lecture 17 - pharmaceutical care in patients with acute coronary syndrome and stable angina Flashcards
what is acs
set of signs and symptoms related to the heart
what is unstable angina?
an unprovoked or prolonged episode of chest pain raising suspicion of acute myocardial infarction (AMI) without definite ECG or laboratory evidence
what is NSTEMI
chest pain suggestive of AMI
non specific ECG changes (ST depression/ T inversion/normal)
w hat do lab tests show in NSTEMI?
release of troponin
what is STEMI
sustained chest pain of AMI
acute ST elevation or new LBBB
what re bedside investiagtions?
blood pressure, pulse, temperature, HR and blood glucose
ecg
what are bloods investigations?
fbc
u and e
lots
lipids
cardiac enzymes
amylase
cap - inflammatory markers
what are imaging investigations?
CXR
what are special investigations
echo - function of heart
angiography - look directly at heart
what are special investigations
echo - function of heart
angiography - look directly at heart
what drugs are used in ACS management? MONA
morphine 5-10mg slow IV injection
oxygen (titrate satsa - aim for 94-98%)
nitrates - GTN spray 400mcg = 1 spray or tablet (300/500/600 mcg)
aspirin 300mg chewed stat
Metoclopramide 10mg IV
Fondaparinux 2.5 mg SC
Triagrelor 150mg stst
What does PCI require
Ticagrelor 180mg dose
Rescue PCI after failed thrombolysis
What is the call to ballon them for pci?
120 minutes
What is thrombolysis ?
the dissolution of a blood clot, especially as induced artificially by infusion of an enzyme into the blood.
what is stemi treated with ?
pci
thrombolysis
beta blocker ie bisoprolol
what is secondary prevention for acs ?
aspirin 75mg once daily
beta blocker first lien is bisoprolol
strain high intensity - at least 40mg atorvastatin most likely 80mg and then reduce to 40mg
what are complications in early <72hrs acute coronary syndrome ?
death
cariogenic shock
heart failure
ventricular arrhythmias
myocardial rupture
thromboembolism
pericarditis
what are late complications of acute coronary syndrome?
ventricular wal rupture
valvular regurgitation
ventricular aneurysms
cardiac tamponade
dressers syndrome
thromboembolism
what are side effects of ace inhibitors ?
Cough
Angiodema - emergency - patient face swelling and cannot breathe
Potassium excess - hypokalaemia
Taste changes - metallic taste
Orthotasaic hypotension
Pregnancy contraindication/ pressure drop
Renal failure / rash
Indomethacin inhibitor/ non steroidal
Leukopenia (rare)
what is used for the management of stable angina?
beta blockers
calcium channel blockers
nitrates
potassium channel activators (nicrorandil)
ivabradine
ranolazine
what is used for the management of stable angina?
beta blockers
calcium channel blockers
nitrates
potassium channel activators (nicrorandil)
ivabradine
ranolazine
what are beta blockers used for?
multiple effects
only anti-agnina with proven effect on mortality
no one better than other - found
