NSTE-ACS Medication Management Quiz
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Questions and Answers

Which of the following medications is NOT typically used in the management of NSTE-ACS?

  • Antibiotics (correct)
  • β-blockers
  • Antithrombotics
  • Nitrates

    • Which of the following medications is a common side effect of nitrates?

  • Headache (correct)
  • Muscle weakness
  • Diarrhea
  • Increased heart rate

    • Which of the following is a commonly used anticoagulant in the management of NSTE-ACS ?

  • Heparin (correct)
  • Aspirin
  • Statins
  • Clopidogrel

    • Which of the following is NOT a type of antithrombotic medication?

    <p>β-blockers (C)</p> Signup and view all the answers

    Which of the following medications can be used to manage NSTE-ACS and has a potential side effect of hypotension?

    <p>Morphine (C)</p> Signup and view all the answers

    Which medication class is used to lower cholesterol levels and can be a part of the management of patients with NSTE-ACS?

    <p>Statins (B)</p> Signup and view all the answers

    Which of the following is a potential side effect associated with β-blockers?

    <p>Bradycardia (D)</p> Signup and view all the answers

    Which of the following medications has a potential side effect of muscle pain?

    <p>Statins (A)</p> Signup and view all the answers

    What is a primary concern regarding the pharmacotherapy for patients with NSTE-ACS?

    <p>Adverse effects due to pharmacotherapy (D)</p> Signup and view all the answers

    In patients with NSTE-ACS at low risk of MACE, what is a potential benefit of using double antiplatelet agents?

    <p>More effective in reducing CVD death than single agents (A)</p> Signup and view all the answers

    What is a consequence of increased bleeding risk associated with certain pharmacotherapies?

    <p>Increased risk of heart failure (A)</p> Signup and view all the answers

    Which outcome is specifically examined in relation to interventional therapy for low-risk NSTE-ACS patients?

    <p>Reduction in all-cause mortality (C)</p> Signup and view all the answers

    What is a potential risk of administering intravenous morphine in NSTE-ACS patients?

    <p>Increased risk of heart attack (B)</p> Signup and view all the answers

    Which factor is assessed by the PRECISE-DAPT score in NSTE-ACS patients?

    <p>Bleeding risks (A)</p> Signup and view all the answers

    In what way can initial interventional therapy impact very high-risk NSTE-ACS patients?

    <p>It may reduce MI, heart failure, and stroke rates (B)</p> Signup and view all the answers

    Why is it important to monitor for adverse effects during pharmacotherapy in NSTE-ACS treatment?

    <p>To identify potential increases in event rates such as MACE (C)</p> Signup and view all the answers

    What is the purpose of prescribing a P2Y12 inhibitor at discharge for patients with NSTE-ACS?

    <p>To prevent platelet aggregation (D)</p> Signup and view all the answers

    Which medication is considered a high-intensity statin usually prescribed at discharge for patients with NSTE-ACS?

    <p>Rosuvastatin 20 mg (D)</p> Signup and view all the answers

    What is a common side effect associated with the use of high-intensity statins?

    <p>Muscle pain or weakness (A)</p> Signup and view all the answers

    Why is aspirin included in the discharge medications for patients with NSTE-ACS?

    <p>To prevent thrombus formation (C)</p> Signup and view all the answers

    What classification of recommendation is given to the use of high-intensity statins in patients with NSTE-ACS?

    <p>Grade I (C)</p> Signup and view all the answers

    Which of the following is a potential side effect of P2Y12 inhibitors?

    <p>Gastrointestinal bleeding (C)</p> Signup and view all the answers

    What is the primary reason for referring patients with NSTE-ACS to a cardiac rehabilitation program post-discharge?

    <p>To boost physical fitness and recovery (C)</p> Signup and view all the answers

    Which statement accurately reflects the evidence used to justify the use of aspirin for NSTE-ACS patients?

    <p>Data from multiple randomized clinical trials supports its effectiveness. (A)</p> Signup and view all the answers

    Signup and view all the answers

    Flashcards

    All-Cause Mortality

    The overall death rate from all causes in a population.

    NSTE-ACS

    Non-ST Elevation Acute Coronary Syndrome, a type of heart condition with reduced blood flow.

    MACE

    Major Adverse Cardiovascular Events including myocardial infarction, heart failure, and death.

    Double Antiplatelet Therapy

    The use of two medications to prevent blood clots in patients.

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    Intravenous Morphine

    A pain relief medication delivered directly into the bloodstream.

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    Systematic Review

    A study that summarizes and evaluates all available evidence on a specific question.

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    Registry Data

    Data collected from patients who are tracked over time to assess outcomes.

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    Intensive Medical Therapy

    A rigorous treatment approach focused on controlling cardiovascular risk factors.

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    PICO

    A method to formulate clinical questions - Population, Intervention, Comparison, Outcome.

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    Risk stratification

    Categorizing patients based on their risk of adverse outcomes.

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    Dual antiplatelet therapy (DAPT)

    Combination of two antiplatelet medications to prevent blood clots.

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    Antithrombotic therapy

    Medications that prevent blood clotting, including antiplatelets and anticoagulants.

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    Percutaneous Coronary Intervention (PCI)

    A non-surgical procedure used to treat narrowed coronary arteries.

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    ACE inhibitors

    Medications that help relax blood vessels by inhibiting the angiotensin-converting enzyme.

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    NSTE-ACS Medications

    Medications prescribed at discharge for Non-ST Elevation Acute Coronary Syndromes include Aspirin, P2Y12 inhibitor, and high intensity statins.

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    Cardiac Rehabilitation

    A program to help patients recover and improve their cardiovascular health post-discharge from NSTE-ACS.

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    Grade I Recommendation

    Indicates that there is evidence or agreement that a therapy is beneficial and effective.

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    Grade II Recommendation

    Conditions have conflicting evidence regarding a therapy's usefulness; can be further divided into II-a and II-b.

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    Grade III Recommendation

    Conditions for which there is consensus that a therapy is not useful or may be harmful.

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    Level A Evidence

    Data from multiple randomized clinical trials or meta-analyses supporting a treatment.

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    Level B Evidence

    Derived from a single randomized clinical trial or large non-randomized studies.

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    Level C Evidence

    Consensus of expert opinions, case studies, or standard care; weakest form of evidence.

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    Study Notes

    Clinical Practice Guidelines - Management of Non-ST Elevation Myocardial Infarction (NSTE-ACS)

    • This is a combination of unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI)
    • The guidelines aim for best clinical practice in the management of NSTE-ACS
    • Adherence to guidelines does not guarantee the best clinical outcome for every patient. Clinicians should use local/personal knowledge and clinical presentation in conjunction with guideline recommendations.

    Statement of Intent

    • The guidelines were developed to be a guide for best clinical practice in the management of Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS)
    • The guidelines are based on the best available current evidence
    • Adherence to these guidelines does not guarantee the best outcome in every patient
    • Clinicians should consider individual patient presentation, locally available options, and clinical expertise.

    Review of Guidelines

    • The guidelines were issued in 2021
    • They will be reviewed in 2026 or earlier if significant new evidence becomes available

    CPG Secretariat

    Message from the Director General of Health

    • Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS) accounts for 55.4% of all Acute Coronary Syndromes (ACS) in Malaysia from 2016 to 2017
    • Ensuring standardized clinical management is paramount for patient safety
    • Improvements in ACS management over the last decade are highlighted
    • Updates to diagnostic and therapeutic measures have been introduced since the 2011 NSTE-ACS guidelines
    • This 2021 guideline is timely, covering the pre-hospital care, use of troponin, risk stratification, and early invasive strategy

    Members of the Expert Panel & External Reviewers

    • Lists of various consultants, specialists, and healthcare professionals from public and private sectors in Malaysia who were involved in developing the guidelines

    Rationale and Process of Guidelines Development

    • Ischemic Heart Disease (IHD) the leading cause of death in Malaysia
    • This guideline has been developed based on evidence and expert reviews from the National Heart Association of Malaysia (NHAM) and Ministry of Health (MOH) and external reviewers.
    • The guideline aims to improve the management of NSTE-ACS and reduce risk of adverse outcomes.
    • Systematic reviews, expert agreement, and public comment influenced this document.
    • The American College of Cardiology Foundation/American Heart Association and other international guidelines used for development considerations.
    • The Appraisal of Guidelines for Research and Evaluation (AGREE II) Tool used as part of the guidelines development.

    Grades of Recommendation and Levels of Evidence

    • The guidelines use a standardized grading system to assess evidence
    • Levels of evidence are given for each guideline recommendation

    List of Abbreviations

    • A list of abbreviations used throughout the guidelines

    Summary

    • Provides a concise overview of the main points of the guidelines.
    • Concise overview of the epidemiology, definition, diagnosis, pathogenesis and strategies used in the guidelines.

    Key Messages

    • Essential takeaways from the guidelines.

    Key Recommendations

    • Summarizes the core recommendations for managing NSTE-ACS.

    Flowcharts and Tables

    • Includes clinical guidelines for diagnosis and management, with decision support tools

    Introduction of Terms

    • Defines NSTE-ACS, UA and NSTEMI
    • Definitions for relevant medical terms

    Pathogenesis

    • Details the processes leading to NSTE-ACS, focusing on the pathophysiology of NSTE-ACS.

    Diagnosis

    • Covers the diagnostic steps/process for NSTE-ACS, including information about history, physical examination, electrocardiography, and cardiac biomarkers

    Risk Scores

    • Provides details on patient risk stratification scores used to classify risk levels in NSTE-ACS
    • The method of calculating different risk scores and use of each score in varying stages of NSTE-ACS

    Pre Hospital Management

    • Details of the immediate pre-hospital steps that should be taken

    In-Hospital Management

    • Information on the necessary in-hospital management required for NSTE-ACS
    • Addresses various crucial issues like the evaluation, monitoring, and procedures in the ED

    NSTE-ACS in Special Groups

    • Details on considerations for certain populations like older individuals, women, and those with chronic kidney disease.

    Post Hospital Discharge

    • Advice on post-discharge patient care (especially on medication, follow-up, and rehabilitation)

    Monitoring of Activity & Quality Assurance

    • Discusses strategies to ensure consistent quality of care throughout the guideline implementation

    External Reviewers

    • List of external experts involved in reviewing the content of guidelines for possible bias and quality of content

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    Related Documents

    CPG Management of NSTE-ACS 3rd Edition 2021 PDF

    Description

    Test your knowledge on the medications used in the management of Non-ST-Elevation Acute Coronary Syndrome (NSTE-ACS). This quiz covers common medications, their side effects, and classifications in cardiology. Identify the medications and their roles in treatment effectively.

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