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CVS > ACS Therapy > Flashcards

ACS Therapy Flashcards

1
Q

What is immediate treatment for UAP + NSTEMI

A

Morphine / analgesia
Oxygen
GTN - give with aspirin prior to hospital or IV nitrates
Aspirin + dual anti platelet with Clopidogrel / Trisagrelol
IV access for blood
12 lead ECG
Anti-emetic

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2
Q

What therapy do you give for UAP and NSTEMI

A 
Anti-platelet - aspirin / clopidogrel - dual therapy 
Anti-coagulant - LMWH until discharge 
Statins 
ACEI - if hypertensive but way up risks 
BB
Decide risk 
Revascularisation if high risk
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3
Q

What therapy if there for STEMI

A

If PCI available in 2 hours give GP IIB/ IIA antagonist
If unavailable = thrombolysis then transfer
Alteplase (fibrin specific)/ streptokinase (no-fibrin specific)

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4
Q

What are the CI of thrombolysis

A 
Haemorrhage stroke
CNS damage
Major trauma < 3 weeks / operation 
GI bleeding
Aortic dissection 
Low platelet
Low glucose
High BP
Pregnant 
Anti-coagulant
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5
Q

What do you use in combination with thrombolysis

A

Aspirin

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6
Q

What do you give post STEMI / ACS

A 
4 therapy 
Aspirin 75mg
Tisagruel or clopidogrel 75mg
Dual anti-platelet 
BB Atenolol 50-100mg 
ACEI 2.5mg - renin angio causes fibrosis 
Statin 80mg

Maybe give
Aldosterone antagonist (eplenerone) if evidence of HF
Anti-arrythmia
GTN

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7
Q

What do you never use in ACS

A

CCB

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8
Q

When do you do coronary revasculiration (CABG / PCI)

A

If high risk of STEMI with UA or NSTEMI
Normally keep in hospital after NSTEMI for CABG to prevent
Look at legs for scars (saphenous)

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9
Q

What are new approaches to NSTEMI / UAP

A

Trimetazidine - metabolic modulation
Ivabradine - inhibit sinus node
Ranolazine - Na inhibitor

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10
Q

When is there an increased risk of bleeding from anti-thrombotic (Heparin)

A 
High BP 
Age >75
Stroke 
Bleeding tendency 
Labile INR >4
Abnormal renal / liver 
Drugs - aspirin / NSAID / alcohol

Low body weight
CKD

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11
Q

When do you do CABG

A

3 vessel disease
Left main stem disease
Disease not amendable to PCI

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12
Q

What does CABG require

A

Adequate lung / hepatic function
Ascending aorta
Distal coronary targets
LV EF >20%

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13
Q

What can you use for CABG

A

Revered long saphenous vein
Internal mammary arteries / radial (if varicose vein surgery)
Artery or veins connected to LAD artery

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14
Q

What is needed during CABG procedure

A

Heart / lung bypass machine
Anti-coagulant
Hypothermia

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15
Q

What are post-op problems

A

Cardiac tamponade - prevents atria filling
Increased JVP, tachy, muffled HS and low BP
Death - stroke / MI

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16
Q

What does aspirin do

A

Inhibits thromboxane A2 production and platelet aggregration by blocking enzyme cyclooxygenase
Anti-Platelet
Reduce MI mortality
Risk of GI bleed so low dose

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17
Q

What does a statin do

A

Lower cholesterol

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18
Q

What are the SE of statin and when is it CI

A 
Myopathy - check CK 
Rhabdomyolysis (check CK) if develop
Liver impairment - discontinue if 3x - measure baseline and at 3 + 12 months 
CI pregnancy / macrolide use
Type II DM
Haemorrhagic stroke = very rare
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19
Q

Who is given statin + aspirin

A

All patients with CVD as secondary prevention or
>10% ris as primary prevention
Think if elderly do they still need

20
Q

What is the action of clopidogrel / tisagrelor / prasagurel

A

Inhibits ADP receptor which stops activation of GB IIa / IIb

Stops aggregation of platelet

21
Q

What is 1st line in ACS

A

Tisagrelor (CI previous stroke)

22
Q

What is used if already on anti-coagulant or will need anti-coagulation or TIA or peripheral arterial disease

A

Clopidogrel

23
Q

What are risks

A

Bleeding - don’t give if CABG
Lower risk of GI bleed than aspirin
Caution asthma / COPD

24
Q

What do BB do

A

Block sympathetic
Decrease HR and contractility
Improves perfusion

25
Q

What can sudden cessation of BB do

A

Cause Mi

26
Q

What are the indications for BB

A 
Angina
Post MI
HF
Arrythmia - drug of choice in AF
Thyrotoxicosis / anxiety
27
Q

What are the SE of BB

A 
Bronchospasm
Cold periphery
Fatigue
Sleep
Erectile dysfunction
Insulin resistance / decreased awareness of hypo
28
Q

When are BB CI

A 
Asthma / COPD
Heart block 
Verapamil use 
If in cariogenic shock 
Peripheral vascular
Raynauds
Uncontrolled HF
Bradycardia
Verapamil use
Cocaine
Vasospasm 
Shock
29
Q

What do nitrates do

A

Relax all smooth muscle

Symptomatic Rx by reducing afterload and preload (dilate vein)

30
Q

What are averse effects of nitrates

A 
Headache
Hypotension - CI BP <90
Flushing
Myalgia
Rhabdomyolysis
31
Q

What anti-coagulants are there

A

LMWH
Fondaparinux
Warfarin
DOAC

32
Q

When should you not give anti-coagulant

A

If angiogram within 72 hours

33
Q

When are anti-coagulants indicated

A

VTE
Valve disease
AF

34
Q

When are anti-coagulants indicated post ACS

A

6 months post MI as risk of aneurysm / embolism

Anti-platelets have a much stronger indication so do risk vs benefit

35
Q

What does Ivabradine so

A

Inhibits sinus node
Slows diastolic depolarisation reducing HR and O2 demand
Only use if HR >70 and if can’t tolerate BB

36
Q

What does Ranazoline do

A

Late Na current inhibition

37
Q

What does Trimetazadine do

A

Metabolic modulation in ischaemic tissue

38
Q

Who should receive a statin

A

Anyone with CVD disease
>10% risk
Type 1 DM Dx 10 years ago or >40 or nephropathy

39
Q

What dose of statin

A

20mg if primary prevention

80mg if secondary

40
Q

What should you do before putting on a statin

A

LFT baseline the 3 months then annual

41
Q

How do you manage DM in CCU

A

Change drugs to insulin infusion sliding scale

42
Q

What should you do if on statin and need macrolide

A

Stop statin

43
Q

What is the action of thrombosis

A

Converts plasminogen to plasmin which degrades fibrin and helps break up thrombi

44
Q

When is Diclofenac CI

A

IHD
PAD
CVS
Congestive HF 2-4

45
Q

What should you do

A

Switch to naproxen or Ibuprofen

46
Q

What should you never use in ACS

A

CCB

CVS (30 decks)

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