ACS Therapy Flashcards
(46 cards)
What is immediate treatment for UAP + NSTEMI
Morphine / analgesia
Oxygen
GTN - give with aspirin prior to hospital or IV nitrates
Aspirin + dual anti platelet with Clopidogrel / Trisagrelol
IV access for blood
12 lead ECG
Anti-emetic
What therapy do you give for UAP and NSTEMI
Anti-platelet - aspirin / clopidogrel - dual therapy Anti-coagulant - LMWH until discharge Statins ACEI - if hypertensive but way up risks BB Decide risk Revascularisation if high risk
What therapy if there for STEMI
If PCI available in 2 hours give GP IIB/ IIA antagonist
If unavailable = thrombolysis then transfer
Alteplase (fibrin specific)/ streptokinase (no-fibrin specific)
What are the CI of thrombolysis
Haemorrhage stroke CNS damage Major trauma < 3 weeks / operation GI bleeding Aortic dissection Low platelet Low glucose High BP Pregnant Anti-coagulant
What do you use in combination with thrombolysis
Aspirin
What do you give post STEMI / ACS
4 therapy Aspirin 75mg Tisagruel or clopidogrel 75mg Dual anti-platelet BB Atenolol 50-100mg ACEI 2.5mg - renin angio causes fibrosis Statin 80mg
Maybe give
Aldosterone antagonist (eplenerone) if evidence of HF
Anti-arrythmia
GTN
What do you never use in ACS
CCB
When do you do coronary revasculiration (CABG / PCI)
If high risk of STEMI with UA or NSTEMI
Normally keep in hospital after NSTEMI for CABG to prevent
Look at legs for scars (saphenous)
What are new approaches to NSTEMI / UAP
Trimetazidine - metabolic modulation
Ivabradine - inhibit sinus node
Ranolazine - Na inhibitor
When is there an increased risk of bleeding from anti-thrombotic (Heparin)
High BP Age >75 Stroke Bleeding tendency Labile INR >4 Abnormal renal / liver Drugs - aspirin / NSAID / alcohol
Low body weight
CKD
When do you do CABG
3 vessel disease
Left main stem disease
Disease not amendable to PCI
What does CABG require
Adequate lung / hepatic function
Ascending aorta
Distal coronary targets
LV EF >20%
What can you use for CABG
Revered long saphenous vein
Internal mammary arteries / radial (if varicose vein surgery)
Artery or veins connected to LAD artery
What is needed during CABG procedure
Heart / lung bypass machine
Anti-coagulant
Hypothermia
What are post-op problems
Cardiac tamponade - prevents atria filling
Increased JVP, tachy, muffled HS and low BP
Death - stroke / MI
What does aspirin do
Inhibits thromboxane A2 production and platelet aggregration by blocking enzyme cyclooxygenase
Anti-Platelet
Reduce MI mortality
Risk of GI bleed so low dose
What does a statin do
Lower cholesterol
What are the SE of statin and when is it CI
Myopathy - check CK Rhabdomyolysis (check CK) if develop Liver impairment - discontinue if 3x - measure baseline and at 3 + 12 months CI pregnancy / macrolide use Type II DM Haemorrhagic stroke = very rare
Who is given statin + aspirin
All patients with CVD as secondary prevention or
>10% ris as primary prevention
Think if elderly do they still need
What is the action of clopidogrel / tisagrelor / prasagurel
Inhibits ADP receptor which stops activation of GB IIa / IIb
Stops aggregation of platelet
What is 1st line in ACS
Tisagrelor (CI previous stroke)
What is used if already on anti-coagulant or will need anti-coagulation or TIA or peripheral arterial disease
Clopidogrel
What are risks
Bleeding - don’t give if CABG
Lower risk of GI bleed than aspirin
Caution asthma / COPD
What do BB do
Block sympathetic
Decrease HR and contractility
Improves perfusion
