache
    - - hypersensitivity to nitrates
      - PDE-5 inhibitors (sildenafil)
    - - Small Vd
      - excreted in urine
      - Fast onset of action
    - - Hypotension/bradycardia
    - - Sublingual tabs: 0.3 mg 5-10 mins prior to activities that may provoke angina
      - Sublingual powder: 1 pack 5-10 mins prior to activities that may provoke angina
    - - Nitroglycerin forms free radical nitric oxide (NO) which activates guanylate cyclase, resulting in an increase of guanosine 3'5' monophosphate (cyclic GMP) in smooth muscle
  - - - inhibits the late phase of the inward sodium channel (late INa) in ischemic cardiac myocytes during cardiac repolarization reducing intracellular sodium concentrations and thereby reducing calcium influx via Na+-Ca2+ exchange. Decreased intracellular calcium reduces ventricular tension and myocardial oxygen consumption. It is thought that ranolazine produces myocardial relaxation and reduces anginal symptoms through this mechanism although this is uncertain. At higher concentrations, ranolazine inhibits the rapid delayed rectifier potassium current (IKr) thus prolonging the ventricular action potential duration and subsequent prolongation of the QT interval.
    - - refractory SIHD
    - - CYP3A4 metabolism
      - time to peak 2-5 hrs
    - - bradycardia
      - dizziness
      - GI effects
    - - 500 mg BID
      - can uptitrate to 1000 mg BID