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Cardiovascular system > ACS and AMI therapy - clinical pharmacology > Flashcards

ACS and AMI therapy - clinical pharmacology Flashcards

1
Q

what are the 4 ACS?

A

unstable angine
NSTEMI
STEMI
sudden cardiac death

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2
Q

what can unstable angina lead to?

A

STEMI
NSTEMI
sudden cardiac death

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3
Q

what can NSTEMI lead to?

A

sudden cardiac death

STEMI

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4
Q

what can STEMI lead to?

A

sudden cardiac death

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5
Q

what are the general aims of pharmacotherapy of acs?

A

increase myocardial oxygen supple

decrease myocardial oxygen demand

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6
Q

what are the ways that myocardial oxygen demand can be decreased (and so manipulated for pharmacotherapy of ACS)?

A

decrease HR
decrease BP
decrease preload or myocardial contractility

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7
Q

what are the ways that myocardial oxygen supply can be increased (and so manipulated for pharmacotherapy of ACS)?

A

through coronary vasodilation (thrombolysis)

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8
Q

what is the most common cause of STEMI and how any patients are seen to have this on an angiogram?

A

coronary thrombus formation (on atheromatous plaque)

90% show evidence of this

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9
Q

if PCI is unable to be performed within 2 hourse of a STEMI what is the treatment?

A

thrombolysis

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10
Q

what are the most common thrombolysis drugs used today and how do they work?

A

serine proteases. work by converting natural plasminogen into plasmin this breaks down fibrin and fibrinogen

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11
Q

which fibrinolytic agents are used in thrombolytic treatment of STEMI?

A

alteplase,
reteplase,
tenecteplase

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12
Q

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

A

streptokinase

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13
Q

what are the contraindications of thrombolysis in STEMI?

A
  • Prior intracranial hemorrhage (ICH)
  • Known structural cerebral vascular lesion
  • Known 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
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14
Q

what is bleeding diathesis?

A

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

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15
Q

giving thrombolysis treatment along with what decreases the chance of mortality?

A

aspirin

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16
Q

which drugs are used in the treatment of ACS that isn’t STEMI?

A 
Aspirin
Tigagrelor (or Clopidogrel)
Fondaparinux/LMW heparin
Intravenous nitrate
Analgesia
Beta Blockers
others:
prasugrel
GIIbIIIa receptor blockers
Statins
17
Q

what is the action of IV nitrate?

A

vasodilator to improve perfusion of myocardium

18
Q

which analgesics are used in the treatment of NSTEMI and unstable angina

A

opiates

19
Q

what is the action of fondaparinux?

A

reduces vasospasm

20
Q

what is the action of prasugrel?

A

platelet inhibitor

21
Q

what is the action of GIIbIIIa receptor blockers?

A

prevent platelet aggregation and thrombus formation

22
Q

which treatments are used to reduces the risk from NSTEMI?

A 
PCI or CABG
Aspirin
Clopidogrel, prasugrel, ticagrelor, ticlopidine or cilostazol
Heparin (LMWH)
Fondaparinux
GIIb/IIIa receptor blockers
Statins
B blockers
23
Q

what is clopidogrel always used with?

A

aspirin

24
Q

what is clopidogrel being replaced by and why?

A

ticagrelor, there is a proportion of the population who do not respond to clopidogrel

25
Q

what is the advantage of prasugrel over clopidogrel?

A

prasugrel inhibits ADP–induced platelet aggregation more rapidly, more consistently

26
Q

which low molecular weight heparin drugs are used to treat ACS?

A

Enoxaparin
Dalteparin
Tinzeparin
Fondaparinux

27
Q

what is thrombocytopenia?

A

low levels of platelets in the bood

28
Q

give an example of a GIIb/IIIa Receptor Blocker?

A

tirofiban

29
Q

what are the risks with using tirofiban (a GIIb/IIIa Receptor Blocker) with heparin?

A
  • thrombocytopenia

- bleeding

30
Q

when are Beta blockers used in the treatment of MI?

A
  1. in the treatment of acute MI

2. also in the secondary prevention of acute MI

31
Q

which beta blockers are given immediately after an acute MI?

A

IV atenolol or metoprolol

32
Q

when are beta blockers given as a preventative measure, and how are they administered?

A

weeks or months post MI, given orally

33
Q

when are beta blockers contraindicated post-MI?

A
  • if the patient is close to cardiogenic shock
  • coronary vasospasm
  • cocaine use
34
Q

what the signs of a patient developing cardiogenic shock?

A

heart rate >110 beats/min
systolic blood pressure < 120 mmHg
(usually age >70 years old)

Cardiovascular system (40 decks)

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