ACS PHARM

Question 1

Initial Treatment of Acute MI

Answer 1

1. Oxygen
   - Morphine (dilates vessels too)
   - Aspirin (chew)
   - Nitro
   - Beta-blockers (dep HR)
   - Thrombolytic agent (within 4-6 hrs of MI) if eligible*

Question 2

STEMI Pharm: Immediate

Answer 2

MONAB

1. O2
   - increases o2 delivery to ischemic area
2. Aspirin
   - Suppresses platelet aggregation (chew)
   - decreases mortality
3. Morphine
   - Decreases pain, reduces preload + afterload
   - Helps preserve ischemic tissue
4. Beta Blocker
   - reduce HR and contractility (reduce o2 demand)
   - Reduces pain, infarct size, and mortality
5. Nitroglycerine
   - Reduces preload + afterload
   - limits infarct size
   - Does NOT reduce mortality

Question 3

STEMI: Fibrinolytic Therapy

Answer 3

Ateplase (tPA)

MOA: Dissolves clot by converting plasminogen to plasmin

Advantage: most effective
Disadvantage: BEST if within 30-70 mins

AE: Bleeding

**Always given with: Heparin and Antiplatelet therapy

Question 4

Nitroglycerine A/E

Answer 4

AE: Severe Hypotension

-particularly with other nitrates or (Cialis, Viagra)

Question 5

Reperfusion Injury

Answer 5

Rapid restoration of blood flow to the myocardium also contributes to injury of MYOCARDIAL STUNNING

Caused by oxidized free radicals generated by WBCs and the cellular response to restored blood flow

Question 6

KEY INFORMATION

Answer 6

Acute MI is leading cause of death in US

Hesitation or delayed request for emergency care are the major causes of death due to MI

Survival rates for treated patients with acute MI are 90-95% in the US

50% of people who have MI are younger than 65

Persons with diabetes and those older than 65 often suffer silent asymptomatic MI YIKES