ACS

Question 1

In a patient suffering an NSTEMI what should be given if patient is exhibiting hypoxia, pulomonary oedema or continuing myocardial ishchaemia?

Answer 1

Oxygen therapy

Question 2

What should be given if sublingual GTN doesn’t relieve ischaemic pain?

Answer 2

Give IV or buccal GTN or IV isosorbide dinitrate. If pain continues slow iv injection of diamorphine or morphine should be given and an antiemetic (metocloprimide)

Question 3

What drug other than nitrates can be given before the patient reaches hospital?

Answer 3

Aspirin, the hospital should be notified that aspirin has already been given, clopidogrel, prasugrel, or ticagrelor can also be given

Question 4

What anticoag therapy will be given as initial therapy of a NSTEMI?

Answer 4

Heparin, unfractioned or LMWH or fondiparinux

Question 5

BB are given indefinitely as management of ACS, if they are inappropriate what can be used as an alternative given they don’t have left ventricular dysfunction?

Answer 5

Dilitazem or verapamil

Question 6

What should be given prior to a PCI?

Answer 6

Heparin

Question 7

What is the time window for PCI to be given? IF that window is passed what is the recommended tx?

Answer 7

90 minutes, if PCI cannot be done within 90mins of diagnosis a thrombolytic drug should be administered along with a heprain or fondiparinux

Question 8

When should an Acei/Arb be initiated after a MI?

Answer 8

Within 24 hours of MI and continued for atleast 5-6 weeks.

Question 9

When considering long term management of a STEMI pt what can be given if clopidogrel is CI or not tolerated and at a low risk of bleeding?

Answer 9

Warfarin and aspirin

Question 10

What BB are recommended if pt has LV dysfunction?
Propanolol
Bisoprolol
Carvedilol
Long acting metoprolol

Answer 10

Propanolol

Question 11

True or false. Dipyrimadole CCB are recommended in long term treatment of an MI?

Answer 11

False, the non-dipyrimadole ccb’s, dilitzaem (unlicensed) and verapamil are recommended if BB cannot be used, but only if pt does not have LV dysfunction

Question 12

In a pt with unstable angina or NSTEMI how long should clopidogrel with aspirin be given for?

Answer 12

Up to 12 months

Question 13

True or false. Rivaroxoban can be given alongside aspirin and clopidorgel?

Answer 13

True. Only in low dose and for prevention of atherthrombotic events following ACS with elevatewd cardiac biomarkers.

Question 14

Thrombolytics are used in what type of MI?

Answer 14

Both NSTEMI and STEMI. Benefit is greatest in those with STEMI or bundle branch block.

Question 15

What is the time window for alteplase and streptokinase in MI?

Answer 15

Alteplase- within 6-we hours
Streptokinase- WIthin 12 hours
Ideally given within the hour

Question 16

What is the MOA of firibnolytics?

Answer 16

Activates plasminogen to plasmin which degrades firbin, breaking up thombi

Question 17

Alteplase is CI if you have hypersenitivity to what antibiotic?

Answer 17

Gentamicin

Question 18

Why is it important to leave a nitrate free window?

Answer 18

Tolerance can rapidly develop. Patches should be left off for 8-12 hours, usually overnight. The second dose of a BD nitrate should be given after 8 hours rather than 12. MR formulations only given OD.

Question 19

What should be administered in a cardiac arrest?

Answer 19

Adrenaline IV injection repeated every 3-5 minutes. IV amiodarone considered after arenaline to treat ventricular fibrilation or pulseless ventricular tachycardia, Lidocaine HCL is a suitable alternative if maiodarone not available.