Which of the following pairs of drugs should be included in the immediate treatment of this patient?
A 50-year-old man was brought to the emergency room by ambulance for management of severe, unrelenting chest pain for the past hour. The man had been suffering from exertional angina for 5 years. Physical examination revealed a middle-aged male in obvious distress with the following vital signs: blood pressure 165/100 mm Hg, heart rate 110 BPM, respiratory rate 22 breath /min. The ECG showed ST-segment depression in multiple leads.
A. Clopidogrel and aminocaproic acid B. Streptokinase and warfarin C. Heparin and aspirin D. Abciximab and warfarin E. Aminocaproic acid and abciximab F. Aspirin and desmopressin
Heparin and aspirin-learning objective: describe the therapeutic uses of aspirin and heparin in unstable angina.
the patient was most likely suffering from unstable angina (see the symptoms and the ecg). unstable angina is a medical emergency to be treated in a cardiac care unit. the immediate challenge is relief of pain and control of all ischemic episodes. pain relief is usually accomplished with iv infusion of nitroglycerin, which has the advantage of fast onset of action and rapid reversibility. opioids should be used to control pain only when it is not adequately relieved by anti-ischemic medication. to reduce intracoronary clotting, aspirin po and heparin iv should be instituted immediately (these drugs have been shown to reduce the incidence of subsequent myocardial infarction).
b) streptokinase is a thrombolytic drug. these drugs can be used to beak down thrombi but not to prevent thrombus formation. therefore they are not useful (and may be harmful) in unstable angina. warfarin is not used for emergency anticoagulation because of its delayed onset of action.
a, d, e, f) each of these combinations have at least one drug which is useless (warfarin,
desmopressin) or contraindicated (aminocaproic acid).