00 Acute Coronary Syndrome (ACS)

Question 1

What is ACS?

Answer 1

Encompasses the clinical conditions of unstable angina (UA), non-ST segment elevation myocardial infarction (NSTEMI), and ST segment elevation myocardial infarction (STEMI)

Question 2

To stabilize the patient and treat the pain, what kind of combination is given upon presentation to the ED?

Answer 2

MONA: Morphine, Oxygen, Nitroglycerin, and ASA (162-325 initially followed by 81mg daily)

Question 3

After initial treatment with MONA, what is usually the next step?

Answer 3

Antithrombotic therapy is then initiated to reduce myocardial damage and prevent further ischemia

Question 4

What does the antithrombotic therapy usually consist of thats given after MONA?

Answer 4

Typically includes a combination of dual oral antiplatelet therapy (e.g., clopidogrel plus ASA) and anticoagulation with heparin, low-molecular weight heparin, or bivalirudin

Question 5

What should all patients without contraindications receive within 24 hours of presenting with ACS?

Answer 5

BB and ACE-I

Question 6

What is the generic name of ReoPro?

Answer 6

Abciximab (GP IIa/IIIa Receptor Antagonist)

Question 7

What is the generic name of Integrilin?

Answer 7

Eptifibatide (GP IIa/IIIa Receptor Antagonist)

Question 8

When are GP IIa/IIIa Receptor Antagonists contraindicated?

Answer 8

Thrombocytopenia (Plt < 100,000), Hx of bleeding diathesis, Active internal bleeding, Recent (w/in 6 weeks) surgery, Increased prothrombin time, Hx of stroke w/in 2 years, Severe/uncontrolled HTN

Question 9

What is the generic name of Plavix?

Answer 9

Clopidogrel (P2Y12 Inhibitor)

Question 10

When do you not want to start a patient on Plavix?

Answer 10

Patients likely to undergo CABG surgery and d/c 5 days prior to any major surgery

Question 11

What is the BBW associated with Plavix?

Answer 11

Effectiveness depends on the activation to an active metabolite mainly by CYP 2C19. Consider alternative treatment strategies in patients identified as 2C19 poor metabolizers

Question 12

What is the generic name of t-PA, rt-PA, Activase?

Answer 12

Alteplase (Fibrinolytic)

Question 13

What is the generic name of TNKase?

Answer 13

Tenecteplase (Fibrinolytic)

Question 14

When us Fibrinolytic use recommended?

Answer 14

When a hospital cannot perform PCI within 90 minutes (door-to-balloon time) and should be initiated within 30 minutes from time of arrival to the hospital (door-to needle time). The STEMI guidelines find Fibrinolytic use still beneficial when given 12-24 hours out from symptom onset of STEMI

Question 15

What are the Long-Term medical management agents in patients S/P MI (secondary prevention)?

Answer 15

ASA (indefinitely), P2Y12 Inhibitor (at least 1 month), Nitroglycerin PRN, BB (at least 3 years), ACE-I, Statin (high-intensity (Atorvastatin 80mg is preferred), Warfarin (if required), Pain relief (no NSAIDs)