Acute Coronary Syndrome

Question 1

Types

Answer 1

UA, NSTEMI, STEMI

Question 2

When to use fibrinolytic

Answer 2

no contraindications, no signs of ischemia for past 12 hours, no cardiogenic shock present, and cannot receive PCI within 120 min of arriving at hospital

Question 3

contraindications to fibrinolytics

Answer 3

hx intracranial hemorrhage, cerebrovascular malformation or intracranial malignancy
ischemic stroke in past 3 mo but not within past 3 hours
s/sx aortic dissection
active bleeding
significant closed-head or facial trauma past 3 mo

Question 4

DAPT treatment duration for
ACS
bare metal stent
drug eluting stent

Answer 4

ACS - 1 yr
bare metal - minimum 1 mo
drug eluting - minimum 3 mo

Question 5

NSTEMI/STEMI inpatient tx

Answer 5

O2 if <90%
Statin (initiate or continue high intensity)
NTG SL q5min x3
ASA non EC LD of 324mg CHEWABLE
P2Y12-i

Question 6

P2Y12-i loading and maintenance doses

Answer 6

Clopidogrel - 300mg LD, 75mg MD
Ticagrelor - 180mg LD, 90mg MD
Prasugrel - 60mg LD, 10mg MD

Question 7

what should patient be discharged on after having an MI

Answer 7

Statin (high intensity)
NTG prn
ASA 81mg indefinitely
P2Y12i x 1 yr
BB - any, as long as no s/sx acute fluid overload
ACE/ARB if LVEF <40%
MRA if EF <40% and K<5