ACS Contras

Question 1

GTN Contras

Answer 1

1. BP <100mmHg
2. HR >150BPM
3. HR <50BPM (except in autonomic dysreflexia)
4. Ventricular tachycardia
5. Current or recent use of PDE5 inhibitors
6. Current Riociguat use
7. Bleeding in pregnancy

Question 2

Aspirin contras

Answer 2

1. Hypersensitivity to aspirin / salicylates
2. Actively bleeding peptic ulcers
3. Bleeding disorders
4. Suspecting dissecting aortic aneurysm
5. Chest pain associated with psychostimulant overdose if SBP >160mmHg

Question 3

Heparin contras

Answer 3

1. Known allergy or hypersensitivity
2. Active bleeding excluding menses
3. Oral anticoagulants
4. Bleeding disorders
5. Hx of Heparin induced Thrombocytopaenia (HIT)
6. Severe hepatic impairment / disease, including oesophageal varices
7. Recent trauma or surgery (<3 weeks)

Question 4

Tenecteplase contras

Answer 4

1. Major surgery in past 3 months
2. Significant head injury in past 3 months
3. Major trauma in past 3 months
4. Stroke / TIA in past 3 months
5. ICH at any time
6. GI/GU bleed in past month
7. Current bleeding disorder, active bleeding (excluding menses) or bleeding tendencies
8. Anticoagulants or glycoprotein IIB / IIA inhibitors
9. Allergy to tenecteplase or gentamicin