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