ACS and AMI therapy - clinical pharmacology Flashcards
what are the 4 ACS?
unstable angine
NSTEMI
STEMI
sudden cardiac death
what can unstable angina lead to?
STEMI
NSTEMI
sudden cardiac death
what can NSTEMI lead to?
sudden cardiac death
STEMI
what can STEMI lead to?
sudden cardiac death
what are the general aims of pharmacotherapy of acs?
increase myocardial oxygen supple
decrease myocardial oxygen demand
what are the ways that myocardial oxygen demand can be decreased (and so manipulated for pharmacotherapy of ACS)?
decrease HR
decrease BP
decrease preload or myocardial contractility
what are the ways that myocardial oxygen supply can be increased (and so manipulated for pharmacotherapy of ACS)?
through coronary vasodilation (thrombolysis)
what is the most common cause of STEMI and how any patients are seen to have this on an angiogram?
coronary thrombus formation (on atheromatous plaque)
90% show evidence of this
if PCI is unable to be performed within 2 hourse of a STEMI what is the treatment?
thrombolysis
what are the most common thrombolysis drugs used today and how do they work?
serine proteases. work by converting natural plasminogen into plasmin this breaks down fibrin and fibrinogen
which fibrinolytic agents are used in thrombolytic treatment of STEMI?
alteplase,
reteplase,
tenecteplase
which non-fibrinolytic agents are used in thrombolytic treatment of STEMI?
streptokinase
what are the contraindications of thrombolysis in STEMI?
- 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
what is bleeding diathesis?
a condition in which there is an unusual susceptibility or predisposition to bleeding.
giving thrombolysis treatment along with what decreases the chance of mortality?
aspirin
which drugs are used in the treatment of ACS that isn’t STEMI?
Aspirin Tigagrelor (or Clopidogrel) Fondaparinux/LMW heparin Intravenous nitrate Analgesia Beta Blockers others: prasugrel GIIbIIIa receptor blockers Statins
what is the action of IV nitrate?
vasodilator to improve perfusion of myocardium
which analgesics are used in the treatment of NSTEMI and unstable angina
opiates
what is the action of fondaparinux?
reduces vasospasm
what is the action of prasugrel?
platelet inhibitor
what is the action of GIIbIIIa receptor blockers?
prevent platelet aggregation and thrombus formation
which treatments are used to reduces the risk from NSTEMI?
PCI or CABG Aspirin Clopidogrel, prasugrel, ticagrelor, ticlopidine or cilostazol Heparin (LMWH) Fondaparinux GIIb/IIIa receptor blockers Statins B blockers
what is clopidogrel always used with?
aspirin
what is clopidogrel being replaced by and why?
ticagrelor, there is a proportion of the population who do not respond to clopidogrel
what is the advantage of prasugrel over clopidogrel?
prasugrel inhibits ADP–induced platelet aggregation more rapidly, more consistently
which low molecular weight heparin drugs are used to treat ACS?
Enoxaparin
Dalteparin
Tinzeparin
Fondaparinux
what is thrombocytopenia?
low levels of platelets in the bood
give an example of a GIIb/IIIa Receptor Blocker?
tirofiban
what are the risks with using tirofiban (a GIIb/IIIa Receptor Blocker) with heparin?
- thrombocytopenia
- bleeding
when are Beta blockers used in the treatment of MI?
- in the treatment of acute MI
2. also in the secondary prevention of acute MI
which beta blockers are given immediately after an acute MI?
IV atenolol or metoprolol
when are beta blockers given as a preventative measure, and how are they administered?
weeks or months post MI, given orally
when are beta blockers contraindicated post-MI?
- if the patient is close to cardiogenic shock
- coronary vasospasm
- cocaine use
what the signs of a patient developing cardiogenic shock?
heart rate >110 beats/min
systolic blood pressure < 120 mmHg
(usually age >70 years old)
