Ischaemic Heart Disease Flashcards
What is the initial pharmacological management of someone with a MI?
- Dual platelet therapy - aspirin and prasugrel/ticagrelor/clopidogrel
- Fondaparinux or a LMWH
- Beta blocker given in the absence of bradycardia or hypotension
- immediate blood glucose control for diabetics with marked hyperglycaemia (>11mmol/L)
What determines whether someone who has had a STEMI has PCI or thrombolysis?
Timing - patient has to present within 12hrs of onset of symptoms and it should only be done if they can get to a hospital within 120 minutes from diagnosis otherwise immediate thrombolytic therapy should be given
for how long should patients with ACS receive dual antiplatelet therapy for?
6 months
should patients with ACS be offered DOACs in addition to dual antiplatelet therapy?
no
what can be given to patients to relieve cardiac pain when they are having an MI?
nitrates
following an MI, what 4 drugs should a patient be offered?
DABS:
- dual antiplatelet therapy
- ACE inhibitor
- Beta-blocker
- Statin
What dose of aspirin should be used for ACS treatment?
loading dose of 300mg followed by 75mg daily
how do beta-blockers help in angina?
overall effect is to reduce myocardial o2 demand and they do this by:
- decreasing HR
- reducing force of contraction
- lower BP by reducing CO
how do calcium channel blockers help in angina?
overall effect is to reduce myocardial O2 demand and they do this by:
- peripheral arterial dilation (dihydropyridines most potent)
- coronary artery dilation
- negative chronotropic effect (diltiazem and verapamil only)
- reduced cardiac contractility (esp. verapamil)
name two dihydropyridine calcium channel blockers and say what they are specific for
amlodipine and nifedepine
selective for the vasculature
name two non-dihydropyridines and say what they are more selective for
verapamil and diltiazem.
verapamil is the most cardioselective whereas diltiazem also have effects on the blood vessels.
how do nitrates work and name two
vasodilators - cause vascular smooth muscle relaxation bymimicking vasodilator efects of endogenous NO.
Glyceryl trinitrate, isosorbide mononitrate, dinitrate
what is the problem with using nitrates for a sustained use of time and how can this be avoided?
tolerance builds up and they are no longer effective.
this can be minimised by careful timing of doses to avoid significant nitrate exposure overnight, when it tends not to be needed