Paper I
2015 February (2010 Scheme) · 40 marks · 120 min

Question

Read the clinical problem and answer the following question: Mr.Shankar, 54 years suddenly developed severe chest pain. He was a diabetic and admitted in the ICCU with the diagnosis of acute myocardial infarction,

  • (a) List the drug to be started immediately after acute myocardial infarction.
  • (b) Write the mechanism of action and two adverse effects of fibrinolytics
  • (c) Name the analgesics used to relieve pain and its rationale for the same
Q26 marksEssays

Answer

(a) Drugs to be started immediately after acute MI

  • Aspirin (chewable, loading dose)
  • Clopidogrel (dual antiplatelet therapy)
  • Fibrinolytic (e.g., Streptokinase/Alteplase) or primary PCI, if within the therapeutic window
  • Beta-blocker
  • ACE inhibitor
  • Statin (high-intensity)
  • Oxygen and analgesic (morphine) as needed

(b) Mechanism of action and adverse effects of fibrinolytics

  • Mechanism: Activate plasminogen to plasmin, which degrades fibrin, dissolving the thrombus occluding the coronary artery and restoring blood flow (reperfusion)
  • Adverse effects: Bleeding (including intracranial haemorrhage — most serious), hypotension/allergic reactions (especially with streptokinase, which is antigenic)

(c) Analgesics for pain relief and rationale

  • Morphine (IV) is the analgesic of choice
  • Rationale: Provides potent analgesia relieving severe ischaemic chest pain, reduces sympathetic overactivity/anxiety, and causes venodilatation which reduces preload and myocardial oxygen demand — all beneficial in acute MI
  • NSAIDs are avoided (increase cardiovascular risk and can impair infarct healing)

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