Unit 6 - Cardiovascular 8 Flashcards
What are the treatment options for patients with STEMI?
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
What is the drug therapy for primary percutaneous coronary intervention (PCI)?
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
How do antiplatelet drugs work to treat STEMI?
Target a variety of mechanisms of platelet activation
- arterial thrombi are platelet rich
Glycoprotein IIb/IIIa complex formation inhibition plays a critical role
What is the goal of drug therapy for fibrinolysis?
To limit the extent of myocardial necrosis by lysing the thrombus
- allowing blood flow
What are fibrinolytic drugs?
Plasminogen activators
- reteplase
- tenecteplase
Why is there a risk of haemorrhagic stroke (especially if BP is high) when using drug therapy for fibrinolysis?
Thombolysis uncovers lesions
- benefit outweighs risk with STEMI
What is dual antiplatelet therapy?
Ticagrelor with aspirin
- unless high bleeding risk
- clopidogrel with aspirin (or aspirin alone)
What may be offered if the patient is stable after fibrinolysis?
Angiography/PCI
How should patients with NSTEMI or unstable angina be formally risk assessed?
Global Registry of Acute Cardiac Events
- GRACE
What is the treatment for GRACE intermediate or higher risk patients?
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
What is the aim of angina treatment?
Improve prognosis - secondary prevention Relieve or prevent symptoms - reduce workload on heart - improve oxygenation of heart muscle - improve exercise tolerance
What are the treatment options for angina?
Non pharmacological - stent - CABG Pharmacological - beta blocker - calcium channel blocker - others
What is the effect of beta blockers as an angina treatment?
- increase time in diastole to improve coronary perfusion
- prognostic and symptomatic benefit
What is the target heart rate when using beta blockers to treat angina?
60 beats per minute
Which patient group should use beta blockers with caution?
Diabetics
Which patient group is contraindicated for using beta blockers?
Asthmatics
What are the effects of using Calcium Channel Blockers to treat angina?
Symptomatic benefit - increased exercise tolerance - reduce attacks Arterial dilatation - reduced afterload Improved coronary perfusion
Give examples of Calcium Channel Blockers used to treat angina
Dihydropyridines - long acting - e.g. amlodipine Diltiazem and Verapamil - rate limiting - caution
What are the side effects of using Calcium Channel Blockers to treat angina?
Ankle swelling
- common
- switch
What is the effect of using nitrates to treat angina?
Vasodilation
- reduced preload
Increased blood flow to endocardium
How should nitrates be used to manage angina?
Relieve attacks - as required
Prevent attacks - regularly
What are the side effects of using nitrates to treat angina?
Hypotension
Dizziness
Flushing
Headaches
How does nicorandil treat angina?
Potassium channel activator
- similar properties to a nitrate
Add on to prevent attacks
What should pharmacists be aware of in patients prescribed Nicorandil?
Can cause GI bleeds
- review in any patient with a suspected GI bleed
