Cardio Module Acs/ihd Sdl

Front 1

STEMI treatment algorithm (for symptoms LESS than 12 hours) (6)

Back 1

1)ASA & Nitro SL/IV
2)Clopidogrel 300mg
3)reperfusion therapy (PCI or fibrinolytics)
4)if using PCI follow w/ UFH, enox, GP2b/3a inhibitor
5)if using fibrinolytics follow w/ UFH, enox, fondaparinux
6)last step is put on BB, statins, ACEI/ARB, sprinonolactone

Front 2

STEMI treatment algorithm (for symptoms MORE than 12 hours) (4)

Back 2

1)ASA/Nitro SL/IV
2)stress test/PCI/CABG
3)clopidogrel
4)finally BB, statin, ACEI/ARB, sprionolactone

Front 3

Eptifibatide brand

Back 3

Integrillin

Front 4

Abciximab brand

Back 4

ReoPro

Front 5

Bivalirudin brand

Back 5

Angiomax

Front 6

Fondaparinus brand

Back 6

Arixtra

Front 7

Treatment of STEMI uses what drugs? (6)

Back 7

1)ASA
2)Nitro (morphine can be used on top of this for angina pain)
3)plavix
4)UFH, enoxaparin, fondaparinux
5)BB
6)thrombolytics

Front 8

a)First generation thrombolytics
b)2nd generation thrombolytics
c)3rd generation thrombolytics

AND WHICH IS MOST FIBRIN SPECIFIC

Back 8

a)streptokinase
b)alteplase
c1)reteplase*****
c2)tenecteplase*****

Front 9

Typical QUALITY (desc) features of angina due to CAD (7)

Back 9

1)discomfort (rather than pain)
2)crushing/pressure
3)squeezing
4)strangling
5)heaviness on chest
6)burning
7)NOT sharp or stabbing

Front 10

Typical LOCATION features of angina due to CAD (5)

Back 10

1)retrosternal
2)visceral
3)across chest
4)diffuse
5)sometimes jaw, neck, arms only

Front 11

Typical RADIATION features of angina due to CAD (6)

Back 11

1)to left shoulder or arm (CLASSIC)
2)sometimes right arm or both arms
3)neck, jaw, teeth
4)back
5)epigastrium
6)NOT below umbilicus or on top of head

Front 12

Typical DURATION features of angina due to CAD (3)

Back 12

1)30sec to 30min
2)waxing and waning
3)NOT continuous for hours

Front 13

Typical PRECIPITATING FACTORS features of angina due to CAD (4)

Back 13

1)exercise/exertion
2)emotional stress
3)cold weather
4)ANYTHING that increases oxygen demand

Front 14

Typical RELIEVING FACTORS features of angina due to CAD (4)

Back 14

1)rest
2)nitro
3)ANYTHING that reduces cardiac workload
4)NOT antacids, NSAIDs or change in position

Front 15

ABSOLUTE CI to thrombolytics (7)

Back 15

1)intracranial hemorrhage
2)known cerebral vascular lesions
3)known intracranial neoplasm
4)ischemic stroke within 3 months
5)suspected aortic dissection
6)Active bleeding or bleeding diathesis
7)significant closed head or facial trauma within 3 months

Front 16

RELATIVE CI to fibronilytics (9)

Back 16

1)uncontrolled HTN
2)ischemic stroke (greater than 3months ago)
3)dementia
4)traumatic/prolonged CPR
5)major surgery less than 3wks ago
6)recent (2-4wks) internal bleed
7)pregnancy
8)active peptic ulcer
9)current warfarin use

Front 17

Componenets of TIMI risk score (6)

Back 17

1)over 65yo
2)more than 3 coronary risk factors
4)ST-segment deviation
5)more than 2 angina events within 24hrs
6)use of ASA within 7 days
7)elevated cardiac markers

Front 18

Risk according to TIMI score (3)

Back 18

1)0-2 low risk
2)3-4 intermediate risk
3)5-7 high risk

Front 19

Management strategies of unstable angina/NSTEMI (2)

Back 19

1)early invasive strategy
2)early conservative strategy

Front 20

Early invasive strategy (4)

Back 20

1)Cardiac cath done in order to....
2)perform a PCI w/o first getting...
3)a noninvasive stress test OR
4)w/o failing medical treatment

Front 21

Early conservative strategy (6)

Back 21

0)medically manage ACS w/ antiplatelet & anti-coag
1)cardiac cath performed ONLY if...
2)persistent or recurrent chest pain
3)depressed LV fxn
4)malignant ventricular arrhythmia
5)high-risk physiologic stress test (+ on it)

Front 22

Drugs used to treat unstable angina/NSTEMI (9)

Back 22

1)ASA/plavix
2)nitro SL/IV
3)UFH/enox/fondaparinux
4)bivalirudin
5)GP2b/3a inhibitor
6)BB
7)statins
8)ACEI/ARB
9)sprionolactone

Front 23

Secondary prevention medications used to reduce long-term mortality (6)

Back 23

1)ASA
2)plavix
3)ACEI
4)aldosterone
5)BB
6)statins

Front 24

How to treat PRIMARY IHD (9)

Back 24

1)lipid lowering therapy
2)HTN management
3)DM management
4)smoking cessation
5)antiplatelet therapy
6)Type A personality
7)post-menopausal
8)binge drinking (moderate drinking is NOT a RF)
9)diet/exercise

Front 25

How to treat SECONDARY IHD (5)

Back 25

1)treat anginal/ischemic episode via Nitro
2)use anti-platelets
3)Maintenance of anginal pain symptoms (via BB (first line) or CCB (2nd) or long acting nitrates (3rd))
4)Ranolazine for anti-ischemia
5)PLUS ABCDE APPROACH

Front 26

Secondary intervention goals (2)

Back 26

1)prevent development of complications from MI (heart failure, arrhythmias, etc)
2)reduce symptoms of angina

Front 27

Major CV risk factors by NCEP and JNC (9)

Back 27

1)smoking
2)HTN
3)low HDL (less than 40)
4)elevated TC and LDL
5)age (over 45men; over 55women)
6)family history of premature heart disease (1st degree male before 55; 1st degree female before 65)
7)inactivity
8)DM (this is considered an "equivalent" risk of an event as someone who has already developed IHD)
9)HDL over 60 is a NEGATIVE risk factor

Front 28

CV effects of smoking (7)

Back 28

1)incr HR
2)incr BP
3)impaired O2 to heart b/c of carbon monoxide from smoke
4)negative inotrope
5)incr platelet adhesion
6)decr threshold for arrhythmias
7)impaired endothelial fxn

Front 29

2 primary goals for treating pts @ risk for IHD (primary prevention)

Back 29

1)prevent pt development of IHD
2)modify pt risk factors for development of IHD

Front 30

When should a pt @ risk for IHD get anti-platelet therapy?

Back 30

pt w/ 10year risk of a cardiac event if greater than 10%

Front 31

General treatment strategies for management of chronic stable angina (3)

Back 31

1)Nitro for acute ischemic attack
2)anti-platelets
3)BB, CCB, long acting nitrate for maintenance of anginal pain

Front 32

ABCDE approach in SECONDARY IHD prevention

Back 32

A)anticoag, ACEI/ARB, anti-anginals
B)BB, BP
C)cholesterol manage, cig smoking, cardiac revascularization
D)DM, diet
E)education, exercise

Front 33

Nitro pt counsel points (6)

Back 33

1)keep in original container, tightly closed
2)Once SL nitro is opened, it is only good for 6months
3)Not addictive
4)take @ onset of chest pain
5)inadequate saliva may interfere w/ absorption of SL nitro
6)HA and sublingual tingling are common ADR's

Front 34

Pharmacological effects of BB in secondary prevention of IHD (5)

Back 34

1)decr oxygen demand
2)decr HR, contractility, BP
3)incr wall tension
4)improves exercise duration
5)delays ST segment changes

Front 35

Pharmacological effects of CCB in secondary prevention of IHD (6)

Back 35

1)vasodilation of arterioles and coronary arteries
2)decr arterial pressure
3)decr coronary vascular resistance
4)decr contractility
5)decr conduction velocity of SA/AV nodes
6)inhibits coronary artery vasospasm

Front 36

Pharmacological effects of long acting nitrates in secondary prevention of IHD (4)

Back 36

1)decr oxygen demand by reducing venous return
2)dilates coronary arteries
3)incr oxygen supply due to vasodilation
4)inhibits vasospasm