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Drugs and Disease > L6- Acute Myocardial Infarction > Flashcards

L6- Acute Myocardial Infarction Flashcards

1
Q

What causes ischaemic heart disease?

A

Caused by coronary atherosclerosis and thrombosis and worsened by heightened sympathetic drive.
Angina is a symptom.
Death may occur due to ventricular fibrillation, heart failure or stroke.

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2
Q

What can acute myocardial ISCHAEMIA lead to?

A

Angina
Arrythmias
Myocardial infarction
Heart failure

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3
Q

What is an acute myocardial infarction?

A

Acute- first few hours after
MI- Heart attack which is the sudden and symptomatic loss of coronary blood flow to the heart muscle in patients with ischaemic heart disease.

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4
Q

How does AMI cause heart failure?

A

Ischaemia lasting greater than 30 minutes without reperfusion causes cells to die (infarction) due to impaired ATP generation.

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5
Q

How does AMI cause arrythmias?

A

Ventricular cells develop local changes in membrane potential and action potential duration

Causes changes in conduction of the electrical wave through the heart- regional slow conduction

Causes ventricular premature beats or lethal ventricular fibrillation

Survivors sometimes also develop arrhythmia’s due to changes

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6
Q

What is the early palliative treatment of AMI?

A

Morphine I.V. relieves chest pain of acute angina ONLY in AMI.

Reduces stress related catecholamine drive (Beta Blockers)

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7
Q

How is death of heart cells limited in the hospital during an AMI?

A

Reperfusion therapy drugs and others

Percutaneous Coronary Intervention (PCI)- stent or balloon via angioplasty to open up the blocked artery

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8
Q

Which drugs are used as prophylaxis for thrombosis happening again after the AMI?

A

Aspirin (COX inhibitor)

ADP (P2Y12) receptor blockers: Prasugrel/Clopidogrel

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9
Q

What is the role of ADP?

A

Metabolite of ATP
Forms in heart during AMI
Adds to coronary constriction
Activates platelets and causes them to aggregate

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10
Q

How do prasugrel and clopidogrel differ?

A

Prasugrel produces a quicker and greater effect

Clopidogrel is a prodrug so not effective in patients with a low CYP2C19 (enzyme) activity

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11
Q

What are the injectible anticoagulant drugs used?

A

Bivalrudin
Heparin
Enoxaparin

Bivalrudin preferred as its effects are most predictable and it does not cause thrombocytopaenia like heparin.

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12
Q

What is the mechanism of action of heparin/enoxaparin?

A

Activate antithrombin III which inhibits thrombin activity which prevents the formation of a fibrin mesh.

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13
Q

What is the mechanism of action of bivalrudin?

A

Directly inhibits thrombin activity and prevents the formation of a fibrin mesh.

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14
Q

What are fibrinolytics?

A

If a blood clot has already formed fibrinolytics are used to try and dissolve it.
Mainly recombinant tissue plasminogen activators (rTPA’s) such as tenecteplase and altepase.
Mimic endogenous TPA actions.

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15
Q

What is the mechanism of action of fibrinolytics?

A

Activate plasminogens which activate plasmin
Plasmin catalyses the breakdown (thrombolysis) of fibrin (which is what links platelets in a thrombus) into fibrin split products and dissolves the clot.

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16
Q

How is arrythmia and cardiogenic shock treated in the hospital?

A

Electrical defibrillation

Intravenous beta adrenoreceptor agonist

17
Q

What drugs are used for prophylaxis against recurrence?

A

Aspirin

Beta adrenoceptor antagonists

18
Q

What is the mechanism of action of aspirin?

A
  • Blocks cyclo-oxgenase enzyme which blocks the synthesis of prostanoids
  • Also blocks good prostanoids such as prostacyclin (inhibits platelet aggregation and promotes vasodilation)
  • Still beneficial because vessel wall can resynthesise COX but platelets cannot
19
Q

What are prostanoids?

A

Prostaglandins (mediators of inflammatory and anaphylactic reactions)
Thromboxanes (mediators of vasoconstriction) Prostacyclins (active in the resolution phase of inflammation.)

20
Q

What is the mechanism of action of beta blockers?

A

Too much sympathetic drive is bad for the heart

Block catecholamines which increase the force of contraction and rate of the heart.

21
Q

What are the different beta blockers?

A
  • Cardioselective (B1 over B2)= Metoprolol
  • Non-selective (B1 and B2)= Propanolol
  • A1 antagonists= Carvedilol

Drugs and Disease (14 decks)

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