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BNF Cardiovascular > Myocardial Ischaemia > Flashcards

Myocardial Ischaemia Flashcards

1
Q

What condition is characterised by predicatable chest pain/pressure often on exertion?

A

Stable angia

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2
Q

What is the pathophysiology behind stable angina?

A

Atherosclerotic plaques in the coronay arteries restricting blood flow to the heart

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3
Q

What type of angia is caused by narrowing or occlusion of the proximal coronary arteries due to spasm - normally at rest?

A

Prinzmetals / vasospastic angina

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4
Q

How should acute attacks of stable angina be managed?

A

GTN spray

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5
Q

How should long term prevention of stable angina be mananged?

A
  1. Beta blocker (atenolol, bisoprolol, metoprolol etc)
  2. RL CCB if beta blocker is inappropriate (e.g. in Prinzmetals angina - amlodipine may also be useful in this type of angina)
  3. BB + CCB
  4. addition of Long acting nitrate, Ivabradine, Nicorandil or Ranolazine
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6
Q

If a patient has stable angia but cannot tolerate a beta blocker or CCB what else can be offered?

A

Long acting nitrate, Ranolazine, Ivabradine, Nicorandil

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7
Q

All patients with stable angina due to atherosclerotic disease should be offered what secondary prevention medications?

A

Aspirin + Statin

consider adding an ACEI (particularly if diabetic)

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8
Q

At what heart rate would you consider discontinuing Ivabradine?

A

50bpm

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9
Q

What is a serious side effect of Nicorandil?

A

serious skin, mucosal and eye infections including GI ulcers whihc may progress to perforation /haemorrhage / fistula

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10
Q

How would you counsel a patient to use GTN spray?

A

Sit down. Spray 1-2 doses under the tongue on the onset of pain. Dose may be repeated 5 minutes after if pain not subsided. Max of 3 doses in one time. If not resolved after 5 mins of 2nd dose call ambulance. If pain resolves when stand up do so slowly and carefully.

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11
Q

What conditions are encompassed under ACS

A

NSTEMI, STEMI, unstable angina

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12
Q

What should be given in the initial management of an NSTEMI / UA?

A
  1. Oxygen
  2. Nitrates - Sublingual/IV/buccal GTN or ISDN
  3. Pain relief - morphine by slow IV
  4. Antiemetics - metoclopramide
  5. Aspirin 300mg ( or clopidogrel is intolerant)
  6. Fondaparinux 2.5mg SC unless coronary angiography is planned within24 hoursof admission then give LMWH
  7. Ticagrelor 180mg STAT then 90mg BD (12 months)
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13
Q

If a patient presents with a low risk NSTEMI what antiplatelet therapy is used?

A

Clopidogrel

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14
Q

If a patient presents with a medium-high risk NSTEMI what antiplatelet therapy is used?

A

Abciximab or eptifabatide ( in combination with LMWH + aspirin) or Tirofiban (+LMWH+Aspirin+clopidogrel)

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15
Q

What 2 medications are given STAT if suspected ACS?

A

300mg Aspirin + 300mg Clopidogrel

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16
Q

What are the secondary prevention medications following ACS?

A
  1. ACEI
  2. Beta blocker
  3. Statin
  4. GTN
17
Q

Initial management of a STEMI

A
  1. Oxygen
  2. Analgesia
  3. Antiemetics
  4. Aspirin 300mg + clopidogrel 300mg Stat ( or prasugrel if patient is undergoing PCI)
  5. PCI - (use a glycoprotein IIb/IIa inhibitor may be necessary in high risk patients)
  6. Nitrates
  7. Beta blocker
  8. ACEI
18
Q

Long term management on STEMI

A
  1. Aspirin + clopidogrel
    2.Beta blocker
  2. ACEI
    4.Nitrates
  3. Statins
    NB: epelernone is licensed following an MI with LV dysfunction
19
Q

Non-pharmacological advice to reduce risk of future MI

A

diet, exercise, smoking cessation,

20
Q

At what weight is prasugrel cautioned?

A

60kg

21
Q

What class of antiplatelet is ticagrelor?

A

P2Y12 inhibitor

22
Q

Within how many hours of symptom onset should Streptokinase or reteplase be given?

A

12 hours

23
Q

Examples of nitrate side effects?

A

Flushing, headache, postural hypotension

24
Q

How long does the effect of GTN last for?

A

20-30 minutes

25
Q

What is the issue with using a GTN transdermal patch over the spray/tablet?

A

Tolerance is more likely to occur

26
Q

What preparation of nitrate is more stable for those who use GTN spray less frequently?

A

Isosorbide dinitrate spray

27
Q

What is the duration of action of MR preparations of nitrates?

A

12 hours

28
Q

How can nitrate tolerance be prevented?

A

Nitrate break for 4 - 12 hours each day

29
Q

If a patient uses a nitrate patch and tolerance is suspected, how long should they leave the patch off for?

A

8 - 12 hours (usually overnight) in each 24 hours

30
Q

What is dobutamines mechanism of action?

A

Works on beta 1 receptors in the heart as a cardiac stimulant to increase contractility

31
Q

What drug should be given every 3 to 5 minutes in cardiac resus?

A

Adrenaline 100mcg/mL solution, 1mg every 3 to 5 minutes

32
Q

How many adrenaline autoinjectors should be prescribed at once?

A

Two

33
Q

What brand of autoinjector had a product recall in may 2020?

A

Emerade

34
Q

How long after the first administration of adrenaline autoinjector can another dose be given?

A

5 to 15 mins

35
Q

When prescribing an adrenaline autoinjector what do prescribers need to specify?

A

the brand ( non bioavailble)

BNF Cardiovascular (10 decks)

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