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Phar 505 > Acute coronary syndrome > Flashcards

Acute coronary syndrome Flashcards

1
Q

What is myocardial infarction

A

Cell death of myocytes

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2
Q

What are the three main spectrums of Acute coronary Syndromes

A

Unstable Angina, Non-ST-Elevation Myocardial Infarction, ST-Elevation Myocardial Infarction

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3
Q

Why does Nitroglycerin and rest not relieve a person’s symptoms in some ACS cases

A

There could be complete occlusion of an artery leading to a need of more intense therapy

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4
Q

T/F: When a patient enters an emergency department with clinical suspicion of ACS with ischemic symptoms and ECG should be within 10 minutes

A

True

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5
Q

What are the two types of ACSs that can be shown from an ECG

A

Non-ST-Elevation Myocardial Infarction, ST-Elevation Myocardial Infarction

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6
Q

T/F: Non-ST-Elevation Myocardial infarction is highly specific for a hear attack

A

False: ST-Elevation Myocardial Infarction is high specific for a heart attack. In Non-ST-Elevation Myocardial infarction ischemia is a concern

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7
Q

What is the cardiac enzyme that is sensitive to having a heart attack (confirms), how long does it take for the enzymes to show up, how long to peak

A

Troponin, 4 hours, 1 day

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8
Q

What is a spontaneous MI (type 1)

A

Spontaneous MI due to plaque rupture, thrombus formation, and low blood flow

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9
Q

What is a risk calculator used in patients with ACS, what does it asses

A

TIMI, Death or myocardial infarction within the next 14 days

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10
Q

On the TIMI score what events are one point each in the variable “HISTORY”

A

Greater than or equal to 2 events in the past 24 hours, Known cardiovascular disease, Aspirin use within 7 days

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11
Q

On the TIMI score what causes a point to be added in the variable “ECG”

A

Changes in ST

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12
Q

On the TIMI score what causes a point to be added in the variable “Troponin”

A

Elevated Troponin

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13
Q

On the TIMI score what causes a point to be added in the variable “Age”

A

Age greater than 65 years

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14
Q

On the TIMI score what causes a point to be added in the variable “Risk factors”

A

Having 3 or more risk factors

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15
Q

When all the points are compiled for the TIMI score what indicates low risk, intermediate risk, High risk

A

0-2, 3-4, 5-7

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16
Q

T/F: A clinical assessment that includes a physical exam gives evidence on whether a patient has heart failure

A

True

17
Q

When getting labs what is needed for coagulation profile

A

INR, PTT

18
Q

When getting labs what is needed for CBC

A

HgB, Hct, platelets

19
Q

What Chem 7 labs are good for treating a patient

A

Electrolytes, BUN, Cr

20
Q

What are the treatment goal for ACS

A

Restore blood flow to limit infarct size if having an MI, prevent/minimize complications, prevent reocculusion, relieve symptoms, resolve ECG changes

21
Q

For patients who are having an acute coronary syndrome what are the treatment considerations (hint:thrombinss)

A 
T: Thinopyridine (P2Y12 inhibitor)
H: Heparin (parental anticoagulant)
R: Renin-angiotensin-aldosterone system inhibitor
O: Oxygen
M: Morphine
B: Beta-blocker
I: intervention (PCI)
N: Nitroglycerin 
S: Salicylate
S: Statin
22
Q

What is the acute supportive care that should be done regardless of whether the patient has a NSTEMI or STEMI

A

Aspirin: 162 mg - 325 mg IR, Nitroglycerin: 0.3 - 0.4 mg sublingual every 5 minutes as need but up to 3 doses
Oxygen: if O2 saturation is less than 90%

23
Q

What drugs should all patients with ACS have, what is the preferred maintenance dose

A

Aspirin, 81 mg

24
Q

T/F: Aspirin is contraindicated in patiens using ticagrelor

A

False: Patients treated with ticagrelor should not use aspirin doses greater than 100 mg daily

25
Q

Why should aspirin tablets be crushed or chewed before eating them for ACS

A

The patient needs to bypass the enteric coating in order to get immediate release

26
Q

T/F: There is no safety and efficacy data for the use of morphine and oxygen in ACS that has been established

A

True

27
Q

What is the rationale behind using morphine, when should oxygen be administered in support

A

Decreases anxiety and calms the patient lowering BP, NTG is not working, IV acts as vasodilator/ When arterial oxygen saturation is less than 90%

28
Q

When nitroglycerin is given IV what determines the titration, how often can this titration occur

A

Pain relief and BP, every 3-5 minutes

29
Q

How does NTG cause headache

A

Vasodilation causes pain in the head

30
Q

When should NTG be avoided

A

The patient has a right ventricular infarct, use of phosphodiesterase inhibitors

31
Q

What phosphodiesterase inhibitors should be avoided with NTG use, how long

A

Sildenafil (Viagra) and Vardenafil (Levitra) within 24 hours, Tadalafil (Cialis) within 48 hours

32
Q

When should oral beta-blockers be started if a patient is having a ACS event

A

Within the first 24 hours

33
Q

When should IV beta-blockers be considered

A

A high blood pressure and high heart rate

34
Q

When should beta blockers be avoided

A

Acute or Congestive heart failure, older than 70, Systolic BP less than 120 mmHg, Heart rate greater than 110 or less than 60, prolonged time since symptom onset

35
Q

If a patient comes in with STEMI what should be done after the patient has had acute supportive care, how

A

Initiate reperfusion therapy: Primary PCI preferred, fibrinolysis if the door to balloon time is greater than 120 mins

36
Q

What is the goal for reperfusion in a patient who has a STEMI, why

A

From door to drug 30 mins (thrombolytics), from door to balloon 90 mins (primary PCI)/ the more time wasted the more heart muscle tissue dies

37
Q

What are two main characteristics a patient must have in order to be an adequate patient for fibronyltics

A

History of acute coronary syndrome presenting with symptoms within 12 hours of the symptom onset, EKG shows there is an ST elevation

38
Q

T/F: Only consider fibronolytics if the patient has the two main indications and cannot recieve a PCI within one hour

A

False: Only consider fibronolytics if the patient has the two main characteristics and cannot recieve a PCI within two hours

Phar 505 (33 decks)

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