ACS

Question 1

Initial meds for acute mgmt of ACS

Answer 1

ASA (162-325mg, chewed)
Nitro (SL, spray)
Beta-blocker
Clopidogrel
Heparin gtt

Question 2

What beta-blockers / doses are appropriate for the acute mgmt of ACS in most cases?

Answer 2

Metoprolol 5mg IVP up to 3 doses, then 50 mg PO 15 min later.
OR
Atenolol 5mg IVP x 2 doses, then 50 mg 1 hr later.

Question 3

What beta-blocker should be used in acute mgmt of ACS if unsure of LV function (worried about cardiogenic shock)?

Answer 3

Esmolol (ultra-short acting) 50 mcg/kg/min increasing to 200-300 mcg/kg/min.

Question 4

What is the bolus dose and goal aPTT of the heparin drip for acute mgmt of ACS?

Answer 4

bolus 60mg/kg; aPTT goal 50-70

Question 5

Clopidogrel dose for acute mgmt of UA/NSTEMI?

Answer 5

300 mg loading dose, then 75 mg daily

Question 6

Clopidogrel dose for acute mgmt of STEMI going to PCI?

Answer 6

600 mg loading dose, then 75 mg daily

Question 7

What initial labs should you get for ACS?

Answer 7

CBC, BMP, cardiac enzymes, coags, and Mg++

Question 8

What should you do for asymptomatic VT 2/2 MI that is sustained (>30sec)?

Answer 8

give amiodarone

Question 9

What should you do for asymptomatic VT 2/2 MI that is unsustained (

Answer 9

observe

Question 10

Duration of Clopidogrel therapy post-ACS if treated medically or with bare metal stent.

Answer 10

> 1 mo,

Question 11

Duration of Clopidogrel therapy post-ACS if treated with DES.

Answer 11

1 yr - lifelong

Question 12

3 mechanical complications of ACS?

Answer 12

papillary muscle rupture, VSD, free wall rupture

Question 13

Aside from lowering LDL, what is the benefit of a statin for pts who have had ACS?

Answer 13

stabilization of atherosclerotic plaques

Question 14

Which statin has been shown to be superior to all others?

Answer 14

hi-dose atorvastatin (80mg)

Question 15

LDL goal in pts who have had ACS

Question 16

If EF=40%, add a drug from what class?

Answer 16

ACE-I / ARB

Question 17

9 things on ACS d/c checklist

Answer 17

ASA
Clopidogrel
beta-blocker
atorvastatin
if EF