Cardiac emergencies

Question 1

What does GTN do in heart failure?

Answer 1

A nitrate medication given sublingually that activates an enzyme to convert triphosphate into cGMP
cGMP - Vasodilation = reduced BP and preload on the heart

Question 2

What are some non emergency drugs?

Answer 2

• Pts may be prescribed ACE inhibitors or ANG 1 blockers to reduce the effect of the RAA system
• These prevent the production of ANG II which prevents aldosterone and that prevents H+ and water retention and some vasoconstriction.
• This reduces vascular resistance, blood pressure and pre load to prevent deterioation of heart failure.

Question 3

What does aspirin do?

Answer 3

• An antiplatlet
• Irreversibly inhibits prostoglandin synthetase which means that thromboplastin cannot be released
• This means that factor VII can’t be activated disrupting the clotting cascade

Question 4

What does GTN do in ACS?

Answer 4

• Uses NO to relax endothelial tissue and smooth muscle
  -This causes vasodilation relieving coronary spasm
• Also dilates systematic veins which lowers Bp on the heart

Question 5

What does morphine do in treating/ managing ACS?

Answer 5

• Binds to mu-opiod receptors to block transmission of nociceptive signals from afferent nociceptive in the parasympathetic nervous system.
• Also activates other inhibitory pathways in descending CNS.
• Both prevent the transmission and processing of pain signals causing reduced pain levels
• Also has cardioprotective effect as histamines are released leading to vasodilation, reduced bp and preload
• Also triggers chemoreceptor trigger zone causing nausea and decreased RR

Question 6

What does paracetamol do regarding the pharmacology?

Answer 6

• Inhibits the production of an isoenzyme which prevents PGS
• PGS indirectly sensitising nocioceptors as cause inflammation causing the feeling pain
• Stop PGS means the reduction of feeling pain