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A 60-year-old man is admitted following an acute coronary syndrome. He receives aspirin, clopidogrel, nitrates and morphine. His 6-month risk score is high and percutaneous coronary intervention is planned. He is therefore given intravenous tirofiban. What is the mechanism of action of this drug?


A. Inhibits the production of thromboxane A2 B. Activates antithrombin III C. Coronary vasodilator D. Glycoprotein IIb/IIIa receptor antagonist E. Reversible direct thrombin inhibitor

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January 2012 exam

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NICE 2010 Unstable angina and NSTEMI guidelines SIGN 2007 ACS guidelines

Acute coronary syndrome: management NICE produced guidelines in 2010 on the management of unstable angina and non-ST elevation myocardial infarction (NSTEMI). They advocate managing patients based on the early risk assessment using a recognised scoring system such as GRACE (Global Registry of Acute Cardiac Events) to calculate a predicted 6 month mortality. All patients should receive - aspirin 300mg - nitrates or morphine to relieve chest pain if required Whilst it is common that non-hypoxic patients receive oxygen therapy there is little evidence to support this approach. The 2008 British Thoracic Society oxygen therapy guidelines advise not giving oxygen unless the patient is hypoxic. Antithrombin treatment. Fondaparinux should be offered to patients who are not at a high risk of bleeding and who are not having angiography within the next 24 hours. If angiography is likely within 24 hours or a patients creatinine is > 265 mol/l unfractionated heparin should be given. Clopidogrel 300mg should be given to patients with a predicted 6 month mortality of more than 1.5% or patients who may undergo percutaneous coronary intervention within 24 hours of admission to hospital. Clopidogrel should be continued for 12 months. Intravenous glycoprotein IIb/IIIa receptor antagonists (eptifibatide or tirofiban) should be given to patients who have an intermediate or higher risk of adverse cardiovascular events (predicted 6-month mortality above 3.0%), and who are scheduled to undergo angiography within 96 hours of hospital admission. Coronary angiography should be considered within 96 hours of first admission to hospital to patients who have a predicted 6-month mortality above 3.0%. It should also be performed as soon as possible in patients who are clinically unstable. The table below summaries the mechanism of action of drugs commonly used in the management of acute coronary syndrome:
Aspirin Clopidogrel Enoxaparin Antiplatelet - inhibits the production of thromboxane A2 Antiplatelet - inhibits ADP binding to its platelet receptor Activates antithrombin III, which in turn potentiates the inhibition of coagulation factors Xa

British Thoracic Society 2008 Emergency oxygen therapy guidelines

Fondaparinux Activates antithrombin III, which in turn potentiates the inhibition of coagulation factors Xa Bivalirudin Reversible direct thrombin inhibitor

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