Chapter 2 BNF (Myocardial Ischaemia) Flashcards
What are the options for acute angina attack?
GTN
Isosorbide dinitrate s/l
When should patients be referred for long term prophylaxis
using short acting drugs more than twice a week?
what is the expiry date for sublingual tablets?
8 weeks
How should short acting vasodilators be taken?
prn or before exercise
take sitting down
max 3 doses the 999
what are the options for long term prophylaxis of stable angina?
Beta blocker or CCB
Beta blocker and dihydropyridine CCB
If one or both are contraindicated, add/use vasodilator
Long acting nitrate
Ivabradine
Ranolazine
Nicorandil (Adults only) ( ulcer risk MHRA)
How do patients take nitrate drug holidays?
Patch: leave off for 8-12 hours
MR dinitrate and Standard mononitrate: leave 8 hours between doses
MR mononitrate: nothing
Nitrates side effects?
flushing headache dizziness postural hypo dyspepsia
Why should abrupt withdrawal of nitrates and CCB be avoided?
worsens angina
Myocardial ischaemia management?
oxygen if hypoxic
GTN/ IV isosorbide dinitrate
IV Diamorphine/morphine with metoclopramide for ISCHAEMIC PAIN
Aspirin 300mg + Clopidogrel 300mg
PCI or Thombrolytic (Alteplase or streptokinase in 12 hours - avoid for 4 days) for REPERFUSION
Parenteral anticoagulation for PREVENTION OF REOCCLUSION
long term management - SAAB
What can be offered for long term therapy post-ACS
SAAB
Statin
Ace
Aspirin indefinitely
Beta blocker
How long is clopidogrel given post ACS?
STEMI- 4 weeks
NSTEMI/Unstable angina - 12 weeks
What medication should be given post PCI?
Dual Antiplatelet Therapy
Aspirin (forever)
Clopidogrel
(elective = one month)
(bare metal stent = 12 month)
(Drug-eluting = 12+ months)
Unstable Angina and NSTEMI in the community:
Dispersible/ chewable ASPIRIN 300mg stat and note
GTN prn
STEMI in the community:
Dispersible/ chewable ASPIRIN 300mg stat and note
GTN prn
Cardiac arrest in the community:
30 compressions 2 breaths
IV adrenaline every 3-5 mins
Amiodarone IV
