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MPharm 2 - PH2113 > Unit 6 - Cardiovascular 8 > Flashcards

Unit 6 - Cardiovascular 8 Flashcards

1
Q

What are the treatment options for patients with STEMI?

A

Reperfusion therapy

  • emergency PCI
  • if not contraindicated
  • offer if presenting in 12 hours of symptoms and PCI can be delivered in 120 mins
  • fibrinolysis
  • only carried out if PCI cannot be carried out in a timely manner
  • recommended within 12 hours of symptom onset if PCI cannot be performed within 120 minutes
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2
Q

What is the drug therapy for primary percutaneous coronary intervention (PCI)?

A

Dual anti-platelet therapy
- Prasugrel with aspirin if not already taking oral anticoagulant
Anti-thrombin therapy
- unfractionated heparin with bailout glycoprotein IIb/IIIa inhibitor
If stenting indicated - offer a drug eluting stent

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3
Q

How do antiplatelet drugs work to treat STEMI?

A

Target a variety of mechanisms of platelet activation
- arterial thrombi are platelet rich
Glycoprotein IIb/IIIa complex formation inhibition plays a critical role

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4
Q

What is the goal of drug therapy for fibrinolysis?

A

To limit the extent of myocardial necrosis by lysing the thrombus
- allowing blood flow

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5
Q

What are fibrinolytic drugs?

A

Plasminogen activators

  • reteplase
  • tenecteplase
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6
Q

Why is there a risk of haemorrhagic stroke (especially if BP is high) when using drug therapy for fibrinolysis?

A

Thombolysis uncovers lesions

- benefit outweighs risk with STEMI

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7
Q

What is dual antiplatelet therapy?

A

Ticagrelor with aspirin

  • unless high bleeding risk
  • clopidogrel with aspirin (or aspirin alone)
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8
Q

What may be offered if the patient is stable after fibrinolysis?

A

Angiography/PCI

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9
Q

How should patients with NSTEMI or unstable angina be formally risk assessed?

A

Global Registry of Acute Cardiac Events

- GRACE

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10
Q

What is the treatment for GRACE intermediate or higher risk patients?

A

Angiography/PCI within 72 hours
Dual anti-platelet therapy
- prasugrel with aspirin
- ticagrelor with aspirin
- clopidogrel with aspirin if on ongoing oral anticoagulant
Unfractionated heparin for PCI
- whether or not they have already received fondaparinux

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11
Q

What is the aim of angina treatment?

A 
Improve prognosis
- secondary prevention
Relieve or prevent symptoms
- reduce workload on heart
- improve oxygenation of heart muscle
- improve exercise tolerance
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12
Q

What are the treatment options for angina?

A 
Non pharmacological
- stent
- CABG
Pharmacological
- beta blocker
- calcium channel blocker
- others
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13
Q

What is the effect of beta blockers as an angina treatment?

A
  • increase time in diastole to improve coronary perfusion

- prognostic and symptomatic benefit

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14
Q

What is the target heart rate when using beta blockers to treat angina?

A

60 beats per minute

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15
Q

Which patient group should use beta blockers with caution?

A

Diabetics

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16
Q

Which patient group is contraindicated for using beta blockers?

A

Asthmatics

17
Q

What are the effects of using Calcium Channel Blockers to treat angina?

A 
Symptomatic benefit
- increased exercise tolerance
- reduce attacks
Arterial dilatation
- reduced afterload
Improved coronary perfusion
18
Q

Give examples of Calcium Channel Blockers used to treat angina

A 
Dihydropyridines
- long acting
- e.g. amlodipine
Diltiazem and Verapamil
- rate limiting
- caution
19
Q

What are the side effects of using Calcium Channel Blockers to treat angina?

A

Ankle swelling

  • common
  • switch
20
Q

What is the effect of using nitrates to treat angina?

A

Vasodilation
- reduced preload
Increased blood flow to endocardium

21
Q

How should nitrates be used to manage angina?

A

Relieve attacks - as required

Prevent attacks - regularly

22
Q

What are the side effects of using nitrates to treat angina?

A

Hypotension
Dizziness
Flushing
Headaches

23
Q

How does nicorandil treat angina?

A

Potassium channel activator
- similar properties to a nitrate

Add on to prevent attacks

24
Q

What should pharmacists be aware of in patients prescribed Nicorandil?

A

Can cause GI bleeds

- review in any patient with a suspected GI bleed

25
Q

What is the effect of using Ivabradine to treat angina?

A

Sinoatrial node modulator

  • controls pacemaker
  • prolongs time in diastole
26
Q

When is Ivabradine useful to treat angina?

A

If a beta blocker is contraindicated

27
Q

When is Ivabradine contraindicated in angina?

A

If heart rate is < 70 beats per minute

28
Q

What is the effect of Ranolazine to treat angina?

A

Unknown mechanism
Stabilises myocardium to reduce ischaemia
No effect on blood pressure or heart rate

Often useful additional drug to manage uncontrolled angina

29
Q

How should patients with angina be monitored?

A

Follow patient up after 2 - 4 weeks
Titrate dose according to symptoms and tolerability
Follow NICE guidelines

30
Q

What are the NICE recommendations for treating angina?

A 
Beta blocker or calcium channel blocker
Swap or add in the other one
Any of:
- nitrate
- nicorandil
- ivabradine
- ranolazine

MPharm 2 - PH2113 (50 decks)

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