ACS and AMI Therapy Flashcards
What is the goal of pharmacotherapy?
Increase myocardial O2 supply (through vasodilation)
Decrease myocardial O2 demand
What would decrease myocardial O2 demand?
Decrease in:
HR
BP
Preload or myocardial contractility
What does a STEMI MI usually occur from and how should it be treated?
Coronary artery occlusion due to formation of thrombus overlying an atheromatous plaque
If no PCI within 2 hours, then thrombolysis
How does thrombolysis work?
Serine proteases convert plasminogen to plasmin
Plasmin lyses clot by breaking down the fibrinogen and fibrin in the clot
What are the two categories of thrombolytic agents?
Fibrin-specific agents - convert plasminogen to plasmin
Non-fibrin specific agents
Give examples of Fibrin-specific agents
Altepase
Retepase
Tenecteplase
Which non-fibrinolytic agents are used in thrombolytic treatment of STEMI?
Streptokinase
What are contraindications to thrombolysis?
Prior intracranial hemorrhage (ICH)
Structural cerebral vascular lesion
Malignant intracranial neoplasm
Ischaemic stroke within 3 months
Suspected aortic dissection
Active bleeding or bleeding diathesis (excluding menses)
Significant closed-head trauma or facial trauma within 3 months
If there is no evidence of a STEMI, what is the treatment protocol for ACS?
Aspirin Clopidogrel (or tigagrelor) Fondaparinux (or LMW heparin) IV nitrate Analgesia B Blocker - reduces O2 demand Statin - reduces inflammatory process
What is bleeding diathesis?
A condition in which there is an unusual susceptibility or predisposition to bleeding
What is clopidogrel always used with?
Aspirin
What is the action of prasugrel?
Inhibits ADP-induced platelet aggregation more rapidly
What is the action of clopidogrel (and other ADP receptor inhibitors i.e. prasugre)?
Irreversibly inhibits the P2Y12 ADP receptor which blocks the GP IIb/IIIa pathway important for platelet aggregation and cross linking go platelets by fibrin
What is the action of fondaparinux?
A selective inhibitor of Factor Xa which interrupts the blood coagulation cascade and thus inhibits thrombin formation and thrombus development
What are two uses of beta blockers post MI?
Treatment of acute MI
Secondary prevention in survivors of an acute MI
What is the action of beta blockers?
Competitively inhibit the myocardial effects of circulating catecholamines (i.e. adrenaline)
Reduce myocardial O2 consumption by lowering HR, BP and myocardial contractility
What is the benefit of beta blocker use?
Evidence that they reduce risk of mortality by 13%
What is the risk of using beta blockers?
In patients at risk of developing cariogenic shock, the shock or death rate was increased with BB use within 24hrs of hospital admission
What is the action of low dose aspirin?
Inhibits platelet thromboxane A2 production, preventing platelet aggregation and vasoconstriction
What is the benefit of using low dose aspirin?
Acute MI: reduces mortality
Unstable angina: reduce MI and death risk
Secondary prevention: reduces reinfarction
What type of drug is simvastin?
HMG-CoA reductase inhibitors (statins) - slows the production of cholesterol in the body to decrease the amount of cholesterol that may build up on the walls of the arteries
What drugs can be used in prevention of MI and angina?
Beta blockers
Simvastatin
ACE inhibitors
Aspirin
