Paper I
2024 June (Supplementary) (2019 Scheme) · 100 marks · 180 min

Question

(

  • (a) Diazepam ( 4 mark(s)
  • (b) Describe the management of Acute Myocardial Infarction. 4 mark(s)
Q78 marksShort Essays

Answer

a) Diazepam A benzodiazepine. MOA: binds the benzodiazepine site on the GABA-A receptor, enhancing GABA-mediated chloride channel opening frequency, producing neuronal hyperpolarization. Uses: status epilepticus (first-line IV), anxiety disorders, skeletal muscle spasm, pre-anesthetic medication, alcohol withdrawal. Adverse effects: sedation, drowsiness, tolerance and dependence with prolonged use, respiratory depression at high doses/IV administration.

b) Management of acute myocardial infarction

  • Morphine — analgesia, reduces sympathetic drive/preload.
  • Oxygen (if hypoxic).
  • Sublingual/IV Nitrates — venodilation, reduces preload, relieves pain.
  • Aspirin (chewed) — immediate antiplatelet effect.
  • P2Y12 inhibitor (Clopidogrel/Ticagrelor) — dual antiplatelet therapy.
  • Heparin/LMWH — prevents thrombus propagation.
  • Beta-blocker — reduces O2 demand and arrhythmia risk.
  • High-intensity statin — plaque stabilization.
  • ACE inhibitor — limits remodeling.
  • Reperfusion: primary PCI (preferred) or thrombolysis if PCI unavailable within 90-120 min.

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