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3.23 > Lecture 17: Pharmaceutical care in patients with acute coronary syndrome and stable angina > Flashcards

Lecture 17: Pharmaceutical care in patients with acute coronary syndrome and stable angina Flashcards

1
Q

What does acute coronary syndrome include?

A
  • Unstable angina
  • NSTEMI
  • STEMI
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2
Q

What is acute coronary syndrome?

A

A set of signs and syndromes related to the heart

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3
Q

What is unstable angina?

A

An unprovoked or prolonged episode of chest pain raising suspicion of acute myocardial infarction, without definate ECG or laboratory evidence

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4
Q

What is NSTEMI?

A

Chest pain suggestive of an acute myocardial infacrtion
- Non specific ECG changes

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5
Q

What is STEMI?

A

Sustained chest pain suggestive of an acute myocardial infarction.

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6
Q

What are modifiable risk factors for acute myocardial infarction?

A
  • Smoking
  • Obesity
  • Lack of excerise
  • Alcohol excess
  • Diet (saturated fat)
  • Hypertension
  • High serum cholesterol
  • Diabetes
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7
Q

What are non modifiable risk factors for acute myocardial infarction?

A
  • Age
  • Gender
  • Ethnicity
  • Family history
  • Past medical history
  • Deprivation
  • Diabetes
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8
Q

What are the clinical features of acute coronary syndrome?

A
  • Chest pain
  • Nausea
  • Tachycardia / bradycardia
  • Dyspoea
  • Palpitations
  • Sweaty
  • Vomiting
  • Syncope
  • Acute confusion
  • Indigestion
  • Fever
  • Pallor
  • Asymptomoatic/ Silent
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9
Q

What are the differential diagnosis of chest pain?

A
  • GI: Oesophageal spasm, GORD, pancreatitis
  • Cardiac: MI, angina, pericarditis, aortic dissection
  • Respiratory: Pulmonary embolism, pneumonia, pneumothorax
  • Muscoskeletal: Costochondriasis, trauma
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10
Q

What is MONA?

A
  • Morphine
  • Oxygen
  • Nitrates
  • Aspirin
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11
Q

What is the dose of morphine for acute coronary syndrome?

A

5-10mg slow IV injection

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12
Q

What is the dose of GTN spray for acute coronary syndrome?

A

400mcg = 1 spray

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13
Q

What is the dose for nitrate tablets for acute coronary syndrome?

A

300/500/600 mcg

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14
Q

What is the dose of aspirin for for acute coronary syndrome?

A

300mg

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15
Q

What is the dose of metoclopramide for acute coronary syndrome?

A

10mg IV

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16
Q

What is the dose of fondaparinux for acute coronary syndrome?

A

2.5mg

17
Q

What is the dose of clopidogrel for acute coronary syndrome?

A

180mg

18
Q

What is the immediate management for unstable angina and NSTEMI?

A
  • Fondapairnuc 2.5mg once daily (max 7 days)
  • Ticagrelor 180mg
  • Beta blocker - atenolol 5mg IV/ bisopralol oral
  • GTN: IV
19
Q

What is the treatment for STEMI?

A
  • Percutaneous coronary intervention
  • Thrombolysis
  • Beta blocker
20
Q

What does Percutaneous coronary intervention require?

A
  • Loading dose of ticahrelor 180mg
21
Q

What are the side effects of ticagrelor?

A
  • Bradycardia (slow heart rate)
  • Shortness of breatg
22
Q

What are the early complications of acute coronary syndrome?

A
  • Death
  • Cardiogenic shock
  • Heart failure
  • Ventriclular arrhythmia
  • Myocardial rupture
  • Thromboembolism
  • Paricarditis
23
Q

What are the late complications of acute coronary syndrome?

A
  • Ventricular wall rupture
  • Valvular regurgiattion
  • Ventricular aneaurysm
  • Cardiac tamponade
  • Thromboembolism
24
Q

What are the side effects of ACE inhibitors?

A
  • Cough
  • Angioedema
  • Potassium excess
  • Taste changes
  • Orthostatic hypotension (dizzy)
  • Pregnancy contraindications/ pressure drop
  • Renal failure/ Rash
  • Indomethacin inhibition
  • Leukopenia (rare)
25
Q

What is the management of stable angina?

A
  • Betablockers
  • Calcium channel blockers
  • Nitrates
  • Potassium channel activators (nicorandil)
  • Ivabradine
  • Ranolazine
26
Q

What is the only anti-angina with proven effect on mortality?

A

Betablockers

27
Q

What cousilling should be given with betablockers?

A
  • Fatigue
  • Dizziness
  • Impotence
28
Q

What cousilling should be given with calcium channel blockers?

A

Couselling on vasodilation and oedema

29
Q

What cousilling should be given with nitrates?

A

Headache, red flushes

30
Q

What are the side effects of potassium channel activators?

A
  • Ulcers
  • Headache
  • Palpitation
31
Q

What do you use if beta blockers are not tolerated?

A

Ivabradine

32
Q

What do you use if patients are intolerant to 1st line treatment?

A

Ranolazine

3.23 (26 decks)

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