ACS

Question 1

NSTEMI/STEMI treatment

Answer 1

MONA + beta: morphine, oxygen, nitrates, aspirin 325, beta-blocker
MONA-GAP-BA: morphine, oxygen, nitrates, aspirin 325 + G2a/3b (abciximab, eptifibitide, tirofiban) + anticoag (warfarin) + P2Y12 (clopidogrel, prasugrel, ticagrelor) - Beta Blocker + ACEi (start w/in 24 hrs if LVEF <40%, HTN, DM, stroke)
avoid NSAIDs, IR nifedipine - inc morbidity

Question 2

GP2a/3b antagonists for ACS treatment

Answer 2

abciximab, eptifibitide tirofiban

Question 3

fibrinolytics for ACS treatment

Answer 3

used only for STEMI (complete blockage)
if unable to use stent/PCI
tPA (Alteplase, Activase)
tenecteplase (TNKase)
reteplase

Question 4

long-term management of ACS

Answer 4

aspriin 81 indefinitely
ticagrelor/clopidogrel + aspirin 81 for 12+ months
nitroglycerin indefinitely
beta-blocker x3 yrs, indefinitely for HF or HTN
ACEi indefinitely if LVEF <40%, HTN, DM, or CKD

Question 5

if A-fib and ACS

Answer 5

warfarin + aspirin + clopidogrel

Question 6

antiarrhythmics for rate control

Answer 6

HR goal <80 w/ symptomatic a-fib
beta blockers preferred or non-DHP CCB (diltiazem, verapamil)
use beta blockers in pts with HFrEF

Question 7

class 1a antiarrhythmics for rhythm control

Answer 7

block Na channels

disopyramide, quinidine, procainamide

Question 8

class 1c antiarrhythmics for rhythm control

Answer 8

block Na channels
c/i in HF, left ventricular hypertrophy
flecanide, propafenone

Question 9

class 2 antiarrhythmics for rhythm control

Answer 9

beta blockers

indirectly block Ca channels

Question 10

class 3 antiarrhythmics for rhythm control

Answer 10

block K channels
amiodarone - DoC if HF + arrythmia
dionedarone, sotalol, ibutilide, dofetilide
s/e: optic neuropathy, thyroid issues, photosensitivity

Question 11

class 4 antiarrhythmics for rhythm control

Answer 11

slow ventricular rate

non-DHP CCB (diltiazem, verapamil)