lecture 17 - pharmaceutical care in patients with acute coronary syndrome and stable angina

Question 1

what is acs

Answer 1

set of signs and symptoms related to the heart

Question 2

what is unstable angina?

Answer 2

an unprovoked or prolonged episode of chest pain raising suspicion of acute myocardial infarction (AMI) without definite ECG or laboratory evidence

Question 3

what is NSTEMI

Answer 3

chest pain suggestive of AMI

non specific ECG changes (ST depression/ T inversion/normal)

Question 4

w hat do lab tests show in NSTEMI?

Answer 4

release of troponin

Question 5

what is STEMI

Answer 5

sustained chest pain of AMI

acute ST elevation or new LBBB

Question 6

what re bedside investiagtions?

Answer 6

blood pressure, pulse, temperature, HR and blood glucose

ecg

Question 7

what are bloods investigations?

Answer 7

fbc

u and e

lots

lipids

cardiac enzymes

amylase

cap - inflammatory markers

Question 8

what are imaging investigations?

Answer 8

CXR

Question 9

what are special investigations

Answer 9

echo - function of heart

angiography - look directly at heart

Question 9

what are special investigations

Answer 9

echo - function of heart

angiography - look directly at heart

Question 10

what drugs are used in ACS management? MONA

Answer 10

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

Question 11

What does PCI require

Answer 11

Ticagrelor 180mg dose

Rescue PCI after failed thrombolysis

Question 12

What is the call to ballon them for pci?

Answer 12

120 minutes

Question 13

What is thrombolysis ?

Answer 13

the dissolution of a blood clot, especially as induced artificially by infusion of an enzyme into the blood.

Question 14

what is stemi treated with ?

Answer 14

pci

thrombolysis

beta blocker ie bisoprolol

Question 15

what is secondary prevention for acs ?

Answer 15

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

Question 16

what are complications in early <72hrs acute coronary syndrome ?

Answer 16

death

cariogenic shock

heart failure

ventricular arrhythmias

myocardial rupture

thromboembolism

pericarditis

Question 17

what are late complications of acute coronary syndrome?

Answer 17

ventricular wal rupture

valvular regurgitation

ventricular aneurysms

cardiac tamponade

dressers syndrome

thromboembolism

Question 18

what are side effects of ace inhibitors ?

Answer 18

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)

Question 19

what is used for the management of stable angina?

Answer 19

beta blockers

calcium channel blockers

nitrates

potassium channel activators (nicrorandil)

ivabradine

ranolazine

Question 19

what is used for the management of stable angina?

Answer 19

beta blockers

calcium channel blockers

nitrates

potassium channel activators (nicrorandil)

ivabradine

ranolazine

Question 20

what are beta blockers used for?

Answer 20

multiple effects

only anti-agnina with proven effect on mortality

no one better than other - found