Acute Coronary Syndrome

Question 1

Troponin 1

Answer 1

Enzyme released with cardiac muscle injury and death.

The most sensitive and specific biomarker for ACS.

Normal serial troponin levels exclude MI, but do NOT exclue unstable Angina.

Elevates 3-6 hours after injury, peaks at 12-18 hours.

Remains raised 5-9 days, up to 2 weeks.

Question 2

What other things cause troponin to elevate other than a MI?

12 of them

Answer 2

tachycardia
AFIB
cardiac trauma
myocarditis
pulmonary embolism
hypertension
renal disease
sepsis
burns
respiratory failure
drug toxicity
hypokalemia

Question 3

Antiplatelet Therapy for ACS includes which medication

classes?

Answer 3

Aspirin

Adenosine Diphosphate Inhibitors (ADP)

Glycoprotein IIB/IIIA Inhibitors

Question 4

Aspirin

Answer 4

First line of defense for suspected ACS or multiple risk factors.

inhibits platelet synthesis of A2.

low dose (81 mg) maintenance

duration: Life Long

Question 5

Adenosine Diphosphate Inhibitors (ADP)

Answer 5

prasugrel (Effient) is contraindicated in Unstable Angina and NONSTEMI patients with a history of stroke, TIA, weight of less than 60kg or age greater than 75.

Inhibitory effect on platelet activation and aggregation

includes:
clopidogrel (Plavix )
ticagrelor (Brilinta)
prasugrel (Effient)

Question 6

Glycoprotein IIB/IIIA Inhibitors

Answer 6

inhibitory effect on platelet activation and aggregation

Includes:
abciximab (ReoPro)
eptifibatide (Intergrilin)
tirofiban (Aggrastat)

Question 7

Anticoagulants:

Answer 7

reduces the ability of the blood to form clots

interfere with clotting cascade and thrombin formation

includes:
enoxaparin (Lovenox)
dalteparin (Fragmin)
fondaparinux (Arixtra)

Question 8

Thrombolytics

Answer 8

activate anticlotting system, conversion of plasminogen to plasmin

breaks down fibrin threads and dissolves any formed clots

Question 9

Nitrates

Answer 9

hold for low BP or right sided MI

temporarily dilates narrowed blood vessels, improving blood flow to and from the heart

contraindicated if taking erectile dysfunction meds: hold for 24 hours for sildenafil (viagra) or vardenafil (Levitra) and 48 hours for tadalafil (cialis)

Includes:
isosorbide dinitrate (Isordil)
glyceryl trinitrate

Question 10

Beta Blockers (Beta-1 adrenergic receptor blocker)

Answer 10

reduces heart rate and cardiac output at rest and with exercise

reduction of systolic blood pressure upon exercise

inhibition of isoproterenol induced tachycardia

reduction of reflex orthostatic tachycardia

Includes:
Atenolol
Metoprolol
Bisoprolol

Question 11

Angiotensin-converting enzyme (ACE) inhibitor

Answer 11

stops angiotensin converting enzyme and inhibits the conversion of angiotensin 1 to angiotensin 2.

decreased angiotensin II equals decreased vasoconstriction which leads to reduced blood pressure

Includes: 
Rampipril
Enalapril
Captopril
Lisinopril

Question 12

Angiotensin Receptor Blockers

ARBS

Answer 12

Angiotensin II inhibitors

Includes:
Eproartan
Olmesartan (Benicar)
losartan (Cozaar)