Acute Coronary Syndromes

Question 1

name three reversible risks for cardiovascular disease

Answer 1

hypertension, hyperlipidaemia, diabetes

Question 2

give the four steps to prevention of cardiovascular diseases

Answer 2

lifestyle changes
control of cholesterol
control hypertension
antiplatelet drugs

Question 3

give three types of antiplatelet drugs

Answer 3

aspirin
clopidogrel
dipyridamole

Question 4

what is the mechanism of action of aspirin

Answer 4

inhibits platelet aggregation by altering balance of thromboxane A2

Question 5

how does clopidogrel work

Answer 5

inhibits ADP platelet aggregation

Question 6

how does dipyridamole work

Answer 6

inhibits platelet phosphodiesterase

Question 7

what would you be concerned about if a patient is on more than one antiplatelet drug

Answer 7

it increases bleeding time
patient is at higher risk of CVD

Question 8

how do anticoagulants work

Answer 8

inhibit clotting cascade - the platelet clot forms as normal but will not be stabilised as fibrin will not be deposited - has no effect on immediate bleeding but clot will break down hours later

Question 9

what does warfarin work on

Answer 9

inhibits synthesis of vitamin K dependent clotting factors

Question 10

what are the four vitamin K dependent clotting factors

Answer 10

2, 7, 9, 10

Question 11

what is INR

Answer 11

a prothrombin ratio

Question 12

what is an ideal INR for a patient

Answer 12

2-4

Question 13

what are DOACs

Answer 13

similar to warfarin but do not require same testing as their bioavailability is predictable

Question 14

what factors do most DOACs work on (accept dabigatran)

Answer 14

factor X inhibitors

Question 15

what does dabigatran have an effect on

Answer 15

direct thrombin inhibitor

Question 16

what DOACs are taken twice daily

Answer 16

dabigatran
apixaban

Question 17

what DOACs are taken once daily

Answer 17

rivaroxaban
edoxaban

Question 18

give three examples of advantages of DOACs

Answer 18

short half life
may only be a short course
no significant interactions in dentistry

Question 19

what are statins

Answer 19

lipid lowering drugs - inhibit cholesterol synthesis in liver

Question 20

what drug do statins especially interact with

Answer 20

fluconazole

Question 21

what must happen with statins during antifungal treatment

Answer 21

they need to be stopped

Question 22

what is the function of beta blockers

Answer 22

reduce heart muscle excitability which reduces risk of ventricular fibrillation and death by preventing increase in heart rate

Question 23

give two examples of beta blockers

Answer 23

propanolol
atenolol

Question 24

what is the action of antidiuretics

Answer 24

increase water and salt loss which reduces plasma volume

Question 25

what are antidiuretics used for

Answer 25

anti-hypertensive heart failure

Question 26

what is an example of a loop diuretic

Answer 26

frusemide

Question 27

what oral effect can diuretics cause

Answer 27

dry mouth

Question 28

what are the two type of nitrate medications available

Answer 28

short acting long acting

Question 29

what is an example of short acting nitrates

Answer 29

GTN - emergency management of angina

Question 30

what is an example of long acting nitrates

Answer 30

isosorbide mononitrate - prevention of angina

Question 31

how do nitrates work

Answer 31

dilate veins returning blood to the heart so reduce the filling pressure (preload) of the heart

Question 32

what are three actions of nitrates

Answer 32

dilate veins - reduce preload dilate arteries - reduce afterload dilate coronary arteries

Question 33

what are calcium channel blockers used to treat

Answer 33

used to treat hypertension and migraines

Question 34

what is an oral side effect of calcium channel blockers

Answer 34

gingival hyperplasia

Question 35

what are the five common types of medication used in cardiac medicine

Answer 35

ACE inhibitors Beta blockers Calcium channel blockers Diuretics Nitrates

Question 36

how do calcium channel blockers work

Answer 36

block calcium channels in smooth muscles - causing relaxation and dilation

Question 37

give examples of ACE inhibitors

Answer 37

enalapril ramapril lisinopril

Question 38

what two things do ACE inhibitors act on

Answer 38

inhibits conversion of angiotensin I to angiotensin II which is a potent vasoconstrictor prevents aldosterone dependent resorption of salt and water

Question 39

what are two potential side effects of ACE inhibitors

Answer 39

cough hypotension

Question 40

what is losartan

Answer 40

angiotensin II blocker - similar to ACE inhibitor but doesnt have same side effects

Question 41

what are three potential oral reactions to ACE inhibitors

Answer 41

lichenoid reaction sudden swelling due to increase in tissue fluid swelling of tongue/ lips

Question 42

what are the two pathological processes involved in acute coronary syndromes

Answer 42

blood vessel narrowing blood vessel occlusion

Question 43

what are the three main heart arteries

Answer 43

right coronary artery left coronary artery circumflex coronary artery

Question 44

when does blood flow into the coronary arteries

Answer 44

during diastole

Question 45

what are three forms of acute ischaemic events

Answer 45

atherosclerosis with blood clot atherosclerosis itself spasm of artery

Question 46

what is stable angina

Answer 46

atherosclerotic plaque narrows artery and restricts blood flow - causes pain on exertion - effects reversed if O2 requirements are reduced

Question 47

what drugs are avoided when patient is taking warfarin

Answer 47

NSAIDs - can cause internal bleeding

Question 48

what are the two types of diuretics

Answer 48

loop and thiazide diuretics

Question 49

give two examples of calcium channel blockers

Answer 49

amlodipine and nifedipine

Question 50

what is the aspirin dose per day

Answer 50

75mg

Question 51

up until which time is ischaemia reversible

Answer 51

20 mins

Question 52

what are the troponin levels like in stable angina

Answer 52

normal as little cardiac muscle death

Question 53

what is unstable angina

Answer 53

atherosclerotic plaque develops plaque on surface but doesn't occlude the lumen - can happen at any time

Question 54

what is seen on and ECG of unstable angina

Answer 54

depression of ST segment and T wave inversion

Question 55

what is an NSETMI

Answer 55

non-ST elevation MI

Question 56

what is a STEMI

Answer 56

no blood and oxygen delivered to heart muscle - ST elevation

Question 57

what is peripheral vascular disease

Answer 57

angina of tissues (usually lower limb)

Question 58

give two side effects of peripheral vascular disease

Answer 58

poor wound healing areas of necrosis and gangrene

Question 59

give four symptoms of an MI

Answer 59

pain nausea sweating pale

Question 60

what is thrombolysis

Answer 60

chemical used to dissolve any blood clot