Acute Coronary Syndrome and Pharmacology Practice Flashcards

These flashcards provide essential definitions, pharmacological details, and clinical management protocols for Acute Coronary Syndrome (ACS), including Aspirin and GTN administration guidelines.

ACUTE CORONARY SYNDROME (ACS)

A spectrum of clinical presentations and conditions ranging from STEMI and NSTEMI (NSTEACS) to unstable angina, sharing a common pathophysiology of disrupted atherosclerotic lesions.

Stenosis

The narrowing and hardening of blood vessels caused by lumen protrusion from the formation of atheroscentic plaque (cholesterol, fats, and blood products).

Angina

Ischemia to the myocardium causing chest pain (CP).

STEMI Care Objective Timing

Rapid identification of STEMI to facilitate timely perfusion (PCI) in $< 90\,min$ and obtaining an ECG within $< 10\,min$ of patient contact.

STEMI

Clinical symptoms of ACS characterized by ST-elevation on an ECG or a new LBBB, caused by unstable atherosclerotic plaque rupture and blood clot formation.

NSTEACS

ACS which does not show ST elevation but may show ST depression or a troponin rise, caused by partial blockage and myocardial ischemia.

Unstable Angina

Presenting ACS symptoms with a normal ECG and normal biomarkers where symptoms begin unpredictably and do not resolve with GTN or aspirin.

Aspirin Pharmacology

An analgesic, antipyretic, anti-inflammatory, and antiplatelet aggregation agent that inhibits $Cox\,1$ receptors within platelets to reduce prostaglandin synthesis.

Aspirin Loading Dose

A dose of $300\,mg$ administered orally via chewable or water-dispersible tablets for ACS.

Aspirin Duration of Action

$8-10\,days$; the anti-platelet effects persist for the natural life of platelets.

GTN Mode of Action

An organic nitrate that relaxes vascular smooth muscle to cause vasodilation, reducing myocardial $O_2$ demand.

Preload Reduction (GTN)

Achieved through venodilation, which promotes venous pooling and reduces venous return to the heart.

Afterload Reduction (GTN)

Achieved through arteriodilation, which reduces systemic vascular resistance and arterial pressure.

GTN Dosage (Sublingual)

$600\,mcg$ S/L if $SBP > 100\,mmHg$ or $300\,mcg$ S/L for small ($\le 60\,kg$), elderly, or frail patients.

GTN Patch Presentation

$50\,mg$ patch that releases $0.4\,mg/hr$ (or $10\,mg/24\,hours$).

GTN Contraindications (Vitals)

$BP < 100\,mmHg$, $HR > 150\,bpm$, and $HR < 50\,bpm$ (except in autonomic dysreflexia).

PDE5 Inhibitor Contraindication Timing

Recent use of Viagra ($24\,hr$), Cialis ($48\,hr$), Levitra ($24\,hr$), or current use of Riociguat.

GTN Sublingual (S/L) Pharmacokinetics

Onset of $1-3\,minutes$, peak at $5\,minutes$, and a duration of at least $25\,minutes$.

mRNA Vaccine Chest Pain Demographic

Occurs $1-10\,days$ post Pfizer or Moderna vaccination, commonly in males aged $12-29\,years\,old$, usually self-resolving in $24-48\,hrs$.

GTN IV Infusion Concentration

Glyceryl trinitrate $15\,mg$ diluted to $50\,mL$ with normal saline or dextrose $5\%$ to reach a concentration of $300\,mcg/mL$.