ACS + AMI therapy - clinical pharmacology

Question 1

what are the 4 ACS?

Answer 1

unstable angineNSTEMISTEMIsudden cardiac death

Question 2

what can unstable angina lead to?

Answer 2

STEMINSTEMIsudden cardiac death

Question 3

what can NSTEMI lead to?

Answer 3

sudden cardiac deathSTEMI

Question 4

what can STEMI lead to?

Answer 4

sudden cardiac death

Question 5

what are the general aims of pharmacotherapy of acs?

Answer 5

increase myocardial oxygen suppledecrease myocardial oxygen demand

Question 6

what are the ways that myocardial oxygen demand can be decreased (and so manipulated for pharmacotherapy of ACS)?

Answer 6

decrease HRdecrease BPdecrease preload or myocardial contractility

Question 7

what are the ways that myocardial oxygen supply can be increased (and so manipulated for pharmacotherapy of ACS)?

Answer 7

through coronary vasodilation (thrombolysis)

Question 8

what is the most common cause of STEMI and how any patients are seen to have this on an angiogram?

Answer 8

coronary thrombus formation (on atheromatous plaque)90% show evidence of this

Question 9

if PCI is unable to be performed within 2 hourse of a STEMI what is the treatment?

Answer 9

thrombolysis

Question 10

what are the most common thrombolysis drugs used today and how do they work?

Answer 10

serine proteases. work by converting natural plasminogen into plasmin this breaks down fibrin and fibrinogen

Question 11

which fibrinolytic agents are used in thrombolytic treatment of STEMI?

Answer 11

alteplase, reteplase, tenecteplase

Question 12

which non-fibrinolytic agents are used in thrombolytic treatment of STEMI?

Answer 12

streptokinase

Question 13

what are the contraindications of thrombolysis in STEMI?

Answer 13

-Prior intracranial hemorrhage (ICH)-Known structural cerebral vascular lesion-Known malignant intracranial neoplasm-Ischaemic stroke within 3 months-Suspected aortic dissection-Active bleeding or bleeding diathesis (excluding menses)-Significant closed-head trauma or facial trauma within 3 months

Question 14

what is bleeding diathesis?

Answer 14

a condition in which there is an unusual susceptibility or predisposition to bleeding.

Question 15

giving thrombolysis treatment along with what decreases the chance of mortality?

Answer 15

aspirin

Question 16

which drugs are used in the treatment of ACS that isn’t STEMI?

Answer 16

AspirinTigagrelor (or Clopidogrel)Fondaparinux/LMW heparinIntravenous nitrateAnalgesiaBeta Blockersothers:prasugrelGIIbIIIa receptor blockersStatins

Question 17

what is the action of IV nitrate?

Answer 17

vasodilator to improve perfusion of myocardium

Question 18

which analgesics are used in the treatment of NSTEMI and unstable angina

Answer 18

opiates

Question 19

what is the action of fondaparinux?

Answer 19

reduces vasospasm

Question 20

what is the action of prasugrel?

Answer 20

platelet inhibitor

Question 21

what is the action of GIIbIIIa receptor blockers?

Answer 21

prevent platelet aggregation and thrombus formation

Question 22

which treatments are used to reduces the risk from NSTEMI?

Answer 22

PCI or CABGAspirinClopidogrel, prasugrel, ticagrelor, ticlopidine or cilostazolHeparin (LMWH)FondaparinuxGIIb/IIIa receptor blockersStatinsB blockers

Question 23

what is clopidogrel always used with?

Answer 23

aspirin

Question 24

what is clopidogrel being replaced by and why?

Answer 24

ticagrelor, there is a proportion of the population who do not respond to clopidogrel

Question 25

what is the advantage of prasugrel over clopidogrel?

Answer 25

prasugrel inhibits ADP–induced platelet aggregation more rapidly, more consistently

Question 26

which low molecular weight heparin drugs are used to treat ACS?

Answer 26

EnoxaparinDalteparinTinzeparinFondaparinux

Question 27

what is thrombocytopenia?

Answer 27

low levels of platelets in the bood

Question 28

give an example of a GIIb/IIIa Receptor Blocker?

Answer 28

tirofiban

Question 29

what are the risks with using tirofiban (a GIIb/IIIa Receptor Blocker) with heparin?

Answer 29

-thrombocytopenia-bleeding

Question 30

when are Beta blockers used in the treatment of MI?

Answer 30

1. in the treatment of acute MI2. also in the secondary prevention of acute MI

Question 31

which beta blockers are given immediately after an acute MI?

Answer 31

IV atenolol or metoprolol

Question 32

when are beta blockers given as a preventative measure, and how are they administered?

Answer 32

weeks or months post MI, given orally

Question 33

when are beta blockers contraindicated post-MI?

Answer 33

-if the patient is close to cardiogenic shock-coronary vasospasm-cocaine use

Question 34

what the signs of a patient developing cardiogenic shock?

Answer 34

heart rate >110 beats/minsystolic blood pressure < 120 mmHg(usually age >70 years old)