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14 Cards in this Set
- Front
- Back
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How do you define unstable angina
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ST depression, but no positive biomarkers for cardiac necrosis
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NSTEMI
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Similiar to unstable angina, but has tropinin elevation and elevated CKMB
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STEMI
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ST elevation, positive biomarkers
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Goals of therapy for NSTEMI/UA
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Prevent total occlusion of infarct related artery
- Glycoprotein IIb/IIIa inhibitors, other anticoagulants - PCI - DO NOT USE THROMBOLYTICS |
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STEMI goals of therapy
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Thrombolytic medications within 30 mins
PCI within 90 mins If presenting to a facility without prompt PCI within 90 mins, should undergo FIBRINOLYSIS Facilitated PCI is PCI after a pharmacologic regimen with fibrinolysis and/or GIIb/IIIa inhibitors Rescue PCI is PCI after failed thrombosis and is indicated in select patients if shock, HF, and/or pulmonary edema |
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How do you calculate a TIMI score
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Age
More than 3 risk factors - HTN, DM, lipidemia, smoking, family hx of CAD, severe angina, ASA, elevated markers, ST deviation |
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Describe MONA+B strategy
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1) Morphine
2) Oxygen 3) Nitroglycerin spray or SL tablet 4) Aspirin 5) Beta blocker: oral or IV |
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What other therapies are indicated in NSTEMI/STEMI
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1) ACEI within 24 hours if HF, LVEF<40%, DM, or CKD
Consider in all pts with CKD Contraindicated in hypotension 2) CCBs - specifically nonDHP CCBs (verapamil, diltiazem) - recommended if cannot tolerate beta blockers |
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How do you dose ASA in ACS
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-Initial therapy: ASA 165-325 orally or chewed x 1
- PrePCI: ASA 75-325mg before PCI - No stent: ASA 75-162 mg/day - Post stent: ASA 165-325 mg/day for at least 1 month (bare metal), 3 months (sirolimus), then 75-162 mg/day indefinitely |
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How do you dose clopidrogrel in ACS
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Initial therapy:
NSTEMI/STEMI: 300-600mg LD x1 STEMI with fibrinolytic: 300mg x1 PrePCI: 300-600mg LD or PRA 60mg LD No stent: 75 mg/day for up to 1 year PostStent: 75mg/day or PRA 10mg/day for at least 12 months |
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What are the GPIIb/IIIa inhibitors and when are they indicated
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Abciximab (Reopro): Only STEMI
Eptifibatide: STEMI or NSTEMI Tirofiban (Aggrastat): STEMI or NSTEMI |
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How do you dose thrombolytics in ACS
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Administer within 12 hours of symptom onset
Patients undergoing reperfusion with fibrinolytics should receive anticoagulation therapy for a min of 48 hours and preferably for the duration of the hospitalization Alteplase 15mg, then 0.75mg/kg over 30 mins (max of 50mg), then 0.5mg/kg (max 35mg) over 60 mins Releplase (Retavase) 10 units IV, repeat 10 units IV in 30 mins Tenecteplase (TNKase) |
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What are the absolute contraindications to using thrombolytics
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Any hemorrhagic stroke, ischemic stroke within 3 months, intracranial neoplasm, active internal bleeding, aortic dissection, BP>180/110, INR 2-3, hx of TIA or CVA 3 months prior
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What is the long term management of ACS
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1) Beta blockers
Indicated for all patients unless contraindicated 2) ACEI Indicated for all patients. Use ARB if ACEI intolerant 3) Aldosterone receptor blocker Indicated if post MI with LVEF less than 40%, DM, and receiving ACEI. Do not use in CLCR < 30 4) Warfarin: indicated either wihout or with low dose ASA if high CAD risk and low bleeding risk 5) Statin management: LDL goal less than 100 with goal of 70 6) Smoking cessation, Hemoglobin A1C <7 |
