Acute Coronary Syndrome

Question 1

Nitroglycerin

Answer 1

Type: Vasodilator
Indication: Angina symptom relief
MOA: Vasodilation-reduces preload
Adverse Reactions: Orthostatic hypotension
NOT used in MI-reduces blood pressure but does not improve outcome
Tolerance can develop

Question 2

Aspirin

Answer 2

Type: Anti-platelet
Indication: Acute MI, Prevent CVD
MOA: Inhibits platelet COX-1 lowers platelet aggregation
Often combined with Clopidogrel

Question 3

Clopidogrel

Answer 3

Type: Anti-platelet
Indication: Acute MI, Prevent CVD
MOA: Irreversible ADP antagonist
Adverse Reactions: Thrombocytopenia purpura

Question 4

Abciximab

Answer 4

Type: Anti-platelet
Indication: before percutaneous coronary intervention to decrease ischemic complications-can be used in conjunction with heparin and aspirin in acute coronary syndrome
MOA: Monoclonal Antibody/ GP IIb/IIIa antagonist-prevent platelet binding to fibrinogen

Question 5

Heparin

Answer 5

Type: Anti-coagulant
Indication: STEMI patients undergoing thrombolysis or PCI (to reduce coagulation)
MOA: increases antithrombin activity (inactivates factors Xa and IIa (thrombin)
NEVER GIVE IM-hematoma
Adverse reactions-HIT-antibodies form against heparin platelet complexes-rapid drop in platelet count
Used in conjunction with thrombolytics and PCI to reduce risk of of coagulation

Question 6

Alteplase

Answer 6

Type: Thrombolytic
Indication: Acute MI, Pulmonary embolism, Ischemic stroke. Most effective if <30 min of arrival
MOA: Activation of fibrin-bound plasminogen

Interactions: Antiplatelet, anticoagulants