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Pharm II > Acute Coronary Syndrome > Flashcards

Acute Coronary Syndrome Flashcards

1
Q

Lack of oxygen and reduced blood flow to the myocardium resulting in an imbalance between myocardial oxygen supply and demand

A

Ischemia

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2
Q

Necrosis (death) of heart muscle caused by an imbalance between oxygen supply and demand

A

Infarction

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3
Q

“Chest pain”; pain or discomfort in the chest or adjacent areas which is due to myocardial ischemia

A

Angina pectoris

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4
Q

: Painless episodes of myocardial ischemia (75% of all ischemia)

A

Silent ischemia

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5
Q

Infarction occurring without chest pain or other common symptoms of ischemia; about 20% of all infarcts

A

Silent infarction

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6
Q

Unstable angina or acute myocardial infarction

A

Acute coronary syndrome

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7
Q

Typically results in an injury that transects the thickness of the myocardial wall
Following an MI pathologic Q-waves are seen on ECG

A

STEMI

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8
Q

Limited to sub-endocardial myocardium
Patients do not usually develop pathologic Q-wave
Differs from unstable angina in that ischemia is severe enough to produce myocardial necrosis

A

NSTEMI

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9
Q

causes of Acute coronary syndrome

A

rupture of atherosclerotic plaque with subsequent platelet adherence, activation, and aggregation (clotting cascade)
clot of fibrin and platelets form

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10
Q

what is a principle cause of morality and morbidity post MI

A

heart failure (due to remodeling)

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11
Q

what are key findings on an ECG indicative or MI or infarction

A

STE
ST- segment depression
T-wave inversion
appearance of new left bundle-branch block

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12
Q

2 biochemical markers that rise in blood following myocardial cell death

A

Troponin

CK-MB

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13
Q

when should you obtain blood samples for troponin and CK-MB.

A

3 times over 12-24 hours period to see the values rise

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14
Q

how many values of troponin or CK-MB must be elevated to dx a MI.

A

at least 1 troponin values or 2 Ck-MD values are greater than the MI decision limit

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15
Q

general tx principles for ACS.

A

Reduce myocardial oxygen demand (low HR, BP, reduce preload)

improve myocardial oxygen supply- dilate coronary arteries, enhance blood flow, prolong diastole

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16
Q

if percutaneous coronary intervention or fibrinolytic therapy preferred for tx acute STEMI

A

PCI

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17
Q

Useful in patients w/ stenosis of coronary artery, LAD, impaired Left ventricular function.

A

Coronary Artery Bypass Grafting (CABG)

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18
Q

anti-anginal, vasodilator
increases coronary blood flow
reduces cardiac workload
alleviate coronary spasm

A

Nitrates

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19
Q

contradindications for nitrates

A

100 bpm
SBP 30 below baseline
don’t use w/ phophodiesterase inhibitor

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20
Q

How should nitroglycerin be used for NSTEM/ UA/ STEMI

A

Take sublingual nitroglycerin and if chest pain hasn’t improved after 5 minutes call 911
get 3 doses total of SL nitroglycerin
after 3 doses- assess need for IV w/ nitro (48 hours)

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21
Q

how does morphine help with ACS?

A

decrease anxiety, HR, BP
pain after nitroglycerin
automatically give with STEMI

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22
Q

DOC for analgesia for STEMI

A

morphine

23
Q

what are some fibrinolytics (most common).

A

Streptokinase

Alteplase

24
Q

what is the only ACS that fibrinolytics are used in?

A

STEMI
new left branch bundle block
posterior MI

25
Q

what timeframe can fibrinolytic therapy be initiated in?

A

within 12 hours symptoms started

lower recommendation for sx onset within prior 12-24 hours and continuing ischemic sx and ST elevation

26
Q

for NSTEMI/UA how should ASA be taken?

A

ASA 162-325 mg should be chewed by patient who haven’t taken it (2 baby aspirin)

27
Q

is someone is intolerant to ASA what should they be given?

A

Clopidogrel (Plavix)

28
Q

conservative strategy with antiplatelets (

A

add clopidogrel to ASA ASAP after admission

continue combo for at least 1 month

29
Q

Invasive strategy with antiplatelets

A

either clopidogrel or an IV GP IIaIIIb inhibitor added to ASA

30
Q

what is the only GP IIaIIIB inhibitor approved is PCI is going to be used

A

Abciximab

31
Q

should abciximab be used any other time but for PCI?

A

No

32
Q

what prevents thrombus formation

A

anticoagulatns

33
Q

Class I recommendation for NSTEMI/UA for anticoagulants

A

add enoxaparin or UFH should be added ASAP

34
Q

Recommendations for those with STEMI undergoing fibrinolytics for anticoagulatns.

A

Reicieve anticoagulants for a minimum of 28 hours and preferably duration of hospitalization (8 days)
start with UFH (48 hours) move to Enoxaparin

35
Q

what anticoagulant shouldn’t be used as the sole anticoagulant to support PCI (class III)

A

fondaparinux

36
Q

what drug shoul not be used as alternative UFH as ancillary tx in patients over 75 w/ fibrinolytic tx or those with renal dysfunction.

A

low molecular weight heparin

37
Q

beta blocks for ACS

A

IV beta blockers then switch to oral as soon as they can tolerate it. (cost savings)

38
Q

precautions with BBs

A

HR <100) mod-severe LV dysfunction, COPD, asthma, signs of hypoperfusion

39
Q

You can only give an ACEI or BB if the patient is what?

A

hemodynamically stable

40
Q

when should ACEI be administered

A

within first 24 hours orally

Don’t give IV (huge risk of HPOTN)

41
Q

is there additionally benefit with CCB for MI?

A

No, can actually increase mortality

42
Q

when should CCB be given?

A

contraindications to BBs

43
Q

what are the 2 CCB that could potentially be given for MI if BB not tolerated

A

verapamil

diltiazem

44
Q

In patients with ACS what do you give ASAP

A

ASA
NTG
BB
ACEI

45
Q

in an STEMI what meds should be given additionally?

A

Clopidogrel + UFH, enoxaparin or fondaparinux

46
Q

Long Term Prevention for CAD

A

ASA indefinitely + Clopiogrel
Nitroglycerin
Beta Blockers
ACEI

47
Q

what is a HMG-CoA reductase inhibitors

A

statins

48
Q

should statins be started on someone with an MI who has good cholesterol?

A

Yes, should be considered regardless of baseline LDL-C

49
Q

when can you not give verapamil and diltizaem?

A

severe left ventricular dysfunction or other contraindications (heart failure)

50
Q

what is the oral anticoagulant

A

warfarin

51
Q

what do you want INR to be between?

A

2.0 to 3.0

52
Q

in patients on warfarin, clopidogrel and aspirin what should that INR be?

A

2.0 to 2.5

53
Q

how long do you give warfarin post MI

A

short time frame in the absence of afib or flutter

Pharm II (16 decks)

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