ACS & AMI - Therapy

Question 1

What does ACS stand for?

Answer 1

Acute coronary syndrome

Question 2

What does AMI stand for?

Answer 2

Acute myocardial infarction

Question 3

What is in the spectrum of acute coronary syndrome?

Answer 3

1) Unstable angina
2) Non-ST elevated myocardial infarction (NSTEMI)
3) ST elevated myocardial infarction (STEMI)
4) Sudden cardiac death

Question 4

What does NSTEMI stand for?

Answer 4

Non-ST elevated myocardial infarction

Question 5

What does STEMI stand for?

Answer 5

ST elevated myocardial infarction

Question 6

What are some causes of acute coronary syndrome?

Answer 6

Atherosclerosis plaque rupture or erosion

Superimposed platelet aggregation and thrombosis

Vasospasm and vasocontriction

Subtotal or transient total occlusion of vessel

Question 7

What is the goal of pharmacotherapy for acute coronary syndrome?

Answer 7

Increase myocardial oxygen supply

Decrease myocardial oxygen demand

Question 8

How can myocardial oxygen supply be increased?

Answer 8

Vasodilation

Question 9

How can myocardial oxygen demand be decreased?

Answer 9

Decrease heart rate

Decrease blood pressure

Decrease preload or myocardial contractility

Question 10

What has a high likelihood of being the cause of patients with STEMI?

Answer 10

Coronary thrombus occluding the infarct artery

Question 11

What is coronary thrombus formation usually due to?

Answer 11

Formation of thrombus overlying an atheromatous plaque occluding the coronary artery

Question 12

What is the treatment for coronary thrombus formation?

Answer 12

If no percutaenous coronary intervention (PCI) within 2 hours then thrombolysis is indicated

Question 13

What does PCI stand for?

Answer 13

Percutanous coronary intervention

Question 14

What is percutaneous coronary intervention?

Answer 14

Non-surgical procedure that uses a catherter to place a stent to open up blood vessels in the heart that have been narrowed

Question 15

What is a stent?

Answer 15

Thin flexible tube

Question 16

What is a non-surgical procedure that uses a catheter to place a stant to open up blood vessels in the heart that have been narrowed?

Answer 16

Percutaneous coronary intervention

Question 17

What agents are used for thrombolysis?

Answer 17

Serine proteases

Question 18

How do serine proteases work?

Answer 18

Converting plasminogen to the fibrinolytic agent plasmin

Question 19

How does plasmin destroy clots?

Answer 19

Breaks down the fibrinogen and fibrin contained in the clot

Question 20

What are the 2 categories of fibrinolytics?

Answer 20

Fibrin specific agents

Non-fibrin specific agents

Question 21

What are examples of fibrin specific agents?

Answer 21

Alteplase

Reteplase

Tenecteplase

Question 22

What is an example of a non-fibrin specific agent?

Answer 22

Streptokinase systemic fibrinolysis

Question 23

What are some contraindications to thrombolysis?

Answer 23

Prior intracranial haemorrhage

Known structural cerebral vascular lesion

Known malignant intracranial neoplasm

Ischaemic stroke within 3 months

Suspected aortic dissection

Active bleeding or bleeding diathesis

Significant closed heart head trauma or facial trauma within 3 months

Question 24

What are the benefits of thrombolysis?

Answer 24

23% reduction in mortality

39% when used with aspirin

Question 25

What can thrombolysis be used with to increase the reduction in mortality?

Answer 25

Aspirin

Question 26

What does the medical treatment protocol if no evidence of STEMI include?

Answer 26

Aspirin Tigagrelol/clopidogrel Fondaparinux/low molecular weight heparin Intravenous nitrate Analgesia Beta blockers

Question 27

What does LMW stand for?

Answer 27

Low molecular weight

Question 28

What does the management to reduce risk from NSTEMI involve?

Answer 28

PCI or CABG Aspirin Clopidogrel, prasugrel, ticagrelor, ticlopidine or cilostazol Heparin Fondaparinux GIIb/IIIa receptor blockers Statins Beta blockers

Question 29

What are examples of antiplatelet agents?

Answer 29

Low dose aspirin Clopidogrel Prasugrel Low molecular weight heparin Glycoprotein IIb/IIIa receptor inhibitors

Question 30

What is considered to be low dose aspirin?

Answer 30

75-150mg

Question 31

What is the formation of platelet aggregates important in the pathogenesis of?

Answer 31

Angina Unstable angina Acute myocardial infarction

Question 32

How does aspirin work?

Answer 32

1) Potent inhibitor of platelet thromboxane A2 production 2) Thromboxane stimulates platelet aggregation and vasocontriction

Question 33

What does thromboxane stimulate?

Answer 33

Platelet aggregation and vasocontriction

Question 34

What kind of drug is clopidogrel?

Answer 34

Prodrug

Question 35

How does clopidogrel work?

Answer 35

1) Irreversible inhibits the P2Y12 ADP receptor which is important in aggregation of platelets and cross linking by fibrin 2) Blockage of this inhibits platelet aggregation by blocking the activation of the GP IIb/IIIa pathway

Question 36

What does clopidogrel combine to?

Answer 36

P2Y12 ADP receptor

Question 37

What is the IIb/IIIa complex?

Answer 37

Receptor for fibrinogen, fibronectin and von WF, activation of this is the final common pathway for platelet aggregation and cross linking of platelets by fibrin

Question 38

What should clopidogrel always be used in combination with?

Answer 38

Aspirin

Question 39

How do some people demonstrate resistance to clopidogrel?

Answer 39

Low levels of CYP 2C19 which is used to activate the drug

Question 40

What activates clopidogrel?

Answer 40

CYP 2C19

Question 41

How does prasugrel work?

Answer 41

Just like clopidogrel, ADP receptor inhibitor

Question 42

What are some different examples of low molecular weight heparin?

Answer 42

Enoxaparin Dalteparin Tinzeparin Fondaparinux

Question 43

What is a major adverse effect of most antiplatelet agents?

Answer 43

Bleeding

Question 44

What are beta blockers used post myocardial infarction for?

Answer 44

Treatment in the acute myocardial infarction Secondary prevention in the survivors of an acute myocardial infarction

Question 45

How do beta blockers work?

Answer 45

Competatively inhibit the myocardial effects of circulating catecholamines and reduce myocardial oxygen consumption by lowering heart rate, blood pressure and myocardial contractility

Question 46

What is an important drug to be given post myocardial infarction?

Answer 46

Beta blockers to reduce mortality and second myocardial infarction