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;
46 Cards in this Set
- Front
- Back
|
What are the 3 classifications of acute coronary syndrome (ACS)?
|
1. Unstable angina - acute angina at rest, prolonged greater than 20 minutes 2. Non STEMI - same as unstable angina with positive cardiac enzymes 3. STEMI - ST segment elevation on EKG with positive cardiac enzymes
|
|
|
What is the goal of therapy for ACS?
|
- minimize infarct size - salvage myocardial ishemia (by restoring oxygen ASAP) - minimize complications - improve outcomes
|
|
|
How do you acutely manage ACS?
|
MONA(H) - Morphine 1-5 mg IV 5-15 min. as need for pain - Oxygen - Nitroglycerin (sublingual tablet 0.4 mg x 3) - Aspirin 325 mg (one time) - Heparin
|
|
|
Name 4 anticoagulants to be used during ACS
|
- Plavix - Aspirin - Heparin - LMWH (Lovenox)
|
|
|
What anticoagulant should be used with a STEMI and why?
|
- definately use Heparin with STEMI - Heparin has a short half-life, so that can it can be stopped before a patient goes to cath lab
|
|
|
When should you not give LMWH?
|
- do not give LMWH for a STEMI - LMWH has a long half-life (12 hrs)
|
|
|
What drug is given to reverse the effects of Heparin?
|
- Protamine - give 1 unit of Protamine for every 100 units of Heparin
|
|
|
What receptor does Plavix work on?
|
plavix binds to the ADP receptor
|
|
|
What is the MOA for GP IIb-IIIa inhibitors?
|
- GP IIb-IIIa inhibtors displace fibrinogen and prevent further platelet cross-linking and thrombosis (prevents platelet aggregation)
|
|
|
What is the MOA of Heparin?
|
- blocks prothrombin - inactivates clotting factors (thrombin, Xa)
|
|
|
When should you give Nitroglycerin IV?
|
- if patient is given nitro sub-lingual and chest pain is unrelieved, then start IV - give dose at 10 mcg/min
|
|
|
What are contraindications of giving nitro?
|
a patient who has used sildenafil or valdenafil in the past 24 hours
|
|
|
What drug is first line in relieving chest pain?
|
beta-blockers
|
|
|
What is the benefit of giving beta-blockers for relieving chest pain?
|
- decreases myocardial oxygen demand - reduces infarct size and left ventricular stress - negative inotropic effects
|
|
|
What is the dose of metoprolol?
|
- Metoprolol 5 mg IV every 5 mins x 3 doses - then 6 hrs later, Metoprolol 50 mg po, then Metoprolol 50 mg po Q 12hrs
|
|
|
What is a contraindication for Metoprolol?
|
bradycardia
|
|
|
What is a compelling indication to give an ACE inhibitor?
|
- left ventricular dysfunction (EF less than 40) - diabetic patient
|
|
|
What are 2 types of stents used?
|
1. bare metal stent 2. drug-alluding stent
|
|
|
What are the 2 types of drug alluding stents? how long should the patient be on Plavix with each type?
|
1. Sirolumous stent - needs to be on Plavix for at least 3 months 2. Taxol stent - needs to be on Plavix for at least 6 months
|
|
|
What is the dosage for Plavix?
|
300 mg loading dose, then 75 mg PO daily
|
|
|
What is the half-life of Plavix?
|
5-7 days
|
|
|
Name 3 GP IIb/IIIa inhibitors
|
- Eptifibatide (Integrillin) - Tirofiban (Aggrastat) - Abciximab (Reopro)
|
|
|
What percentage of platelets need to be inhibited to have full platelet inhibition?
|
80%
|
|
|
What are the treatment goals of glycoprotein inhibitors?
|
- reduction in triple endpoint (death, MI, urgent revascularization) - minimize complications - decrease length of stay
|
|
|
What are indications to use Eptifibitide (Integrillin)?
|
- in medical management of ACS (no percutaneous coronary intervention [PCI]) - use as an adjunct to PCI (either emergent or elective PCI) - also has a IIB/IIIa recommendation from ACC(American College of Cardiology) to use for NSTEMI
|
|
|
What are indications of using Abciximab (ReoPro)?
|
- indicated in unstable angina with planned PCI - IIA recommendation for NSTEMI (higher recommendation rate that Integrillin) - also indicated for STEMI
|
|
|
Which glycoprotein inhibitor is a monoclonal antibody?
|
Abciximab (ReoPro)
|
|
|
What are indications for using Tirofiban (Aggrastat)?
|
- same as Integrillin - indicated in chest pain (unstable angina) - does not have indication in NSTEMI
|
|
|
What are contraindications of GP IIb/IIIa inhibitors?
|
- active internal bleeding - bleeding predisposition or evidence of active bleeding in the last 30 days - history of CVA or hemorrhagic CVA - intracranial neoplasm, AV malformation, or aneurysm - IV dextran (Dextran can act as an anticoagulant) - Nursing or pregnant women - oral anticoagulants in last 7 days - pediatrics (less than 17 y/o) - recent GI or GU bleeding (< 6 weeks) - recent major surgery, dental surgery or trauma - severe uncontrolled HTN (B/P > 200/100) - Thrombocytopenia or coagulopathy
|
|
|
What are baseline labs to monitor when using a GP inhibitor?
|
- baseline CBC, PT, aPTT, PLT, Type & Screen, SCr - CBC w/ PLT count 4& 12 hrs after bolus - Daily SCr in the morning
|
|
|
What is the appropriate action if a patient on a GP inhibitor has a platelet count that drops below 100,000?
|
stop drip and call MD or PA
|
|
|
What is the appropriate action if a patient on a GP inhibitor has a platelet count that drops below 60,000?
|
stop GP inhibitor, Heparin, ASA, and call MD or PA
|
|
|
What labs should be ordered STAT if there are signs of overt bleed?
|
HgG, HcT, PLT
|
|
|
What labs should be ordered on a patient prior to discharge?
|
CBC, PLT, Scr
|
|
|
What is the first line drug in ACS?
|
- Aspirin 325 mg daily or 81 mg for long term therapy
|
|
|
What are contraindications for using aspirin?
|
- contraindications are allergy, severe asthma, or current GI bleed
|
|
|
What is the definition and clinical presentation of a STEMI?
|
• definition is complete occlusion of an artery • clinical presentation: 1) Chest pain > 20 min 2) ST segment elevation 3) Positive cardiac enzymes
|
|
|
What are therapeutic goals in treating a STEMI?
|
• restore patency • prevent complications • control chest pain and associated symptoms
|
|
|
What are treatment options for STEMIs?
|
• thrombolytics • PCI (either PTCA or STENT implantation) * PTCA = Percutaneous Transluminal Coronary Angioplasty
|
|
|
What is the mechanism of thrombolytics?
|
activates plasmin, which digests fibrin clots
|
|
|
How soon after onset of STEMI symptoms must a thrombolytic be administered?
|
must adminster thrombolytic within 12 hours of symptoms
|
|
|
What is always the best option for treatment of STEMI?
|
primary PCI in hospitals with cath labs
|
|
|
Name 3 thrombolytics
|
• Alteplase (TPA): double bolus & infusion • Reteplase: bolus & infusion • Tenecteplase: weight-based bolus
|
|
|
What is the dose of Heparin when administering with a thrombolytic?
|
• give a lower bolus dose and infusion • 60 units/kg (bolus) & 12 units/kg/hr (infusion)
|
|
|
What is the dose of Enoxaparin (Lovenox) when given with a thrombolytic?
|
Lovenox 1 mg/kg sc Q 12hr
|
|
|
What other medications used in STEMI?
|
• ACE inhibitors (conserve cardiac muscle; decreasing remodeling of the heart) • Statins (improve morbidity and mortality)
|
