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Toronto Notes 2019 Common Medications Table 18. Commonly Used Cardiac Therapeutics (continued)
Cardiology and Cardiac Surgery C49
Side Effects
Bleeding, GI upset, GI ulceration, impaired renal perfusion
Bleeding, thrombotic thrombocytopenic purpura, neutropenia (ticlopidine)
Bleeding
Bleeding
Headache, dizziness, weakness, postural hypotension
Myalgia, rhabdomyolysis, abdominal pain
Myalgia, rhabdomyolysis, abdominal pain
GI side effects common
Drug Class
ANTIPLATELETS
Salicylates Thienopyridines
Nucleoside analogues GPIIb/IIIa inhibitors
THROMBOLYTICS
NITRATES
Examples
ASA (Aspirin®)
clopidogrel (Plavix®), ticlopidine (Ticlid®) prasugrel (Effient®)
ticagrelor (Brillinta®)
eptifibatide, tirofiban, abciximab
alteplase, reteplase, tenecteplase, streptokinase
nitroglycerin
Mechanism of Action
Irreversibly acetylates platelet COX-1, preventing thromboxane A2- mediated platelet aggregation
P2Y12 antagonist (block platelet ADP receptors)
P2Y12 antagonist (but different binding site than thienopyridines)
Block binding of fibrinogen to Gp IIb/IIIa
Convert circulating plasminogen to plasmin, which lyses cross-linked fibrin
Relax vascular smooth muscle, producing venous and arteriolar dilation
Inhibit HMG-CoA reductase, which catalyzes the rate-limiting step in cholesterol synthesis
inhibits gut absorption of cholesterol
monoclonal antibody
1
2 slow Ca2+ influx 0
Indications
CAD, acute MI, post-MI, post-PCI, CABG
Acute MI, post-MI, post-PCI, CABG
Acute MI, particularly if PCI is planned
Acute STEMI
CAD, MI, CHF (isosorbide dinitrate plus hydralazine)
Dyslipidemia (1o prevention of CAD), CAD, post-MI (2o prevention of CV events)
Decreases LDL but does not reduce mortality
Primarily in familial hypercholesterolemia
hypercholesterolemia
Contraindications
Active bleeding or PUD Active bleeding or PUD
Recent surgery or bleeding, bleeding diathesis
See Table 8, C29
Concurrent use of cGMP phosphodiesterase inhibitors, angle closure glaucoma, increased intracranial pressure
Liver or muscle disease
Liver or renal impairment
LIPID LOWERING AGENTS
Statins
Cholesterol absorption inhibitor
Miscellaneous Investigational
atorvastatin
(Lipitor®), pravastatin (Pravachol®), rosuvastatin (Crestor®), simvastatin (Zocor®), lovastatin (Meracor®)
ezetimibe (Ezetrol®)
fibrates, bile acid sequestrates, nicotinic acid
PSCK9 inhibitor
Antiarrhythmics
Na+ influx threshold
4 Na+ influx TIME
Figure 46. Representative cardiac action potential
3
K+ efflux
MEMBRANE POTENTIAL