Clinical Pharmacology of Acute Coronary Syndrome Flashcards
Describe the goals of therapy for NSTEMI and Unstable Angina.
The goals include increasing myocardial O2 supply, coronary vasodilation, correcting hypoxemia, stopping platelet aggregation, stopping progression to STEMI, and decreasing myocardial oxygen demand.
What are the initial management steps for NSTEMI and Unstable Angina according to the MONA-BAC protocol?
Morphine, Oxygen, Nitrates, Aspirin, Clopidogrel/Ticagrelor/Prasugrel, and Fondaparinux.
How do beta blockers like Bisoprolol contribute to the management of NSTEMI and Unstable Angina?
They help decrease myocardial oxygen demand by reducing heart rate, blood pressure, preload, contractility, and wall stress.
Define the role of antiplatelets in the treatment of NSTEMI and Unstable Angina.
Antiplatelets like Aspirin, Clopidogrel/Ticagrelor/Prasugrel, and Fondaparinux inhibit platelet activation and aggregation, reducing the risk of thrombosis.
Describe the mechanism of action of Fondaparinux in the management of NSTEMI and Unstable Angina.
Fondaparinux is a synthetic pentasaccharide that binds to antithrombin III, potentiating Factor Xa inhibition by 300 times. This leads to decreased thrombin formation and fibrin production.
Describe the goals of therapy for a STEMI (ST-elevation myocardial infarction)
Unblock the artery, stop platelet aggregation, and perform emergency angioplasty or thrombolysis if angioplasty is not available.
How does recombinant tissue plasminogen activator (rtPA) work in thrombolysis?
It converts plasminogen to plasmin, a natural clot-busting agent, which lyses clots by breaking down fibrinogen and fibrin within a clot.
Define thrombolysis in the context of STEMI treatment.
Thrombolysis is the administration of thrombolytic agents to dissolve blood clots in the coronary arteries, aiming to restore blood flow to the heart muscle during a heart attack.
Do fibrin-specific thrombolytic agents act in the presence or absence of fibrin?
Fibrin-specific agents catalyze the conversion of plasminogen to plasmin in the presence of fibrin, aiding in clot dissolution.
Describe the difference between Alteplase and Tenecteplase in thrombolytic therapy.
Tenecteplase is a mutated form of alteplase with higher fibrin specificity and a longer half-life of elimination, often administered as a bolus infusion compared to alteplase’s 2-hour continuous infusion.
Describe the contraindications for thrombolysis.
Prior intracranial haemorrhage, known intracranial lesion, ischaemic stroke within 3 months, suspected aortic dissection, active bleeding, significant closed head trauma (<3 months).
What is ‘The Smokers Paradox’ in the context of thrombolysis?
It refers to the observation that smokers have a lower risk of mortality after a heart attack compared to non-smokers.
How soon after thrombolysis can Rescue PCI be performed according to evidence?
2-24 hours post thrombolysis.
Define the principles of treatment for acute coronary syndromes.
Reduce myocardial workload, improve coronary artery perfusion, prevent myocardial damage, unblock the artery through interventions like percutaneous coronary intervention or thrombolysis.
What are some examples of haemodynamic support devices that can be used in emergency situations related to acute coronary syndromes?
Intra-aortic balloon pump, Impella device.
