MI Flashcards
Immediate treatment?
Includes morphine, oxygen, nitrates, aspirin, rest and reassurance.
Thrombolytic agents end in
-ase
E.g. of thrombolytic agents
Alteplase and reteplase
How are thrombolytic agents administered
Administered by IV within 12 hours of onset of chest pain
When are thrombolytic agents usually administered
Typically in ED and followed up by transfer to the cardiac care unit (CCU)
What needs to be avoided post-administration of thrombolytics?
Post-administration need to avoid IM and other invasive procedures during IV therapy
What do patients need to be monitored for after thrombolytics administration
Need to be monitored for hypotension and treated accordingly
When do you stop treatment with thrombolytics?
If severe bleeding occurs, stop infusion and treat
How do thrombolytics work?
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
Contraindications of thrombolytics
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
What do anti platelets do
Inhibit platelet aggregation thus reducing the risk of clot formation on stent
What is aspirin and what does it do
Aspirin, low dose standard therapy, works by inhibiting platelet aggregation by irreversibly inhibiting cyclo-oxygenase
Aspirin is an
anti platelet
Clopidogrel is an
anti platelet
What does clopidogrel do
Clopidogrel binds to the platelet P2Y12 receptors and inhibits platelet aggregation
What are the side effects of anti platelets
All have side effects e.g. bleeding and thrombocytopenia
What do anticoagulants do
Provide symptom relief, prevent further clots, reduce morbidity and mortality.
Heparin is an
anticoagulant
What does heparin do
Forms a complex with antithrombin III, inactivates clotting factors IIa (thrombin) and Xa to prevent further clots (does not dissolve current clots)
Low-molecular-weight heparin (LMWH) and danaparoid have a
much greater effect on factor Xa than on thrombin
What is danaparoid
an anticoagulant that is a more selective inhibitor of factor Xa than LMWHs
Heparin is administered in
high doses for treatment and low doses for prevention
AEs of heparin
Bleeding, bruising and pain at injection site, hyperkalaemia, mild reversible thrombocytopenia (does not necessarily indicate increased risk for severe thrombocytopenia)
What do you monitor when using heparin
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
