ACS part 2

Question 1

if initial ECG is not diagnostic what do you do

Answer 1

serial ECG every 15-30 minutes for the first hour

Question 2

serial troponin levels:

Answer 2

-levels should be obtained at presentation and 3-6 hours after symptom onset
- high sensitivity preferred
- repeating troponin levels will identify a rising and/or falling pattern

Question 3

MONA

Answer 3

morphine
oxygen
nitroglycerin
aspirin

Question 4

morphine info from slides

Answer 4

• relieve chest pain
• initial dose: 4-8 mg IV, followed by 2-8 mg IV q5-15 minutes

Question 5

morphine side effects: 3

Answer 5

sedation, respiratory depression, N/V

Question 6

T or F: Avoid NSAIDs during hospitalization

Answer 6

True, especially aspirin

Question 7

why do you avoid NSAIDs during hospitalization

Answer 7

NSAIDs lead to sodium and water retention which leads to an increased risk of MACE

Question 8

oxygen early hospital care

Answer 8

maintain saturation >90%

Question 9

early hospital care: NTG

Answer 9

-vasodilator that increases blood flow to the heart
- sublingual NTG: 0.3-0.4 mg q5min x 3 for ischemic pain
- IV NTG: for persistent ischemia, HF, or HTN

Question 10

doses for IV NTG

Answer 10

start at 10 mcg/min, titrate by 5mcg/min q5min (max is 200 mcg/min)

Question 11

side effects NTG

Answer 11

headache, hypotension

Question 12

tachyphylaxis=

Answer 12

when a drug loses part of or its entire efficacy over time as the body develops tolerance to it

Question 13

nitrates are CI’s with recent use of PDE-5 inhibitors, give the times considered “recent” for the following:
sildenafil
vardenafil
tadalafil

Answer 13

24 hours
24 hours
48 hours

Question 14

early hospital care: aspirin

Answer 14

• 162-325 mg chewable aspirin x 1 dose
• given to ALL patients without contraindications ASAP

Question 15

what are two procedures for reperfusion

Answer 15

PCI and CABG

Question 16

what is a pharmacological option for reperfusion

Answer 16

fibrinolytic therapy

Question 17

“absolute” contraindications to fibrinolytics: (6)

Answer 17

• history of intracranial hemorrhage
• ischemic stroke within 3 months
• presence of a cerebral vascular malformation or a primary or metastatic intracranial malignancy
• aortic dissection
• active bleeding
• significant closed-head or facial trauma within last 3 months

Question 18

T or F: Reperfusion therapy doesn’t need to be administered in all STEMI patients whose symptoms began in the past 12 hours

Answer 18

F, it should be

Question 19

reperfusion therapy: STEMI
door-to-needle time:
door-to-balloon time:

Answer 19

within 30 minutes of hospital arrival
within 90 minutes of hospital arrival