MI Flashcards

1
Q

Immediate treatment?

A

Includes morphine, oxygen, nitrates, aspirin, rest and reassurance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Thrombolytic agents end in

A

-ase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

E.g. of thrombolytic agents

A

Alteplase and reteplase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How are thrombolytic agents administered

A

Administered by IV within 12 hours of onset of chest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When are thrombolytic agents usually administered

A

Typically in ED and followed up by transfer to the cardiac care unit (CCU)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What needs to be avoided post-administration of thrombolytics?

A

Post-administration need to avoid IM and other invasive procedures during IV therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What do patients need to be monitored for after thrombolytics administration

A

Need to be monitored for hypotension and treated accordingly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When do you stop treatment with thrombolytics?

A

If severe bleeding occurs, stop infusion and treat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do thrombolytics work?

A

Work by converting plasminogen to plasmin, which then catalyses or breaks down the fibrin clot. They help to dissolve the embolus but can cause bleeding and transient hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Contraindications of thrombolytics

A

Contraindicated for use in active bleeding, recent major surgery (<1 month), trauma, risk of intracranial haemorrhage, history of stroke (haemorrhage) or ischaemic stroke within a year, intracranial neoplasm and intracranial aneurysm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What do anti platelets do

A

Inhibit platelet aggregation thus reducing the risk of clot formation on stent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is aspirin and what does it do

A

Aspirin, low dose standard therapy, works by inhibiting platelet aggregation by irreversibly inhibiting cyclo-oxygenase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Aspirin is an

A

anti platelet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Clopidogrel is an

A

anti platelet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does clopidogrel do

A

Clopidogrel binds to the platelet P2Y12 receptors and inhibits platelet aggregation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the side effects of anti platelets

A

All have side effects e.g. bleeding and thrombocytopenia

17
Q

What do anticoagulants do

A

Provide symptom relief, prevent further clots, reduce morbidity and mortality.

18
Q

Heparin is an

A

anticoagulant

19
Q

What does heparin do

A

Forms a complex with antithrombin III, inactivates clotting factors IIa (thrombin) and Xa to prevent further clots (does not dissolve current clots)

20
Q

Low-molecular-weight heparin (LMWH) and danaparoid have a

A

much greater effect on factor Xa than on thrombin

21
Q

What is danaparoid

A

an anticoagulant that is a more selective inhibitor of factor Xa than LMWHs

22
Q

Heparin is administered in

A

high doses for treatment and low doses for prevention

23
Q

AEs of heparin

A

Bleeding, bruising and pain at injection site, hyperkalaemia, mild reversible thrombocytopenia (does not necessarily indicate increased risk for severe thrombocytopenia)

24
Q

What do you monitor when using heparin

A

Monitor activated partial thromboplastin time (aPTT) aiming for levels around 1.5-2.5 times more than the normal measurement. Measure ~6 hours after a bolus dose and then adjust for IV infusion

25
Q

LMWH are

A

Similar in size and have the same anticoagulant activity (affect only factor Xa). No need to monitor aPTT

26
Q

AEs of LMWH

A

Haemorrhage, gut-bleeding, bruising and pain at injection site

27
Q

Clinical considerations for heparin

A

o Standard heparin: monitor aPTT (normal 25-40 sec)
o LMWH: longer half-life, safer and no need to monitor aPTT
o Report signs of bleeding

28
Q

What does warfarin do

A

Inhibits epoxide reductase thus depleting vitamin K from the liver and interfering with the hepatic synthesis of vitamin K-dependent clotting factors X, IX, VII and II (prevents a new thrombus forming)

29
Q

Normal dosage of warfarin?

A

A loading dose of 5-10mg for 2 days is then adjusted according to the International Normalised Ratio (INR) test. The daily maintenance dose range is 1-10mg

30
Q

What do warfarin interact with?

A

Warfarin interacts with herbal meds, excessive amounts of green leafy vegetables and numerous other drugs

31
Q

AEs warfarin

A

bleeding, alopecia (rare), fever, rash and hepatic dysfunction

32
Q

How is rivaroxiban given?

A

Orally

33
Q

Who is rivaroxiban given to

A

Is overtaking warfarin in younger patients with atrial fibrillation, acute venous thromboembolism and prevention

34
Q

What is the mode of action of rivaroxiban?

A

Mode of action: selective inhibition of Xa, blocking thrombin production and thrombus formation (no human data for pregnancy)

35
Q

AEs of rivaroxiban

A

Bleeding, itch, peripheral oedema, muscle spasm