Ischaemic Heart Disease

Question 1

What is the initial pharmacological management of someone with a MI?

Answer 1

1. Dual platelet therapy - aspirin and prasugrel/ticagrelor/clopidogrel
2. Fondaparinux or a LMWH
3. Beta blocker given in the absence of bradycardia or hypotension
4. immediate blood glucose control for diabetics with marked hyperglycaemia (>11mmol/L)

Question 2

What determines whether someone who has had a STEMI has PCI or thrombolysis?

Answer 2

Timing - patient has to present within 12hrs of onset of symptoms and it should only be done if they can get to a hospital within 120 minutes from diagnosis otherwise immediate thrombolytic therapy should be given

Question 3

for how long should patients with ACS receive dual antiplatelet therapy for?

Answer 3

6 months

Question 4

should patients with ACS be offered DOACs in addition to dual antiplatelet therapy?

Answer 4

no

Question 5

what can be given to patients to relieve cardiac pain when they are having an MI?

Answer 5

nitrates

Question 6

following an MI, what 4 drugs should a patient be offered?

Answer 6

DABS:

1. dual antiplatelet therapy
2. ACE inhibitor
3. Beta-blocker
4. Statin

Question 7

What dose of aspirin should be used for ACS treatment?

Answer 7

loading dose of 300mg followed by 75mg daily

Question 8

how do beta-blockers help in angina?

Answer 8

overall effect is to reduce myocardial o2 demand and they do this by:

• decreasing HR
• reducing force of contraction
• lower BP by reducing CO

Question 9

how do calcium channel blockers help in angina?

Answer 9

overall effect is to reduce myocardial O2 demand and they do this by:

• peripheral arterial dilation (dihydropyridines most potent)
• coronary artery dilation
• negative chronotropic effect (diltiazem and verapamil only)
• reduced cardiac contractility (esp. verapamil)

Question 10

name two dihydropyridine calcium channel blockers and say what they are specific for

Answer 10

amlodipine and nifedepine

selective for the vasculature

Question 11

name two non-dihydropyridines and say what they are more selective for

Answer 11

verapamil and diltiazem.

verapamil is the most cardioselective whereas diltiazem also have effects on the blood vessels.

Question 12

how do nitrates work and name two

Answer 12

vasodilators - cause vascular smooth muscle relaxation bymimicking vasodilator efects of endogenous NO.
Glyceryl trinitrate, isosorbide mononitrate, dinitrate

Question 13

what is the problem with using nitrates for a sustained use of time and how can this be avoided?

Answer 13

tolerance builds up and they are no longer effective.
this can be minimised by careful timing of doses to avoid significant nitrate exposure overnight, when it tends not to be needed