Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
25 Cards in this Set
- Front
- Back
|
How do you treat unstable angina including NSTEMIs and Non STEMIs
|
Morphine 1-5 mg IV
Oxygen Nitro 0.4 mg x 3 sublingual Aspirin 325 mg x 1 |
|
|
Name the anticoagulants
|
Plavix
Aspirin Heparin LMWH |
|
|
which anticoagulants would you not give with a STEMI?
|
LMWH (lovenox) because it has a long half life
|
|
|
How do GP 2b/3a inhibitors work?
|
by stopping platelet aggregation
|
|
|
what is the dose for Nitro IV?
|
start at 10 mcg/min IV and titrate up
|
|
|
what are the side effects of nitro?
|
hypotension, headache, bradycardia
|
|
|
What is the dose of BB (metoprolol) IV?
|
IV metoprolol 5 mg iv every 5 minutes times three doses, then 50 mg po every 6 hours, and then q12h
|
|
|
What are the indications for ACE Inhibitors in ACS
|
Left ventricular dysfunction (EF less than 40) or diabetic or both
Start on oral form |
|
|
what is the contraindication for metoprolol
|
HR less than 50;
also if acute COPD with edema |
|
|
what part of the platelet does plavix work on?
|
ADP pathway
|
|
|
what part of the platelet does aspirin work on?
|
Cyclooxygenase pathway
|
|
|
which anticoagulant is used in patients with ACS going to Cath lab?
|
Clopidrogel (Plavix)
300 mg loading dose, then 75 mg po daily |
|
|
what drug would a patient that got a stent be on and for how long?
|
Plavix for a minimum of 3 months
|
|
|
what are GPIs contraindications?
|
Active internal bleeding
Recent (< 6 weeks) GI or GU bleeding History of CVA, or h/o any hemorrhagic CVA Bleeding diathesis or evidence of active bleeding within previous 30 days Oral anticoagulants (warfarin) within 7 days and PT > 1.2 x control or INR 1.2 seconds Thrombocytopenia (<100,000 cells/uL) or coagulopathy (PT > 1.2 x control, INR 1.2 seconds, or PTT > 35 seconds) Recent major surgery (< 6 wks), dental surgery or trauma Intracranial neoplasm, AV malformation, or aneurysm Severe uncontrolled HTN (BP > 200/110) IV dextran before PCI, or intent to use during PCI Pediatrics - less than 17 years old Nursing or pregnant women For Integrilin only: serum creatinine > 4 mg/dl |
|
|
what are the options for treating a STEMI
|
Thrombolytic
PCI: PTCA (Percutaneous Transluminal Coronary Angiography) STENT implantation or both |
|
|
when do you give thrombolytics?
|
With STEMIs, preferably within 6 hours, after 12 no benefit just increased risk of bleeding
|
|
|
name some thrombolytics
|
Alteplase- (TPA) Double bolus and infusion
Reteplase- Bolus and infusion Tenecteplase- Weight based just bolus 1 dose |
|
|
what are the GP 2b/3a Inhibitors indications?
|
Treatment of ACS
|
|
|
what is the first and only glycoprotein Inhb. to have a 2b recommendation for the use of STEMIs
|
Abciximab (ReoPro®)
use with unstable angina with planned PCI It also has a NSTEMI - IIA recommendation |
|
|
which glycoprotein inhibitors can you use with NSTEMIs
|
Integrilin
Reopro |
|
|
what do you monitor in a pt on glycoprotein inhibitors
|
CBC- if platelets drop below 100k, stop drug; if <60k, stop all anticoagulants
Also monitor SCr |
|
|
what other Medications are used in STEMIs
|
Unfractionated heparin- can be given with thrombolytics
Lovenox (enoxaparin) ACE Inhibitors – Conserve cardiac muscle Statins – Improve morbidity and mortality Life – Style modifications |
|
|
how do you treat STEMIs in the ER?
|
1. PCI- PTCA/stent
2. Thrombolytics (Alteplase-double bolus and infusion) 3. Unfractionated Heparin 4. ACE I-conserves cardiac muscle 5. Statins-improves M/M Outside the ER: MONA & Heparin |
|
|
What's the first line Tx in relieving chest pain, reducing infarct size and LV stress?
|
BBs
IV metoprolol 5 mg every 5 min x 3; then 50 mg po Q6; then Q12 |
|
|
what's the clinical presentation of a STEMI?
|
C/P > 20 min
ST elevation Positive enzymes |
