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63 Cards in this Set

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what are the 3 classifications of Acute Coronary Syndrome?
1.USA: unstable angina: acute angina at rest, prolonged > 20 min
2. Non-STEMI: USA + pos cardiac enzymes
3.STEMI: ST elevation + cardiac enzymes
what is the acute management for USA/NSTEMI?
Morphine: 1-5mg IV q 10min PRN for pain
Oxygen
Nitroglycerin: sublingual o.4mg x 3
ASA: 325mg
Heparin
what is the MOA for morphine?
dilating; improves O2 demands for the heart
name 4 main anticoagulants
Plavix
ASA
Heparin-> for STEMI's monitor PT
LMWH= "lovenox" (12hr 1/2 life)
what is the usual dose for Nitro IV?
10 mcg/min
what are the contraindications of Nitro?
if patients have used sidenafil or valdenafil in the past 24 hours (viagra)
what is the first line tx in relieving chest pain?
beta-blockers
ex: Metoprolol IV
5mg IV q5min x3
Then 50mg po q6 then q12
what fx does BB have on p with chest pain?
reduce infarct size, relieve L ventricular stress, DECREASE myocardial o2 demand
when are ACE inhibitors indicated?
Left ventricular dysfunction!
EF < 40
diabetic
once p is stable: enalopril IV
where does clopidrogel (PLAVIX) work?
on the ADP pathway to prevent platelet aggregation
what are the 3 classifications of Acute Coronary Syndrome?
1.USA: unstable angina: acute angina at rest, prolonged > 20 min
2. Non-STEMI: USA + pos cardiac enzymes
3.STEMI: ST elevation + cardiac enzymes
what is the acute management for USA/NSTEMI?
Morphine: 1-5mg IV q 10min PRN for pain
Oxygen
Nitroglycerin: sublingual o.4mg x 3
ASA: 325mg
Heparin
what is the MOA for morphine?
dilating; improves O2 demands for the heart
name 4 main anticoagulants
Plavix
ASA
Heparin-> for STEMI's monitor PT
LMWH= "lovenox" (12hr 1/2 life)
what is the usual dose for Nitro IV?
10 mcg/min
what is the dose for PLAVIX when treating acute coronary syndrome?
300mg loading dose.
75mg QD.
what is the half life of plavix?
5-7 days...long.
what is the best, non-invasive, non-surgical procedure to verify the need for plavix (anticoagulation)
PCI: percutaneous coronary intervention
these anti-coagulants are classified as potent platelet inhibitors. These agents are used to prevent platelets from binding together, which can occur in patients with heart attacks and after angioplasty with or without stent placement
Glycoprotein IIb/IIIa inhibitors
give 3 examples of glycoprotein inhibitors
Abciximab (ReoPro)
Eptifibatide (Integrilin)
Tirofiban (Aggrastat)
what are the contraindications for using GP IIb IIIa?
-active internal bleeding
-recent GI or GU bleeding
-history of CVA
-oral anticoagulants within 7 days
-thrombocytopenia
what are the contraindications for ASA?
allergy
severe asthma
GI bleed
what is the dose for PLAVIX when treating acute coronary syndrome?
300mg loading dose.
75mg QD.
what is the half life of plavix?
5-7 days...long.
what is the best, non-invasive, non-surgical procedure to verify the need for plavix (anticoagulation)
PCI: percutaneous coronary intervention
what are the clinical findings of a patient with a STEMI?
-angina >30 min
-ST segment elevation on EKG
-pos. cariac enzymes
what are the first two lines of tx for a patient c STEMI?
1st: PCI
2nd: thrombolytics
what is the MOA of thrombolytics?
plasminogien is a proenzyme and is converted to the active enzyme plasmin by plasminogen activeators, plasmin digests fibrin.
when must thrombolytics be administered by?
preferably within 6 hours. no benefit after 12.
what is the "door to balloon time"
90 minutes
what are some examples of thrombolytics
"TAR"
Tenecteplase
Alteplase:double bolus
+ infusion
Reteplase: bolus + infusion
what anticoag. cannot be given with thrombolytics?
LMWH.
what is the dose for enoxaparin "lovenox"
1mg/kg sc q12 hours
other than thrombolytics, what are other meds used in STEMI?
ACE inhib: conserve cardiac muscle
Statins: improve morb/mort
Life:style modifications
what are the 3 major complications of ACS?
myocardial ischemia
myocardial o2 demands
nitro patches at home c clots
how does morphine relieve angina?
1-5mg IV q5min x3
opiate receptors in heart, by dilating vessels and bringing 02 to the heart
patient presents to ER, with ACS NON-stemi. 8/10 angina. no ekg changes. could be PWMI.
what will they be treated with?
Plavix, ASA, BB
what is the drug of choice for a STEMI?
heparin. short half life. and you have the ability to know levels by measuring PTT.
how do you reverse heparin?
protamine 1:100
which drugs bind prothrombin (work on Factor Xa)
heparin, enoxaparin
patient in ER and angina is unrelieved by Morphine, what tx do you put them on now?
nitro
10mcg IV. titrate accordingly
what is the FIRST LINE tx for chest pain?
BB. Lopressor/metoprolol: 5mg IV q5 min x3 to relieve stress, bring o2 to the heart. reduce infarct size and LV stress/damage
p is having an MI/ACS, but is also in acute pulmonary edema. (COPD) should you give BB?
for acute state, hold BB: it will exacerbate the CHF.
in ACS what is a compelling syndrome to use an ACE?
LV dysfunction
or
DM
which drugs bind prothrombin (work on Factor Xa)
heparin, enoxaparin
patient in ER and angina is unrelieved by Morphine, what tx do you put them on now?
nitro
10mcg IV. titrate accordingly
what is the FIRST LINE tx for chest pain?
BB. Lopressor/metoprolol: 5mg IV q5 min x3 to relieve stress, bring o2 to the heart. reduce infarct size and LV stress/damage
p is having an MI/ACS, but is also in acute pulmonary edema. (COPD) should you give BB?
for acute state, hold BB: it will exacerbate the CHF.
in ACS what is a compelling syndrome to use an ACE?
LV dysfunction
or
DM
if a patient has an ASA allergy, what is a great alternative?
plavix
why is asa better for the heart than plavix?
asa has protective qualities for the heart, and it relieves pain. plavix does not
what is the most definitive way to get an EF?
by pumping iodine into the left main
(invasive)
at what point (%) are your platelets completely anticoagulated?
80%
when would you give a GPI?
p undergoing cath lab procedure, after 4x 75mg of plavix, you start a drip to work with plavix during procedure.
what is the treatment goal of GPI's?
absolute reduction in triple endpoint:
DEATH
MI
REVASCULARIZATION
what would you give a NON-STEMI patient who refuses CATH LAB or an elderly patient for medical management?
Integrilin
what do MD's argue is the best treatment for patient with ACS + DM?
REOPRO: monoclonal antibody. chemically engineered. long lasting effects
what is an alternative to heparin + GPI for patient getting PCI?
Bivalirudin (angiomax)
2.5mg/kg
what are contraindications of GPI's?
active internal bleeding
motor vehicle accident victims
history of CVA
oral anti-coag's
warfarin
what is a STEMI?
a complete occlusion of an artery
if a hospital does not have a cath lab what are your options to treat a stemi?
PCI
PTCA
STENT
what is an example of a thrombolytic?
tenecteplase. weight based bolus. just one.
can unfractionated heparin be given with thrombolytics?
yes. 70 units/kg bolus then 15 units/kg.
if you gave a thrombolytic, drop it by 10 units.