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6 Cards in this Set

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Anti-Ischemic Tx:
Nitrate
BB
CCB (for asthmatics)
Morphine
O2
NTG 0.4mg SL q 5min x 3
Metoprolol 5mg IV q 5min x 3, then 25PO q 6hrs, titrate to HR55-60.
Verapamil 5mg IV
Morphine Sulfate 2-5mg IV q5-30min
O2 for sats <90%
Anti-Platelet:
ASA
Clopidegrel
GPIIbIIIa Inhibitor
ASA 325mg PO, then 162mg PO daily
Clopidogrel 300mg PO, then 75mg PO daily (takes 6hrs to reach steady state, some people use 600mg initial dose)
Abciximab 0.25mg/kg IVB then 0.125mcg/kg/min OR
Integrilin (Eptifibatide) 180mcg/kg IVB, then 2mcg/kg/min (1 if CrCl<50)
Anti-Coagulation Tx:
LMWH
UFH
Direct Thrombin Inhibitor (pts with HIT) at PCI?
Xa Inhibitor
Enoxaparin 1mg/kg SC bid
UFH 60U/kg IVB (max 4000U) then 12U/kg/h (max 1000U/hr)
Angiomax (Bivalivudin) 0.1mg/kg IVB, then 0.25mg/kg/hr.
At PCI: 0.50mg/kg IVB, then 1.75mg/kg/hr
Arixtra (Fondaparinux) 2.5mg SC daily. Must supplement with UFH if PCI
TIMI Score
Age (greater than 65 years)
Markers (raised serum cardiac markers)
ECG (ST-segment depression at presentation)
Risk factors (at least three for coronary artery disease)
Ischemia (at least two anginal events in previous 24 hours)
Coronary stenosis (prior stenosis of 50% or more)
Aspirin (use in previous 7 days)
AMERICA
Indications for PCI
Skilled technician available w/o delay
High risk STEMI
Contra to lysis
Late presentation (>3h)
Dx STEMI in doubt
Indication for fibrinolysis
<3hrs
Delay to PCI (>90min)
invasive not an option