Pharmacology of ACS

Question 1

What is the treatment of ACS?

Answer 1

Increase myocardial O2 supply (vasodilation, correct hypoxaemia, stop platelet aggregation).

Decrease myocardial O2 demand (reduce HR, BP, preload, contractility, and wall stress). Use bisoprolol, nitrates, ramipril and atorvastatin.

Question 2

What is the management of ACS?

Answer 2

Morphine.
Oxygen.
Clopidogrel, Ticagrelor, Prasugrel.
Fondaparinux.

Question 3

What is STEMI therapy?

Answer 3

Unblock the artery.
Vasodilators don’t work.
Stop platelet aggregation.
Emergency angioplasty.

Question 4

What is thrombolysis?

Answer 4

Fibrin specific agents - catalyses conversion of plasminogen to plasmin (alteplase, tenecteplase (higher fibrin specificity, longer half-life)).
Non-fibrin specific agents - catalyses systemic fibrinolysis (streptokinase - low efficacy and low bleeding risk).

Question 5

What are the contraindications of thrombolysis?

Answer 5

Prior intracranial haemorrhage.
Known intracranial lesion.
Ischaemic stroke (within 3 months).
Suspected aortic dissection.
Active bleeding.
Significant closed head trauma (within 3 months).