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74 Cards in this Set
- Front
- Back
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goals of tx
prevent |
progression of MI
development of HF Death |
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goals of tx:
relieve |
cp
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goals of tx:
reestablish --- --- --- |
coronary bl flow
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when is asa given
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1st signs of cp
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why give asa
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reduces mortality and reinfarction
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how much asa to give
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325 mg chewable
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t/f
nitrates improve outcome |
f
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dose of nitrates
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titrate to cp relief
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bb have a 13% reduction in --- - - ---- among pts w/ unstable angina
and 40% decrease in ----- |
risk of MI
mortality |
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morphine used for pts w/ ---- ----- as analgesic and ---- that would decrease ----
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refractory angina
venodilator preload |
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anticoagulant used for mi
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ufh
enoxaparin |
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CI of ASA
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allergy
recent gi bleed recent intracranial hemorrhage |
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benefit of asa:
decrease in -------- |
ACM in AMI by 20%
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benefit of asa:
decrease in recurrent ----, ----, --- and ---- ---- |
ischemia
reinfarction stroke cardiac death |
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MP of ASA
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bleeding
rash GI upset |
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route of nitrates
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SL or spray
then IV if no relief w/ SL or spray |
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when do you stop nitrates
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pt's relieved/EKG resolution
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duration of nitrate administration
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24-48 hrs
may convert to PO or paste once stable |
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ade of nitrates
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hypotension
HA relfex tachycardia |
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CI of nitrates
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hypotension
sildenafil (PDEI) |
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MP:
SBP should not fall < -- mmHg caution if SBP less than ---- mmHg |
90mmHg
100 mmHg |
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no ---- benefits w/ nitrates
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mortality
symptom control |
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route of bb
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IV followed by PO
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metrolol dose for MI
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metoprolol: 5 mg iv q 5 min x 3 doses
50 mg-100 mg po q6h x 48 hr then, 100mg po q 12 hr (what pt is d/ced w/) |
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atenolol dose for mi
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5 mg IV q 5 min x 2 dose then,
50-100 mg PO qd |
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caution w/ bb:
HR? SBP |
< 60bpm
<100 mmHg |
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caution w/:
mod/severe---- w/ ----; --- ---- |
LVH
CHF Heart block |
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benefits of bb: reduction in ---- and ----- mortalitiy
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early (1 day)
late (2 years) |
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benefits of bb: reduction in -- size, -- incidence adn ----
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infarct
HF arrhythmia |
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benefits of bb:
decrease in risk of MI in pts w/ --- by --% |
UA
13 |
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b1 selective bb
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metoprolol tartate 100 mg po BID
metoprolol succinate 200 mg po qd atenolol 100 mg po qd |
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bb nonselective
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carvedilol 25 mg bid po
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ccb used in --- and --- ACS and reserved for pateints CI to ---
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STE
NSTE BB (class 1A) |
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ccb inhibit Ca --- to myocardial and --- ----- --- cells
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influx
vascular smooth muscle |
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ccb cause vaso----
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dilation
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which ccb have additional anti-ischemic effects
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nDHP
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ccb slow --- via -- node coduction
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HR
AV |
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what effects of ccb might worsen outcomes
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negative inotrophic effects
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when are fibrinolytics indicated for stemi patients?
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w/in 12 hrs of symptom onset and have 1 mm of ste on EKG
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fibrinolytics given to pt's w/in -- hrs of symptom onset and have - mm of STE on EKG
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12
1 |
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fibrinolytics not indicated for ----- patinets
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NSTE ACS
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fibrinolytics CI w/
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high bleeding risk
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door to needle time ----- min
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< 30
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benefit of fibrinolytic
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saves lives out to at least 10 yrs
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MP of fibrinolytics:
resolutio of ----, ---- changes, s/s of ------- |
CP
EKG ICH |
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w/ fibrinolytics look out for s/s
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stroke
other major bleeding ICH |
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when should stemi pts received either fibrinolysis or primary pci
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w/in 3 hrs of symptom onset
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which has lower mortality rate pci or fibrinolysis
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pci
open arteries more than fibrinolytics |
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what does tpa activate
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plasminogen
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absolute CI include:
---- dissection active ---- ----- h/o ----- hemorrhage |
aortic
internal bleeding cerebral |
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absolute CI:
h/o ---- or --- w/in 1 yr --- tumor |
stroke
CVA intracranial |
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absolute ci include:
acute ------ |
pericarditis
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absolute CI include:
closed ---/--- trauma w/in --- mo |
head/face
3 |
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relative ci:
pt's > --- y/o recent ---/---- |
75
sx/trauma |
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relative ci include:
recent ---- bleeding CA pregnancy INR > ----- |
internal
2 |
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relative CI:
BP> ----/---- mmHg ---- dyfunction |
180/110
hepatic |
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for tx w/ fibrinolytics the more fibrin specificity the less ---- bleed and ---- risk
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systemic
ICH |
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fibrinolytic w/ the most specificity
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tenecteplase (TNK)
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fibrin w/ most risk for systemic bleed
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strepokinase
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least fibrin specificity
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streptokinase
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the lease systemic bleed
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tenecteplase (TNK)
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most expensive
least expensive fibrin |
most: tenecteplase
least: steptokinase |
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difference w/ NSTE and STE early tx
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w/ NSTE
fibrinolytics not given GP2b/3a receptor blockers administered to mod and high-risk pt undergoing pci no standard quality performace for NSTE ACS w/ unstable angina |
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limitations of stents
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prolonged use of clopidogrel
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GP 2b/3a prevents cross linking of ---- thru inhibition of GP 2b/3a ----
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platelets
receptors |
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GP 2b/3a may help w/ early opening of --- ----
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coronary arteries
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ci of GP 2b/3a
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active bleeding
thrombocytopenia hx stroke |
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mp: of GP 2b/3a
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aPTT
H/H platelet count |
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when is GP 2b/3a recommended w/ stemi
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for pt's undergoing pci
not recommended by itself |
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which GP 2b/3a med is preferred w/ stemi
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abciximab
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which GP 2b/3a med is preferred for nstemi w/o revascularization or pt w/ continued ischemia despite tx w/ asa, clopidogrel and anticoagulant
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tirofiban
epifibatide |
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which GP 2b/3a med is recommended for pts undergoing pci
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abciximab
epifibatide |
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which GP 2b/3a is not selective
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abciximab
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which has the shortest t1/2
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abciximab
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