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24 Cards in this Set
- Front
- Back
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1. Next step and treatment of unstable angina pectoris/MI?
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a. MONA
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2. MOA of morphine for unstable angina/MI?
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a. Can achieve adequate analgesia which decreases levels of circulating catacholamines , thus reducing myocardial oxygen consumption
b. It must be initiated rapidly if nitroglycerin cannot alleviate the discomfort |
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3. Use guidelines of oxygen for unstable angina/MI?
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a. 2 to 4 L per minute by nasal cannula
b. May be discontinued after 6 hours of oxygen saturation remains normal without other complications |
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4. MOA/Use of nitroglycerin for unstable angina/MI?
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a. Must be given sublingually, initially every 5 min. for a total of 3 doses (in the absence of hypotension or contraindications such as sildafenil (VIAGRA) use)
b. Then advance to IV or transdermal routes. |
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5. Directions for aspirin use with unstable angina/MI?
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a. 325 mg should be chewed and swallowed.
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6. What should be given if aspirin allergy exists?
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a. Clopidogrel (Plavix)
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7. MOA of Clopidogrel (Plavix)?
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a. Irreversibly binding to the P2Y12 receptor on platelets, preventing adenosine diphosphate (ADP) from activating platelets.
b. It belongs to a class of drugs called P2Y12 inhibitors. |
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8. MOA of β-adrenergic antagonist for unstable angina/MI?
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a. Reduces myocardial damage may limit infarct size
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9. MOA of Glycoprotein (GP) IIb/IIIa inhibitors for unstable angina/MI?
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a. Glycoprotein (GP) IIb/IIIa inhibitors reduce endpoint of death or recurrent ischemia when given in addition to standard therapy for patients with high-risk unstable angina or non-ST elevation myocardial infarction treated with percutaneous coronary intervention, or who are refractory to prior treatment
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10. What changes seen in the ECG are indicative of angina?
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a. ST segment elevation or depression
b. And/or T-wave inversion. c. Myocardial infarction that these changes plus elevated CK-MB and/or troponin levels. |
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11. Significance of pathologic Q waves?
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a. Pathologic Q waves may also indicate cardiac pathology, but typically represent myocardial tissue necrosis from a completed infarction.
b. When Q waves are present, the benefits of thrombolytic therapy are uncertain. |
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12. Note: not all myocardial infarction will have ECG changes!!!
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12. Note: not all myocardial infarction will have ECG changes!!!
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13. If characteristic ECG changes are not seen for an MRI, when should you decide to draw cardiac enzymes?
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a. Any person with symptoms of angina who has a left bundle branch block (LBBB) because there is a high degree of correlation between lbbb and organic heart disease, especially CAD.
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14. Significance of lbbb?
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a. Lbbb Kamas signs in myocardial pathology, as it can mimic both acute and chronic ischemic changes.
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15. Angina pectoris?
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a. Severe pain around the heart caused by a relative deficiency of oxygen to the heart muscle.
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16. Class I angina?
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a. Angina only with unusually strenuous activity
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17. Class II angina?
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a. Angina with slightly more prolonged or slightly more vigorous activity than usual .
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18. Class III angina?
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a. Angina with usual daily activity
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19. Class IV angina?
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a. Angina at rest
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20. Unstable angina?
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a. Angina of new onset
b. Angina at rest or with minimal exertion c. Or a crescendo pattern of angina with episodes increasing frequency, severity, or duration. |
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21. Treatment of unstable angina?
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a. Aspirin and heparin reduce the risk of subsequent MI and cardiac death in patients with unstable angina.
b. Heparin usually should be continued for 48 hours or until angiography is performed. c. Patients suffering from unstable Angela with ECG changes should also be given platelet glycoprotein 2B/3A receptor inhibitors because of the composite risk of death, myocardial infarction, and recurrent ischemia is significantly reduced with these medications |
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22. How should nitroglycerin be given initially?
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a. IV because of the ability to achieve predictable blood levels rapidly.
b. Once stabilized after 24 hours, asymptomatic patient should be switched to a long-acting oral or transdermal nitrate. |
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23. Note: the combination of nitroglycerin and beta-adrenergic antagonist reduces the risk of subsequent myocardial infarction. β-blockers decreased mortality reduce infarct size and many clinical trials
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23. Note: the combination of nitroglycerin and beta-adrenergic antagonist reduces the risk of subsequent myocardial infarction. β-blockers decreased mortality reduce infarct size and many clinical trials
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24. Utility of ace inhibitors?
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a. They reduce short-term mortality when started within 24 hours of acute MI.
b. Postinfarction ace inhibitors prevent left ventricular remodeling and recurrent ischemic events c. It is reasonable to recommend their indefinite use in the absence of any contraindications. |
