ACS

Question 1

What is the treatment for ACS?

Answer 1

1. Aspirin 300mg
2. GTN 600mcg S/L if SBP>110
   or 300mcg if frail or never had GTN before

repeat @ 5 min, no max dose

3. GTN patch if BP>90
   50mg (0.4mg per hour)

Pain relief if required
-> Morph of fent IV

Question 2

What do you do if STEMI onset is less than 12 hours?

Answer 2

Manage as per STEMI CPG

Question 3

What do you do if STEMI onset is over 12 hours

Answer 3

transmit 12 lead and notify hospital

Question 4

What are the contraindications for Aspirin?

Answer 4

1. Hypersenitivity
2. Bleeding disorders
3. Actively bleeding peptic ulcers
4. Suspected AAA
5. Chest pain associated with Psychostimulant overdose with SBP>160

Question 5

What are the contraindications for GTN?

Answer 5

1. Hypersensitivity
2. Tablet = SPB < 110
3. Patch = SBP<90
4. HR <50
5. HR>150
6. Viagra or Levitra in the last 24 hours
7. Cialis in last 4 days
8. VT
9. Right Ventricular Myocardial Infarctio
10. Inferior STEMI with a SPB below 160

Question 6

What are the precautions of Aspirin

Answer 6

1. peptic ulcer
2. asthma
3. pts on anticoagulants

Question 7

What are the side effects of aspirin

Answer 7

• heartburn
• nausea
• GIT bleeding
• increased bleeding time
• hypersensitivity reactions

Question 8

What are the precautions for GTN?

Answer 8

1. no previous administration
2. Elderly
3. Recent MI
4. Concurrent use with other Tocolytics

Question 9

What are the side effects of GTN?

Answer 9

• Tachycardia
• Hypotension
• Headache
• Skin flushing
• Bradycardia

Question 10

What is the onset peak and duration of GTN S/L

Answer 10

onset= 30sec - 2 min
peak = 5-10 mins
duration = 15-30 mins

Question 11

What is the onset peak and duration of GTN Patch

Answer 11

onset= upto 30 mins
peak = 2 hours