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Common Congenital Heart Lesions - page 47 / 126

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*Because they block platelet activation & aggregation via 2 different pathways, the combination of the two is better than when used alone. Thienopyridines are also used as a substitute for aspirin if a patient has an aspirin allergy. *Once initiated, anti-platelet therapy should be continued daily

  • GP IIb-IIIa inhibitors (ie. Eptifibatide, Tirofiban, &

Abciximab)Æinhibition of platelet aggregation

*These are especially useful in the high risk cases of UA & NSTEMI

Anticoagulants

  • Unfractionated or LMW HeparinsÆbinding & activation of ATIIIÆincreased potency of ATIII for thrombinÆinhibition of thrombinÆinhibition of further clot formation

OR Unfractionated or LMW HeparinsÆdirect inactivation of XaÆinhibition of further clot formation

*LMWH preferentially blocks Xa & is preferred over Unfractionated Heparin as it’s easier to administer, has a predictable bioavailability, & doesn’t require repeated monitoring & dose adjustments (unlike Unfractionated Heparin)

Antischemic Therapy

  • NitratesÆvenodilitationÆreduced venous return/preloadÆreduced

myocardial O2 demand

OR NitratesÆvasodilitationÆincreased flow to the coronary arteries & reduced likelihood of vasospasmsÆimproved myocardial O2 supply

  • Beta-BlockersÆreduced sympathetic driveÆnegative inotrophy & chronotropy, & electrical stability

  • Non-dihydropyridine Ca Channel BlockersÆnegative inotrophy & chronotrophy

*Nitrates are particularly useful in those patients with CHF *Non-dihydropyridines Ca Channel Blockers are used only when Nitrate &/or Beta-Blocker therapy has failed

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