Acute Coronary Syndrome

Question 1

2 “any” absolute contraindications for fibrinolytics in ACS

Answer 1

1. Any hx of intracranial hemorrhage
2. Any hx of cerebrovascular lesions (aneurysms)

Question 2

3 “active” absolute contraindications to fibrinolytic therapy in ACS

Answer 2

1. Active intracranial cancer
2. Active aortic dissection
3. Active bleeding or bleeding diathesis

Question 3

3 “history of” absolute contraindications to fibrinolytic therapy in ACS

Answer 3

1. Hx of CVA in the last 3 months
2. Hx of Head trauma in the last 3 months
3. Hx of neurosurgery in the last 2 months

Question 4

EKG change that shows success with fibrinolytic treatment

Answer 4

> 50% improvement in the ST segment

Question 5

Other than diffuse ST elevation, EKG sign that is pathomnemonic for pericarditis

Answer 5

Depressed PR interval

Question 6

Maximum travel time for interfacility transfer to a PCI capable hospital

Answer 6

60 minutes

Question 7

Goal time to fibrinolytic administration in ACS

Answer 7

30 minutes

Question 8

Goal balloon time in ACS at primary PCI hospital

Answer 8

90 minutes

Question 9

Time in STEMI from symptom onset to start treatment

Answer 9

< 12 hours or < 24 if worsening ischemia/ongoing symptoms

Question 10

“Out the door” time for non-PCI hospital to transfer patient

Answer 10

30 minutes

Question 11

Balloon time if being transferred from a non-PCI hospital

Answer 11

120 minutes

Question 12

ACS Clopidogrel loading and ongoing doses

Answer 12

Loading 600 mg

Ongoing 75 mg daily

Question 13

ACS Prasugrel loading and ongoing dose

Answer 13

Loading 60 mg

Ongoing 10 mg daily

Question 14

ACS Ticagrelor loading and ongoing dose

Answer 14

Loading 180 mg

Ongoing 90 mg BID

Question 15

ACS Alteplase dose

Answer 15

100 mg over 90 minutes

Question 16

ACS Tenecteplase dose

Answer 16

30-50 mg bolus

Question 17

ACS Reteplase dose

Answer 17

10 mg bolus x 2

Question 18

ACS Streptokinase dose

Answer 18

1.5 million U per 60 minutes

Question 19

Only antiplatelet that can be given if fibrinolytics are used

Answer 19

Clopidogrel

Question 20

Clopidogrel dose < 75 years old if fibrinolytics given

Answer 20

Loading 300 mg

Ongoing 75 mg daily

Question 21

Clopidogrel dose > 75 years old if fibrinolytics given

Answer 21

Loading 75 mg

Ongoing 75 mg daily