ACS and AMI Therapy

Question 1

What is the goal of pharmacotherapy?

Answer 1

Increase myocardial O2 supply (through vasodilation)

Decrease myocardial O2 demand

Question 2

What would decrease myocardial O2 demand?

Answer 2

Decrease in:
HR
BP
Preload or myocardial contractility

Question 3

What does a STEMI MI usually occur from and how should it be treated?

Answer 3

Coronary artery occlusion due to formation of thrombus overlying an atheromatous plaque

If no PCI within 2 hours, then thrombolysis

Question 4

How does thrombolysis work?

Answer 4

Serine proteases convert plasminogen to plasmin

Plasmin lyses clot by breaking down the fibrinogen and fibrin in the clot

Question 5

What are the two categories of thrombolytic agents?

Answer 5

Fibrin-specific agents - convert plasminogen to plasmin

Non-fibrin specific agents

Question 6

Give examples of Fibrin-specific agents

Answer 6

Altepase
Retepase
Tenecteplase

Question 7

Which non-fibrinolytic agents are used in thrombolytic treatment of STEMI?

Answer 7

Streptokinase

Question 8

What are contraindications to thrombolysis?

Answer 8

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

Question 9

If there is no evidence of a STEMI, what is the treatment protocol for ACS?

Answer 9

Aspirin
Clopidogrel (or tigagrelor)
Fondaparinux (or LMW heparin)
IV nitrate 
Analgesia 
B Blocker - reduces O2 demand 
Statin - reduces inflammatory process

Question 10

What is bleeding diathesis?

Answer 10

A condition in which there is an unusual susceptibility or predisposition to bleeding

Question 11

What is clopidogrel always used with?

Answer 11

Aspirin

Question 12

What is the action of prasugrel?

Answer 12

Inhibits ADP-induced platelet aggregation more rapidly

Question 13

What is the action of clopidogrel (and other ADP receptor inhibitors i.e. prasugre)?

Answer 13

Irreversibly inhibits the P2Y12 ADP receptor which blocks the GP IIb/IIIa pathway important for platelet aggregation and cross linking go platelets by fibrin

Question 14

What is the action of fondaparinux?

Answer 14

A selective inhibitor of Factor Xa which interrupts the blood coagulation cascade and thus inhibits thrombin formation and thrombus development

Question 15

What are two uses of beta blockers post MI?

Answer 15

Treatment of acute MI

Secondary prevention in survivors of an acute MI

Question 16

What is the action of beta blockers?

Answer 16

Competitively inhibit the myocardial effects of circulating catecholamines (i.e. adrenaline)
Reduce myocardial O2 consumption by lowering HR, BP and myocardial contractility

Question 17

What is the benefit of beta blocker use?

Answer 17

Evidence that they reduce risk of mortality by 13%

Question 18

What is the risk of using beta blockers?

Answer 18

In patients at risk of developing cariogenic shock, the shock or death rate was increased with BB use within 24hrs of hospital admission

Question 19

What is the action of low dose aspirin?

Answer 19

Inhibits platelet thromboxane A2 production, preventing platelet aggregation and vasoconstriction

Question 20

What is the benefit of using low dose aspirin?

Answer 20

Acute MI: reduces mortality
Unstable angina: reduce MI and death risk
Secondary prevention: reduces reinfarction

Question 21

What type of drug is simvastin?

Answer 21

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

Question 22

What drugs can be used in prevention of MI and angina?

Answer 22

Beta blockers
Simvastatin
ACE inhibitors
Aspirin