Acute Coronary Syndromes Flashcards
(41 cards)
Which drug should be used for pain relief as soon as possible in an acute coronary syndrome?
Glyceryl trinitrate (sublingual or buccal)
Sublingual (tablet): 1 tablet, dose may be repeated at 5 minute intervals if required (for treatment of angina)
Apart of glyceryl trinitrate, what other medication can be used for pain relief in acute coronary syndrome (particularly acute MI)?
Morphine (for severe pain)
Acute pain (oral, subcutaneous injection, IM injection): Initially 10 mg every 4 hours (adult) Elderly: initially 5 mg every 4 hours
In an acute coronary syndrome, a loading dose of (?) should be given as soon as possible.
aspirin 300 mg
Should oxygen be routinely administered to patients with acute coronary syndromes?
NO
Monitor oxygen saturation and give supplemental oxygen if indicated
All patients admitted to hospital with an acute coronary syndrome should be closely monitored for (metabolic derangement?)
Hyperglycaemia
Those with blood glucose concentration greater than 11.0 mmol/L should receive insulin
What are the two options for coronary reperfusion therapy in a STEMI?
Primary PCI
Fibrinolysis
What is the criteria for a patient to receive a primary PCI in the treatment of a STEMI? (2)
Present within 12 hours of symptom onset
AND
Within 120 minutes of the time when fibrinolysis could have been given
Most patients with a STEMI or NSTEMI should be offered a second antiplatelet agent in addition to aspirin. What are the three options for the second antiplatelet agent?
Prasugrel
Ticagrelor
Clopidogrel
The choice of second antiplatelet depends on the planned intervention (PCI, fibrinolysis or conservative) and the patient’s bleeding risk
Which second antiplatelet agent is preferred for most patients undergoing a primary PCI for a STEMI?
Prasugrel (oral)
- Initially 60 mg for 1 dose, then 10 mg once daily for up to 12 months (adult 18-74 years, body weight 60kg and above)
- Initially 60 mg for 1 dose, then 5 mg once daly usually for up to 12 months (adult 18-74 years, body weight up to 60kg; AND adult 75 years and over)
Unless the risk of bleeding outweighs its effectiveness (e.g. if taking an oral anticoagulant use clopidogrel)
What drug should be used during a PCI with radial access for anticoagulation?
Heparin (unfractionated)
What drug should be used during a PCI with femoral access for anticoagulation?
Bivalirudin (IV)
- Initially 750 micrograms/kg, followed immediately by 1.75 mg/kg/hour during procedure (IV infusion) and for up to 4 hours after procedure, then (by intravenous infusion) reduced to 250 micrograms/kg/hour for a further 4–12 hours if necessary.
Bivalirudin, a hirudin analogue, is a thrombin inhibitor
What is the drug action of bivalirubin?
A hirudin analogue (thrombin inhibitor)
Which drug can be used as rescue or bailout therapy to manage complications arising during PCI?
Glycoprotein (GP) IIb/IIIa inhibitors
For patients undergoing fibrinolysis for a STEMI, what other drug class should be given at the same time?
Antithrombin agent
If a patient with an NSTEMI does not have an immediate PCI planned and they do not have a high bleeding risk, which drug (in addition to antiplatelets) should be given?
Fondaparinux sodium (antithrombin therapy)
- Subcutaneous injection
- 2.5 mg once daily for up to 8 days (or until hospital discharge if sooner)
A patient with an NSTEMI is given fondaparinux sodium, but then is scheduled for a coronary artery bypass graft surgery. How many hours prior to the surgery should the drug be stopped and how many hours after surgery should the drug be restarted?
Stopped: 24 hours before
Restarted: 48 hours post-operatively
A patient has an NSTEMI and significant renal impairment is NOT undergoing an immediate coronary angiography and are not high bleeding risk, which antithrombin therapy should they receive?
Heparin (unfractionated)
Following an acute coronary syndrome, all patients should be offered a cardiac rehabilitation programme. What 3 things does this include?
Lifestyle changes
Stress management
Health education
Lifestyle interventions include healthy eating, reducing alcohol, regular exercise, smoking cessation and weight management
Is there a difference in the treatment for secondary prevention if the patient had a NSTEMI or STEMI?
NO
Clinical judgement is used in patients with unstable angina
What drugs are offered as part of secondary prevention following an acute coronary syndrome? (4)
ACE inhibitor or ARB
Beta-blocker
Dual antiplatelet therapy
Statin
When do you start a patient on an ACE inhibitor and beta-blocker after an acute coronary syndrome?
Once they are haemodynamically stable
Following an acute coronary syndrome, how long does a patient need to take a beta-blocker if they have a reduced left ventricular ejection fracture?
Indefinitely
In those without reduced LVEF, it may be appropriate to discontinue beta-blocker therapy after 12 months
Following an acute coronary syndrome, how long does a patient need to take a beta-blocker if they do NOT have a reduced left ventricular ejection fracture (LVEF)?
12 months minimum
Discontinue only after discussion with the patient and the potential benefits and risks of continuation are taken into account
For secondary prevention after an acute coronary syndrome (ACS), which 2 drugs can be used as an alternative to beta-blocker therapy if the patient does NOT have pulmonary congestion or a reduced LVEF?
Diltiazem hydrochloride
- initially 60 mg 2-3 times a day (max. 360 mg per day)
Verapamil hydrochloride
