Lecture 17: Pharmaceutical care in patients with acute coronary syndrome and stable angina Flashcards
What does acute coronary syndrome include?
- Unstable angina
- NSTEMI
- STEMI
What is acute coronary syndrome?
A set of signs and syndromes related to the heart
What is unstable angina?
An unprovoked or prolonged episode of chest pain raising suspicion of acute myocardial infarction, without definate ECG or laboratory evidence
What is NSTEMI?
Chest pain suggestive of an acute myocardial infacrtion
- Non specific ECG changes
What is STEMI?
Sustained chest pain suggestive of an acute myocardial infarction.
What are modifiable risk factors for acute myocardial infarction?
- Smoking
- Obesity
- Lack of excerise
- Alcohol excess
- Diet (saturated fat)
- Hypertension
- High serum cholesterol
- Diabetes
What are non modifiable risk factors for acute myocardial infarction?
- Age
- Gender
- Ethnicity
- Family history
- Past medical history
- Deprivation
- Diabetes
What are the clinical features of acute coronary syndrome?
- Chest pain
- Nausea
- Tachycardia / bradycardia
- Dyspoea
- Palpitations
- Sweaty
- Vomiting
- Syncope
- Acute confusion
- Indigestion
- Fever
- Pallor
- Asymptomoatic/ Silent
What are the differential diagnosis of chest pain?
- GI: Oesophageal spasm, GORD, pancreatitis
- Cardiac: MI, angina, pericarditis, aortic dissection
- Respiratory: Pulmonary embolism, pneumonia, pneumothorax
- Muscoskeletal: Costochondriasis, trauma
What is MONA?
- Morphine
- Oxygen
- Nitrates
- Aspirin
What is the dose of morphine for acute coronary syndrome?
5-10mg slow IV injection
What is the dose of GTN spray for acute coronary syndrome?
400mcg = 1 spray
What is the dose for nitrate tablets for acute coronary syndrome?
300/500/600 mcg
What is the dose of aspirin for for acute coronary syndrome?
300mg
What is the dose of metoclopramide for acute coronary syndrome?
10mg IV
What is the dose of fondaparinux for acute coronary syndrome?
2.5mg
What is the dose of clopidogrel for acute coronary syndrome?
180mg
What is the immediate management for unstable angina and NSTEMI?
- Fondapairnuc 2.5mg once daily (max 7 days)
- Ticagrelor 180mg
- Beta blocker - atenolol 5mg IV/ bisopralol oral
- GTN: IV
What is the treatment for STEMI?
- Percutaneous coronary intervention
- Thrombolysis
- Beta blocker
What does Percutaneous coronary intervention require?
- Loading dose of ticahrelor 180mg
What are the side effects of ticagrelor?
- Bradycardia (slow heart rate)
- Shortness of breatg
What are the early complications of acute coronary syndrome?
- Death
- Cardiogenic shock
- Heart failure
- Ventriclular arrhythmia
- Myocardial rupture
- Thromboembolism
- Paricarditis
What are the late complications of acute coronary syndrome?
- Ventricular wall rupture
- Valvular regurgiattion
- Ventricular aneaurysm
- Cardiac tamponade
- Thromboembolism
What are the side effects of ACE inhibitors?
- Cough
- Angioedema
- Potassium excess
- Taste changes
- Orthostatic hypotension (dizzy)
- Pregnancy contraindications/ pressure drop
- Renal failure/ Rash
- Indomethacin inhibition
- Leukopenia (rare)
What is the management of stable angina?
- Betablockers
- Calcium channel blockers
- Nitrates
- Potassium channel activators (nicorandil)
- Ivabradine
- Ranolazine
What is the only anti-angina with proven effect on mortality?
Betablockers
What cousilling should be given with betablockers?
- Fatigue
- Dizziness
- Impotence
What cousilling should be given with calcium channel blockers?
Couselling on vasodilation and oedema
What cousilling should be given with nitrates?
Headache, red flushes
What are the side effects of potassium channel activators?
- Ulcers
- Headache
- Palpitation
What do you use if beta blockers are not tolerated?
Ivabradine
What do you use if patients are intolerant to 1st line treatment?
Ranolazine
