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Acute Coronary Syndrome Flashcards

1
Q

What are the 3 types of ACS

A

Unstable angina
STEMI
NSTEMI

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2
Q

What are acute coronary syndromes

A

When the heart isnt getting enough blood and so gets less oxygen causing angina

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3
Q

How to diagnose ACS

A

ECG, biochemical markers -troponin

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4
Q

Whats troponin

A

Released in the blood when your having an MI

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5
Q

Whats the difference between STEMI and NSTEMI

A

STEMI is a full blown heart attack whereas NSTEMI is when the heart is partially blocked

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6
Q

How do you differentiate a STEMI and NSTEMI on an ECG

A

STEMI has an elevated ST segment which is a sign of a full blown heart attack

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7
Q

Causes of ACS

A

Plaques obstruct blood in artery (partial or complete)

Lack of oxygen to the heart (angina)

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8
Q

Whats the first sign of a heart attack

A

Angina

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9
Q

Whats an MI

A

When the heart muscle begins to die (necrosis) due to extensive obstruction of blood flow

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10
Q

Angina symptoms

A

Chest pain (stabbing, dull, tight, heavy)
Travelling pain to jaw, neck, left arm and back

SOB
Sweating
Fatigue
Dizziness
Nausea

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11
Q

Whats the difference between stable and unstable angina

A

Stable occurs during exercise/ stress and relieved at rest

Unstable occurs while resting, lasts longer and more occurring. Severe chest lain

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12
Q

Whats used for stable angina acute attacks (before exercise)

A

Sublingual GTN

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13
Q

Whats the long term prevention of ACS

A
  1. BB or CCB
  2. BB + CCB
  3. Replace BB or CCB with long acting nitrate, ivabradine, nicorandil, ranolazine

And secondary prevention of CVD

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14
Q

If BB and CCB are contraindicated in a patient what would you recommend as 1st line

A

Long acting nitrate, ranolazine, ivabradine, nicorandil

They can be given as monotherapy but if 2 drugs fail to control angina refer to specialist

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15
Q

Whats the secondary prevention of CVD used in ACS

A

Lifestyle
Acei + BB (can give diltiazem or verapamil if CI)

Statin - atorvastatin 80mg

Low dose Aspirin -75mg + clopi for 12 months
- if high cardiac biomarkers - triple (aspirin, clopi, rivaroxaban)

ACEi especially in diabetics

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16
Q

BB cant be given with _____ because of heart block

A

Verapamil

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17
Q

Whats the initial management of ACS

A

GTN sublingual/ buccal ASAP - pain relief
Aspirin 300mg ASAP

Oxygen - if needed
IV opioids - morphine if severe pain
Insulin - if hyperglycaemic : glucose >11mol/l

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18
Q

Initial management in STEMI

A

Aspirin 300mg + clopidogrel/ticagrelor/prasugrel

Heparin (unfractionated) for sig renal impairment

Antithrombin for fibrinolysis patients

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19
Q

Initial management in unstable angina

A

Aspirin 300mg + ticagrelor/prasugrel/clopidogrel

Fondaparinux sodium

Heparin (unfractionated) for sig renal impairment

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20
Q

Aspirin cautionary and advisory labels

Normal
Dispersible
G/R

A

Take with or just after food

This product contains aspirin dont take any other product with aspirin whilst taking this medicine

Dispersible:
Dissolve or mix with water before taking

G/R
Swallow whole. Do not chew or crush.
Dont take indigestion remedies 2 hours before or after you take this medication

21
Q

Can aspirin 300mg tablets be chewed

A

Normal tablets
Not G/R

22
Q

When would you use triple anticoagulant therapy in secondary prevention of CVD

A

If they have high cardiac biomarkers

23
Q

Which DOAC is the only one used in ACS secondary prevention of CVD?
Dose?

A

Rivaroxaban
2.5mg BD

24
Q

What formulations do nitrates come in

A

Sprays
Tablets
Patches

25
Nitrates MOA
Vasodilator and reduces venous return which reduces left ventricular work
26
Common SE of nitrates
Flushing Throbbing headache Postural hypotension
27
Nitrates onset and duration of action
Onset is rapid but relief lasts 20-30 mins
28
When is long term prophylaxis required in angina
When GTN is used more than twice a week
29
A patient is using GTN for their acute attacks. They are using it 4x a week. What do you do
If theyre using it more than twice a week long term prophylaxis is required which includes 1. BB or CCB (amlodipine, verapamil etc.) 2. BB + CCB 3. Replace ccb or bb with ivabridine, nicorandil, ranolazine or long acting nitrate
30
Whats the advantage and disadvantage of transdermal GTN
Prolonged action But tolerance may develop
31
When is GTN used as an ointment
Rectal fissure to relieve pain
32
How do you use GTN tablets for prophylaxis of angina
1 tablet before activity likely to cause angina
33
How do you use GTN tablet/spray for treatment of angina
1 tablet/spray repeated at 5 mins intervals if required. If symptoms not resolved after 2 doses call 999
34
GTN spray for angina prophylaxis how do you use
1-2 sprays under tongue before activity likely to cause angina
35
GTN patches for prophylaxis of angina
1-2 every 24 hrs
36
Available strength of GTN sublingual tablets
300mg 500mg 600mg
37
What kind of container should the GTN sublingual tabs be supplied in
Glass containers closed with a foil line cap No cotton wool wadding
38
Discard GTN sublingual tabs …….. after opening
8 weeks
39
Discard GTN rectal ointment ……. After opening
8 weeks
40
What position do you take GTN in and why
Sitting down to prevent postural hypotension
41
Whats the difference between isorsobide mononitrate and dinitrate
Mononitrate is given OD whereas dinitrate can be given 2-3x a day Dinitrate is broken down into mononitrate and then absorbed by the body
42
MR isorsobide dinitrate duration of action
12 hours
43
Are MR preps of isorsobide mononitrate available and what are they licensed for
Yes Angina prophylaxis
44
When are IV GTN or IV isorsobide dinitrate used
For more severe symptoms when sublingual form is ineffective
45
Main caution of nitrates
Tolerance
46
How do you reduce tolerance in nitrates tablets
Take MR isorsobide OD For BD, take second dose after 6-8 hours not 12 hours
47
How do you reduce tolerance in nitrate patches
Leave patch off for 8-12 hours (usually overnight) in each 24hrs
48
Isorsobide dinitrate onset of action
Slow
49
Isorsobide mononitrate and tadalafil interaction
Increases risk of hypotension

Cardiovascular (9 decks)

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