CVS Flashcards
1
Q
3 types of atrial fibrillation
A
paroxysmal AF- episodes stop within 48h without trt
persistent AF- last > 7 days
permanent AF- present all the time
2
Q
4 class of anti-arrhythmic drugs
A
CLASS I: Na+ blocker, membrane stabilising drugs: disopyramide, flecainide/propafenone (C/I in asthma, severe COPD, avoid in structural/ ischaemic heart disease) lidocaine
CLASS II: B blocker: propranolol, esmolol
CLASS III: K+ blockers: amiodarone (use b/f and a/f cardioversion), SOTALOL, dronedarone
CLASS IV: CCB (rate-limiting): verapamil, diltiazem
OTHER: adenosine, digoixin
3
Q
two pathways for cardioversion to restore sinus rhythm
A
1 electrial current
2 pharmacological
4
Q
which cardioversion method is preferred for arrhythmias > 48h
A
electrical
5
Q
trt for acute new-onset presentation of arrhythmias 1-life threatening haemodynamic instability
A
electrical cardioversion
6
Q
trt for acute new-onset presentation of arrhythmias 2- <48 hrs
A
rate or rhythm control (electrical or amiodarone/flecainide)
7
Q
trt for acute new-onset presentation of arrhythmias 2- >48 hrs
A
rate control (verapamil, BB)
8
Q
maintenance trt for arrhythmias: 1st line
A
rate control (BB not sotalol, CCB, digoxin) monotherpy -> dual therapy -> rhythm control
9
Q
maintenance trt for arrthymias: 2st line
A
rhthym control: SOTALOL, amiodarone, dronedarone, flecainide, propafenone
10
Q
What is “pill in the pocket” and which drug
A
self treatment for arrhythmias, FLECAINIDE or propafernone
11
Q
preferred surgical treatment for atrial flutter
A
catheter ablation
12
Q
What is the screening tool for risk of stroke
A
CHADS-VASc tool
13
Q
what does CHA2DS2-VASc stand for? what score indicates treatment
A
Chronic heart failure Hypertension Age >75 (score2) Diabetes Stroke / TIA/ VTE Hx (score2) Vascular disease Age 65-74 Sex (M-1,F-2) Treat if score >2 or more
14
Q
Treatment for pulseless/V fibrillation
A
immediate defibrillation and CPR then IV amiodarone in refractory
15
Q
Trt for UNSTABLE sustained V tachycardia
A
direct current cardioversion, if fail add IV amidodarone
16
Q
Trt for STABLE sustained V tachycardia
A
IV amiodarone preferred
17
Q
Trt for NON-SUSTAINED V tachycardia
A
BB
18
Q
maintanance trt for pt at high risk of cardiac arrest (2 types of therapy)
A
- implantable cardioverter defibrillator
2. some pt needs drugs e.g. sotalol, BB alone or BB + amiodarone
19
Q
what’s prolonged QT interval also called
A
torsade de pointes
20
Q
trt for QT prolongation i.e. TdP
A
magnesium sulphate
21
Q
what are the causes for QT-prolongation (4)
A
- sotalol
- other drugs that prolong QT e.g. cirpofloxacin, amitriptyline, risperidone, ACE abx
- hypOKalaemia
- bradycardia
22
Q
PSVT can go away spontaneously or with relflex vagal nerve stimulation (reduce BP) such as
A
valsalva manoeuvre, carotid sinus massage, immerse face in ice cold water
23
Q
IV trt for PSVT
A
adenosine *c/i in asthma/copd, verapamil
24
Q
trt for recurrent PSVT
A
catheter ablation or anti-arrhythmic drugs
25
what are the indications of amiodarone
- PS arrhythemia
| - V arrhythemia
26
titration of amiodarone
200mg TDS for 7, 200mg BD for 7, 200mg OD as maintenance
27
S/e of amidarone (6)
1. EYES: Corneal microdeposits (night time glares "dazzled" by headlight at night, no vision impairm)
Optic neuropahty/neuritis (blidness) --> stop
2. SKIN: Phototoxicity (burning)
Grey skin on light exposure (shield skin from sunlight)
3. NERVES: Peripheral neuropathy (numb, tingling hands and feets, tremors)
4. LUNGS: Pneumonitis, pulmonary fibrosis (SOB, dry cough)
5. LIVER: Hepatotoxicity (report if jaundice, NV, fatigue, pruritus, ab pain, 3x LTA
6. THYROID
28
how does amiodarone affect thyroid level and why
amiodarone contains iodine -> hyPERthyroid and hyPOthyroid
hyper- weight loss, tachycardia, heat intolerance/ give carbimazole PRN, w/d amiodarone
hypo- weight gain, bradycardia, cold intolerance
start levothyroxine, no w/d of amio
29
Monitoring required with amiodarone
- yearly Eye test
- chest x ray
- LFT every 6/12
- thyroid TSH,T3,T4 before and every 6/12
- BP (hypo) ECG (bradycardia)
- K+ level (hypOKal)
30
Key interactions of amiodarone
1. Grapefruit juice (enzyme inhibitor) increases amiodarone conc
2. Amiodarone (enzyme inhibitor) —> reduce dose for warfarin phenytoin HALF DOSE digoxin
3. Statins —> myopathy
4. Bb, CCB —> Brady/AV block
5. Floxacin, ACE thromycin, TCA, Li, quinine, anti malarial, antipsych (esp sulpiride amisulpiride pimozide
31
how does digoxin work?
increase force of contraction (+ve inotrope)
| reduce conductivity in AV node (-ve chronotrope)
32
what type of drug is digoxin
cardiac glycoside HIGH RISK DRUG
33
therapeutic level of digoxin
1-2 mcg/L
34
how long after dosing can digoxin conc reach the therapeutic level
6 hours after does
35
is regular monitoring of digoxin level required as a high risk drug
no, not during maintenance therapy
36
under what condition monitoring of digoxin level is required
only if toxicity is suspected OR in RENAL impairment (renally cleared)
37
how often do you take digoxin as a maintenance therapy
OD
38
indications for digoxin and the associated dosage
worsening/severe HF 62.5-125mcg
| atrial flutter/ non-paroxysmal AF in sedentary pt 125-250mcg
39
different dosage form of digoxin have different BA: -elixir, -tab, -IV
- exlixir 75%
- tab 90%
- IV 100%
40
what are the signs of digoxin toxicity (5)
```
SLOW and SICK Dr:
bradycardia/ heart block
NV, D+ ab pain
yellow blurred vision
confusion, delirium
rash
```
41
what factors increase the risk of digoxin toxicity (5)
- hypOK (diurectics, theophylline, B2 agonist: salbutamol,tiotropium,aclidinium, steroid- prednisolone)
- hypO Mg
- hypER Ca
- hypoxia
- renal impairment (ACEi/NSAID)
42
what are the 2 options for digoxin toxicity
withdraw
| digoxin-specific antibody if life-threatening V arrhythmia unrepsonsive to atropine
43
what are the key interactions with digoxin CRASED
C- ccb (RATE)
R- rifampicin (R = inducer) reduce dgx conc
A - amiodarone (A=inhibitor) increase dgx conc - toxicity HALF DGX DOSE
S - st.johns wort (S=inducer)
E - Erythromycin (ACE=marcorlids=inhibitor) increase dgx conc
D - diuretics (loop/thiazide) hypOKal
44
digoxin + NASID/ ACEi
reduced renal function --> toxicity (dgx renal excreted)
45
theothylline can ___ K level
Klevel reduces as theothylline conc increases --> hypOKaleamia
46
VTE risk assessment in hospital
- immobility
- obesity BMI>30
- cancer
- age>60
- Hx of VTE
- thrombophilic disorder
- 1st degree of relative with VTE
- HRT/COC
- varicose vein (lost elasticity) with phlebitis (inflam vein)
- pregnancy
- critical care
- sig co-morbidities
47
risk of bleeding assessment
```
HAS-BLED
hypertension (uncontorlled BP)
abnormal renal/liver func
stroke
bleeding tendency (throbocytopenia-low platelet)
labile INR
age >65
drugs eg aspirin/NSAID/alcohol
```
48
duration of VTE prophylaxis for general surgery
5-7 days or until mobility
49
duration of VTE prophylaxis for major cancer surgery in ab or pelvis
28 days
50
duration of VTE prophylaxis for knee/hip surgery
extended duration
51
which IV VTE drug is preferred in pt with renal impairment
unfractionated heparin
52
what needs to be monitored in pt using unfractionated heparin
APTT: activated partial thromboplastin time
53
what is a APTT test and what is the normal value and the value when taking heparin
speed of clotting
normal aPTT value is 30- 40 sec
heparin value 60-80 seconds
54
preferred choice for VTE in pregnancy
LMWH
55
MOA for unfractionated heparin
UH (renal imapir) activates antithrombin
56
MOA for LMWH
LMWH inactivates factor Xa
57
longer duration of action, UH or LMWH
LMWH
58
suitable for pt with high risk of bleeding, UH or LMWH
UH
59
used in pregnancy, UH or LMWH
LMWH
60
lower risk of oeteoporosis, heparin-induced thrombocytopeonia, UH or LMWH
LMWH
61
essential to measure APTT, UH or LMWH
UH
62
antidote for haemorrhage (heparin induced)
protamine
63
s/e of heparin
1. hypERKalaemia
2. osteoporosis
3. thrombocytopoenia (low platelet)
64
how does heparin cause hypERKalaemia
heparins inhibit aldosterone secretion. aldosterone is an endogenous mineralcorticoid that retains Na and Water, excretes K
65
which group of pt use heparin IN CAUTION
DM and CKD (poor excretion of K already)
66
MOA of warfarin
Vit K antagonist
67
how long does it take for warfarin to work
2-3 days
68
what strength of warfarin are available in pharmacy and what colour are they
0.5mg white
1mg brown
3mg blue
5mg pink
69
standard initial dose of warfarin and how often is monitoring
5mg monitor daily
70
maintenance dose of wargarin
3-9mg same time each day
71
how often is the monitoring for warfarin pts whoes INR is stable
every 3 months
72
what is INR
international normalised ratio
73
target INR (=/-0.5unit) in pts with VTE, AF, MI, cardioversion, prosthetic mitral valve
2.5
74
target INR (=/-0.5unit) in pts with RECURRENT VTE who's receving anticoags
3.5
75
s/e of warfarin
any form of bleeding
| calciphylaxis
76
what is calciphylaxis
| which gp of pt has higher risk of getting it
calcium accumulates in small blood vessels of the fat and skin tissues. Calciphylaxis causes blood clots, painful skin ulcers and may cause serious infections that can lead to death (increased risk in end stage renal disease)
77
patient conselling for warfarin
- yellow booklet INR
- check INr level 2.5-3.5
- check dosage
- report painful skin rash (calciphylaxis)
- check OTC med (miconazole- report if nose bleed/ blood in urine)
78
major interactions involving wafarin...
1. warfarin x miconazole = miconazole, a potent enzyme inhibitor, increase anticog effect of warfarin --> increase risk of bleeding,report if nose bleed/ blood in urine
2. warfarin x antivirals (hepC) = change in liver func= labile INR
79
what is the antidote of warfarin
Vit K/phytomenadione=vitK1
80
what to do when bleeding while on warfarin?
1. stop wafarin
2. IV phytomenadione =VitK1 (IV if active bleeding, PO if INR>8)
3. Dried prothrombin complex OR fresh frozen plasma
81
what to do if pt has INR 5-8, no bleeding (on warfarin)
withhold 1-2 dose, reduce maintenance dose, measure INR after 2-3 days
82
what to do if pt has INR 5-8 and minor bleeding (on warfarin)
omit warfarin, IV phytomenadione, restart warfarin INR <5
83
what to do if pt has INR > 8, no bleeding (on warfarin)
omit warfarin, oral phytomenadione, restart warfarin INR<5
84
what to do if pt has INR > 8, minor bleeding (on warfarin)
omit warfarin, IV phytomenadione, restart INR<5
85
how many days before elective surgery to stop warfarin, what to give if INR>1.5 before surgery, when to restart
5 days, PO phytomenadione, restart on eve or next day
86
surgery + pt at high risk of VTE (prev VTE, AF, TIA, mechanical valve)
gradually stop warfarin and bridge with LMWH (try dose) and stop 24h before surgery
87
when to start which anticoag after a surgery if pt is at high risk of bleeding
restart LMWH 48h after surgery
88
what to do if pt on warfarin needs emergency surgery
1. delay 6-12h
| 2. no delay, give IV VitK and dried prothrombin complex
89
MOA of noval oral anticoags (NOACs)
inhibit clotting factors ie thrombin or factor Xa
90
4 examples of NOACs
dabigatran
apixaban
edoxaban
rivaroxaban
91
how does dabigatran work? (MOA)
inhibit thrombin directly
92
what is the storage advice for dabigatran?
special container to protect from moisture, use within 4 months once opened
93
how does apixaban work? (MOA)
inhibit clotting factor Xa
94
what is an ischaemic stroke
blood clots obstructs blood supply in brain
95
what is a haemorrhagic stroke
weak blood vessels in brain burst causing intracerebal haemorrrhage
96
is TIA (mini stroke) ischaemic or haemorrhagic
ischaemic (transient ischaemic attack)
97
long term trt for TIA
M/R dipyridamole AND aspirin
98
long term trt for ischaemic stroke
CLOPIDOGREL
99
long term trt for both TIA and ischaemic stroke
```
STATIN, irrespective of cholestrol level
treat HYPERTENSION (now with BB)
```
100
what to avoid in intracerebral haemorrhage
avoid aspirin, statin, anticoags as increase risk of bleeding
101
trt for intracerebral haemorrhage
treat hypertension
102
name 5 anti-platelets
1- 75mg aspirin (2ndary prevention of CVD)
2- clopidogrel (following acute coronary syndrome or PCI-stent)
3 dipyridamole (take 1h before food, 2ndary prevention of stroke)
4- prasugrel
5- ticagrelor
103
storage advice for M/R dipyridamole
special container, use within 6 weeks once opened
104
BP of stage 1 hypertension
BP =/> 140/90
105
trt for stage 1 hypertension
lifestyle advice only
106
when to use drug trt for stage 1 hypertension
under 80s with 1. target organ damage (heart LV, kidney, eye)
2. CVD or CVD 10yr risk >20%, CKD, DM
107
BP of stage 2 hypertension, lifestyle advice or trt
above 160/100, treat all
108
BP of stage 3 HT
above 180/110
109
what is hypertensive emergency
BP over 180/110 WITH acute target organ damage
110
what is hypertensive urgency
BP over 180/110 WITHOUT target organ damage
111
route of adm for HT emergency
IV
112
aim of trt in HT emergency
reduce BP SLOWLY, otherwise reduced organ perfusion = blindness, MI, cerebral infarction, severe renal impair
113
aim for HT urgency
reduce BP SLOWLY over 24-48H
114
clinical BP target for under 80s
lower than < 140/90 (gold standard for normality)
115
bp target for under 80s with CVD/DM/CKD/retinopathy
bp < 130/80 (gold standard for any target organ complications, lower and more strict BP, more control)
116
bp target for OVER 80s
bp <150/90
117
bp target for pt with proteinuria > 1g in 24 hours, what trt need to be added
<130/80, consider ACEi/ARB for proteinuria
118
bp target for renal disease pt (without CKD)
<140/90
119
bp target for diabetic pt
<140/80 (odd one out)
120
bp target for diabetic pt with complications in eye/kidney/cerebrovascular
<130/80
121
bp target for pregnant women with chronic HT
bp< 150/100
122
bp target for pregnant women with chronic HT and target organ damage or give birth
bp<140/90
123
what are the 3 pharmalogical trt for HT in pregnancy
1. labetalol (hepatotoxic)
2. methylDOPA (stop 2 days after birth)
3. MR nifedipine (unlicensed)
124
MOA of ACEi
inhibits the conversion from angiotensin 1 to angiotensin II, AgII cause vasoconstriction
125
which is the only ACEi that needs to be taken BD instead of OD
captopril
126
which ACEi needs to be taken 30-60 min before food
Perindopril
127
when is the best time to take the FIRST dose of ACEi
first dose at BED-TIME
128
step ONE of the HT treatment
AB <55, CD>55, afro-carribean origin
| AB (ACEI/ARB OR BB) CD (CCB OR Diuretics thiazide like)
129
step TWO of the HT trt cascade
A/B + C/D (vice versa for 55+/ afro-carribean)
130
Step THREE of the HT trt cascade
A + C + D
131
step FOUR of the HT trt cascade (resistant HT)
A + C + D (thiazide) + D (low dose spironolactone or high dose TLD if K+ > 4.5); if other D CI, add A- or B-blocker
132
which HT drugs to avoid in diabetic pt and why
TLD and BB can cause hypERglycaemia
133
s/e for ACEi
1. dry cough (give ARB)
2. hypPERKalaemia (higher risk in DM/ CKD)
3. anaphylactoid rxns (angioedema)
4. renoprotective in renal disease (CKD); nephrotoxic in AKI
5. hepatotoxic (jaundice, stop if liver transaminases 3x normal)
6. oral ulcer, taste disturbance and
7. hypOglycaemia
134
what is the renal effects from ACEI
ACEI reduces eGFR via EFFerent arteriole dilation; avoid in renovascular disease (may give in unilateral renal artery stenosis NOT severe bilateral stenosis)
135
can you use ACEI in pregnancy
NO should be avoided
136
what are the drugs that are nephrotoxic
DAMN (diurectics, ACEi/ARB, metformin, NSAID)
137
4 common drug interactions with ACEi
1. hypERKalaemia: avoid aliskeren, ARB, spironolactone, eplerenone, amiloride (k sparring D)
2. hypOtension: avoid Diuretics
3. Nephrotoxic: avoid DAMN, esp NSAID- double wammy AFFerent ateriole constriction
4. Renal impairm (avoid ACEi + ARB in diabetic nephropathy
138
what causes the dry cough when using ACEi
build up of BK (bradykinin)
139
what is aliskiren
renin inhibitor, renin converts Ag to Ag2
140
name 3 centrally acting anti-hypertensives
- methylDOPA (central alpha inhibitor?
- clonidine
- moxonidine
141
name 2 vasodilator antihypertensives (not CCB)
- Hydralazine
| - Minoxidil
142
name 3 common alpha blockers
- doxazsin
- prazosin
- indoramin
143
Which class of anti-arrhythmic drug does sotalol belong to?
sotalol blongs to Class 3 (K+ channel blocker)
144
which b-blocker is ususally used peri-operatively as it has a short half life?
Esmolol
145
which b-blockers cause LESS bradycarida, COLD extremities? What is this effect called?
ICE PACO - Pindolol, Acebutol, Celiprolol, Oxyprenolol
| intrinsic sympathomimetic activity
146
which b-blockers cause LESS nightmare? Why is this?
WATER CANS - Celiprolol, Atenolol, Nadolol, Sotalol
| CANS are water solution, less likely to cross BBB in brain to cause nightmares
147
Which b-blockers are more cardio-selective therefore less bronchospasm thus can be rx for WELL-controlled ASTHMA or under SPE care
Be A MAN - Bisoprolol, Atenolol, Metoprolol, Acebutol, NebIvolol (CardIao)
148
which b-blockers are longer acting thus OD dosing?
BACoN - bisoprolol, Atenolol, Celiprolol, Nadolol
149
what are the main side effects of b-blockers? (3)
hypotension
bradycardia
GBL - hyPO and hyPER: mask symp of hyPO (shaky, tachycardia)
150
C/I (conditions) of B-blockers (4)
ASTHMA: brochospasm (inc eye drops TIMOLOL)
UNSTABLE HF (worsen)
2nd/3rd degree HEART BLOCK
severe HYPOTENSION and BRADYcardia
151
common interactions with b-blockers (2)
- VERAPAMIL INJECTION = asystole and hypotension
| - THIAZIDE-like-DIURETIC = hyPERglycaemia (avoid in DIABETES)
152
which dihydropyridine CCB (vasodialation) requires SAME M/R brand
NIFEDIPINE
153
s/e of dihydropyridine CCB (3)
ankle swelling, flushing, headaches (common)
154
C/I condition for rate limiting CCB
Heart failure
155
which rating limiting CCB is the ONLY CCB licensed for arrhythmias
VERAPAMIL
156
diltiazem requires to be maintained on SAME BRAND when doses above xx mg?
SAME BRAND when dose > 60mg
157
what can increase conc of CCB? thus what to AVOID (diet)
enzyme inhibitor = AVOID grapefruit juice
158
what is pheochromocytoma?
tumour in adrenal glands which releases adrenaline and noradrenaline, causes HIGH BP, HEAVY SWEATING
159
trt for pheochromocytoma?
B-blocker and alpha-blocker (e.g. phenoxybenzamine) vasodilation
160
what is the key SE of vasoconstrictor sympathomimetics (noradrenaline, phenylephrine)
reduced PERFUSION to vital ORGANS (e.g. KIDNEYS)
161
3 key symptoms of HF
1- dyspnoea (rest/exercise)
2- exercise intolerance
3- oedema (PULMONARY/PERIPHERAL) SOB/ swollen ankles, legs
162
NICE guidance trt of HF stage1-3
stage 1. ACEi + b-blocker
stage 2. add SPIRONOLACTONE
stage 3. add IVARABADINE or add DIGOXIN (severe)
163
what is the alternative option instead of ACEI+ BB in HF
HYDRALAZINE + ISOSORBIDE dinitrate. specialist/afro-carib
164
which ARBs are licensed in HF
candeSARTAN, valSARTAN
165
which BB is used in mild-mod stable HF and 70+
NEBIvolol (carDIO-selective)
166
which BBs are used in ALL grades of LVSD
BISOprolol, CARDEvilol
167
Which ACEI/ARB combination is used in HF with LVEF <35%
Sacubutril + valsartan
168
which 2 types of DIURETICS are used in fluid overload in HF, which has limited effect in certain condition
1. LOOP diuretics (furosemide, bumetanide)
| 2. THIAZIDE diuretics in mild HF (ineffective if eGFR<30)
169
what is the manifestation of hyperlipidaemia
- fat in BV (atherosclerosis)
- CVD (MI,angina)
- strokes TIA
- peripheral sterial disease
170
which groups of population require PRIMARY prevention of CVD (6)
```
T1DM
T2DM only if CVD risk >10%
QRISK2 10years CVD risk >10%
CKD/albuminuria (eGFR<60)
familial hypercholesterolaemia
85+
```
171
which group of population needs SECONDARY prevention of CVD
previous established CVD
172
QRISK2 is suitable for age under what
age under 84
173
cholesterol targets - diagnosis of hyperlidaemia
6mmol/L total cholesterol
174
TOTAL CHOLesterol for HEALTHY adults should be
= 5mmol/L
175
TOTAL CHOLesterol for HIGH RISK adults should be
=4mmol/L
176
LDL (bad cholesterol) for HEALTHY adults should be
= 3mmol/L
177
LDL (bad cholesterol) for HIGH RISK adults should be
=2mmol/L
178
HDL (good cholesterol - higher the better) for general adults should be
>1mmol/L
179
Triglycerides level in adults should be
<1.7mmol/L
180
Which 4 groups of drug can cause hyperlipidaemia
antipsychotics - weight gain
immunosuppressants
corticosteroids (increase BGL?)
antiretrovirals (HIV drugs)
181
which 5 conditions can cause hyperlipidaemia?
```
hyPOthyroidism
liver/kidney disease
DM
family Hx
lifestyle e.g. smoking, alcohol, obesity, fatty diet
```
182
dosage for Atorvastatin in PRIMARY and 2NDARY prevention of CVD
20mg OD
| 80mg OD -2ndary
183
high intensity of rosuvastatin and simvastatin
```
rosuvastatin 10mg
simvastain 80mg (MHRA warning high risk of myopathy)
```
184
what is the effect of thiazide like diuretic and ACEI on K+ level
thiazide like diuretics--> hyPOKALaemia
ACEI--> hyPERKalaemia
together - K+ neutral
185
how does diuretics affect the exerction of uric acid and what is the implication
diuretics reduces uric acid excretion --> gout
186
high dose of loop diurectics can also cause ... (s/e) therefore cant be used with which ABx
tinnitus, hearing loss, AVOID aminoglycoside ( gentamicin, amikacin, tobramycin, neomycin, and streptomycin.) increase ototoxicity, nephrotoxicity
187
equivalent of bumetanide 1mg = xx furosemide
1mg bumetanide= 40mg furosemide
188
how does loop diuretic affect eletrolyte level
LOW eletrolyte state : LOW Na, K, Ca, Mg, Cl
189
Treatment for HF with reduced LVEF
ACEI AND BB
190
Treatment for HF with reduced LVEF after ACEI AND BB and LVEF<35
```
- replace ACEI /ARB with
Sacubitril and valsartan
- add ivabradine for sinus rhythm with HR> 75
- add hydrazine and nitrate (esp afro)
-add digoxin
```
191
Treatment for stable angina
Either BB OR CCB
| Or nitrate/ ivabradine/ nicorandil/ ranolazine
192
Medical management for STEMI
300mg aspirin
Ticagrelor with aspirin or
Clopidogrel with aspirin or aspirin alone if high bleeding risk
193
Medical treatment for NSTEMI
300mg aspirin and continue indefinitely
| Fondaparinux
194
Secondary prevention for MI
Acei
Two Antiplatelet including aspirin for 12M
Bb or ccb heart
Statin
