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Billy Week 126 > ACS management > Flashcards

ACS management Flashcards

1
Q

Initial management of ACS?

A

MONA

Morphine or diamorphine 5-10mg slow IV with anti-emetic

Oxygen, but only to avoid hypoxia

Nitrates. Sublingual GTN, IV GTN if ineffective.

Anti-platelets. 300mg aspirin STAT. Clopi 300 second line.

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2
Q

Secondary prevention following ACS in ALL patients, regardless of outcome?

A

The MI-5

Aspirin
Clopidogrel
ACEi
Beta-blocker
Statin
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3
Q

MOA of aspirin?

A

Irreversible COX1 and COX2 inhibitor = decreased formation of thromboxane A therefore inhibiting platelet aggregation

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4
Q

Dose of aspirin following ACS?

A

75mg OD in ALL patients while considering GI risk and comorbidities

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5
Q

AEs of aspirin?

A 
GI irritation (+ haemorrhage)
Bronchospasm
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6
Q

Contraindications for aspirin?

A

Hypersensitivity
Active peptic ulcer
Haemophilia and other bleeding disorders

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7
Q

Interactions of aspirin?

A

Drugs which increase GI bleed risk

AntiPLTs, AntiCOAGs, SSRIs, NSAIDs, prednisolone, nicorandil

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8
Q

Clopidogrel MOA

A

Pro-drug, converted to active metabolite by CYP enzymes

Irreversible blockade of P2Y12 components of adenosine receptors ON PLATELET SURFACE

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9
Q

Indications for clopidogrel?

A
  1. NSTEMI: dual therapy with aspirin for 12 months, then LDA after
  2. STEMI: dual therapy for 1 month then LDA after
  3. BARE METAL STENT: dual therapy with aspirin for 1 month then LDA
  4. DRUG ELUTING STENT: dual therapy with aspirin for 12 months then LDA
  5. UNABLE TO TOLERATE ASPIRIN - monotherapy
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10
Q

AEs of clopi?

A

GI irritation

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11
Q

COntraindications of clopi?

A

Active bleeding

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12
Q

Interactions of clopi?

A

Other drugs which increase risk (NSAIDs, prednisolone, antiPLTs, antiCOAGs, nicorandil, SSRIs)

FLUOXETINE - reduces antiPLT effect

Enzyme inducers - reduce antiPLT effect

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13
Q

Which drugs should clopi not be prescribed with?

A

Fluoxetine

Enzyme inducers:

  • Carbamazepine
  • Fluconazole
  • PPIs (omerazole)

All reduce anti PLT effect

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14
Q

Which anti PLT shouldnt be prescribed w/ fluoxetine?

A

Clopi

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15
Q

Prasugrel MOA?

A

Similar to clopi…. P2Y12 component of adenosine receptor on platelet blockade = reduced aggregation

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16
Q

Indications of prasu?

A

Combination with aspirin post-PCI for 12 months in STEMI patients

Stent rethrombosis after clopidogrel

17
Q

AEs of prasu

A

Haemorrhage (GI and intracranial)

18
Q

Contraindications for prasu

A

Active bleeding
Stroke / TIA hx
Reduce dose in elderly

19
Q

Interactions of prasu

A

Drugs which increase bleeding

20
Q

Ticagrelor MOA

A

Reversibly and non compeittive inhibition of P2Y12 component of adenosine receptor on platelets - reduces aggregation

21
Q

Indications of ticagrelor

A

Combo with aspirin in ACS for 12 months

22
Q

AEs of ticagreol

A

Haemorrhage

SOB

23
Q

Contraindicationsof ticagreol

A

Active bleeding

Hx of ICH

24
Q

Interactions of ticagrelor

A

Other drugs which increase bleeding

Clarithromycin, simvastatin, digoxin - increases plasma concentration

25
Q

ACEi MOA

A

Inhibits ACE = less ATII

  1. inhibition of arteriolar vasoconstriction
  2. Inhibiton of aldosterone = less Na+/H2O retention
26
Q

AEs of ACEi

A 
Drug cough
Hyperkalaemia
Renal impairment
Hypotension
Angioedema
Hepatic impairment
27
Q

ACEi indications

A

ALL patients post MI

Low dose then titrate

28
Q

Contraindications to ACEi

A

Hypersensitivity

Caution w/ renal impairment - monitor function during initiation and titration

Severe aortic stenosis

Bilateral renal artery stenosis

29
Q

Interactionsof ACEi

A

Diuretics - cause v rapid fall in BP in volume depleted patients

Nephrotoxic drugs

30
Q

ATII receptor blockers (ARBS) MOA

A

Antagonist of ATII receptors - reduces vasoconstriction and aldosterone release

Doesnt cause accumulation of bradykinin so no dry cough as in ACEi

31
Q

Indicationsof ARBs

A

ACEi intolerance e.g. dry cough

32
Q

AEs of ARBs

A

Hypotension
Hyperkalaemia
Renal impairment
Angioedema

33
Q

Cautions of ARBs

A

Renal artery stenosis

Renal impariment

34
Q

Interactions of ARBs

A

Diuretics

ACEi

35
Q

Which is the shorter acting BB?

A

Metoprolol

Billy Week 126 (2 decks)

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